Adjustment of food textural properties for elderly patients

Over the next twenty years the number of people over 60 years will exceed one billion. Changes associated with ageing have an impact on food texture choices for healthy elders and those used therapeutically for people with swallowing difficulties (dysphagia). The ideal “swallow-safe” bolus is moist, cohesive and slippery. A general reduction in muscle strength is seen throughout the ageing oropharyngeal musculature, resulting in a reduced ability to safely and efficiently manage hard or fibrous textured foods. Reduced masticatory ability combined with dental loss further compounds the issue. Dry mouth is commonly associated with old age, making it difficult to propel dry or sticky textures through the pharynx, and increases the likelihood of pharyngeal residue. An age related reduction in laryngopharyngeal sensitivity dampens the ability to detect residue, increasing choking risk. Reduced tongue pressure, increases in pharyngeal transit time, valleculae residue, number of clearing swallows and slower and less efficient oesophageal transit occur with aged swallowing. Food textures that are sticky and adhesive will require increased lingual effort to propel them into and through the pharynx. Taken in combination these factors mean that food textures prescribed to the elderly need to be soft and moist and for fibers to be easily broken. To improve moisture content, additional nutrient dense products (e.g., milk, cream or butter) may be required to artificially moisten the bolus. Careful, individualized attention to diet recommendations will result in a diet that is appealing and also provide a variety of textures that are swallow-safe and nutrient dense. Practical Application: Aged related changes in the oral cavity and the oral, pharyngeal and oesophageal phases of swallowing require special thought to the suitability of food textures for the elderly. Foods that are fibrous, hard or dry may be unsuitable due to difficulties with safe particle size reduction and bolus formation for swallowing. Foods that are sticky and adhesive are also problematic and increase risk for both choking and residue. Food texture properties that are ideally suited for the elderly include those that are soft, moist, and easily reduced with minimal chewing effort. Hard food textures that break down and dissolve easily with minimal chewing should be investigated. Increased aroma and flavor may improve appeal lost through reduced variety in food textures. Diet reviews need to consider both textures that can be safely managed and the nutrient density of those textures

Nurse experiences of medication administration to people with swallowing difficulties living in aged care facilities: a systematic review of qualitative evidence

To identify nurses' experiences of administering oral medications to residents of aged care facilities (ACFs) with swallowing difficulties.Administering medicines to older people with swallowing difficulties is a challenging task. Nurses frequently modify oral medications e.g. by crushing/splitting tablets or opening capsules, to facilitate the administration process. These practices are associated with an increased risk of medication administration errors. However, the reasons for these practices from the nurse's perspective are not well understood.The review investigated studies on the experiences of nurses of any level with the responsibility of medication administration in ACFs in terms of problems and challenges they encountered when administering oral medicines to aged care residents with swallowing difficulties. Aged care facilities providing all levels of care were considered for inclusion. Qualitative studies including, but not limited to, phenomenology, grounded theory, ethnography and action research designs as well as mixed methods studies and text and opinion papers were considered.A comprehensive database search of PubMed, CINAHL, Embase and Scopus was conducted between October and December 2016. MedNar and ProQuest Dissertations and Theses were used to search for gray literature. No date limitation was applied. The Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI) was used to assess the quality of the papers. The JBI-QARI data extraction instrument was used to extract qualitative findings. Data synthesis was not applicable in the final analysis due to the inclusion of only one article.The initial search resulted in 1681 unique titles for screening. A total of 202 abstracts were screened, after which a full-text review conducted for 19 articles. After the full-text review, only one article was eligible to be included in the final report. The included study scored highly in terms of methodological quality. The findings highlighted issues around time constraints, complexity of medication administration process to residents of ACFs with swallowing difficulties, cost and resources for alternative strategies, inefficient information flow and communication among healthcare professionals, and nurses' knowledge and training needs.The limited findings of this systematic review indicate that further research is necessary to provide evidence of nurses' experiences with regards to administering oral medications to older people with swallowing difficulties living in ACFs. A comprehensive understanding of these experiences may lead to organizational system changes to support nurses and older people with swallowing difficulties in ACFs

Dosage form modification and oral drug delivery in older people

Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people

An infant‐led approach to complementary feeding is positively associated with language development

The timing and strategy with which parents first introduce their infants to solid foods may be an important predictor of subsequent developmental outcomes. Recent years have seen a decline in the prevalence of traditional parent‐led feeding of soft, puréed food and a rise in the prevalence of infant‐led complementary feeding. Although there has been some research espousing the benefits of infant‐led complementary feeding for improving food fussiness and self‐regulation, there has been little exploration of this approach that may impact on other developmental outcomes in children. The current study explores whether aspects of the infant‐led approach, specifically the child eating unaided and consuming finger foods and eating with the family, are related to child language outcomes. One hundred thirty one parents of children aged 8–24 months completed questionnaires about their approach to complementary feeding, their current feeding practices, their child's experiences with family foods and child language comprehension/production. The findings suggest that an approach to complementary feeding which promotes infant autonomy in feeding (i.e., eating finger foods rather than puréed foods) and consuming more family foods is related to more advanced child language production and comprehension. Specifically, the prevalence of eating family foods mediated the relationship between eating unaided at the onset of the complementary feeding period and later language outcomes. This study is the first to find a significant relationship between different approaches to introducing solid foods and child language outcomes and these findings highlight the potential for different complementary feeding approaches to influence behaviour beyond mealtimes