A Mixed-Methods Study on Carers' and Aged-Care Staff's Perception and Appropriate Utilization of Molded Puree in Older Adults.

内容摘要

While molded puree is marketed as a dignified alternative to traditional texture-modified diets for older adults and patients with dementia, the clinical implications of their rapid commercialization remain under-examined. To investigate the knowledge, clinical expectations, and psychosocial drivers regarding molded puree for older adults among community carers and aged-care professionals. This concurrent mixed-methods study recruited 164 community carers (public cohort) and 60 aged-care professionals (staff cohort) who work in non-governmental residential aged-care networks in Hong Kong SAR. Quantitative data were collected via cross-sectional surveys evaluating self-rated knowledge, swallow safety perceptions, and clinical expectations on consumption of molded puree in older adults. Qualitative data were obtained through semi-structured, in-depth interviews with a purposive sub-sample of 12 community carers to explore underlying behavioral drivers. Quantitative differences were analyzed using Mann-Whitney U and Chi-Square tests, while qualitative data underwent thematic analysis. Self-rated knowledge about molded puree was significantly lower in the public cohort compared to professional staff (p < 0.001). A puree equivalence fallacy was prevalent; 23.8% of the public believed molded puree shares the exact texture of conventional puree, and 39.3% assumed it requires no chewing. Staff were significantly more aware of biomechanical differences (65.0% disagreed with equivalence). The public held significantly higher expectations regarding improvements in feeding behaviors (50.6% agreement) and nutritional value (26.2%) compared to professionals (p< 0.05). Qualitatively, thematic analysis revealed twohigher-order themes: psychosocial motivations centered on restoringdining dignity and avoiding dietary stigma, and structural hurdlesinvolving procedural ambiguity. A significant knowledge-perception gap exists between the general public and healthcare professionals. While molded puree offers substantial psychosocial benefits, the prevalence of the puree equivalence fallacy underscores a potential risk for vulnerable older adults. Clinical interventions should prioritize evidence-based swallow safety and standardized screening over aesthetic appeal. Why was this Study Done? Age-related swallowing difficulties, known as dysphagia, often require foods to be blended into a smooth puree. Molded purees are a newer option where blended food is reshaped using gelling agents to look like standard meals, improving visual appeal and dining dignity. This study investigated whether the general public and healthcare professionals understand how to utilize these products safely. How was the Study Conducted? We surveyed 164 community members and 60 professional staff from residential aged-care facilities to compare their understanding. We also conducted in-depth interviews with 12 public respondents to explore their underlying motivations. What did the Study Find? A significant knowledge gap exists between the public and professional staff. Many community members mistakenly believed that molded purees share the exact texture of standard pureed food and require no chewing. In reality, gelling agents alter food behavior, requiring oral processing to swallow safely. Public respondents held highly optimistic expectations regarding nutritional and behavioral improvements. Interviews revealed that the public is heavily motivated by the desire to restore dining dignity and avoid dietary stigma, an aesthetic focus that often overrides essential swallow safety considerations. What does this Mean for the Future? Molded puree effectively enhance mealtimes. However, public education must emphasize that a speech-language pathologist should evaluate individuals before introducing these meals, ensuring physical safety is maintained alongside visual appeal.