Vegetarian Journal's Foodservice Update
Healthy Tips and Recipes for Institutions
Volume VI, Number 1 Winter 1998
DESIGNING A VEGAN MENU FOR HOSPITAL
PATIENTS NEEDING TEXTURED DIETS
By Nancy Berkoff, R.D., Ed.D.
Patients of any age may need a modification in the texture of the food they eat; this can be a temporary or a permanent change. The key is to keep the patient's interest up while conforming to the textural needs of the diet. This is not always easy to do!
There can be many different reasons for textural changes. Physical trauma to the jaw, dental work, stroke, and even psychological diagnoses can indicate an inability to chew or swallow regularly textured foods. As foodservice professionals we are always hopeful that they will be temporary changes, which means we may have to have a selection of transitional textures. For example, a recent stroke patient may only be able to tolerate thickened liquids, gradually moving to semisolid foods (such as thin mashed potatoes or very soft fruit or vegetables), then onto some solid foods (such as a baked potato), and gradually onto all types of foods.
As foodservice veterans can tell you, patience with patients is the rule of the day when it comes to textured diets. Pureed and mechanically altered diets may mean different things to different patients. To guarantee that patients will be receiving foods which they can maximally tolerate, be sure to have an open dialogue with the patient and caregivers, including nurses and nurses' aides, speech therapists, and family members (who may be present at mealtime). Be able to individualize diets as much as possible (within the constraints of your department) and be sure that the physicians who are ordering diets have an understanding of what mechanically soft (used for patients who have difficulty chewing solid foods) and pureed (for patients who cannot chew solid foods) mean. Be sure to clarify what types of foods will not be offered with these diets (generally, this means no sticky or chewy items, nuts or seeds, large raw pieces of fruits or veggies, etc.).
Foods used for mechanical soft diets can be altered by cooking, chopping, mincing, or mashing and foods for pureed diets can be mashed, blenderized, or pureed. Foods should be altered as little as possible, both for ease of preparation and for patient appeal. For example, a patient receiving a mechanical diet can probably tolerate a soft baked apple or an apple cobbler (with soft topping) and does not need to receive something as soft as apple sauce.
A meal pattern (taken from "Simplified Diet Manual," Iowa Dietetic Association, 6th edition, 1994) for a mechanically altered or pureed diet is as follows (we've adapted for vegan): breakfast to include soft fruit or juice, cereal with soy or rice milk, toast or soy or rice milk toast with jelly and a hot beverage; lunch to include soup or juice, soft casserole, soft vegetables, bread and margarine, soft dessert, soy or rice milk; dinner to include soft casserole with grain or potato, soft vegetable, soft dessert, hot beverage, soy or rice milk.
Dysphagia patients may have problems with both food and fluids. If a patient chokes on thin liquids (broth, coffee or tea, water) then thickened liquids will need to be offered. Nectars, sherbets, creamy-style soups, and firm tofu and fruit smoothies may all be better tolerated.
Natural or commercially prepared thickeners can be used for both pureed and dysphagia diets. Commercial thickeners can be purchased which need only to be mixed with thin liquids, such as juice or coffee; read the label, they may have a certain amount of gelatin (a non-vegetarian item), sugar or salt. Arrowroot and agar are natural thickeners. Arrowroot is neutral in flavor and has twice the thickening ability of flour. Dilute it in water and add at the end of cooking; puddings and sauces thickened with arrowroot have a beautiful gloss. Agar can be used to thicken liquids and gel-like desserts. Agar is derived from ocean vegetables and can be found in powder or flakes. Agar is added at the beginning of cooking and does not need to be diluted before being used.
Creating soft foods is easy. Making them attractive and interesting is a little more difficult. If you have a large quantity kitchen and an equipment wish list, wish for a Hobart (also called a buffalo) chopper, a vertical chopper, an institutional-size blender, and a hopper attachment (with several blades) for your kitchen. For smaller kitchens, food processors (with several blades) and commercial blenders should do the trick.
Try to select ingredients that lend themselves to being "soft." For example, root veggies (carrots, turnips, beets, etc), hard-shelled squash, all potatoes, grains, and most fruit tolerate being mashed or pureed. On the other hand, summer squash (like zucchini) or leafy greens (like spinach or collards) are a disaster when altered. Use them as combination ingredients, not stand-alones.
For creamy, soft, pleasant textures, tofu and avocados are a vegan dream. Since both are neutral they can be used to "texture" sweet or savory dishes. Avocados are higher in fat, but it is mostly unsaturated fat with decent amounts of Vitamin A and potassium. Many patients eating modified diets may need the extra calories. You can select the fat content of the tofu you use in your kitchen. Tofu can be used for a binding, a soft thickener, and even a moisturizer in casseroles that are combinations of cooked grains and vegetables.
Make a light dinner entree (or a heavy dessert) by layering pureed (or chopped) peaches, sweetened tofu (buy it already sweetened or mix in orange or apple juice concentrate), and avocado puree (small cubes) into a parfait glass. Garnish with a spoonful of jelly or preserves. Along the same lines, a breakfast "swirl" of cooked cereal, pureed fruit, and avocado cubes is attractive and packed with nutrition while being easy to swallow.
Bananas, berries, peaches, apricots, apples, and pears can be cooked or mashed into flavorful sauces. Puree some fresh strawberries, sweeten with orange juice concentrate, and use as a sauce for puddings or cakes. Freeze this blend and have a cool, smooth sorbet.
Pureed vegetables, such as carrots or peas, and beans can be cooked or pureed into a smooth, creamy consistency, perfect for soups and sauces. Puree cooked black beans, season with onions and cilantro, heat, and swirl in soft tofu, and you have soup that everyone will like! Potage Crecy is a fancy way of saying pureed carrot soup�puree cooked carrots with rice or rice cereal, dill, and parsley; mix in some soft tofu, and you will have a soup that is pretty to look at and great to taste.
How do gingered white beans with butternut squash sound? How about citrus oats or frozen apricot frappe? All can be made for textured diets. The beans are cooked, tossed with cooked squash squares and some mirin. Cook it soft for the mechanicals and serve over rice pilaf, or puree it and serve over seasoned mashed potatoes. Rolled oats (not quick) can be soaked overnight in soy milk with orange and lemon zest, cinnamon, and soft fruit. It can be served, uncooked, for mechanical soft diets and cooked for pureed. Combine canned, drained apricots, soy milk, fresh ginger, and ice cubes in a blender for the frappe; this item can be used for everybody!
The sky is the limit with texturized menus. You may find that you are preparing the same menu items for the whole house!
Excerpts from the Winter 1998
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