In part one of this second series on swallowing, Kathryn Kilpatrick, who has been a speech-language pathologist for over four decades and is the author of the popular 5-volume “Therapy Guides for Language and Speech Disorders workbooks, ” helped us understand some of the causes of swallowing issues and how to cope. Here, in part two, Kilpatrick gets down to one of the major challenges of the issue: food preparation:
A pureed diet
Families may be instructed to puree all foods, but they could be unsure exactly what that means. Additionally, a plate with a pile of pureed meat, vegetables and other foods may not be very appealing to anyone, so arrangement of the food is important. The following suggestions should help, but may need to be modified if a patient has restrictions in their diet due to other medical conditions or has to have their liquids thickened.
Initially diets may consist primarily of mashed potatoes and pudding or yogurt but that soon gets old. There are many other things you can do to make the choices more appealing while promoting a balanced diet.
- Take pureed meat and add it to gravy over mashed potatoes.
- Take pureed soups and do the same thing.
- Protein intake is often reduced since meat is chewy. Sometimes a family will opt to use the baby food pureed meats – especially beef – when they need a quick option.
With a good chopper almost any meal can be pureed. There are now many products that can do the job, even an inexpensive mini chopper.
The wife of one of my patients was a great cook and her husband always complimented her cooking and ate well. He went to a mechanical soft diet from time to time but with health changes had to go back to pureed food until he got stronger. His attitude made it easier for him to adapt. I loved his comment that he did not understand why people protested eating pureed foods because the only difference to him was that he did not have to chew. Some of his favorite dishes were her lasagna and several specialty chicken dishes even when they were pureed.
- To simplify the preparation, especially meats, I suggest that larger quantities of favorite meats be pureed and frozen in small containers or in the ice cube tray and transferred to labelled bags so that protein can be added to foods like creamed soups without having to prepare it each time. Care partners are often overwhelmed with other obligations, so anything to simplify the process is welcome. Perhaps friends and family in the area could make extra meat when they are cooking and bring it over pureed and ready for use as needed.
- To maximize nutritional intake of fruits and vegetables, smoothies can be an excellent option. Protein powders or a nutritional supplement can also be added when needed.
The input of a speech-language pathologist is invaluable when the person with swallowing problems has to have thickened liquids in addition to modifications with solid food textures. The pathologist will take the caregiver through the steps so that he or she has the confidence to continue the process alone.
A mechanical soft diet
- A mechanical soft diet consists of foods easy to chew, however chewy foods may require chopping. Again the mini chopper or similar appliance is a lot quicker than doing it by hand, especially when meat pieces need to be finely chopped. Frequently the problem is that the food, especially meats, are too dry so a person just chews and chews without swallowing. Many things can be used to moisten the chopped foods such as gravy, salad dressings or broth, as long as dietary restrictions are followed.
One of my hospice patients loved and needed gravy on his meats, but he said his wife did not like making gravy and he did not like it from a bottle or can. I suggested that if there was a friend or family member who made gravy he liked, perhaps that person would be willing to make a larger batch and the wife could freeze small portions to use as needed. They knew who that person would be and it was a win-win situation!
Bigger picture: Focus on caregiver
Many years ago a patient’s husband told me his wife needed pureed foods and could not handle thin liquids so he took her bowl of cereal with a small amount of liquid, pureed it and she loved it. He even took the mini chopper to a small family restaurant they frequented so the food she picked out was pureed and presented attractively on the plate. I laughed when after my suggestions he referred to me as the “Martha Stewart” of swallowing.
Food is often one of the only things a person might enjoy and the care partners can struggle with having to make these changes. Preparing the food can be time consuming. They want to make it as pleasurable yet as safe as possible.
Recently there was a daughter who tried all her mom’s favorite foods but her mom only ate a few bites. The older woman had advanced dementia. My suggestion was to try fruit smoothies as well as her mom’s favorite pureed soups rather than cooking anything she could think of in hopes that her mom would eat more than a few bites. Interestingly her mom liked both of those food options, and they required less prep time, allowing more time to share just being together listening to music or looking through photo albums.
Another daughter, whose mom had late Alzheimer’s disease, needed pureed foods. The daughter went to the nursing home every evening to feed her what ended up being just a few bites. Her mom had not recognized her for years but the daughter wanted to continue this connection. Their background was German and the daughter still cooked some of those dishes passed down to her by her mom. I suggested a way to enhance this experience would be to make some of her ethnic dishes and then puree a small amount. She could feed that to her mom some evenings while surrounding her with stories related to their memories.
A huge thanks to my friend and colleague Kathryn Kilpatrick for the information in this two-part series on swallowing.