Texture modifications for dysphagia in a rural residential aged care facility – recommendations vs reality.

Abstract

Background/aim: Dysphagia is prevalent among residents of residential aged care facilities (RACFs), with 55–65% of residents experiencing swallowing difficulties. Speech-language pathologists (SLPs) often prescribe texture modified food and fluids to mitigate the risk of dysphagia in residents with compromised oropharyngeal function. This study aimed to assess whether residents with dysphagia in a rural RACF received food and fluid textures consistent with SLP recommendations, and to identify barriers to adherence to these recommendations. Population setting: Residential aged care facility with approximately 100 residents, located in a rural Victorian community with a population of nearly 15,000 people. Methods: The first phase of this study involved texture audits (n=42) of meals provided to residents with dysphagia who were prescribed texture-modified food or fluids by SLP staff. The second phase involved semi-structured focus groups with nursing and food preparation staff (n=11) to identify barriers to the implementation of texture-modified recommendations. Results: Texture audits identified that 64.3% (n=27) of meal trays contained foods that were not consistent with SLP prescribed textures. Major barriers identified from focus group data included complicated communication and documentation processes involving nursing, food services and SLP staff. Time pressures, staffing issues, resourcing of the kitchen, resident preferences and perception of texture-modified meals were also identified as contributing factors. Based on the barriers identified, recommendations were made regarding communication processes, staff training, presentation of texture-modified meals, and dysphagia management procedures. Conclusion: Provision of SLP prescribed texture-modified food and fluids was influenced by multiple factors, particularly complicated communication and documentation processes. Strategies to facilitate more effective dysphagia management were identified and implemented. Translational impact/implications for future practice: An extensive update of organisational dysphagia management procedures was completed with input from key stakeholders. A real-time online menu management system was implemented to improve consistency in documentation and reduce potential communication errors, and food moulds for texture-modified meals increase visual appeal. Mandatory dysphagia-specific training is now provided for nursing and food services staff, and visual cues (e.g. bed signage, coloured meal trays) are used to indicate dysphagia requirements. A repeat of the texture audit process is planned to measure the longer-term impact of these changes on the accuracy of the provision of texture-modified food and fluids