Textured soft diets and feeding techniques among the elderly mentally ill

Abstract

The elderly mentally ill with advanced stages of dementia are nutritionally at risk in both how they are fed and what they eat. This risk increases with a behaviour feeding problem or swallowing difficulties. Nevertheless it is common practice in institutions to alter the texture of the diet to a mechanically soft, minced or liquidized form. By such an alteration, these patients may be at a greater risk of developing swallowing problems than if a textured soft diet were used. The textured soft diet consists of soft food (soft enough to be mashed with a fork) but not liquidized. Mixed dishes with large pieces of food or food with different consistencies are excluded. Sticky foods may also cause problems with some patients. Correct feeding techniques are important, i.e. correct positioning, a relaxed environment, patient orientation, appropriate utensils and careful control of amount and rate of feeding. Multi‐disciplinary team work (involving the nursing staff, occupational therapist, speech and language therapist and dietitian) is therefore needed to prevent nutritional problems arising from feeding difficulties. A pilot study was undertaken to establish if these principles were being put into practice in a general psychiatric hospital. Having identified a number of poor practices, a brief staff training programme was implemented.