Long-Term Care

Diet textures and food acceptance

LTC Nursing Assistant Trainer, December 29, 2011

Nursing and dietary personnel must work closely with the speech language pathologist and dietitian to ensure food acceptance. Attractive appearance and proper temperature are essential. For example, adults may be resistant to eating pureed food because it resembles baby food. The goal is to ensure that the food is the proper consistency to meet the resident’s needs and reduce the risk of aspiration.

If pureed foods are used, the dietitian and speech language pathologist will prescribe the consistency needed by the resident. Generally speaking, pureed diets should not be watery or runny. When properly prepared, pureed items should be the consistency of pudding and support a plastic spoon in the upright position.

Altered texture diets, such as mechanical soft and pureed diets, are ordered for residents with dysphagia (difficulty swallowing). The National Dysphagia Diet Task Force (NDDTF) is developing standardized definitions for food and fluid consistencies for dysphagia treatment. The NDDTF has defined four diet levels:

1. Dysphagia pureed

  • pureed, homogenous, cohesive, pudding-like

2. Dysphagia mechanically altered

  • cohesive, moist, semisolid
  • requires some chewing ability
  • ground or minced meats with fork-mashable fruits and vegetables
  • excludes most bread products, crackers, and other dry foods

3. Dysphagia advanced

  • soft-solid
  • requires more chewing ability
  • easy-to-cut meats, fruits, vegetables
  • excludes hard, crunchy fruits and vegetables, sticky foods, very dry foods

4. Regular

  • any solid textures

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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