Holding food in the mouth, known as food pocketing or hoarding, is a common behavior in individuals with dementia. This behavior can distress caregivers, raising questions about comfort, nutrition, and well-being. Understanding its reasons is important for appropriate care and support.
Cognitive and Neurological Changes
Dementia directly impacts brain functions involved in eating. Impaired memory can lead to a person forgetting food is in their mouth or the necessary steps to swallow, resulting in retention.
Deficits in executive functions, including planning and sequencing, can disrupt the complex steps of eating. These steps include chewing, moving food, and initiating a swallow. When not coordinated effectively, food can remain unswallowed.
Conditions like oral apraxia further contribute to these difficulties. Apraxia is a motor disorder where the brain struggles to send correct signals for learned movements, such as mouth and tongue coordination during eating. This impacts the ability to manipulate food and initiate the swallow reflex.
Oral and Swallowing Difficulties
Physical issues in the mouth and throat also play a role in food retention. Dental problems, such as ill-fitting dentures, tooth pain, or gum disease, can make chewing uncomfortable. This discomfort can cause a person to avoid chewing thoroughly or hesitate in swallowing.
Dry mouth, or xerostomia, is another contributing factor, often caused by medications prescribed to individuals with dementia. Reduced saliva production makes it harder to form a food bolus and move it towards the throat. This lack of moisture can make swallowing more challenging.
Dysphagia, or difficulty swallowing, is prevalent as dementia progresses, affecting up to 90% of individuals. This condition can range from mild to severe, making it difficult or unsafe for food to pass from mouth to stomach. Individuals may hold food in their mouth to avoid the discomfort or perceived danger of swallowing.
Sensory and Environmental Factors
Changes in sensory perception can alter how food is experienced, influencing eating behavior. Diminished taste and smell can make food less appealing or unrecognizable. This reduced sensory input can lead to a reluctance to swallow, as the food may not provide the expected flavor or aroma.
The dining environment can significantly impact a person with dementia. An overly stimulating setting with loud noises, activity, or bright lights can overwhelm them. Such distractions can disrupt their focus on eating, causing them to stop mid-meal or hold food in their mouth.
Restlessness or an inability to sit still can also interrupt the eating process. This agitation can make it difficult for an individual to concentrate on chewing and swallowing, contributing to food being held in the mouth. A calm and predictable mealtime routine is beneficial.
Potential Health Implications
Consistently holding food in the mouth can lead to several adverse health outcomes. One risk is aspiration pneumonia, where food particles or liquids accidentally enter the lungs instead of the stomach. This can cause severe lung infections and is a common complication.
Inadequate food intake due to food pocketing can result in malnutrition and unintended weight loss. When food is not swallowed, the body does not receive necessary nutrients and calories. This can weaken the individual, making them more susceptible to other health issues.
Dehydration is another concern, as individuals may also avoid swallowing liquids. This can exacerbate existing health conditions and contribute to overall decline. The presence of food in the mouth for prolonged periods increases the risk of choking. Poor oral hygiene, including cavities and gum infections, also arises from food sitting against teeth.