Texture Modification Technologies and Their Opportunities for the Production of Dysphagia Foods: A Review

Recent progress in protein-based high internal-phase Pickering emulsions: Composition, stabilization, applications, and future trends

Protein-based high internal-phase Pickering emulsions (HIPPEs) have attracted widespread attention in recent years because they exhibit unique advantages for 3D printing and dysphagia food, including moist, soft, and creamy texture, good swallowing behavior, and excellent 3D printing effect. HIPPEs stability vastly influences its 3D printing accuracy, texture, and swallowing behavior. This review aims to comprehensively explore crucial factors influencing the formation and stability of HIPPEs, presenting reasonable strategies to enhance HIPPEs stability. Our emphasis lies in uncovering the relationship between protein-based particles' interfacial behavior, HIPPEs stability, and the application of HIPPEs on 3D printing and dysphagia food. Furthermore, the convergence of 3D printing and dysphagia foods expected to deepen, facilitating development of HIPPEs-based dysphagia food. Although application prospect of HIPPEs is very wide, looking ahead, there are many areas where further research is still required: (1) exploring more sources of protein fibrils, microalgae and insect proteins as Pickering particles to stabilize HIPPEs; (2) constructing mathematical model that unraveling the relationship between particles' interfacial behavior and HIPPEs stability; (3) combining dual-nozzle 3D printing with infill structure to modify the texture behavior and obtain more attractive appearance of HIPPEs-based dysphagia foods; (4) linking rheological behavior with oral processing and swallowing will be a research trend for exploring the texture and mouthfeel of dysphagia foods at different stages of oral processing; (5) developing evaluation system connected with oral processing behavior of dysphagia foods; (6) exploring the nutrition retention and texture behavior of dysphagia foods during 3D printing, post-processing, and chewing/swallowing process.

Exploring the potential of 3D-printed texture-modified diets for the management of dysphagia

Dysphagia is a swallowing disorder characterized by mild to severe pain during food ingestion. Patients with dysphagia require special care and food that meet the patient's requirements of nutrition and ease of swallowing which can be achieved by texture-modified diets. Texture modification is important for improving swallow safety and control and preventing aspiration, pneumonia, and choking. 3D printing is the leading technology in today's era and is widely used for the texture modification of food for patients with swallowing disorders. 3D printing is fast, reliable, and customizable and has the potential to fabricate unappealing and tasteless food into different colours, textures, and shapes. Our discussion brings to review the present and future of 3D printing in preparing texture-modified diets for dysphagia. The challenges associated with dysphagia diets that can be overcome by 3D printing have also been discussed. The review also focuses on the IDDSI framework for determining the suitability of food for dysphagic patients. The key factors such as the material used, and viscosity have been discussed along with various pre-existing literature. The key challenges with the food industry and future research areas have also been discussed.

Recent advances in 3D food printing: Therapeutic implications, opportunities, potential applications, and challenges in the food industry

3D food printing (3DFP) offers a transformative approach in the food industry, diverging from traditional manufacturing techniques. The integration of food science and nutrition with 3DFP is pioneering personalized, eco-friendly, and nutrient-rich food options, overcoming limitations of traditional manufacturing methods. For the past 10 years, we have been strongly focused on creating innovative, efficient, and functional food products while allowing customization of food based on preferences for nutrition, flavor, texture, mouthfeel, and appearance. Beyond customization, 3DFP demonstrates promise in addressing pressing global challenges including food security, famine, and malnutrition by facilitating the production of fortified, shelf-stable food products suitable for resource- constrained environments. This comprehensive review explores the intersection of 3DFP with food constituents, emphasizing its potential in enhancing customization, sustainability, food safety, and shelf-life extension. Additionally, it discusses the therapeutic potential of 3D printed foods for various diseases, including gastrointestinal disorders, cancer, diabetes, neurodegenerative disorders, and food allergies. Moreover, the review examines potential food applications of 3DFP, such as in space food, food packaging, dairy industry, fruit and vegetable processing, and cereal-based foods. The review also addresses key challenges associated with 3DFP and underscores the importance of four-dimensional food printing (4DFP).

The possibility of the computer simulation-assisted IDDSI framework for the development of thickened brown rice paste

Increasing requests for thickened fluid food are demanded with population aging, while the limited information provided by the International Dysphagia Diet Standardisation Initiative (IDDSI) is insufficient for food development. Recently, the introduction of computer simulation seems to be able to overcome this dilemma. Here, a thickened fluid system (xanthan gum and konjac glucomannan, XG and KGM) at different ratios was kept at the same IDDSI level 3. An obvious synergy was observed in the ratio of 1:9 (XG: KGM) with high surface tension, zero-shear viscosity, firmness and cohesion, and thus was used to prepare the brown rice paste. From computer simulation, the brown rice pastes (0.3 % and 0.5 % thickener) splashed and that with higher thickener content resulted in more residue. The thickener content of 0.7 % provided enough viscosity and cohesion to avoid splash, and most of the bolus flowed consistently, showing the best sensory quality and swallowing properties.

The Beneficial Role of Polysaccharide Hydrocolloids in Meat Products: A Review

Polysaccharide hydrocolloids have garnered increasing attention from consumers, experts, and food processing industries due to their advantages of abundant resources, favorable thickening properties, emulsification stability, biocompatibility, biodegradability, and high acceptance as food additives. This review focuses on the application of polysaccharide hydrocolloids and their beneficial roles in meat products by focusing on several commonly used polysaccharides (i.e., cellulose, chitosan, starch, sodium alginate, pectin, and carrageenan). Firstly, the recent advancements of polysaccharide hydrocolloids used in meat products are briefly introduced, along with their structure and potential application prospects. Then, the beneficial roles of polysaccharide hydrocolloids in meat products are comprehensively summarized and highlighted, including retarding lipid and protein oxidation, enhancing nutritional properties, improving texture and color quality, providing antibacterial activity, monitoring freshness, acting as a cryoprotectant, improving printability, and ensuring security. Finally, the challenges and opportunities of polysaccharide hydrocolloids in meat products are also introduced.

Fish Protein Hydrolysate as Protein Enrichment in Texture-Modified Salmon Products

The aim of this study was to develop a chilled, texture-modified salmon product for dysphagia patients, enriched with dairy and fish hydrolysate proteins. The challenge was to create a product with appealing sensory qualities and texture that meets level 5 (minced & moist) of the IDDSI framework. Atlantic salmon (Salmo salar) was heat-treated (95 °C/15 min), blended, and reconstructed by adding texture modifiers, casein and whey protein, and enzymatically derived fish hydrolysate. The products were packaged in oxygen-free plastic trays, heat-treated to a core temperature of 95 °C for 15 min, chilled and stored at 4 °C for 29 days and analyzed for microbiology, instrumental texture, and sensory properties. The texture analyses showed that products with fish protein hydrolysate were softer than those only with casein and whey protein, a result also confirmed by the IDDSI fork pressure test. Quantitative descriptive analysis of salmon products revealed significant differences (p < 0.05) in sensory attributes within flavour (fish flavour), and texture (softness and adhesiveness) but there was no significant change in bitterness. The shelf-life study at 4 °C showed good microbiological quality of the product, and safety after 29 days with appealing sensory and textural properties, i.e., a product at IDDSI level 5 for age care facilities and commercial production was obtained.

Multimodal deep ensemble classification system with wearable vibration sensor for detecting throat-related events

Dysphagia, a swallowing disorder, requires continuous monitoring of throat-related events to obtain comprehensive insights into the patient's pharyngeal and laryngeal functions. However, conventional assessments were performed by medical professionals in clinical settings, limiting persistent monitoring. We demonstrate feasibility of a ubiquitous monitoring system for autonomously detecting throat-related events utilizing a soft skin-attachable throat vibration sensor (STVS). The STVS accurately records throat vibrations without interference from surrounding noise, enabling measurement of subtle sounds such as swallowing. Out of the continuous data stream, we automatically classify events of interest using an ensemble-based deep learning model. The proposed model integrates multiple deep neural networks based on multi-modal acoustic features of throat-related events to enhance robustness and accuracy of classification. The performance of our model outperforms previous studies with a classification accuracy of 95.96%. These results show the potential of wearable solutions for improving dysphagia management and patient outcomes outside of clinical environments.

Comprehensive review of dysphagia and technological advances in dysphagia food

As the global population ages, dysphagia is becoming increasingly common among the elderly, posing serious risks such as choking, aspiration pneumonia, and even death. Leveraging advanced technologies to develop specialized food products for those with dysphagia not only serves the economic interests of the elderly food market but also significantly enhances the nutritional health and social satisfaction of this demographic. This review examines the causes and early symptoms of dysphagia, the development of texture-modified foods (TMFs), and the relevant regulations and standards. It also addresses the key factors influencing the swallowing of foods, focusing on rheology and tribology. Most texture-modified foods currently available do not provide an enjoyable eating experience for the elderly or those with dysphagia. The integration of artificial intelligence (AI) and mathematical modeling with food additive manufacturing technology appears promising for improving foods designed for the elderly and those with dysphagia. This paper highlights the critical benefits and potential applications of AI, mathematical modeling, and food additive manufacturing in creating dysphagia-friendly foods and provides a conceptual system for designing diets based on AI for dysphagic foods. AI and mathematical model-based food processing technology enable the food industry to achieve digitalization and large-scale customization, potentially revolutionizing the approach to dietary management in dysphagia.

Study on Starch-Based Thickeners in Chyme for Dysphagia Use

A dysphagia diet is a special dietary programme. The development and design of foods for dysphagia should consider both swallowing safety and food nutritional quality. In this study, we investigated the rheological properties (viscosity, thixotropy, and viscoelasticity), textural properties, and swallowing behaviour of commercially available natural, pregelatinised, acetylated, and phosphorylated maize starch and tapioca starch. The results showed that all the samples belonged to food grade 3 in the framework of the International Dysphagia Dietary Standardization Initiative (IDDSI) and exhibited shear-thinning behaviour in favour of dysphagia patients, except for the sample containing pregelatinised starch, which was grade 2. Rheological tests showed that the samples had good structural recovery properties. At the same starch concentration, the elastic modulus of phosphorylated cassava starch FSMP was significantly greater than that of the starch solution, whereas that of acetylated starch was significantly less than that of the starch solution, and the combination of acetylated starch and protein led to a significant viscosity reduction phenomenon, resulting in FSMPs with good stability and fluidity; this may provide an opportunity for the incorporation of more high-energy substructures. The textural results showed that all the samples possessed textural properties of low hardness, low adhesion, and high cohesion, all of which could be used as food for dysphagia patients. This study may provide a theoretical basis for the creation and design of novel nutritional foods for dysphagia.

Effect of high hydrostatic pressure treatment on food composition and applications in food industry: A review

Nowadays, with the diversification of nutritious and healthy foods, consumers are increasingly seeking clean-labeled products. High hydrostatic pressure (HHP) as a cold sterilization technology can effectively sterilize and inactivate enzymes, which is conducive to the production of high-quality and safe food products with extended shelf life. This technology reduces the addition of food additives and contributes to environmental protection. Moreover, HHP enhances the content and bioavailability of nutrients, reduces the anti-nutritional factors and the risk of food allergen concerns. Therefore, HHP is widely used in the processing of fruit and vegetable juice drinks, alcoholic, meat products and aquatic products, etc. A better understanding of the influence of HHP on food composition and applications can guide the development of food industry and contribute to the development of non-thermally processed and environmentally friendly foods.

Association Between Malnutrition and Food Texture Levels in Integrated Facilities for Medical and Long-Term Care

OBJECTIVES

 This study aims to investigate the association between malnutrition using the global consensus criteria and food texture levels in residents of Integrated Facilities for Medical and Long-Term Care (IFMLCs), which are new long-term care insurance facilities in Japan.

METHODS

This single-center study had a retrospective cross-sectional design. The study was conducted from November 1 to 30, 2021, and the study participants were residents admitted to an IFMLC during the study period. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Food texture levels consumed by patients at admission were categorized based on the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Multivariate logistic regression models were used to determine the association between the food texture levels consumed and malnutrition.

RESULTS

A total of 98 older residents were analyzed in this study. The median age of the participants was 88 years, and 68 (69%) female participants were included. The IDDSI framework levels were 24% in levels 7 and 6 and 26% in levels 5 and 4. A significant difference in the prevalence of low BMI, reduced muscle mass, and reduced food intake or assimilation was noted between IDDSI framework levels 4 and 7. Multivariate logistic regression analysis was performed for malnutrition, adjusting simultaneously for potential confounders. IDDSI level 4 (odds ratio, 5.074; 95% confidence interval, 1.059-28.092; p=0.042) consumption was independently associated with malnutrition.

CONCLUSIONS

The consumption of lower food texture levels categorized using the IDDSI framework was associated with a higher malnutrition prevalence in IFMLC residents.

Food Processing and Nutrition Strategies for Improving the Health of Elderly People with Dysphagia: A Review of Recent Developments

Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.

Formulation and characterization of 3D printed chickpea protein isolate-mixed cereal dysphagia diet

The feasibility study of making 3D printed dysphagia diet was undertaken. A mixture of corn flour and buckwheat flour was used as the model cereal and chickpea protein isolate (CPI) was used as the model protein. Printing gels (inks) of the mixed cereal (control) and CPI-cereal mixture were produced by heating the formulations at 95 °C for 30 min and then cooling them to room temperature. The results showed that all the ink formulations containing CPI had higher apparent viscosity, preferable shear thinning behavior and shape supporting characteristics than that of the control. The cohesiveness and shape supporting ability of 10%CPI-cereal and 20%CPI-cereal formulations were poor and could not produce stable printing shape. The 30%CPI-cereal and 40%CPI-cereal formulations had suitable apparent viscosity, shear thinning behavior, storage modulus, yield stress and printing accuracy and the 3D printed products were stable. The control ink and 10%CPI-cereal ink had low cohesion and also could not pass the spoon tilt test. The 50%CPI-cereal formulation had high hardness and also could not pass the fork pressing test. The 30 % to 40 % CPI-cereal formulations were found to be suitable as dysphagia products as they could be classified as level 5 dysphagia diet.

The Impact of Food-Shaping Techniques on Nutrition, Mealtime Experiences, and Quality of Life for Older Adults in Aged Care Settings: A Systematic Review

OBJECTIVE

Food-shaping methods, particularly for texture-modified foods, present numerous opportunities to improve the visual appeal of food and potentially the nutrition of older people with dysphagia (swallowing difficulty). This review appraises and synthesizes the evidence on the use of food-shaping methods to enhance nutrition in older adults with swallowing difficulties.

METHODS

In August 2022, five electronic databases (PubMed, CINAHL, Scopus, Cochrane Library, and Web of Science) were searched for original research related to the intersection of nutrition, food shaping, and older adults with swallowing difficulties. Characteristics of included studies were described and data from results and findings extracted for analysis across studies.

RESULTS

Eighteen studies met the inclusion criteria and encompassed a variety of settings, including aged care settings (n = 15) and food science laboratories (n = 3). Qualitative and quantitative findings demonstrated a variety of impacts of food shaping for the older adult with swallowing difficulty, including enhanced nutrition and wellbeing. The content themes identified across studies were: links between food shaping and nutrition, shaping food for individual choice, food shaping for enjoyment, a combination of supporting factors, collaborative inter-disciplinary teams and roles, and implementation aligns with local contexts.

CONCLUSION

With recent growth in research on food shaping, the body of studies reviewed identified an influence of food-shaping methods on the nutritional status of older adults with swallowing difficulties. Given the identified potential benefit of food shaping and attention to the visual appeal of food for older people, further research examining links between food shaping and nutrition are warranted.

Malnutrition in aged care: interplay between dysphagia and diet

PURPOSE OF REVIEW

This review aims to deliver expert insights on the current advances and challenges in managing malnutrition in aged care settings, with a specific emphasis on the interaction between dysphagia and diet.

RECENT FINDINGS

Several reviews identify the high prevalence of dysphagia in aged care facilities and highlight the correlation between dysphagia and malnutrition. Recent studies underscore the importance of nutrition and cancer screening and assessment, yet highlight the lack of consensus on the definitive tools to be used. There is a growth in employing innovative implementations for enhancing swallowing function and optimizing texture-modified foods.

SUMMARY

Early identification and strategic interventions are vital for managing malnutrition and dysphagia in aged care facilities, as these conditions are widespread and lead to a higher risk of complications. Although nutritional strategies have shown potential in enhancing oral intake for residents requiring texture-modified foods, lack of investigation on functional outcomes and long-term impact have been highlighted, emphasizing the need for continued research and development of effective assessment tools and targeted interventions to optimize the care for this at-risk group.

Designing of texture modified fruit juices using food hydrocolloids: Storage influence on viscosity

Elderly individuals require special dietary considerations due to various physiological dysfunctions (such as dysphagia, constipation, etc.) and specific nutritional needs. Dysphagia, the difficulty associated with swallowing can lead to some challenges in containing and transitioning of food or liquids within the mouth, increasing the risk of aspiration pneumonia. Thickening fluid is an effective method for alleviating swallowing difficulties. It works by slowing down the flow of liquids during swallowing, thus reducing the risk of aspiration into the airway. The purpose of this research is to develop texture-modified (TM) fruit juices to cater to the needs of elderly individuals with impaired swallowing abilities. To achieve this goal, we created TM fruit juices thickened with hydrocolloids, specifically guar gum (GG), xanthan gum (XG), and starch (S), at different concentrations. The thickened liquids, classified at three National Dysphagia Diet levels, were stored at 4 °C for three months. Physicochemical analyzes of the fruit juices were performed before and after storage. The sensory differences and flow behaviors of orange juice samples containing ascending concentrations of all studied thickeners were investigated at the end of the three-month storage. The results indicated significant changes in the physicochemical properties of the samples, depending in the type of fruit, the hydrocolloid used, and the storage period. Sensory evaluation revealed that orange juices containing starch were more preferred compared to other samples. Therefore, using orange juice thickened with easily swallowed, and less viscous starch will be a safer option for the elderly and individuals with swallowing difficulties.

Sensory properties of thickened tomato soup enhanced with different sources of protein (whey, soy, hemp, and pea)

Thickened soup formulations were created with different proteins (hemp, soy, pea, and whey) to improve protein and fluid intake. The formulations consisted of a control soup, and soups with 6% whey protein, 6% hemp protein, 6% pea protein, and 6% soy protein by volume. The suitability of the samples for those living with dysphagia was evaluated using the international dysphagia diet standardization initiative (IDDSI) spoon tilt test and a sensory trial (51 older adults and 51 younger adults). The sensory trial used nine-point hedonic scales and check-all-that-apply to evaluate the different formulations. The sample with the whey addition was not significantly different than the control in terms of liking of flavor and texture, but it decreased the participants' overall liking. The hemp, pea, and soy decreased overall liking as well as liking of flavor and texture. They were associated with off-flavors, aftertaste, and astringency. The responses from the older and younger adults were compared and significant differences were found in their liking of the texture, with the older adults finding the formulations' texture significantly more acceptable. Overall, the study identified that hemp, pea, and soy did not create acceptable thickened soup formulations and the hemp and pea formulations did not achieve a consistency level that is acceptable for those living with dysphagia.

Three-Dimensional Printing of Foods: A Critical Review of the Present State in Healthcare Applications, and Potential Risks and Benefits

Three-dimensional printing is one of the most precise manufacturing technologies with a wide variety of applications. Three-dimensional food printing offers potential benefits for food production in terms of modifying texture, personalized nutrition, and adaptation to specific consumers' needs, among others. It could enable innovative and complex foods to be presented attractively, create uniquely textured foods tailored to patients with dysphagia, and support sustainability by reducing waste, utilizing by-products, and incorporating eco-friendly ingredients. Notable applications to date include, but are not limited to, printing novel shapes and complex geometries from candy, chocolate, or pasta, and bio-printed meats. The main challenges of 3D printing include nutritional quality and manufacturing issues. Currently, little research has explored the impact of 3D food printing on nutrient density, bioaccessibility/bioavailability, and the impact of matrix integrity loss on diet quality. The technology also faces challenges such as consumer acceptability, food safety and regulatory concerns. Possible adverse health effects due to overconsumption or the ultra-processed nature of 3D printed foods are major potential pitfalls. This review describes the state-of-the-art of 3D food printing technology from a nutritional perspective, highlighting potential applications and current limitations of this technology, and discusses the potential nutritional risks and benefits of 3D food printing.

Mineral bioaccessibility in 3D printed gels based on milk/starch/ĸ-carrageenan for dysphagic people

Dysphagia is a condition that affects the ability to chew and swallow food and beverages, having a major impact on people's health and wellbeing. This work developed gel systems with a customized texture suitable for intake by dysphagic people using 3D printing and milk. Gels were developed using skim powdered milk, cassava starch (native and modified by the Dry Heating Treatment (DHT)), and different concentrations of kappa-carrageenan (ĸC). The gels were evaluated in relation to the starch modification process and concentration of gelling agents, 3D printing performance, and suitability for dysphagic people (following both the standard fork test described by the International Dysphagia Diet Standardization Initiative (IDDSI), and also using a new device coupled to a texture analyzer). Moreover, the best formulations were evaluated for mineral bioaccessibility through simulated gastrointestinal digestion based on INFOGEST 2.0 standardized method. The results showed that ĸC had a dominant effect compared to the DHT-modified starch on gel texture, 3D printing performance, and fork tests. The gels obtained by molding or 3D printing resulted in different behaviors during the fork test, which was associated with the gel extrusion process that breaks down their initial structure. The strategies applied to tailor the texture of the milk did not affect the mineral bioaccessibility, which was kept high (>80%).

Effects of Different Blanching Methods on the Quality of Tremella fuciformis and Its Moisture Migration Characteristics

Blanching is a critical step in the processing of Tremella fuciformis (T. fuciformis). The effects of different blanching methods (boiling water blanching (BWB), ultrasonic-low temperature blanching (ULTB), and high-temperature steam (HTS)) on the quality and moisture migration characteristics of T. fuciformis were investigated. The results showed that the T. fuciformis blanched by ULTB (70 °C, 2 min, 40 kHz, 300 W) had the best quality, including a brighter appearance, superior texture, and good sensory features, with a polysaccharide content of 3.90 ± 0.02%. The moisture migration characteristics of T. fuciformis after blanching exhibited four peaks, displayed strong and weak chemically bound water, immobilized water, and free water, whereas ULTB had a weak effect on the freedom of water in T. fuciformis. The study will provide the foundation for the factory processing of T. fuciformis.

The future of software-controlled cooking

To date, analog methods of cooking such as by grills, cooktops, stoves and microwaves have remained the world's predominant cooking modalities. With the continual evolution of digital technologies, however, laser cooking and 3D food printing may present nutritious, convenient and cost-effective cooking opportunities. Food printing is an application of additive manufacturing that utilizes user-generated models to construct 3D shapes from edible food inks and laser cooking uses high-energy targeted light for high-resolution tailored heating. Using software to combine and cook ingredients allows a chef to more easily control the nutrient content of a meal, which could lead to healthier and more customized meals. With more emphasis on food safety following COVID-19, food prepared with less human handling may lower the risk of foodborne illness and disease transmission. Digital cooking technologies allow an end consumer to take more control of the macro and micro nutrients that they consume on a per meal basis and due to the rapid growth and potential benefits of 3D technology advancements, a 3D printer may become a staple home and industrial cooking device.

The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review

BACKGROUND

Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous.

OBJECTIVE

We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes).

METHODS

A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded.

RESULTS

Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal.

CONCLUSIONS

Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion.

TRIAL REGISTRATION

OSF Registries 79AFZ; https://osf.io/79afz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44201.

Feasibility of hydrocolloid addition for 3D printing of Qingtuan with red bean filling as a dysphagia food

Glutinous rice flour, the main component of Qingtuan, has increased adhesiveness after gelatinization and hardness after aging; this results in great challenge in swallowing if for patients with dysphagia. Dual nozzle 3D printing has great potential for developing innovative Chinese pastries with fillings that conform to dysphagia diets. In this experimental study, the gelatinization and retrogradation behavior of glutinous rice starch was improved by designing printing inks of optimal properties made with different soluble soybean polysaccharide (SSPS) additions (0%, 0.3%, 0.6%, 0.9%). The internal structure of Qingtuan was modified by adjusting different filling densities (75%, 100%) in combination with the dual nozzle 3D printing. The objective of these tests was to enhance the texture of Qingtuan so that it meets the requirements of International Dysphagia Diet Standardization Initiative (IDDSI). The experimental results showed that 0.9% SSPS addition could effectively reduce the hardness and adhesiveness of the Qingtuan, which met the Level- 6 -soft & bite-sized standard while lower filling density lowers both hardness and adhesiveness.

Application of HPP for the Development of a Dessert Elaborated with Casein and Cocoa for a Dysphagia Diet

In this study, the application of high-pressure processing (HPP) for optimizing the texture of a cocoa dessert rich in casein and developed for people with dysphagia was investigated. Different treatments (250 MPa/15 min; 600 MPa/5 min) and protein concentrations (10-15%) were combined and evaluated for choosing the optimum combination leading to an adequate texture. The selected formulation was a dessert containing 4% cocoa and 10% casein and subjected to 600 MPa for 5 min. It showed a high nutritional value (11.5% protein) and high antioxidant capacity, which was slightly affected by the HPP processing. The rheological and textural properties showed that HPP had a clear effect on the dessert structure. The loss tangent decreased from 2.692 to 0.165, indicating the transition from a liquid to a gel-like structure, which is in a suitable range for dysphagia foods. During storage (14 and 28 days at 4 °C), progressive significant changes in the structure of the dessert were observed. A decrease in all rheological and textural parameters occurred, except for the loss of tangent, which increased its value. In any case, at 28 days of storage, samples maintained the weak gel-like structure (0.686 loss tangent) that is acceptable for dysphagia management.

Enrichment of 3D-Printed k-Carrageenan Food Gel with Callus Tissue of Narrow-Leaved Lupin Lupinus angustifolius

The aim of the study is to develop and evaluate the printability of k-carrageenan inks enriched with callus tissue of lupin (L. angustifolius) and to determine the effect of two lupin calluses (LA14 and LA16) on the texture and digestibility of 3D-printed gel. The results demonstrated that the enriched ink was successfully 3D printed at concentrations of 33 and 50 g/100 mL of LA14 callus and 33 g/100 mL of LA16 callus. The feasibility of 3D printing is extremely reduced at higher concentrations of callus material in the ink. The hardness, cohesiveness, and gumminess of the 3D-printed gel with LA16 callus were weakened compared to the gel with LA14 callus. The results of rheological measurements showed that an increase in the content of LA16 callus interfered with the formation of a k-carrageenan gel network, while LA14 callus strengthened the k-carrageenan gel with increasing concentration. Gel samples at different concentrations of LA14 and LA16 calluses formed a spongy network structure, but the number of pores decreased, and their size increased, when the volume fraction occupied by LA14 and LA16 calluses increased. Simple polysaccharides, galacturonic acid residues, and phenolic compounds (PCs) were released from A-FP gels after sequential in vivo oral and in vitro gastrointestinal digestion. PCs were released predominantly in the simulated intestinal and colonic fluids. Thus, incorporating lupin callus into the hydrocolloid ink for food 3D printing can be a promising approach to developing a gelling material with new mechanical, rheological, and functional properties.

Progress in Extrusion-Based Food Printing Technology for Enhanced Printability and Printing Efficiency of Typical Personalized Foods: A Review

Three-dimensional printing technology enables the personalization and on-demand production of edible products of individual specifications. Four-dimensional printing technology expands the application scope of 3D printing technology, which controllably changes the quality attributes of 3D printing products over time. The concept of 5D/6D printing technology is also gradually developing in the food field. However, the functional value of food printing technology remains largely unrealized on a commercial scale due to limitations of printability and printing efficiency. This review focuses on recent developments in breaking through these barriers. The key factors and improvement methods ranging from ink properties and printer design required for successful printing of personalized foods (including easy-to-swallow foods, specially shaped foods, and foods with controlled release of functional ingredients) are identified and discussed. Novel evaluation methods for printability and printing precision are outlined. Furthermore, the design of printing equipment to increase printing efficiency is discussed along with some suggestions for cost-effective commercial printing.

Patients with dysphagia: How to supply nutrition through non-tube feeding

OBJECTIVE

Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear.

SETTING AND PARTICIPANTS

All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia.

METHODS

We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English.

RESULTS

We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics.

CONCLUSION AND IMPLICATIONS

It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.

Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial

BACKGROUND

As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets.

METHODS

This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6-6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance.

RESULTS

The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment - Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption.

CONCLUSIONS

As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents' dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents' acceptance.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).

Meat texture modification for dysphagia management and application of hydrocolloids: A review

Dysphagia is a medical condition that describes the difficulty of swallowing food, and texture modified food (TMF) is the best intervention for dysphagia. The relevant guidelines to identify dysphagia food are provided by the International Dysphagia Diet Standardization Initiative (IDDSI). Developing texture modified meat is a challenging task due to its fibrous microstructure and harder texture. Various meat tenderization attempts are therefore evaluated in the literature. Meat texture modification for dysphagia is not just limited to tenderization but should be focused on safe swallowing attributes as well. The application of hydrocolloids for designing TMF has a major research focus as it is a cost-effective method and offers an opportunity for careful control. The present review focuses on the meat texture modification attempts that have been used in the past and present, with special attention to the use of hydrocolloids. Several studies have shown improvements in texture upon the addition of various hydrocolloids; however, few studies have attempted to develop texture modified meat for people with dysphagia. This area has to be further developed along with the sensory evaluations conducted with the dysphagia population, to validate the industrial application of hydrocolloids to TMF.

Preparing a Personalized Meal by Using Soy, Cricket, and Egg Albumin Protein Based on 3D Printing

Recently, personalized meals and customized food design by means of 3D printing technology have been considered over traditional food manufacturing methods. This study examined the effects of different proteins (soy, cricket, and egg albumin protein) in two concentrations (3% and 5%) on rheological, textural, and 3D printing characteristics. The textural and microstructural properties of different formulations were evaluated and compared. The addition of soy and cricket protein induced an increase in yield stress (τ₀), storage modulus (G′), and loss modulus (G″) while egg albumin protein decreased these parameters. The textural analysis (back extrusion and force of extrusion) demonstrated the relationship between increasing the amount of protein in the formula with an improvement in consistency and index of viscosity. These values showed a straight correlation with the printability of fortified formulas. 3D printing of the different formulas revealed that soy and cricket proteins allow the targeting of complex geometry with multilayers.

Attitudes towards Freshly Made and Readily Prepared Texture-Modified Foods among Speech-Language Therapists, Dietitians, and Community-Dwelling Older Adults

Texture-modified foods (TMFs) are recommended for patients suffering from swallowing difficulties. Given the increasing aging population, the use of TMFs is on the rise. Research to date has focused on the nutritional value, malnutrition indices and healthcare practices in relation to TMFs, but the perception of these diets from a patient and healthcare practitioner perspective has received less consideration. This study explored how currently available TMFs (including Soft & Bite-Sized, Minced & Moist, and puree) are perceived by key stakeholders. Four types of TMFs were consumer tested: freshly made TMFs following foodservice recipes and three types of readily prepared TMFs (commercially packaged, sous-vide and hydrolysed). The selected samples were tested through five focus groups (including nine dietitians, seven speech-language therapists, and five community-dwelling older adults), which involved a sensory rating using a validated 7-point scale meal assessment tool and a semi-structured focus group discussion. Analysis was conducted using quantitative and qualitative approaches. Soft & Bite-Sized meals had significantly higher palatability ratings than others. Sous-vide meals were most suitable for Soft & Bite-Sized texture, while commercially packaged samples were most appropriate for minced moist and pureed meals. Three main themes emerged through content analysis: (1) palatability of TMFs, (2) perceived challenges with the currently available TMFs and (3) key differences in opinion between stakeholders. Freshly made TMFs were more appealing and tastier, whereas readily prepared (pre-cooked, packaged and require reheating) TMFs had a more consistent texture. The texture of all TMFs requires enhancement, particularly in pureed meals. Developing nutritious and safe TMFs for people with dysphagia requires the promotion of active insight exchange between dietitians and speech-language therapists.

3D Food Printing Applications Related to Dysphagia: A Narrative Review

Dysphagia is a condition in which the swallowing mechanism is impaired. It is most often a result of a stroke. Dysphagia has serious consequences, including choking and aspiration pneumonia, which can both be fatal. The population that is most affected by it is the elderly. Texture-modified diets are part of the treatment plan for dysphagia. This bland, restrictive diet often contributes to malnutrition in patients with dysphagia. Both energy and protein intake are of concern, which is especially worrying, as it affects the elderly. Making texture-modified diets more appealing is one method to increase food intake. As a recent technology, 3D food printing has great potential to increase the appeal of textured foods. With extrusion-based printing, both protein and vegetable products have already been 3D printed that fit into the texture categories provided by the International Dysphagia Diet Standardization Initiative. Another exciting advancement is 4D food printing which could make foods even more appealing by incorporating color change and aroma release following a stimulus. The ultra-processed nature of 3D-printed foods is of nutritional concern since this affects the digestion of the food and negatively affects the gut microbiome. There are mitigating strategies to this issue, including the addition of hydrocolloids that increase stomach content viscosity and the addition of probiotics. Therefore, 3D food printing is an improved method for the production of texture-modified diets that should be further explored.

Spray drying of non-chemically prepared nanofibrillated cellulose: Improving water redispersibility of the dried product

Despite increasing interest in using nanofibrillated cellulose (NFC) as food thickener and emulsifier, poor water redispersibility of dried NFC, which is form suitable for practical utilization, significantly limits such applications. Studies are lacking on preparation of dried NFC with superior redispersibility. The present study therefore proposed and examined strategies to improve water redispersibility of spray dried NFC via the use of selected co-carriers, i.e., gum Arabic with/without xanthan gum, carboxymethyl cellulose or pectin. Synergistic interactions between NFC and co-carriers, as confirmed by X-ray diffraction (XRD) patterns and Fourier transform infrared (FTIR) spectra, helped prevent NFC agglomeration during spray drying. All reconstituted spray-dried NFC/co-carriers suspensions exhibited shear-thinning and gel-like behaviors, thus supporting the use of such suspensions as thickener and emulsifier. Spray-dried NFC with 80% gum Arabic and 20% xanthan gum (SD-NFC/GA20XG) resulted in suspension with highest viscosity; the suspension also performed best at recovering viscous characteristics of NFC. Water thickened by SD-NFC/GA20XG had strongest shear-thinning behavior, indicating that SD-NFC/GA20XG suspension resulted in smoothest mouth feel and easiest swallowing. Such observations were supported by XRD patterns of SD-NFC/GA20XG, which suggested that its relative crystallinity was the lowest. Its FTIR spectra also showed the highest intensity of -OH bending and carbonyl bands, which are directly related to water adsorption capability of NFC. Use of reconstituted SD-NFC/GA20XG as emulsifier also resulted in highest stability for oil-in-water (O/W) Pickering emulsion during storage for up to 30 days.

Towards the Development of 3D-Printed Food: A Rheological and Mechanical Approach

Additive manufacturing, or 3D printing, has raised interest in many areas, such as the food industry. In food, 3D printing can be used to personalize nutrition and customize the sensorial characteristics of the final product. The rheological properties of the material are the main parameters that impact the 3D-printing process and are crucial to assuring the printability of formulations, although a clear relationship between these properties and printability has not been studied in depth. In addition, an understanding of the mechanical properties of 3D-printed food is crucial for consumer satisfaction, as they are related to the texture of food products. In 3D-printing technologies, each manufacturing parameter has an impact on the resulting mechanical properties; therefore, a thorough characterization of these parameters is necessary prior to the consumption of any 3D-printed food. This review focuses on the rheological and mechanical properties of printed food materials by exploring cutting-edge research working towards developing printed food for personalized nutrition.

Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke

BACKGROUND/OBJECTIVES

Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia.

SUBJECTS/METHODS

This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran-Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels.

RESULTS

Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P < 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P < 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P < 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia.

CONCLUSIONS

In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia.

A review of the impact of food design on the mealtimes of people with swallowing disability who require texture-modified food

Texture-modified foods are a common component of interventions provided to people with dysphagia (swallowing disorders) to maintain their respiratory health, nutritional health and to reduce the risk of aspiration-related illness or choking on food. However, the unsightly and unappetizing appearance of texture-modified foods may negatively impact on the mealtime experience and acceptance of texture-modified foods of persons with dysphagia. The aim of this review was to determine what is known about the impact of specific elements of food design ‐ food structure and visual appeal ‐ on the mealtime experiences of people with dysphagia. This review of 35 studies presents evidence on how the physical characteristics of texture-modified foods for people with dysphagia can be considered during food production, formulation or service to improve their mealtime experience. Overall, the visual appeal, texture, taste, aroma, temperature, mealtime environment and mealtime assistance all impact upon mealtime experiences and should be considered carefully in the design of a person’s mealtime plan and food-related dysphagia interventions to improve their mealtime-related quality of life. Further research needs to include the views of people with dysphagia, particularly those with lifelong conditions, who might require texture-modified food for an extended period over their lifespan.

The Effectiveness of International Dysphagia Diet Standardization Initiative-Tailored Interventions on Staff Knowledge and Texture-Modified Diet Compliance in Aged Care Facilities: A Pre-Post Study

Background

The International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients.

Objectives

This study aims to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care.

Methods

Five aged care facilities received tailored interventions, which were guided by the Expert Recommendation for Implementing Change process and used the corresponding barriers identified in the previous study: 1) tailored material, delivery, and planning; 2) opinion leaders and professional input; 3) strategies to attract and involve staff; and 4) reflections and evaluations. Meal compliance against IDDSI standards and staff knowledge acquisition were the primary outcomes evaluating the impact of the intervention. Written consent was obtained from facility managers. Staff trainings were delivered by a dietitian, accompanied with electronic and printed materials. An audit was conducted on all items listed on the TMD daily menu (lunch, dinner, and midmeals). TMD IDDSI audits and staff self-administered surveys were conducted before and 6 mo after the intervention.

Results

Audits of 68 and 79 TMD meals/items were conducted pre- and postintervention, respectively. Significant improvement in meal compliance was found in all 3 levels of TMDs, including soft and bite-sized (50%; P = 0.0001), minced and moist (44%; P = 0.0024), and puréed (42%; P = 0.0024). The overall IDDSI compliance increased by 46% postintervention (P < 0.0001). Staff achieved higher scores in both dysphagia and IDDSI knowledge sections (P < 0.0001).

Conclusions

Tailored interventions facilitated IDDSI implementation in aged care evidenced by increased TMD compliance and staff knowledge, which remained at 6 mo postintervention.

Food for the elderly based on sensory perception: A review

Background

The impairments of physiological functions caused by aging are common problems in the elderly, especially the impairments of sensory perception. Besides, close relationship between food sensory perception and nutritional status also suggests the importance of dietary management for the elderly population. The foods taking sensory perception into account are urgently needed by the elderly.

Scope and approach

This review analyzed sensory perception changes and their effects on food behaviors and nutritional status. Besides, sensory properties essential for aged-foods and acquisition methods, as well as current status of such foods were summarized.

Key findings and conclusions

Soft, smooth and moisty foods were more suitable for the elderly with chewing and swallowing dysfunction, which can be prepared by gelation, enzyme treatment, blade tenderization and other non-thermal technologies. Flavor enhancement/enrichment, irritant addition and packet sauces were recommended to compensate the impairment of chemical sensory. Molds, piping bag and 3D printing were suggested for refining appearance of pureed foods, and improving appetite of the elderly.

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Sensory perception changes of the elderly affect food behaviors and health.

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Soft, smooth, and moisty foods are more suitable for the elderly.

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Gelation and enzyme treatment are applied to modify the texture of aged food.

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Packet sauces may meet the heterogenetic flavor requirements of the elderly.

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Visually attractive food made by 3D printing can increase the appetite of elderly.

Correlation between Instrumental and Sensory Properties of Texture Modified Carrot Puree

This study was undertaken to determine the correlation between instrumental and sensory evaluation on texture modified carrot puree. Texture modified foods (TMF) are prescribed to dysphagia individuals to aid in the oral manipulation and facilitate swallowing of food. There is a lack of correlation between instrumental measurements and sensory attributes on TMF. Understanding this correlation will aid in the formulation of safe foods with desired sensory properties for dysphagia patients. Instrumental measurements of carrot purees were performed by back extrusion method using a texture analyser and the attributes obtained were firmness, consistency, cohesiveness and adhesiveness. Quantitative Descriptive Analysis (QDA) with eight trained panellists was employed to characterize the texture of the carrot puree based on seven sensory attributes: Firmness, viscous, adhesive (mouth), smoothness, adhesive (throat), rate of breakdown, difficulty to swallow. Five thickeners, namely gellan gum, xanthan gum, Suberakaze, UNI-PURE® Dys-sperse instant thickener, ULTRA-SPERSE® M Starch were evaluated against carrot puree without any thickener as control. The correlation results obtained from texture analysis and sensory evaluation were statistically significant (p < 0.05). The firmness attributes from instrumental and sensory results were positively correlated. The consistency parameter was positively correlated to sensory attribute viscous and negatively correlated to smoothness. The sensory attribute rate of breakdown was negatively correlated to instrumental parameter of cohesiveness. Lastly, instrumental adhesiveness was positively correlated to sensory attributes adhesive to mouth and throat, and difficulty to swallow. The correlation results showed a well-designed instrumental technique can be used to understand the impact of thickeners on TMF for dysphagia subjects. This article is protected by copyright. All rights reserved.

Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study

Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types; however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive.

The care needs of persons with oropharyngeal dysphagia and their informal caregivers: A scoping review

INTRODUCTION

Besides affecting physical health, Oropharyngeal Dysphagia (OD) entails limitations in daily activities and social participation for both patients and their informal caregivers. The identification of OD-related needs is crucial for designing appropriate person-centered interventions.

AIMS

To explore and map the literature investigating the care needs related to OD management of adult persons with OD and their informal caregivers during the last 20 years.

METHODS

A scoping review was conducted and reported following PRISMA guidelines. Five electronic databases and reference lists of eligible publications were searched for original works in English or Italian, published between January 2000 and February 2021. Two independent raters assessed studies' eligibility and extracted data; a third rater resolved disagreements. Extracted care needs were analyzed using a Best fit framework synthesis approach.

RESULTS

Out of 2,534 records preliminarily identified, 15 studies were included in the review and 266 care needs were extracted. All studies were conducted in Western countries. Research methods primarily consisted of qualitative interviews and focus groups (14 studies, 93.3%); head and neck cancer was the most frequent cause of patients' dysphagia (8 studies, 53.3%); caregivers' perspective was seldom investigated (5 studies, 33.3%). Both patients and caregivers primarily reported social (N = 77; 28.9%) and practical (N = 67; 25.2%) needs, followed by informational (N = 55; 20.7%) and psychological (N = 54; 20.3%) ones. Only patients reported physical needs (N = 13; 4.9%), while spiritual needs were not cited.

CONCLUSIONS

The recurrence of personal and social needs besides physical ones highlighted the manifold impact of OD on patients' and caregivers' lives. Larger and more focused studies are required in order to design tools and interventions tailored to patients' and caregivers' needs.