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My mom has had to be on a pureed diet for a little over a year due to pocketing her food previously. She has lost a lot of weight and I'm certain it's because of not getting enough calories. Everytime I see her at her memory care home, she is eating a bowl of pureed vegetables and water. One time she was having pureed vegetables and chicken. I asked if she was getting a balanced diet long ago and was reassured by the director she was. However, I just saw my mom again, and for dinner they were feeding her pureed beans and water. She has gone from a size 14/16 to a 12, and I had to buy her new pants. They are open to suggestions. Where do you get a meal plan for your loved one if they're on a pureed diet? Do I get a referral from her doctor to see a nutritionist for her or is there something online I can print out? Thank you for any ideas!

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Wasting of muscle and mass happens no matter what. You would be amazed how little it takes to keep seniors alive. You can ask doc for nutrition consult but the truth is that intake becomes less and less and less until honestly an elder cannot swallow well and does not wish to eat. Ask for advice on some nutrition booster drinks served with some thick-it thickening.

But over all this amounts to the body giving up and giving in to time that takes it's toll on everyone. And the truth is that underweight is better than overweight in terms of general health, diabetes and complications and etc.

Speak to your doctor if you require further guidance or more info.
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My mom's diet at the nursing home was essentially the same as everyone else, just pureed.... I've often told the story about the pureed and then thickened chicken caesar salad, yes it really did taste like it should but was really not worth the effort the kitchen staff must have put in 🤣
Bottom line is if they have the ability to puree one type of food they have the ability to puree anything and if they don't that's a problem. And my mom's NH was also on top of any weight loss, residents meals were supplemented with calorie dense puddings and drinks (and they definitely should know all about these products).
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I gave my Husband everything that I made for myself. I just pureed it.
I also "boosted" some of his breakfast a bit. Making Cream of Wheat I would add an egg the last few minutes of cooking,
Lots of soups and stews
He loved Key Lime Pie so I would make the filling and bake it in a ramekin without a crust and he would have that.

Your mom should be getting anything on the menu just pureed.
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RFM - I was able to be at the NH daily and I made it my habit to be there at meal times so I could sit with her in the dining room and see what my mom was eating and know that she was actually being fed at least once per day. If possible try to visit over her meal times and observe what she and others are eating, mix it up so that you observe breakfast, lunch and dinner.
Ask about the Hormel Vital Cuisine 500 Oral Supplement Shake, or other Hormel products
https://www.hormelhealthlabs.com/brand/hormel-vital-cuisine/

(And at this stage of life don't worry too much about a balanced diet, desserts are calorie dense and usually appreciated 😉)
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I pureed all my husbands meats, and vegetables, and of course there is oatmeal, yogurt, ice cream, and lots of creamed soups that one can eat as well.
Like already said, whatever the memory care is serving for breakfast, lunch or supper, it can all be pureed, so shouldn't be an issue.
And you mentioned that one time your mom was eating "pureed vegetables and chicken." What is not balanced about that? She's getting her protein and her vegetables.

My late husband after almost dying from aspiration pneumonia had to have all his foods pureed, and his drinks thickened with the product Thick It, and he seemed to eat less and less as time went by, so I don't think what you're describing is all that unusual. Just make sure that the memory care facility is only serving your mom thickened drinks as well, as she can also aspirate on those too if not thickened.
Best wishes to you and your mom.
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KPWCSC Jul 2023
Thickened drinks are not recommended for all swallowing issues. She said her mom was “pocketing” which has its own issues and needs. So thickening may help or hinder. Only a speech therapist should determine if thickening is needed after a swallowing study.
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My husband is in hospital now and due to choking and swallowing issues on puréed diet.I bring him yoghurts, pure ice cream, smoothies, chocolate shakes, home made puréed soups. The problem is he eats very little, no appetite.Consider that perhaps Mom does not need as much food, maybe talk to swallowing specialist like I did and she made few suggestions.
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Deb555 Jul 2023
If he needs thickened foods then ice cream and shakes are not safe because they become liquid as they melt in the mouth. Please ask for consult with the dietitian and/or speech therapy.
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Her memory care should have a nutritionist on staff. Ask for a consultation.

She may need Ensure or Boost milkshakes to up her calorie count, but ask them to give her the diabetic formula because they're loaded with sugar. My mother developed severe gout from drinking those sugary milkshakes, but they were also her only source of nutrition and she was drinking three a day.

It's also possible that she's simply taking in fewer calories because she needs fewer calories and her body is just losing weight naturally as a result.
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My dad is on a puree diet , we add lots if veggies and pure cream in when we can and some sugar to add empty calories. He is diabetic so got ve careful but its a end life situation so whatever helps keep weight up. Also add ensure when he can drink it. Also smoothies. With protein powders. Another trick is not to allow jim to fill up on liquids when he eats so he has more room for food sometimes.
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Is there enough staff to encourage her to eat? In memory care, there was not enough one on one to spend time with my mother timed between her frequent naps combined with her refusal to eat or drink. I had to consistently check with staff documentation to be sure my mom had a daily bowel movement because of her lack of solid food and random intake of Ensure products followed by Miralax. The cycle would cause rock hard constipation followed by explosive diarrhea.
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When swallowing difficulties begin, it means the start of the long slide that the body is shutting down. It may take a year before death and usually there is no suffering from hunger. You can get a nutritionist referral but after a swallow study but I suspect that has already been done.
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KPWCSC Aug 2023
MACinCT, I’m glad I didn’t read your opinion ten years ago when my husband started having issues nor when his PEG feeding tube was inserted seven years ago! With proper swallowing therapy, some can improve as my husband did when he went from NPO to eating again and only needing to supplement his diet with one tube fed meal a day to improve his nutrition. Only recently has he had a setback and is NPO again but hoping to get back into therapy to see if he can improve again. Yes, for some it may mean a slide down… but it is not a given in every case. I hope your answer does not encourage some here to give up if they begin to have swallowing issues.
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My husband enjoyed Boost High-Calorie Drink (530 calories). It helped to keep his weight stable.
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Suggestions….
First meet with the dietician at the facility and see what her trays should contain.
Ask to see the records where they are suppose to record how much of the tray has been eaten. (This is not always a true picture). I know for my father we sometimes put his tray on the cart and no one asked how much he had eaten. However, just asking may let them know you are aware of procedures and encourage them to pay more attention.
You should not have to supplement her diet, they are already being paid for that. However a nice treat brought in would be nice.
Maybe a second opinion with an outside dietician may be in order.
A swallow test may be in order to see if what she is given to eat is still appropriate.

Difficulty in swallowing can be a sign end of life is near, but like in our case it is not always because my husband’s issues began about 10 years ago. For those who are otherwise reasonably healthy there are a lot of options.

When my father was in a nursing home and began choking, his doctor refused to order a swallowing test because he had said he did not want a PEG Tube. There are lots of swallowing therapy techniques that can help those with swallowing issues. A swallowing test identifies the muscles that are affected and having a test does not mean someone has to have a tube placed. You can say no then pursue possible therapy.

This was before my husband began having swallowing issues… I wish I knew then what I’ve learned from caring for my husband. I have learned a lot about swallowing in the ten years of caring for my husband… the last seven years have been using a PEGTube for his meds and to supplement what he ate by mouth… and he is still very mobile.
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KPWCSC Jul 2023
I meant to include this link to products we have used at times…
https://www.hormelhealthlabs.com/products/

You don’t have to purchase from the manufacturer… check other websites and compare prices. Being Italian, the only one he refused to eat was the lasagne. I mainly used the Thick and Easy puréed meals for convenience on hectic days.
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What a great site! Thanks to all for suggestions.
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Roseformom: Perhaps your mother could see a nutritionist.
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Yes, get her PCP involved and, if/ as PCP feels appropriate for her level of care needs , he/ she can make a referral to a nutritionist. Her PCP needs to be contacted as the PCP may deem other assessments be made to determine the patient's
" level of care needs" which includes nutrition and, feeding options
( which can include assessment for risk of aspiration while eating any consistency of food).
Call PCP

Practice self care.....
Remember that often a loved one will not want to eat or may lose interest in food or their ability to eat as diseases progress. This is a very anxious and grief provoking time for loved ones and, one may have challenges acknowledging pts needs/ desires vs family needs/ desires to see the patient " eat".
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Her meal should basically resemble a healthy diet for everybody:
1/2 plate with produce (fruits and vegetables)
1/4 of plate with protein (dry beans, dry peas, nut butters, meats)
1/4 of plate with starchy carbs (potatoes, pasta, rice, bread)
She should also get 3 servings of calcium rich foods or drinks daily (milk, non-dairy milk, yogurt, cheese, tofu, and most drink supplements)
Make sure her drinks are thickened to the consistency recommended by her speech therapist. There are commercial thickeners that can be added to soups and all drinks.
Depending on her height, you can look up her weight on a BMI chart to see if she is at a healthy weight for her height. She might have been overweight before; the weight loss could be a good thing. American Diabetic Association also have charts to recommend good diets based on the amount of calories needed for people.
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Baby food in a jar is already pureed. Probably could use some spicing up, though.
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I would get a nutritionist consult.
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I just bought the baby food where it was fruit, vegetables & protein together. (He wouldn’t eat anything but fruit so this hid it).
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My fiancé is on puréed diet as tumor in neck, etc. I’ve tried for over a week to get dr to call me as he’s in hospital but haven’t been able to. He chokes on bottled water & carton of milk even when I give him a straw. I didn’t know that there was a thickener for drinks. Any brands or names?
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BarbBrooklyn Sep 2023
Thick-it is the brand I recall.
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As a retired nutrition clinical staff member of a nursing home for 27 yrs…We “pureed” whatever the meals were for others using a little water, gravy or juice as appropriate.. serve the same meal you would eat..
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Difficulty swallowing is part of decline and aging. Weight loss follows and frequently with loose stools from liquid diet. Plus you cannot force a person to take in more calories. You might get some help from dieticians from referral. Who will be preparing food from any of the suggestions? Do consider her quality of life here
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Maybe it is time to let nature to take its course and stop interceding to find ways to keep this woman going. She has dementia and if she is in MC it must be pretty bad. I know she is a cherished and loved member of your family but when is enough enough?
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