Texture-modified diets in long-term care facilities: assessing adherence to nutrition standards

Texture-modified diets (TMDs) are commonly required for older adults but are associated with nutritional risks. The nutritional quality of TMDs provided in long-term care (LTC) facilities in Ireland is understudied. This study evaluated the nutritional quality of TMDs in one LTC facility against international menu standards and dietary reference values.

A cross-sectional nutritional analysis of TMDs (International Dysphagia Diet Standardisation Initiative Levels 3-6) was conducted over two non-consecutive days in a residential long-term care facility in Ireland, encompassing all foods, drinks, and recipes as served over two typical days for Levels 3-6. Items were quantified and analysed using Nutritics (v6) and R (v4.3.3). Mean (SD) daily and per-meal energy and protein provision were compared with standards from the British Dietetic Association (BDA) Nutrition and Hydration Digest, the BDA Care Home Digest, and Canadian Menu Planning in LTC guidance. Other macro- and micronutrients were assessed against dietary reference values.

Mean daily energy and protein provision were below recommended standards for all TMDs, except energy at Level 3. Per-meal provision was also suboptimal for most meals, except protein at Level 3 for lunch. All TMDs exceeded recommended total and saturated fat ranges and failed to meet dietary fibre targets, while sodium met guidelines. All TMD Levels were below recommendations for vitamin D (except for Level 3), vitamin C, potassium, magnesium, iron and zinc.

Routine TMD provision in this facility did not meet key nutrient standards, highlighting potential nutritional vulnerability among LTC residents. Improved menu planning, enrichment strategies, staff training, and clearer guidance are required, although further work examining intake and outcomes is needed.