Australas J Ageing. 2019;1–9. wileyonlinelibrary.com/journal/ajag | 1 © 2019 AJA Inc. 1 | INTRODUCTION Texture-modified diets (TMDs) are a necessity for many res- idential aged care facility (RACF) residents, whether due to swallowing difficulties (dysphagia), poor dentition, sensory, physical and/or cognitive impairments. 1 Internationally, prevalence of TMD use in RACFs has been reported as being between 15% and 30%. 2 Residents on TMDs have been shown to have lower energy intake and increased risk of malnutrition and are more likely to require feeding assistance compared to residents on regular diets. 3-5 Increasing mealtime assistance, improving the appearance, taste appeal fortification of TMDs have all been shown to result in improvements to intake and weight for older adults in RACFs. 6,7 Limited investigation of TMD practice in New Zealand aged care settings pro- vides little guidance to food service and health profession- als considering service improvement initiatives. Typically, dietitians and speech-language therapists provide resident- specific nutritional and swallowing support on request and offer sporadic training. Although not mandated, many of the larger RACFs employ a dietitian to advise on their seasonal menus. The aim of this mixed methods exploratory study was to characterise the prevalence and characteristics of residents on TMDs in RACFs, exploring food consumed, nutritional and dysphagia diet compliance, menu quality, dining room experience and feeding assistance. Received: 9 May 2018 | Revised: 30 January 2019 | Accepted: 17 February 2019 DOI: 10.1111/ajag.12640 RESEARCH Texture-modified diets in aged care facilities: Nutrition, swallow safety and mealtime experience Anna Miles 1 | Victoria Liang 2 | Julia Sekula 2 | Sharon Broadmore 3 | Paul Owen 3 | Andrea J. Braakhuis 2 1 Faculty of Science, Speech Science,  The University of Auckland, Auckland, New Zealand 2 Faculty of Medical and Health Sciences, Discipline of Nutrition,  The University of Auckland, Auckland, New Zealand 3 Auckland District Health Board, Auckland, New Zealand Correspondence Anna Miles, Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand. Email: a.miles@auckland.ac.nz Objectives: Over 35 000 people live in residential aged care facilities (RACFs) in New Zealand. Texture-modified diets (TMDs) are commonplace. They are associ- ated with malnutrition. The aim of this study was to characterise TMD prevalence and practice in RACFs. Methods: Data from 35 460 residents were extracted from the interRAI™ database. Mealtime observations (including 459 residents), meal audits (IDDSI, 2018) and menu audits (Dietitians New Zealand Menu Audit Tool for RACFs 2013) were com- pleted at 10 RACFs. Results: One-third of residents were on TMDs. Half the residents ate full meals. Feeding assistance was more common in residents on TMDs compared to those on regular diets (P < 0.001). The majority of pureed meals met IDDSI standards; none of soft and bite-sized meals complied. TMD carbohydrate and protein servings did not comply with standards. Conclusions: Texture-modified diets reflect 1/3 of meals produced in RACFs. This study provides insight into TMD use in RACFs and highlights service gaps and train- ing opportunities. KEYWORDS deglutition disorders, dysphagia, food services, nutritional status, old age homes