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Have been caring for mom for 7 years and is bedridden with dementia, COPD, and Parkinson's. We have had to remove her dentures due to Parkinson's and her nurse has determined that she has no gag reflex left. I have been making smoothies with yogurt, ensure plus, instant oatmeal, and fresh strawberries and this has been successful. I attempted to crush a chicken sausage in the blender and add it too some chopped creamed spinach and feed it with some soft mashed potatoes. That part is not working too well. I am using THICKIT for all other liquids but am looking to others as to what have you used to ensure your loved one has a nutritious meal and you do not have to worry about aspiration. At times if I show up with a bowl of her favorite ice cream, that is the best thing.


Mom will be 90 in December so any and all ideas would be appreciated.


Thank you!

What makes doctor's apprehensive when it comes to ur Mom. Why would a doctor ask you to leave his office and say they would call the police?
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redroseman Aug 13, 2020
Because mom was on a gurney and we arrived via an ambulance with two attendants, and when the doctor saw it, he decided he couldn't see her and sent the receptionist out to say so. When asked why we were even given an appointment, she got pissed that we were even asking the question, and told us to leave.
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To all who have responded, a heart felt thank you for all your input. I forgot to mention in my original post that we have had to take her dentures out due to them moving around.

I do have a suction machine bedside and it works and is a life saver.

The nurse I have for mom has 40 years experience working with the elderly but do agree I will call her doctor and get someone in here. During this time of Covid I am not going to take her out of this home; so a home visit will be required.

To Gardenartist, I will look for a doctor who can do the xray and determine what can be done here.

The doctors here are apprehensive at best, and it brings up the time I took mom to a podiatrist and even after making an appointment and completing paperwork the doctor refused to see my mother and we were told to leave the office promptly or they would call the police.

Updates to follow and If I could give you all a hug, it would be the biggest you ever received!
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Thanks cwillie for a respectful reply, I appreciate it very much!
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cwillie, I had no problem understanding and I am doing just fine. In my experience some people are too confident and get into major trouble. I am very competent, but I know my limits and that is when I leave it to the professionals. Dysphagia is nothing to take lightly. My mother is fortunate, we have great hospitals and wonderful doctors. I think Mass General in Boston Mass tops most! Have a good night, cwillie.
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I think it comes down to how confident (and competent) the caregiver is in finding and applying information earlybird, I spent many hours searching and reading various studies and feel I was probably better able to assess my mother's needs than the "experts" I encountered. A swallow study is no guarantee that caregivers can understand or or will follow advice, or even that the "professional" will give appropriate, easy to follow, personal directions.
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cwillie
My mother had an ER nurse do a simple gag swallow test to determine if she needed a swallow evaluation with a radiologist and she did. She had one the next day, delayed swallowing was her final diagnosis and thickened honey consistency liquids recommended with thickened foods by radiologist and speech therapist after the procedure. I would never rely on internet information without consulting a doctor for the initial diagnosis, my mother is too precious to me and caregivers could make a huge mistake at the expense of the patient. I was told from the speech therapist a patient choked to death due to a caregivers negligence. The ice cream is just one thing of many, cwillie, there a so many foods to stay away from. My mother was in the hospital recently and she consulted with a speech therapist, it was determined by the therapist when she did a simple gag test and tried different foods textures, my mother possibly could advance from honey consistency liquids to nectar consistency because delayed swallowing seems to have improved, but that will be determined by another swallow evaluation by a radiologist for safety purposes. I was pleased with the expertise from the staff in the radiology department.
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I have to say that modifying a diet isn't rocket science, my mom never had a swallow study while she was living with me and frankly the woman who evaluated her after she was at the nursing was an a$$ who caused more problems than she solved. IMO it doesn't really matter what the correct diagnosis is, and anyone whose condition is as advanced as the OP's mother isn't likely to benefit from exercises. There is tons of information on line about modified diets and dysphagia and the nurse is no doubt experienced in this and can give sound advice.

(redroseman - One thing I missed first time I posted was your mention of ice cream - you need to be very careful with this when you are thickening fluids because it can melt in the mouth to an unsafe consistency, for the same reason gelatin is also something to avoid)
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Very dangerous situation doing this alone with a diagnosis from a nurse, potential for choking and aspiration. Your mother needs a swallow evaluation order from her primary physician. Speech therapist and radiologist will be doing the swallow evaluation, I was allowed in the room. You will need need to consult with a speech therapist and a nutritionist sometime after the procedure. It was about a week for my mom. Appointments were set up for my mother. Simple procedure, eating different textured foods and seeing how well she did swallowing the different textures. I saw small bites of chopped up food going down the trachea. Glad I was able to be present, took it very seriously.
My mother had a swallow evaluation due to a delay in swallowing and coughing after food intake. I met with speech therapy as well as a nutritionist about a week after the procedure, both were very knowledgeable and informative. I was a little nervous, but with experience I got much better with preparation. I would suggest getting these done and after that message me and I will be glad to help you with food planning. I hired a personal chef for my mother at the beginning for a few months. I have great recipes from the chef as well as my own. My mother likes most of them. Please message me if interested in the foods I prepare for my mother. The best to you.
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Found another good source for you, but it has 5 (!) dysphagia levels!    This is why it's critical to know what level of dysphagia has been diagnosed for your mother, so you can prepare the foods properly.   If not, she could choke.

https://www.gicare.com/gi-health-resources/dysphagia-diet/

My father got Meals on Wheels, so I pureed them, to the extent possible, by adding gravies or juices.   He also liked Hungry Man dinners, and they were generally easy to prepare if I got ones with meat such as Swiss steaks, meats that had already been softened as opposed to roasts, which required more time in the blender.

What you could do is list Mom's favorite foods and try to find them in the lists I cited, and add liquids accordingly.    But I just can't emphasize enough that a swallow test needs to be done so a qualified professional can determine what level of food she can eat.

Another issue is presentation:  piles of mush aren't particularly appealing.    Hormel produces a variety of already pureed foods, at a very high price.

https://www.hormelhealthlabs.com/product/thick-easy-pureed-meals/
https://www.hormelhealthlabs.com/brand/thick-easy/
https://www.hormelhealthlabs.com/product/thick-easy-shaped-pureed-frozen-foods/

You can get some ideas from their foods.

Another thought:  caution on seeds:   My father couldn't eat any fruits with seeds, especially small seeds like strawberry seeds.   That might be something to explore with a speech therapist. 
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Today just isn't my day!  I just lost a long post with suggestions, references, and other issues addressing dysphagia.  

Redroseman, here are just a few of the suggestions I lost when my post disappeared:

https://www.amyspeechlanguagetherapy.com/dysphagia-treatment-strategies.html

This is a good synopsis of exercises, postures and positions, etc. that are appropriate for dysphagia patients.  No exercises should be done though w/o a speech pathologist prescribing them.

Dysphagia has been discussed here periodically:  these are other threads on the topic, some suggesting foods to puree and tricks to make them more palatable:

https://www.agingcare.com/search?term=dysphagia+diets

There used to be 3 levels of dysphagia; I've seen a fourth, which is a "normal diet".    Your mother should have been diagnosed with a specific level, so that her food can be prepared accordingly.

This is a good synopsis of what dysphagia is and how it occurs, including the dangers of aspiration (when food goes into the lungs):

https://www.saintlukeskc.org/health-library/dysphagia-diet-level-1

Your mother should have had a swallow study, in which a few foods are fed to her while she's positioned in front of an x-ray type machine which shows the path of everything she eats.  This allows a speech therapist to determine if someone does have dysphagia, and which level.    It has to be performed by a speech pathologist or someone of comparable knowledge of speech functions.

My father typically had his at a hospital, but during rehab, the pathologist ordered studies for several patients and the medical pro (doctor, perhaps  - I don't remember) brought the equipment to the nursing home.

After the test, the pathologist can advise whether to follow a level 1, 2 or 3 diet, each of which addresses slightly different preparation of foods.   

Some adaptations can be made as well:   our pathologist suggested using applesauce on cookies, as it absorbs the crumbs.   It worked!   There are other little "tricks":   instead of giving a bowl of ice cream, provide it a few tablespoons at a time, so that it doesn't have time to melt, which makes it more susceptible to aspiration.   Just keep refilling the bowl with a few more scoops of ice cream.

I used prepared gravies to puree meats, and cider to puree ham.   Meats are perhaps the hardest to soften.
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JoAnn29 Aug 13, 2020
When this happened to me, a member suggested using Word and then copying and pasting to the question.
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I am with Alva. Have never heard of losing the gag reflex. Mine gets worse as I get older. Losing the ability to swallow is a different thing. I think Mom needs to see a doctor. There is therapy for this and certain ways food needs to be prepared.

Just a question, this Nurse is she an RN or LPN? Is Mom on hospice? Lots of people call CNAs nurses.
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Meat is always the most difficult thing to puree successfully, I found that even in the nursing home it was seldom smooth or appetizing. How did the mashed potatoes go? If that was acceptable then lots of other veggies can be done the same way, perhaps topped with a cheese sauce for added protein. Cream of vegetable soups are easy to modify, puddings and custards, cream of wheat for breakfast, polenta with a nice tomato sauce (and perhaps some cheese melted in here too), there are all those flavoured apple sauces or you could make your own... there was actually very little on my mom's nursing home menu that they didn't attempt to modify!


Unfortunately even the smoothest of foods and the most careful feeding is no guarantee against aspiration, once they reach this point even their own saliva is apt to go the wrong way - aspiration pneumonia is a fairly common cause of death in advanced dementia and it was the ultimate cause of death for my mother.
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You say that her nurse determined this loss of a gag reflex. I don't know how informed you are about all that this means. Have you seen her doctor regarding an evaluation by the experts; often this is done with occupational therapist. There shouldn't be a reason it couldn't be done in the home in Covid-19 times. They can determine how severe this is; you may be looking soon at the choice of placement of a tube for feeding.
The lack of a gag causes it to be easy, no matter how hard you try, for a person to aspirate food into the lung. In an elderly person with little gag, choke, etc, this means aspiration pneumonia, and of course pneumonia used to be called "the old person's friend" because it took then directly to heaven.
Along with the evaluation you might request a nutritional counselor for you as you cook for her. All your ideas are good. Cream soups are wonderful because of the variety you can introduce pureed, such a cheese and broccoli, potato with whatever, squash, and etc.
Wishing you good luck. I don't want to scare you, but I think you understand that this isn't good. A gag reflex is almost essential to life.
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ANY soup is good to blend down. Adding bone broth or cream when needed.

I highly recommend a good bone broth as your liquid for any savory meal that you are blending, it adds loads of nutrients and flavor. Almond milk for people that can not eat dairy and heavy cream for those that can.

Organic apples are a good addition to sweet smoothies and you can add some spinach or other greens to kick up the nutritional value.

Rice pudding with raisins and walnuts blended smooth is a nutritious meal.

I think that what you use to thin the food makes all the difference. So the sausage can be thinned with bone broth (always removing the casing before cooking will be helpful too) and grass fed organic butter, creamed spinach could be thinned in the mashed potatoes adding sour cream and butter, grass fed organic is the most nutritious, with some bone broth to thin it down.

Carrots and sweet potatoes are good mashed and can be dressed up to change the flavor. A bit of nutmeg and cinnamon with butter and walnuts, blended to a paste, a little bit of brown sugar and you have a healthy dessert or dinner, bone broth to thin adds a layer of flavor and nutrients.

You can make several servings at a time and freeze for later. Freezing will usually soften the texture even further, so another added benefit of preparing multiple servings.
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