[Dysphagia] diet recommendation

[mbrueckner at zoomtown.com (mbrueckner@zoomtown.com)]

Looking for diet recommendations for the following case:

80 yo female with PMH of HTN, afib, GERD, weight loss, anorexia, hyponatremia dementia, esophageal stricture, mild cricopharyngeus dysfunction & depression.
No other history or information available.  Patient is in a long-term care facility.  

Primary complaint is that she is not eating (admitted to behavioral health unit) and she complains that eating makes her nauseated and she feels that food is stuck in her throat.  Current diet is cardiac.

At bedside she was observed to consistently clear her throat on thin liquids.  Puree, honey thick liquids and soft masticated were tolerated well. 

An MBS was done with the puree, honey, nectar, thin & soft masticated.  Results were: poor bolus control, minimal oral residue, 2-3 second delay of swallow with pooling to the valleculae (& pyriform sinuses with all liquids), minimal airway penetration, decreased laryngeal elevation & mild cricopharyngeal dysfunction with all consistencies.  She did aspirate after the swallow a minimal amount of puree with a delayed cough response on the first out of 4 trials.  She was unable to maintain a chin tuck position given verbal and tactile cues.  Spontaneous consecutive swallows did clear oral residue, but did not completely clear vallecular stasis which was minimal.  Stasis was bilateral.  

What would you recommend for this women?