Dr. Matt Durant, PhD, CDE, PDt, is Associate Professor at the School of Nutrition and Dietetics, Acadia University. He also consults to seniors in long-term care residences, primarily in rural Nova Scotia.
(nutrition.acadiau.ca)
Why can puréed meals cause problems for some residents?
As the level of refinement of consistency of meals goes from a regular diet over to a purée, the general appreciation and liking of those products decreases for most individuals. Even individuals with dementia tend to have lower levels of intake on a puréed diet than on a regular diet even if they’re able to consume a regular diet. I did a study a couple of years ago where we put individuals who were on a regular diet onto a modified diet for a two-week period just to assess the type of change in their intake. It was the same food, they were weighed the same way, but it was just that some of them were minced versus being completely intact. And just that change in consistency decreased individuals’ intake by about 10 per cent on average across that population. I would assume that it’s just because they didn’t enjoy the modified food as much as the regular food. There was really no qualitative component to this study.
How can we ensure that these puréed meals are providing appropriate nutrition?
I think a lot of it comes down to education of the staff as well. A lot of times individuals who are on those puréed diets are also quite limited in their overall mobility and independence and are dependent for their energy and their dietary intake at mealtime on supplements. And one of the things I’ve noticed with individuals on puréed diets is that often their personal care workers take purée that has a line of peas, a line of potatoes and a line of vegetables and just mix it into one consistent gruel. They don’t leave it as three distinct food items. Often they’re trying to cool it down and they end up mixing it all together. If you consider you take your Thanksgiving dinner and instead of having a bite of potatoes, a bite of turnip, a bite of turkey, if everything was just thrown in the blender and mixed together, your overall enjoyment of it would decrease considerably as well.
What else can we do to help seniors who have these difficulties at mealtimes?
Educate the staff that it’s really important to try to maintain as high a level of dignity as possible for these residents. Even if they are suffering from profound forms of dementia or other types of organic brain disease, people are often still aware of the food that they’re being given. We want to do whatever we can to maximize their enjoyment of mealtimes, and I think one of those steps is making sure that we do keep those different puréed foods separate and then tell people, “Here’s what I’m about to give you. I’m about to give you a bite of turkey. I’m about to give you a bite of potato,” as opposed to shovelling this mass of food into the mouths of the residents.
What is the most important thing that retirement residences can do to improve the dining experience for their residents?
This is going back to my experience with residents who need a higher level of care, but just trying to maximize the one-on-one interaction at mealtime. I see too often one individual who is trying to feed two or three residents at the same time. I really think if you want to maximize somebody’s dining experience in these residences, you have to be there. You have to be showing a general concern for that individual at mealtime and be seen as though you’re there to share that experience and not just as a service to them. Most of the people in that population group, the last thing they want to be is a burden to anybody. If they feel as though you’re just there to feed them, then often they’ll stop eating before they’re actually truly finished. And if they’re really enjoying themselves, they’ll tend to eat for longer and therefore take in more food. I think just trying to find enough staff— and I think realistically you’re talking volunteers at this point. Most of these places don’t have the financial means to have enough people at mealtime to feed individuals one on one. Making sure that you’re doing your best to take into consideration everybody’s preferences, likes and dislikes, and I know that can be really difficult, but making sure there’s a minimum of two hot choices at mealtime. Anytime individuals have some degree of choice in what they get . . . I think that you can absolutely relate that to a much higher level of satisfaction with the food that you’re giving. When there’s only one choice, then there is no choice.
What advice do you have for retirement residence executives as they plan their food service operations for the next five years?
I think the quality of the food in these residences is generally pretty good, but you know I think that only accounts for about 50 per cent of seniors’ satisfaction at mealtime. It’s really the atmosphere around eating. It’s making sure that the dining rooms where they eat are welcoming, that the people that are there to help them at mealtime are really earnest and genuine in their approach and work hard to develop a rapport with the seniors. Whether that’s staff who are bringing in a tray for people who can still eat independently or individuals who are entirely dependent. I think a good percentage of satisfaction at mealtime relates to that relationship that seniors have with their caregivers. So I think there has to be an equal focus at mealtime for seniors rather than just, “OK, what kind of food do you like best? Let’s make sure that it’s there at the right temperature.” . . . I think there’s more to it than that.
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