Design and Development of Texture-Modified Meals for the Elderly

[[abstract]]隨著社會經濟的發展和醫療技術及生活水平的提高，造成老年人口快速增長，再加上生育率下降，導致全球人口趨於老齡化。老年人因為年齡的增長，生理機能逐漸衰老，會遇到牙口不佳、唾液分泌不足、吞嚥困難、腸胃道蠕動變慢、消化液分泌減少、便秘、肌肉和骨質流失等問題，所以協助長者獲得足夠的營養攝取是極為重要的課題。 本研究依據衛生福利部國民健康署（衛福部國健署）訂定之65歲以上銀髮族每日飲食建議，每日總熱量以活動強度稍低之男性1950大卡與女性1600大卡為準，並參考衛福部國健署公告之飲食質地分類原則，設計及製作出符合熱量及營養素需求的「容易咬」及「牙齦碎」兩種質地調整套餐菜單。套餐內容以午餐及晚餐為主，餐食區分為主食、中脂主菜、低脂主菜、中脂半葷素配菜、低脂半葷素配菜、全素配菜及湯品共七大類，且每大類的代換份數固定；午餐和晚餐的餐食組合為主食1道、中脂或低脂主菜1道、中脂或低脂半葷素菜1道、素菜2道、湯品1道及水果1份；但限定每日的中、低脂主菜和中、低脂半葷素配菜只能各選1道。為補足熱量差異，男性額外多加2/3道的主食、中脂及低脂主菜。長者的營養素攝取量是以國人膳食營養素參考攝取量(第八版)為標準；熱量及營養素是依照衛福部食品藥物管理署之食品成分資料庫的資料來計算；質地則以衛福部國健署提供之簡易檢測方式確認。 結果顯示，套餐菜單之熱量及營養素攝取量在適當選擇及組合下，皆可達到銀髮族飲食的建議值，質地符合容易咬及牙齦碎的檢測標準。故本研究所設計之菜單及料理內容應可作為一般長者在家庭或長照機構之飲食照顧的參考，但在實際應用上仍有限制及考量，如：套餐之七大類餐食雖然代換份數固定，但因同類食材之營養組成並非完全相同，致使同類餐食之熱量及營養素含量有頗大的差異；套餐內容以午晚餐為主，使得一餐之供應份量可能過多；套餐菜單以能自由選擇搭配為前提，若未充分瞭解同類餐食在營養組成上的差異，可能造成營養失衡的狀況。[[abstract]]With the development of social economy as well as the improvement of medical technology and living criteria, coupled with the declined fertility rate, the elderly population continues to grow rapidly and the world is also growing older quickly. The physiological functions of elderly gradually deteriorate with increasing age. Common problems in older age include poor salivary and digestive fluid secretion, difficult swallowing, slow gastrointestinal motility, poor bowel movement and so on. Thus, it is extremely important to assist the elderly to obtain adequate calories and nutrient intake. This study followed the directions of the “Daily Dietary Recommendations for the Older Adults” declared by the Ministry of Health and Welfare (MOHW) to design and develop 2 types of food texture modified combo meals, “easy to chew” and “soft & bite-sized”. The daily calories are 1950 kcal for the males and 1600 kcal for the females to meet the energy needs for slightly low-intensity activity level. The combo meal items were designed for lunch and dinner and divided into 7 categories, including staple dishes, medium-fat main dishes, low-fat main dishes, medium-fat side dishes, low-fat side dishes, vegetable side dishes, and soup. The food exchanges of each category were fixed. Each lunch or dinner consists of 1 serving of each following category, including staple dishes, medium- or low-fat main dishes, medium- or low-fat side dishes, soup and fruit, plus 2 servings of vegetable side dishes. Medium- and low-fat main dishes and medium- and low-fat side dishes were limited to 1 serving per day. The males had 2/3 more servings from staple dishes, medium-fat and low-fat main dishes to cover the different energy requirement. The nutrient intakes for the elderly were based on the suggested levels of the Dietary Reference Intakes (8th edition). The calories and nutrient contents were calculated based on the related data from the Food Composition Database established by the MOHW. The texture of designed meals was tested according to the simple testes for food texture revealed by the MOHW. The results showed that the calories and nutrient intakes of the combo meals could fulfill the recommended intakes for the older adults with proper selection and mix. The food texture of the designed meals passed the simple tests for “easy to chew” and “soft & bite-sized”. The combo meals designed and developed from this study could be used as good references for home and institutional meal preparation for the elderly. However, there are still some limitations and concerns for practical application. For example, the food exchanges of each category are fixed, but the nutrient contents of similar food materials are not exactly the same, which making considerable variations in the calories and nutrient contents of each combo meal item in the same category. In addition, since the combo meals were mainly designed and developed for lunch and dinner, the food portions might be too large for the elderly to finish during a meal. Finally, to freely choose and mix the combo meal items is one of the objectives of the study. Nevertheless, malnutrition might happen without sufficient nutrition knowledge to make proper meal combinations