I’ve seen a number of cases of elderly or older folks who develop difficulty swallowing. They may find it hard to eat food normally and would often choke or have food stuck in their throat, unable to swallow without water.
Note: I know of a lady who have Alzheimers who also develop difficulty swallowing like my mom around the same time. However, her caregiver was wise enough to quickly transition her to blended food, taking the time to sit down to patiently hand feed her scoop by scoop. Hence till today, she did not require a feeding tube. Whereas for my mom, because I did not practice this, my mom had to be on tube feeding.
When you notice they could no longer consume food on their own and is losing weight, it is time for them to transition to soft food diet. In a way the transition would be similar to one of a baby. That means that food would need to be cooked, blended and then made in a paste to be consumed with porridge.
To ensure the elderly are meeting the daily dietary requirement, it is advisable to consult with a dietican or nutritionist to craft out a nutritional plan based on the ingredients used. From then, the caregiver would know the portion of ingredients required to prepare the food.
Cooking the food vs raw food diet:
I would strongly advocate having the food cooked first before they are being blend. In YouTube, I’ve seen a lot of raw food blended diet being promoted. While theoritically raw blended vegetables and fruits like smoothies are supposed to be packed with nutrients, they are detrimental for those with digestive issue, difficulty swallowing and disease such as gastroparesis.
From the perspective of Chinese healing system, having a blended soft diet from raw food such as vegetables and fruits is considered detrimental. Reason being uncooked raw food is ‘cooling’ or ‘yin’ in nature. When a person can no longer swallow, there is already weakness, usually the digestive system is very ‘yin’. To add these diets would weaken the digestive system further, accelerating the deterioriation of health.
Overall process of preparing soft blended food:
The overall mechanics is to wash all the ingredients, then add a little water to stew them over a pot till the ingredients soften. Then wait for the cooked food to cool a little before placing them in a blender to blend the food.
If you wish to have an idea of the ingredients and the process, you may refer to the Tube Feeding Food section of this blog. Here I have blog post and videos of the ingredients and preparation for tube feeding. It is sourced from YouTube channels from Thailand hospitals where the nurses and nutritionists explain on how to prepare the tube feeding food. It provides an overall good nutritional balance for general cases but of the person have special health condition like diabetes, cholesterol, heart condition, etc which requires certain diet restriction, please consult a doctor who would then refer to a dietician or nutritionist.
The process is similar with preparation of soft blended food except the food need not be sieved if the food is not fed using a feeding tube. For tube feeding, the final process requires the blend to be sieved to prevent food from getting stuck and blocking the feeding tube.
If we are doing hand feeding, the food just need to be cooked, then blended to make sure it is soft and easier to swallow.
I have seen a caregiver cook a pot and blend in the morning. The food is made into 3 portions to be fed to the elderly during breakfast, lunch and dinner- the blended ingredients are mixed with rice porridge only during the meal time. Otherwise, the blended food is not mixed with the rice porridge.
The rice porridge is stored inside a thermal pot to maintain warmth the whole day. While the blended food that is not yet consumed is stored in a container and kept in the fridge (do not put in the freezer) for later meals- where it needed to be heated a brief while on the stove before being mixed with the porridge. Then allowed the mixture to cool down a little before giving to the elderly person. Unconsumed food, both the blended food and the rice porridge should be disposed. All the food should be cooked fresh daily.
Often, the older person may find it hard to eat blended food. Especially if they are a food lover and had been all along a picky eater. However, we need to coax and convince them the importance of switching to blended food in order for them to be able for their body to receive the daily nutritional needs.
If they are old and frail, then we have to take the time to hand feed them scoop by scoop….. just like we would do so with a baby. Please do it with patience and never with a sour face. Initially we may feel impatient but once we get used to doing it, it becomes a habit.
I have known of 2 Thai ladies who took care of their elderly mothers for a few years and they would cook and feed their mothers with soft blended food during that time (their mothers were also bedridden so were on diapers and require bed baths).
If we do not make the effort to switch them on a soft food diet, and hand feed them (if they are relunctant to eat), they would gradually ‘forget’ to swallow and lose the swallowing reflex. By then, doctors would suggest to put them on tube feeding in order to sustain their life. Once on tube feeding, they would become inactive and fully bedridden. This may be followed by choking due to build up of phlegm and secretions that they have difficulty getting rid off.
One of my biggest regret is that I did not monitor my mom closely enough to notice she was gradually forgetting to swallow, thus not making her food blended (I always made them into tiny chunks but that is not good enough) and made the effort to hand feed her to encourage her to eat. Also to ensure she was consuming enough nutrition from her food to sustain her health (that time mom was a child and wanted to eat her favourite food like cakes and biscuits which I had allowed her to indulge, perhaps a little too much). Had I have taken precaution, she may still be able to eat on her own today instead requiring a feeding tube.