Sunday 7 June 2015

Celebrating Dysphagia Month

To celebrate Dysphagia Month I searched for some delicious dessert options.
Time is precious when you are caring for someone who needs special food. As a dietitian I am aware of the need to balance the diet as well as making the food tasty and looking good. When I am testing and presenting new recipes to my own family for comments I become overwhelmed with the efforts of cooking and washing up, thanking my lucky stars for my dishwasher.
In a recent article in DYSPHAGIA CAFÉ called ‘Moving beyond the isolated swallow: Dysphagia in the context of a shared mealtime’, Samantha Shune reflects on the shared mealtime and ageing. The assessments and interventions from the therapist must reflect the multifactorial nature of the process. The therapist needs to know and be part of the education of other members of the group or family. If the family meal table or social group is available for normal socialisation for at least some meals of the day the food is a large part of the pleasure of this. If at least some of the components are presented to share and thought of as delicious then life is good.

Three Variants for the Parfait Dessert for a Holiday Gathering
The time taken to prepare different meals for the various members around the table can become a burden for the carer/cook. This can be solved by preparation of some of the courses like smooth thick soups (see previous blogs) and desserts (see ‘Super Foods for Small Appetites’) for everyone. The family can then pick and choose to suit their appetite at that time, and may be unaware the items are designed to be suitable as smooth purée. Often a small appetite can only manage the soup and dessert. If these are prepared using all the food groups this will often suffice.
A traditional colourful dessert bought at the local ice cream parlour when I was a child used to be called “A Knickerbocker Glory”. The components are presented in layers and consist of jelly, custard, fruit, ice cream, and cream. A more contemporary name is ‘Parfait’. The acceptance within the family and or social group of the safety aspects and consequences of eating the ‘wrong’ food has to be part of the story along with the acceptance of any other sort of diet or preferences where there are restrictions. This should mean that the items and foods available at the table are there for some who choose it. For example the granola, made from oats, nuts, seeds and maple syrup sprinkled on the parfait are not suitable for the person with dysphagia or indeed the very little people in the family.

A Close-up of a Parfait showing the Layers

The recipes I offer here can be part of this sort of presentation and the family can mix and match according to their taste. My family like both vanilla and chocolate custard as part of their chosen layers. Thick custards are available in the supermarket, as are flavoured mousses if time is limited for preparation.
I chose to offer a recipe for a soft fruit jelly, made from fruit juice, gelatine and some tapioca flour to ensure the jelly does not melt too quickly in the mouth; an apple and rhubarb snow; an iced coffee mousse and I suggest plain yoghurt or custard to separate the layers. If a high energy protein supplement is recommended I have included the recipe for RESOURCE® Fruit Flavoured Jelly. (adapted from “Super Foods for Small Appetites”).

RESOURCE® Fruit Flavoured Jelly.
Ingredients:
237 ml box of RESOURCE® Fruit Flavoured Beverage
¼ cup cold water
1 ½ tsp gelatine
1 tbsp tapioca flour
½ tbsp. sugar

Method
  1.  Mix the dry ingredients together.
  2. Add the water slowly making a paste initially.
  3. Heat either over hot water or more directly on a slow heat until the gelatine has dissolved and the tapioca mix has a glassy appearance.
  4. Slowly stir in the fruit Drink until well mixed.
  5. Refrigerate until set.
  6. Serve broken up with a fork.

Nutrition Information per serve (300ml): Energy 1334kJ, protein 12.9g, fat 0, carbohydrate 67g, sugars 40g, fibre 0.1g, sodium 91mg. (Other nutrients important as part of this supplement not shown).

For the purpose of the exercise I made a Soft Cranberry Jelly and a Soft Queen Garnet Plum Jelly, substituting the Nestlé Healthcare Supplement with fruit juice. The family preferred the Queen Garnet Jelly as it had a full bodied sweet taste. Obviously a favourite fruit juice can be used, although I am told pineapple juice will not set. The amount of gelatine may have to be varied to achieve desired soft consistency. The amount made was enough for 4 glasses of the mixed layered dessert.

Nutrition Information per 100g of QG Plum Jelly: Energy 262kJ. Protein 1.9g, fat 0, carbohydrate 13.2g, 10.7g, fibre 0.1g, sodium 8mg.

Apple Rhubarb Snow
Ingredients:                                       Serves 4
2 apples red unpeeled
280g rhubarb chopped
20g sugar
1 cup water
1 egg white

Method
  1. Chop apples and rhubarb into small pieces and place in pan with water and sugar.
  2. Bring to the boil and simmer until soft, uncovered.
  3. Allow to simmer until product is thick.
  4. Blend in vitamiser until smooth.
  5. Whisk egg white until soft peaks form.
  6. Fold into the cooled fruit.
  7. Serve in a bowl or use as part of your layered dessert.

Nutrition Information per 100g: Energy 143kJ, protein 0.9g, fat 0.1g, carbohydrate 6.8g, sugars 6.7g, fibre 1.4g.


Apple Rhubarb Snow

Iced Coffee Mousse
Ingredients:                                      Serves 4
1 tbsp instant coffee
1 tbsp hot water
1 ½ cups milk
2 tsp gelatine dry
1 ½ tbsp. water extra
3 tbsp ice cream

Method
  1. Combine coffee and hot water. Add milk.
  2. Pour mixture into pan and bring to simmer point.
  3. Combine gelatine and extra water, add a little of the hot milk from step 2 and stir to dissolve.
  4. Place coffee milk, dissolved gelatine, sugar and ice cream in vitamiser and blend until smooth. The idea of this is to create a product with a creamy froth topping.
  5. Pour into small glasses or coffee cups and refrigerate to set. Or use as a coffee layer in your layered dessert.

Nutrition Information per 100g: Energy 386kJ, protein 5.0g, fat 4.0g, carbohydrate 9.6g, sugars 9.5g, fibre 0.1g, sodium 45mg.
 
Iced Coffee Mousse