Dementia is a progressive disease that affects memory, thinking, and behavior. As dementia progresses, patients often develop problems with eating and swallowing. One common issue is that dementia patients will hold food in their mouth without swallowing it. This can happen for several reasons.
Chewing and swallowing problems
Many dementia patients have difficulty properly chewing and swallowing food. This is known as dysphagia. Dysphagia occurs because dementia damages the parts of the brain that control chewing and swallowing.
As a result, dementia patients may not fully chew up food before swallowing. Or they may have a delayed swallowing reflex, meaning they don’t automatically swallow after chewing. This causes them to hold food in their mouth longer than normal before swallowing it.
Some specific chewing and swallowing problems in dementia include:
- Weakened mouth and tongue muscles, making it hard to move food around the mouth
- Difficulty starting the swallowing motion
- Forgetting to swallow or losing awareness that food is in the mouth
- Problems sensing food in the mouth
- Pooling of food in mouth pockets due to poor tongue coordination
All of these dysphagia effects can result in dementia patients unintentionally holding food in their mouth after chewing and before swallowing.
Forgetting to swallow
Short-term memory loss is one of the main symptoms of dementia. As dementia gets worse, patients have more trouble remembering things that just happened.
This short-term memory loss also affects eating. Dementia patients may forget they have food in their mouth and need to swallow it. They get distracted and the swallowing reflex never kicks in.
As a result, food can sit in the mouth until the patient is reminded or notices it. This gives the appearance that the dementia patient is deliberately holding food in their mouth. But in reality, they just forgot it was there.
Sensory changes
Dementia also commonly causes changes to the senses, including taste and smell. Taste changes make food seem bland or metallic. Smell changes take away familiar food aromas.
These sensory changes may cause dementia patients to hold food in the mouth longer while trying to taste it. They may be seeking more flavor from the food before swallowing.
But because their sense of taste is dulled, food will never taste “right”, leading to extended holding in the mouth.
Behavioral changes
Personality and behavior changes frequently occur with dementia. These changes are caused by damage to brain regions that control mood, inhibition, and judgment.
Some behavioral changes like stubbornness or suspicion may cause dementia patients to resist swallowing. If they feel someone is forcing them to eat, they may passively resist by holding food in their mouth and refusing to swallow.
Or they may forget social manners and chew with their mouth open, unaware that food is accumulating in their mouth. Decreased inhibition makes them less self-conscious about how this looks.
Poor oral health
Maintaining oral health through brushing and flossing takes diligence and memory. Dementia patients often have very poor oral health due to neglect of their teeth and gums.
Problems like cavities, gum disease, and ill-fitting dentures can all contribute to holding food in the mouth. Pain or discomfort while chewing may cause them to hesitate before swallowing.
Bacteria and plaque buildup on the teeth can also reduce sensations in the mouth. This may prevent dementia patients from realizing they have food accumulated in the mouth.
Risks of holding food in mouth
When dementia patients hold food in their mouth for prolonged periods, it puts them at risk for:
- Choking – If they forget the food is there and try to talk or breathe, choking can occur.
- Aspiration pneumonia – Food can be accidentally inhaled into the lungs, causing aspiration pneumonia.
- Poor nutrition – Holding food instead of swallowing prevents proper calorie and nutrient intake.
- Dehydration – Fluids are not consumed adequately.
Choking is an especially serious risk. Brain damage from oxygen deprivation during choking accidents can worsen dementia symptoms.
Aspiration pneumonia
Aspiration pneumonia is one of the most common respiratory infections in dementia patients. It occurs after food, saliva, or liquids are aspirated from the mouth into the lungs.
When dementia patients hold food in their mouth, fragments can be accidentally inhaled into the airway. The lungs are not capable of clearing out these foreign particles. Bacteria multiply and cause aspiration pneumonia.
Symptoms of aspiration pneumonia include:
- Cough
- Fever
- Shortness of breath
- Wheezing
- Chest pain
Aspiration pneumonia can be mild or life-threatening, depending on how much food enters the lungs. Prompt medical treatment with antibiotics and breathing support is needed.
Preventing food holding
While holding food in the mouth is common in dementia, certain strategies can help minimize it:
- Frequent verbal reminders to chew and swallow
- Verbal cues to close the mouth while chewing
- Avoiding difficult textures like dry, sticky, or tough foods
- Cutting food into very small pieces for easy chewing and swallowing
- Taking time to ensure each bite is swallowed before the next bite
- Minimizing distractions and maintaining eye contact during meals
- Regular oral care to improve mouth comfort and sensations
- Trying different food temperatures and flavors if sensory changes are causing problems
- Treating any dental problems or ill-fitting dentures
With patience and the right support, it may be possible to reduce food holding behaviors in dementia patients at mealtimes. But dysfunction in chewing, swallowing, and memory will still affect eating capabilities as dementia worsens. At end stages of dementia, tube feeding may be required to ensure adequate nutrition and hydration.
Conclusion
Holding food in the mouth without swallowing is a common eating problem in dementia patients. It happens due to chewing and swallowing dysfunction, short-term memory loss, sensory changes, poor oral health, and behavioral issues. When food is held in the mouth too long, it puts dementia patients at high risk for choking, aspiration, malnutrition, and dehydration. Caregivers can help reduce food holding by providing verbal cues, minimizing distractions, preparing suitable textures, and maintaining good oral hygiene. But eating difficulties will continue toprogress as dementia worsens. Tube feeding may eventually be needed to provide nutrition. With a patient and adaptive approach, it is possible to make mealtimes safer and more enjoyable for dementia patients.
