Being fed a 'soft diet' but he's still capable of eating solids - is this right?

[Mariette]

I am new to this forum; can anyone help?

W has vascular dementia, which was described, as 'end-stage' on discharge from hospital 3 yrs ago. He does sometimes cough; and occasionally vomits. His GP has advised his Carers in the Nursing Home to feed a 'soft diet', even though he is capable of eating carefully selected solid foods, eg soup; sandwiches; soft fruit; smooth yogurts.

I am concerned that, by withdrawing solid foods, W will lose his ability to eat/swallow without continuing to exercise his jaw. I am aware that he may lose his ability to eat due to his condition, but my question is 'might feeding a soft diet accellerate his decline?'

 

[Jess26]

I'm not a medic but I would say what your dad is eating at the moment constitutes a "soft diet" i.e. soup, smooth yoghurt. As apposed to meat or toast.

 

[Mariette]

Thank you for your prompt reply. They're feeding him blitzed/blended food only. My concern is that the carers don't know what's in it, and is he getting a balanced diet? I am considered a 'rebel' because I've continued to feed him sensible food, ie what you would consider to be a 'soft diet'. I tasted the offerings yesterday and the 'main course' was so salty and the 'dessert' like syrup.

My main question is whether he will more rapidly lose the ability to eat

 

[BeckyJan]

I suspect the GP has recommended this as there is always a chance of aspiration pneumonia, which is often caused by poor/incompetent swallowing mechanism.

It seems to me the ability to swallow has gone and it is now very important that giving food in this way is so important. If you are worried about nutrition you should probably mention food supplements to be used within the drinks/soft food.

My husband also reached this stage - not easy but I found he accepted the food quite readily much to my surprise and he remained well nourished for many months.

I hope this reassures you a little.

PS - re carers not knowing what is in the food, you could ask for a daily record of food intake with detail of the content. My husband's NH did this as routine.

 

[Chris Edgerton]

Soft food - Speech Therapist

Might sound strange but has “W” seen a http://www.youtube.com/watch?v=wTQA5tOijBg they assess swallowing issues. Appointment is through your doctor.
Also, how does the food look like, I hope it’s not one grey mush. Food should have colour and possible shape on plate. Not as here http://twitpic.com/ad8mhx yes, a socialcare worker may say its “mashed and meat”, but oh boy it’s wrong. It’s called “dignity in care” a well presented soft diet.
Also many issues, what position is “W” in when fed, how are medicines administered, use of sip cup (over used I feel, many people can still use cup, sip cup changes swallowing and aids deskilling person) etc, that’s why an assessment from a Speech Therapist should be done.
I would look out for dehydration issues, there are many carless admissions from care, nursing homes to hospitals for rehydrated.
Aspiration pneumonia is an issue which can result from poor feeding practice; food, drinks, giving medication when not in the right position.

 

[Mariette]

This is very helpful Jan.

Yes the GP is concerned about aspiration, although he didn't mention pneumonia, but I see what you mean.

When you say about the importance of food being given in this way; do you mean blended only; or softer solid foods as well?

I have pushed for the Swallowing Specialist (SALT) Nurse and the GP has finally agreed. In the meantime I will ask the NH Manager for a daily record of food intake with detail of the content, and about food supplements.

W lost the ability to walk after a prolonged stay in hospital and being confined to bed for many weeks. On reflection, we wondered if had he been kept mobile whether he would have been able to walk for longer. We'll never know whether this was down to natural deterioration or whether being deprived of the opportunity to get out of bed contributed to this. I don't want that same nagging question about losing his ability to eat.

Like you with your husband, I just want the right thing for him

 

[Chris Edgerton]

Food given in the right way

Food given in the right way. I mean the position of the person in the bed or chair, the position of the neck in relation to the body etc, so the food, drink goes down the right way.

As for nutrition, soft food should have the same nutrition as for unblended food, and so no supplement is required if the person is taking the soft food.

I also felt that my mother was not encouraged to walk, and now uses a hospital bed and a special day chair.

 

[Mariette]

I've checked out your links Chris - that photograph of the blended food in your twitpic is exactly what he's getting; no variation of colour and definitely no form.

We've expressed our concerns for years about his seating position, in the good old days when he was allowed to sit, and continue to worry about his eating/meds position now he's permanently in bed.

He has a thickener in his tea/juice; and this consistency has helped; and yes, it's always a sip-cup.

De-skilling is a great description; why is it constant fight for dignity?

 

[Jessbow]

I used to cook for age concern day centre before I became full time carer. We had a chap that needed a soft diet sue to mouth /jaw surgery.

I gave him things like shepherds pie, cottage pie, fish In sauce, mash rather than roast potatoes for instance. There were occasions that I had to blitz things for him, he far preferred a thick paste to a soupy slop, not excuse for grey slop either, Everything can be blitzed individually and presented nicely.

lots of puddings are fine too - the addition of custard and carefully amalgamated with the main pudding, almost everything is manageable - with the exception of perhaps oats.

 

[Mariette]

Thank you Jess some very useful ideas - I think a number of the Residents could benefit from what I hope will transpire