Supplementary Material for: A quasi-experimental study on feeding behaviors and related outcomes by provision of molded puree in aged care facilities

Introduction
Texture-modified diets are commonly used in the management of dysphagia in older adults. Conventional pureed diets, although safe, are often visually unappealing, potentially leading to reduced intake and negative feeding behaviors. Molded purees are created using food molds and gelling agents and aim to improve mealtime experiences through enhanced presentation. This study evaluated the effects of molded puree on feeding behaviors and intake amount in residents of aged care facilities, and whether any factors were associated with more favorable outcomes.
Methods
A quasi-experimental repeated measures study design was used, involving 130 residents from four nursing homes. Participants received molded puree meals instead of their original prescribed diet once per week over 3 weeks. Feeding performance was assessed using the Edinburgh Feeding Evaluation in Dementia Scale (EdFED) and amount consumed were also recorded. Wilcoxon signed rank test was used to compare outcomes between molded puree and their original diets. Subgroup analyses were conducted based on medical diagnoses and swallowing status.
Results
Molded puree meals were associated with significantly lower EdFED scores compared to conventional purees, indicating improved feeding behaviors (p < 0.001). Participants also consumed significantly more molded puree than their original diets (p < 0.001). Subgroup analyses revealed participants with dementia showed greater benefit in feeding behaviors and amount consumed when they were provided with molded puree.
Discussion
Molded puree improved feeding behavior and food intake among residents in aged care, in particular patients with dementia, but independent of their swallowing function. These findings support the potential for molded purees to enhance mealtime experiences in this population, although further research is needed to evaluate long-term clinical outcomes.