Spitting can be a challenging behavior in individuals with dementia, often distressing for the individual and caregivers. While perplexing, this behavior is often communication or a symptom of underlying issues, not intentional defiance. Understanding its root causes is key to effective management and improving quality of life. This article explores why spitting occurs in dementia and offers practical management approaches.
Common Causes of Spitting
Spitting in dementia can stem from medical/physical conditions or behavioral/environmental influences. Recognizing these distinctions helps identify interventions.
Medical and Physical Reasons
Dysphagia (difficulty swallowing) is common in dementia and can lead to spitting. Struggling to manage food or liquids may cause spitting to prevent choking or discomfort, often due to weakened swallowing muscles or impaired reflex coordination. Excessive saliva production (sialorrhea) can cause pooling, leading to spitting when swallowing is ineffective.
Conversely, dry mouth (xerostomia) can contribute to spitting. This discomfort may cause spitting to moisten the mouth or clear perceived stickiness. Dental problems (e.g., gum disease, cavities, ill-fitting dentures) can cause pain or irritation, prompting spitting to alleviate discomfort or expel irritants. Certain medications for dementia or other conditions can alter saliva production or oral sensation, contributing to spitting.
Behavioral and Environmental Factors
Spitting can be a form of communication when verbal abilities decline. Individuals might spit to express discomfort, pain, or frustration when unable to verbalize needs. Agitation and anxiety, common in dementia, can manifest as challenging behaviors like spitting, especially when overwhelmed or threatened. Sensory issues (e.g., aversion to taste, texture, or temperature of food/drinks) can cause rejection by spitting.
Spitting can also be an attempt to gain attention, becoming a learned behavior if reinforced by caregiver reaction. Discomfort with environments (e.g., noisy rooms) or care routines (e.g., oral hygiene, medication) can trigger spitting. The individual may be asserting control or expressing distress.
Approaches to Managing Spitting
Managing spitting in dementia requires a careful, individualized approach. This involves observation, environmental adjustments, and care strategies, focusing on understanding and responding to underlying causes.
Observing when and where spitting occurs is foundational. Caregivers can log patterns: during meals, medication, or social situations. This helps pinpoint triggers and provides clues about the underlying reason, allowing for targeted interventions.
Environmental adjustments can reduce spitting triggers. Creating a calm, quiet atmosphere during mealtimes or care routines lessens agitation and discomfort. Appropriate lighting and minimizing distractions help the person feel more secure and less prone to reactive behaviors. Modifying the physical space reduces sensory overload, supporting a more comfortable experience.
Effective communication is important when verbal expression is difficult. Caregivers can use simple, clear language, visual cues, or gestures to convey messages and understand needs. Responding calmly and empathetically to non-verbal cues, including spitting, helps de-escalate frustration and build trust. Offering choices, when appropriate, empowers the individual and reduces resistance.
Good oral hygiene and adequate hydration can alleviate physical discomforts contributing to spitting. Regular mouth care (e.g., brushing teeth and gums) prevents dental problems and keeps the mouth fresh. Providing sips of water or ice chips addresses dry mouth and helps manage excess saliva, making swallowing easier.
Mealtime routine modifications can be beneficial if dysphagia is suspected. Adjusting food consistency (softer or pureed), offering smaller, more frequent meals, and pacing the eating process can make swallowing safer and more comfortable. Specialized eating utensils or cups can assist in managing liquids and solids effectively. Gentle redirection and engaging the person in other activities can shift focus away from spitting.
When to Consult a Healthcare Professional
Consult a healthcare professional if spitting is new, worsening, or accompanied by other concerning symptoms. Sudden onset, especially with swallowing difficulties, coughing, or choking during meals, warrants immediate medical evaluation. These signs could indicate a change in swallowing function or other medical issues.
Other indications include unexplained weight loss, pain or discomfort, or if the behavior causes distress to the individual or caregivers. If spitting becomes frequent, aggressive, or unmanageable despite interventions, seek expert guidance. A healthcare professional can differentiate between medical causes and behavioral issues.
A doctor, dentist, speech-language pathologist, or geriatric specialist can provide a comprehensive assessment. They can diagnose underlying medical conditions, review medications for side effects, or develop specialized behavioral management plans. Managing spitting often requires a multidisciplinary approach, involving specialists who offer tailored strategies and support for the individual and caregivers.
References
Dysphagia in older people. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8900600/]. Sialorrhea. [https://www.ncbi.nlm.nih.gov/books/NBK560731/]. Oral health and dementia. [https://www.www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-health-and-dementia]. Medication-induced xerostomia and salivary gland hypofunction. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968779/]. Understanding challenging behaviors in dementia. [https://www.nia.nih.gov/health/alzheimers-and-dementia/understanding-challenging-behaviors-dementia]. Sensory issues in dementia. [https://www.alz.org/help-support/caregiving/stages-toughest-behaviors/sensory-changes]. Dementia care management. [https://www.ncbi.nlm.nih.gov/books/NBK554388/].