On Thursday and today, I went on site visits to two local hospitals to inspect their catering facilities.
The catering in Doncaster has been optioned for public tender and two global, multinational ?Conglomerates have submitted bids.
I went with a motley group of hospital colleagues to inspect, question, challenge and taste.
I was there as the dementia & older people guy.
The whole experience was incredible – my first time inside a hospital kitchen, my first experience of standing in a -18C freezer (thoughts of The Shining) and, my first real experience of textured food.
What is textured food?
This is the euphemism we use to describe food that is pureed (aka baby food) that people who experience dysphagia (difficulty swallowing) are prescribed to reduce the risk of choking and aspiration (that is, food going into the lungs rather than the stomach).
I am no expert in textured food, but the recent categorisation used by Speech and Language Therapists says that texture E is soft, mashable (that which can be mashed by a fork) – not that far off normal food and texture C is… well… it’s pap. (Texture D is in the middle)
Individuals who must eat these diets are predominantly those who have experienced strokes, but also people who have head and neck cancer and those at the extremes of life – people too weak to protect their airway or whose level of consciousness is not sufficient to guarantee consistent closure of their epiglottis.
Some of my patients have these meals.
Sometimes however we determine that given the severity of the person’s dementia, it is preferred that they eat something with the risk a greater risk of aspiration than nothing at all – we call this ‘comfort eating’ – which is, the acknowledgment that it is better a person has the experience of eating – the taste, texture, nourishment than they are constrained by doing what is safe.
I worry however about the people prescribed staged (textured) diets.
The food I tested on my travels was bad.
It looked bad (see pictures), and, tasted bad – that is, bland, creamy gloop, much like wallpaper paste.
The manufacturers are it seems too concerned with limiting amounts of sugar, salt and monosodium glutamate to these foods to consider that taste is important.
All of us, as we grow older have a diminished sense of taste (and smell), which means that chefs, caterers and nutritionist must incrementally try harder to stimulate a person’s appetite.
The bland pap I experienced did not meet these criteria.
I don’t think this is the fault of the multinational, multimillion, conglomerates – it is just the way it is. We – that is all of health, social and specialist care haven’t quite worked-out how to make food fantastic for people who are at risk of aspiration or choking.
Perhaps one day we will learn how to make pureed broccoli, fish and chips appetising.
For now, let us be very sure that when we say either ‘nil by mouth’, texture C or D or E, we are confident in our assertions and not practicing some form of defensive medicine.
Maybe, let all of us – have a taste test of the mush. Have a go. Don’t think – there but for the grace of God go I; think – there go I, let me see what my brother, sister or, patient is eating.