As our loved ones age they may come to a point where they have difficulty chewing or swallowing food. The concern at this point is two-fold: one, we need to make sure they’re still able to get proper nutrition and two, if they have trouble swallowing they may accidentally aspirate (inhale) food or beverage into their lungs. Any food aspirated into the lungs may lodge there and cause an aspiration pneumonia, which can be fatal in seniors.
If you notice your loved one having multiple instances of ‘food going down the wrong pipe’, then you want to communicate this to their primary care physician as soon as possible and ask for a referral to a speech therapist. Yes, a speech therapist, beyond helping people with speech problems they specialize in all the anatomy and physiology of the areas of the mouth, esophagus and trachea, including the mechanics of swallowing. They will observe your loved one swallowing multiple food textures and will recommend a food plan to minimize aspiration risk.
The biggest thing as a caregiver dealing with the additional care needs of a special diet is to find ways to make things as simple for yourself as possible while striving to provide your loved one with a high quality of life.
My dad had developed problems with swallowing and to avoid an aspiration pneumonia he was placed on a puree food diet. This basically meant that all of his food and drink had to be the consistency of either pudding or jello.
For his drinks I would use a product I would buy from my local pharmacy that would thicken liquids. It comes as a powder and depending on how much you use it will make the viscosity of the liquid like either nectar, honey or puree.
Food was another matter altogether! I won’t say that I never went out and bought baby food from the supermarket, because I did, but even those I tried to make more appetizing with seasonings. I really feel that it is important to keep the food interesting and flavorful even at this stage. For many seniors, as they lose the ability to participate in favorite activities, the ability to enjoy good food becomes even more important. Try to keep in mind the foods and flavors that have been life-long favorites when preparing meals.
I want to give some tips of things I figured out to help make a puree diet more palatable and hopefully diverse.
Stock up on stock (chicken, beef, vegetable …).
Stock up on juices.
Break out your blender. (I used our Magic Bullet quite a bit because it made clean up easier.)
Don’t forget the dessert.
Buy instant mashed potatoes.
If I was cooking chicken or beef for dinner I would simply cut Dad’s portion into small pieces and pop them into the blender with a splash of the corresponding stock (or gravy if I was using it for the meal). I would spin it up and check the consistency after a couple of minutes. If it was too dry I would add more stock. Once the long fibers of the meat were cut short, I would double-check the consistency once more. If it was too dry I would add just a teaspoon more of the stock at a time until it was just right. If there was too much liquid I would add about a teaspoon of mashed potato flakes, stir, let sit a minute and repeat if necessary.
Veggies can be blended up quite nicely with a bit of vegetable stock (or chicken). Once again add either more stock or mashed potato flakes to even out the texture.
Fruits can also be pureed using a complementary flavored juice. If you get this too runny the thickening powder can help fix the consistency. I must admit to using a lot of applesauce!
With my dad he could only eat about 1/2 to 1 cup of food at any one time, so I started feeding him about 5 times a day and made extra effort to get more calories into his food. One thing I made a lot of was jello, lots of jello! I discovered that if I bought vanilla flavored whey powder (like they have in the health care aisle) it would make the berry flavored jello taste like berries with cream. When making the jello I would also use juice instead of the cold water.
Here’s the recipe for my enhanced jello:
1 pkg jello (use the amount of boiling water specified on the packaging and use a 1 to 1 substitution of juice for cold water)
vanilla flavored whey powder (protein powder)
juice (complementary flavor to jello)
Mix recommended amount of whey (protein) powder with the juice. Mix well and set aside.
Pour packet of jello into a bowl and stir in the boiling water making sure the jello fully dissolves.
Give your juice/protein mix another stir and mix into jello mix.
Stir together until fully incorporated and refrigerate until set.
One day we were having a birthday party with a great, big chocolate cake which I knew was one of Dad’s favorite things. I really wanted to share it with him and decided to try to see if I could get it into a form that he could eat. So into the blender went a piece of chocolate cake (frosting and all) and to that I added a splash of milk. I spun it around for about a minute and it seemed to be ok – but a smidge of ice cream mixed in smoothed out the texture a bit more. Dad enjoyed every single bite!
Here’s some more quick ideas to provide more nutrition on a limited appetite:
- Mix applesauce (or other fruit puree) into malt-o-meal or oatmeal
- Offer small snacks in between meals
- Use honey to sweeten teas or other foods
If your loved one has a favorite food that I haven’t covered, I would encourage you to experiment on how to get it to the texture they need and improvise around the theme.