Pureed foods diet for older adults
A pureed foods diet for older adults sounds tricky! In reality, it is a diet of food that does not need any chewing (think pudding, yogurt, or mashed potatoes). The food is smooth and easy to swallow and usually eaten with a spoon. A pureed diet is necessary for some older people. Others just prefer it!
Why is a pureed foods diet needed for some older adults?
There are many reasons that people need or prefer a pureed diet, including:
-Swallowing problems
The health professional that is the “swallowing expert” is the speech-language pathologist (aka speech therapist). Through certain tests and observations, the speech therapist can diagnose a swallowing problem. (The fancy word for swallowing difficulty is dysphagia.) Then, a special diet may be prescribed. One of these diets is a pureed diet.
Often, swallowing can become weaker or dangerous as people age. Studies show that 40% of those 65 or older have dysphagia (1). This increases dramatically in those 85 years and older. The weakness could be from a stroke or because of a disease like Parkinson’s. It could also be from general weakening of the muscles from aging.
Signs of dysphagia
There are common signs of dysphagia that may be beneficial to watch for in an elderly loved one (or yourself!). If you see one of these, reach out to your doctor and ask about having an assessment by a speech-language pathologist.
Some common signs of dysphagia to look out for include:
Drooling
Spilling food from the mouth
Difficulty chewing
Coughing or choking when swallowing food or medications
Refusing to eat
Weight loss
Complaint of food “getting stuck”
-Painful teeth/gums/dentures
I’ve met some people who have painful gums, teeth, or dentures. A pureed diet allows them to eat without pain until the pain is addressed of course. A pureed diet is not a long-term answer for pain. But, it can be a stop-gap to eating enough and preventing weight loss until the person sees a doctor or dentist.
After the pain is gone and the oral issue is fixed, then the person may be able to move to a more challenging diet texture.
-Confusion or Dementia
Some folks may prefer a pureed diet. Through trial and error, I’ve found that a pureed diet is best accepted by some people, especially those with confusion or a dementia diagnosis. I could venture to guess that a pureed diet is easier to eat and the smooth texture is less jarring to the senses. But, not everyone can communicate their reasoning. If there’s no medical reason for a certain diet texture, a person is free to choose what they prefer!
-General weakness
With aging comes overall weakness. Illness makes weakness even worse. Sitting upright to eat or chewing for any length of time is not possible for some people. For them, they are not able to eat enough to meet their nutrition needs and prevent weight loss. A pureed diet may be the answer!
A smooth mashed potato is much easier to swallow than roasted potato wedges with the skin. Because of this, people are able to eat more! They may even be able to eat a variety of foods when before, they were tired after a couple of bites.
-Healing After Oral or dental surgery
A pureed diet may be needed temporarily for people that have recently had oral or dental surgery. A pureed diet is soft enough for a tender mouth and will encourage healing more than foods that need to be chewed.
Pureed Foods Diet for Older Adults: The Details
A pureed diet means everything is smooth – think pudding or cream of wheat. Any lumps or textures in the food are not safe. Take the example of meatloaf. The meatloaf would need to be put into a blender or food processor and processed until absolutely smooth.
Even though this diet is tricky, it is important to still offer a balanced diet to someone on a puree diet. This ensures their nutrition needs are met. First, build the meal like usual, and then alter it so that it is a pureed texture. By doing this, you won’t forget to offer enough fruits, vegetables, protein, or starches.
How to create a pureed foods diet for older adults the right way
Pureeing foods may seem intuitive, but it can be tricky!
Because you are losing the texture of the food through pureeing, it is SO important to remember the flavor. You don’t want to add water to the blender and water down the food, making it tasteless and less calorie-dense. Add liquids that have some nutritional benefit like:
- Juice
- Whole milk
- Heavy cream
- Half and half
- Gravy
Choose a liquid that would fit with the food. Apple juice would puree well with apple pie. Milk would puree well with mashed potatoes. Apple juice would not puree well with bean soup.
I’ll list the steps to a perfect pureed diet, and give a few pointers to help make you more successful.
- Cut the food into smaller pieces and portion it into the blender. (A high powered-blender or food processor will make a puree more smooth.)
- Choose your liquid add-in based on the food you are blending. Add only enough liquid to get the blender going.
(Some foods like canned mandarin oranges don’t need any extra liquid added.) - Start the blender slowly and slowly increase the speed.
- Blend until the food is creamy like pudding. You should be able to scoop the food with a spoon. The food will fall off the spoon in one lump when tilted.
- If the food is very loose or watery, you may need to add a commercial thickener (see my links below). Or, you could try regular or panko breadcrumbs, crackers, or a slice of bread and puree again.
- Only add puree garnishes like sour cream, a drizzle of heavy cream, or a pureed hot sauce.
Do not add garnishes that are not pureed (this includes fresh herbs or nuts)
Naturally pureed foods
Several foods are naturally a pureed texture. These foods are smooth and safe for elders on a pureed diet without you having to do anything to them. For people that do not like a pureed diet, it can be helpful to offer these foods because they may seem more “normal.”
These include:
- Yogurt (regular and greek) without fruit or other add-ins
- Applesauce
- Gravy without lumps
- Smooth cream of wheat or grits
- Smooth, skinless mashed potatoes
- Pate
- Pudding
- Smoothies with no lumps or texture
- Ricotta cheese
- Ice cream with no add-ins (like plain chocolate ice cream)
Pureed Foods Diet for Older Adults: One-Day Menu
Here’s an example of a puree diet menu for one day.
| Breakfast | Lunch | Dinner |
| -Cream of wheat made with whole milk
-Pureed scrambled eggs -Applesauce -Coffee/tea -Fruit juice with no pulp |
-Pureed chicken noodle soup
-Tuna salad prepared with mayonnaise and pickle relish, pureed with a slice of bread -V8 juice -Coffee/tea |
-Pureed meatloaf with gravy
-Smooth mashed potatoes with gravy -Steamed broccoli pureed with a slice of bread and butter -Chocolate pudding |
| Morning snack | Afternoon snack |
| -Greek yogurt with honey
-Pureed fruit |
-Smoothie made with avocado, strawberries, spinach, and milk of choice |
Foods that don’t work well on a pureed diet
Popcorn
Popcorn is dry and crumbly. Plus, the kernel is tough and sharp.
Fresh vegetables
Fresh vegetables are too fibrous to safely puree and create an appetizing side dish.
Potato chips
Potato chips are dry and crumbly like popcorn.
Bacon
Bacon is tough and fibrous, and would not be safe nor appetizing when pureed.
Coconut or nuts
Both coconut and nuts are tough, dry, and crumbly. When pureed, they do not become smooth.
Remember to use positive words!
Words – positive or negative – have a HUGE impact on what people do. In my own experience, I’ve heard comments from caregivers like, “Yuck,” or “I don’t know how you could eat that,” or “that makes me want to vomit,” thrown around when pureed foods are involved. Yes, seriously!
Why would you eat something that anyone, especially the preparer (!), has made poor comments about?
Know that positive language goes a long way!
Even if you’re not excited to eat the food yourself, a little positive reaction goes a LONG way.
(Please feel free to share the charts and graphs within this post. Please give credit to The Geriatric Nutrition Connection and link back to this page.)
Sources:
Kawashima, K., Motohashi, Y. & Fujishima, I. Prevalence of Dysphagia Among Community-Dwelling Elderly Individuals as Estimated Using a Questionnaire for Dysphagia Screening. Dysphagia 19, 266–271 (2004). https://doi.org/10.1007/s00455-004-0013-6.