Has your loved one with dementia been struggling to eat or swallow their food? Are they losing weight, avoiding meals, or coughing while eating? If so, pureed food specifically for dementia patients might help.
This post is a follow-up to my recent article on dental soft diets. While soft diets help when chewing becomes harder, pureed diets are often the next step when chewing or swallowing becomes very difficult. In this post, I’ll explain what a pureed diet is, when it’s needed, how to make pureed foods, and how to ensure your loved one is still eating healthy, balanced meals—even if their food needs to be very soft.
What is a Pureed Diet?
What is pureed Food
Pureed food is food that has been blended into a smooth, moist texture. It should be lump-free, and soft enough to not require chewing. If you’re not sure if it looks right, remember that it should have the feel of pudding or mousse (1).
What does Pureed Food look like?
Pureed food for dementia patients is very soft and easy to chew. It should have the consistency of pudding. What should you look for (1, 2)?
- Smooth, like pudding
- Soft and moist
- Should not be sticky, as this makes it easier to swallow
- Ideally it should hold its shape on a spoon, but fall off easily when the spoon is tilted. That means that it is not too watery and not too sticky
What’s the Difference Between a Soft and a Pureed Diet?
Both soft and pureed diets help when chewing and swallowing become difficult.
A dysphagia soft diet includes foods that are soft and moist, but still require some chewing – like tender meats or soft-cooked vegetables.
A pureed diet is smoother and is used when chewing is no longer possible or safe. It takes little effort to swallow pureed food.
What is a Level 4 Diet?
If you or your loved one has been in a hospital or in a long-term care facility, and needs a pureed diet, you may have heard the term Level 4 diet or IDDSI Level 4 (2).
IDDSI stands for the International Dysphagia Diet Standardisation Initiative. This organisation ranks food textures from easiest to chew to hardest to chew, or from 0 (regular liquids) to 7 (regular foods). Pureed foods are Level 4.
These foods, by definition:
- Must be smooth with no lumps
- Cannot be sticky
- Must not be so sticky that it cannot pass the “spoon tilt test” in which it must hold its shape on a spoon and slide off easily
- Must be firm enough that it passes the “fork drip test” in which the food can sit in mound on the fork and not drip though the fork prongs.
Why Would Dementia Patients Need Pureed Foods?
People with dementia can sometimes develop dysphagia, or difficulty swallowing. This can happen for several reasons (3):
- Swallowing is a very complicated series of movements.
- Dementia can affect the brain’s ability to coordinate swallowing.
- Some people with dementia forget how to chew properly, which means they will not be able to safely swallow their food.
- Some people with dementia may stop using their dentures
- They may have forgotten that they need them because of their dementia
- Their dentures may no longer fit because of weight loss.
Does your Loved One with Dementia have Dysphagia?
Dysphagia means difficulty swallowing. It can affect any part of the swallowing process and increases the risk of choking, food going down the wrong way, pneumonia, and ultimately, can increase the risk of malnutrition.
What signs should you look for?
Not sure if your loved one with dementia has a swallowing problem (3)? If your loved one is:
- Coughing when eating
- Spitting food out
- Avoiding harder foods
- Eating much less than usual
They might be having a problem with swallowing. Pureed foods might help meet their nutritional needs more safely.
Need in-person help?
You can also consult a Speech Language Pathologist, who is a swallowing expert and can meet with you to help you figure out how to help your loved one with their swallowing.
- Find a Speech Language Pathologist in the United States.
- Especially now, it is important for you to know if these services will be covered by your insurance. This guide to SLP insurance coverage can help you.
- Find a Speech Language Pathologist in Canada.
- Find a Speech Language Pathologist in the UK
- Ask your GP and try this guide to find an SLP.
How can pureed foods help them to swallow?
Pureed food made for dementia patients is smooth, moist, and therefore easier to swallow because it can easily slide down the throat.
This means that if your loved one gets pureed food, they won’t have to chew and will more easily be able to swallow their foods. This reduces the risk of choking or of food going into the lungs, which is very dangerous.
Pureed food can also help people eat more if they are avoiding food because chewing is too much effort or too painful (3).
I had a client who was eating less and less at meals. When I looked at what he ate at a meal, I noticed that he only took his mashed potatoes, but not his peas or the meat. When I spoke to him about it, he let me know that the other foods hurt his gums in his dentures. I offered him some pureed food, and while he was a bit wary because it did not look like food he was used to, he admitted that he could eat it very easily, and could finish the whole plate with no problem.
Is your loved one avoiding harder foods? This might be the reason!
Can pureed foods be healthy?
Yes! Pureed meals can absolutely be nutritious.
Balanced meals
The first key to making healthy pureed meals is to make sure that the meal is balanced.
To create a balanced meal, use the plate model (4):
- Half of your plate: vegetables and fruit
- One-quarter of your plate: carbohydrates
- One-quarter of the plate: protein foods (such as meat, plant protein, and dairy)
Making meals that are balanced in this way will ensure that your loved one with dementia is getting the nutrition that they need, even though their food may look different.
Cook at home
Many of the rules around making healthy food for a non-pureed meal also apply to pureed meals.
If you are making pureed food for your loved one separately from your regular food, it can be helpful to focus on making less processed food. Start with minimally processed vegetables (fresh or frozen), starches like potato or rice, and freshly cooked meat. You also do not necessarily have to make pureed foods as a separate meal – you can simply puree the foods made for the rest of the family.
Mixed foods
What if the meal you made does not have separate vegetables, starches and protein? If, for instance, you make a casserole make of pasta and ground beef, you can puree this with some sauce and you have the starch and protein part of the meal ready to go! All you would have to do is then puree a vegetable dish for your loved one.
How to make pureed foods
Tools you’ll need
Making pureed food does not need very special equipment – in fact, you probably have the required equipment in your kitchen now!
- Blender or food processor
- Spatula to scrape down sides
- Small bowls to present the food so that is does not spread out too much on the plate
Step-by-step instructions
To make pureed food for a dementia patient, use a blender or food processor (1).
- Start with ½ cup to 1 cup of the food item you want to puree. Cut it into small pieces and add it to the blender or food processor.
- Add 1 tablespoon of liquid. Choose one that matches the flavor of the food:
- Use juice for fruit
- Gravy or broth for meats
- Milk, cream, cheese sauce, broth or gravy for carbs
- Don’t use water. It doesn’t add calories or flavor and can make the food too thin and unappealing, especially for someone who already likely is not eating well and may have lost weight.
- Blend until smooth and moist, like a pudding.
- If the food is too dry, add more liquid 1 tablespoon at a time.
TIP: Most fruits and soft vegetables don’t need extra liquid added. Drain canned foods before blending.
How to check if it’s pureed enough
Remember, your pureed food should be soft and moist. If it looks lumpy, it needs to be pureed more.
It also should not be too sticky. To be sure it’s not, use the spoon tilt test (2):
- The food should sit on a spoon and slide off easily when tilted.
- It should not be sticky, firm, or crumbly
Staples to keep on hand
What kinds of foods should you keep around if your loved one is on a pureed diet?
Fluids to help you puree food
You’ll want some fluids that can make pureeing foods easier, and for convenience, foods that are already soft enough to be safe for a person who needs pureed food.
- Broth, gravy, milk, juice, cream.
- If your loved one has lost some weight, try to use the following more often:
- Cream (for sweet or savory foods)
- Gravy (for savory foods) more often as they contain more calories.
Foods that are already pureed
It is also a good idea to keep some foods that are already soft enough to be considered pureed
- Fruits
- Fruit sauces like applesauce
- Protein
- Soft (silken) tofu
- Dairy
- Yogurt
- Carbohydrates
- Instant potatoes, cream of wheat
Should you buy baby food?
You can try this, but I find that people can find it difficult to accept pureed foods because of their appearance.
If you buy baby food, I would advise you to not show the bottle to your loved one with dementia because it may make them even less likely to eat it. You also should remember that an adult will eat far more than a baby would, and may go through large amounts of this food!
What foods can be pureed?
Carbohydrates
- Cooked pasta, potatoes, rice
- Hot cereals (cream of wheat, oatmeal)
- Pancakes or muffins (softened with milk or syrup)
Proteins
- Cooked meat, fish, or poultry (moist and tender)
- Soft tofu, cottage cheese, Greek yogurt
- Cooked beans, lentils
Vegetables
- Cooked and peeled vegetables like carrots, peas, squash
- Canned vegetables (drained)
- Steamed spinach or cauliflower
Cook meats and vegetables until very tender before pureeing. Moist cooking methods (boiling, steaming, braising) work best.
What foods cannot be pureed?
Avoid foods that are:
- Hard items or foods containing hard items
- Nuts and Seeds
- Chocolate chips
- Dried fruits
- Granola
- Fibrous or with skins
- Corn, grapes
- Celery, salads do not puree well
- Meat with a casing, like sausages. Remove the skin.
These can be hard to blend and can become choking hazards (1)
Troubleshooting
- Too thick? Add more liquid (broth, gravy, milk—not water!).
- Too thin? Add more solid food.
- You can also thicken it with mashed potato flakes, breadcrumbs or a commercially available thickener.
- Ask your pharmacist to help you find a commercial thickener and follow the instructions on the package.
- You can also thicken it with mashed potato flakes, breadcrumbs or a commercially available thickener.
- Grainy or chunky? Blend for a longer time. If that doesn’t work, strain the puree through a fine mesh sieve.
Puree food recipes
Do you want to dive in and make some pureed foods for dementia patients from scratch? Try these recipes!
Mashed potatoes with gravy is a classic dish that fits very easily into a pureed diet. Here is a great elevated version! For a truly pureed dish, don’t add the optional nutty topping.
This is a quick and easy green bean puree that is also very flavourful!
Roasted butternut squash and garlic soup
Pumpkin and squash are some of the first foods people think of when they try to make a pureed vegetable dish. If you are considering a pureed squash dish, here’s a great recipe to try! Just don’t add the nut and thyme topping you see in the image.
If you and your loved one have had enough of the same old pureed vegetables, remember there are lots of other options! Here is one for pureed eggplant. It’s a popular Middle Eastern dish, and a fun addition to a meal!
This is a beautifully green side dish that is flavourful and has butter and heavy cream added, which will make it a great calorie-rich item if your loved one does not eat much.
I was very excited by this recipe. It’s very simple recipe that blends cottage cheese, a great high protein item, to make it safe for somebody who needs pureed food. It also gives other taste options, including adding peanut butter to give it even more protein, or honey and cinnamon to make it into a protein-rich sweet treat.
Tofu smoothie with black sesame
Are you trying to add more protein to your loved one’s diet? This tofu smoothie has a smooth texture and will do just that! Just don’t add any zucchini slices to it for a truly pureed dish.
Does your loved one like tuna salad sandwiches? They can still have the flavour of tuna salad in a form that is safer for somebody who needs pureed food!
Cottage Cheese Chocolate Mousse
This chocolaty, high-protein mousse recipe is a great option if your loved one needs pureed food and isn’t a fan of eating a lot at once!
How to make pureed foods more appealing
In my experience, the biggest challenge with pureed food for dementia patients is the fact that it looks quite unfamiliar.
I have literally had clients look at it and call it “baby food”. If someone really does need pureed food, though, I find that once they try it for a meal or two and realize that it still tastes like the food they know and they can eat it without worrying about swallowing problems or hurting their teeth, they do accept it.
Do you need help getting the pureed food to look like something your loved one with dementia will accept for the first time? Some of the rules around making regular food more appealing applies to pureed food as well.
Colour
First, pay attention to the colours.
If you have a meal that is made of a chicken breast with mashed potatoes and cauliflower, it might be a balanced meal, but you will notice that everything on that plate has sort of an off white colour to it. It doesn’t look very interesting. The only thing that distinguishes the three things on the plate before you eat it is their shape. If you serve someone pureed chicken along with mashed potatoes and pureed cauliflower, you will end up with a plate of three off white piles. Not very appealing!
Now, try a plate of pureed beef with gravy, mashed sweet potato, and pureed broccoli. These look much more interesting and are easier to distinguish as they are different colours!
Shape
If you’re making pureed food, you can simply puree it in your blender or food processor and then remove it from the food processor with a spatula and put it on the plate. However, you can end up with a shapeless mound which isn’t very interesting or appealing.
Giving pureed foods some shape can make them more visually interesting. The simplest thing you can do is use an ice cream scoop to make the pureed food into a round shape. If you want to go all out, you can use a piping bag to make the food into different shapes or silicone molds for different foods!
These small touches can help a person with dementia recognize and enjoy their food more.
Where to get premade meals
If you don’t have time to cook or blend every meal, you’re not alone. Some helpful options include:
- Meals on Wheels.
- Yes, depending on where you live, you may be able to get pureed foods from Meals on Wheels!
- Google “Meals on Wheels” and your area, to find out who to contact.
- Campbell’s (yes, the soup company) has a line of pureed meals that you can buy.
- Google pureed food in your area.
- A quick search showed me multiple places to buy pureed foods local to me, but this will, of course, depend on where you live.
Eating out on a pureed diet
Dining out is still possible if you plan ahead. Here are some tips:
- Look at the menu at home. Look for smooth soups, mashed potatoes, or custards on the menu
- Ask if the kitchen can puree meals or serve items with extra sauce
- Let staff know you need a soft, smooth texture and no hard or chewy pieces
Some caregivers also bring small containers of pureed sides when dining out.
Final thoughts
A pureed diet can feel like a big change—but it doesn’t have to mean boring or unhealthy food. With the right approach, your loved one with dementia can continue to eat delicious, nourishing meals that are safe and easier to swallow.
Whether you’re blending meals at home, using molds for fun presentation, or choosing premade options, you’re doing something incredibly important: helping your loved one eat well, feel good, and stay safe.
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