Patent Application
20170079310
The pureed food served in hospitals leaves much to be desired; it is often incompletely consumed if not refused outright. No one today would simply throw a slice of pizza into the blender—the first example of such cuisine I witnessed in the 80's—nonetheless there is little, if any, time or space within hospital nutrition services departments to develop any new philosophy or method of food preparation and presentation. It is an enormous challenge for both the cook and the clinical dietitian to take into account every prescribed regime, with both personal and ethnic preferences. Problems of chewing and swallowing are still, more or less, handled with the blender.
This problem is not as obscure or as marginal as it may at first sound. In the U.S. population alone, there may be five million having some degree of dysphagia; it's safe to say that most of us will eventually experience some degree of dysphagia ourselves. Those admitted to hospital acute or inpatient rehab facilities face up to three hours of physical, occupational and speech therapy every day. Morale is, in fact, an essential component to the success of these therapeutic regimes. In nearly eight-hundred such facilities, non-acceptance of a dysphagia diet is a persistent and quantifiable problem.
The easiest example which comes to mind is coffee. Nurses and therapists frequently—if not always—start the day with a pint or more of the strongest, most flavorful, calorie laden or calorie-restrained beverage commercially available. Our patients may have been in line at the drive-up of the same coffee house only two weeks prior to admission at a rehab facility. They must now ready themselves for as many as three hours of unfamiliar physical and psychokinetic exercise in the course of the day, not to mention psychometric evaluation. We offer them a modest serving of something weak, starched to almost undrinkable thickness and calorie-less. It is understandably refused. We have all had our coffee: they haven't. This is not acceptable.
Coffee aside, one appealing class of dysphagia cuisine in use today is that of “formed puree”: puree food skillfully crafted into direct imitations of various regional and ethnic cuisines. These are usually one-off examples of culinary art requiring much time and attention. Production of this type of dysphagia cuisine is now routinely available in the UK through DysDine, which markets homogenous puree products molded into direct imitations of traditional English cuisine. Puree chicken shaped into a drumstick, a serving of peas molded into the shape of a mound of peas, &c. I myself have seen memorable examples of formed puree served at what is now called Avamere Olympic Nursing and Rehab in Sequim, Wash. And where I work today, at Community Hospital of the Monterey Peninsula, formed puree occasionally shows up as a quarter-scale slice of french toast—or a portion of scrambled eggs the same size and shape—or a miniature waffle.
Formed puree, at its most attractive, is too time-consuming to be employed in the vast majority of hospitals. When it can be produced centrally, the process of rendering in large vats the material to be formed must inevitably produce a taste impression inferior to normal cuisine: such as in the overly rendered cans of “adult baby food” commercially available.
A ready-made item of dysphagia cuisine does not necessarily have to present itself as a direct imitation of any food product, but its aroma, appearance and taste may present a strong appeal analogous to the texture lost in rendering the food safe to swallow. This texture analog may, in fact, recoup all of the appeal lost in such cuisine.
Seasonings traditionally served in a mix are presented in distinct layers to allow the consumer to experience a rapid succession of tastes at different parts of the tongue. These impressions combine to produce an impression of the customary dish, but with an element of surprise or discovery in the transition from the analog to the relatively homogenous bolus formed prior to swallowing: a process analogous to mastication in something which did not actually require chewing to be swallowed safely.
Such dishes should be nutrient dense: thickened with chia rather than starch to enhance protein and fiber content. The elements may be further separated by thin layers of highly seasoned butter or coconut oil, the bulky layers being relatively bland, enhancing a staccato alternation of tastes to produce a sense of surprise analogous to the breaking down of textured food in the act of chewing. Butter and coconut oil, solid at room temperature enhance the sense of texture without sacrificing safety. The product is nutrient and calorie-dense, portions are small and non-threatening, inviting complete consumption without waste.
The elements should be minimally processed, cooked in small batches and slowly fine-ground or chopped to preserve cell structure in meats and vegetables.
The shape of the container should itself present an element of surprise or variation between different food items. Presentation in a transparent container affirms, at first glance, that the product is not homogenous: appearing crafted, in layers of appealing variation and a decorative surface finish.
