How do you treat pocketing food dementia patients?

According to studies, swallowing difficulties (dysphagia) and other eating problems are common in advanced dementia, affecting up to 93% of patients. Learning how you treat pocketing food dementia patients is a critical caregiving skill to ensure safety, nutrition, and dignity during mealtimes.

Quick Summary

Managing food pocketing in dementia involves creating a calm, low-distraction environment, modifying food textures, and employing careful feeding techniques with gentle reminders to swallow, while also watching for signs of aspiration.

Key Points

• Modify Food Texture: Soften foods, cut them into small pieces, or offer finger foods to make chewing and swallowing easier.

• Create a Calm Environment: Minimize distractions like television and loud noise to help the patient focus on eating.

• Use Gentle Reminders: Offer simple, positive verbal cues such as 'chew slowly' or 'swallow now' without causing frustration.

• Ensure Proper Positioning: Seat the patient upright with their head tilted forward to facilitate safer swallowing.

• Consult a Specialist: If pocketing persists, a speech-language pathologist can provide an expert assessment and tailored recommendations.

• Monitor for Complications: Be vigilant for signs of choking, aspiration, or malnutrition, which can be serious risks.

Understanding Food Pocketing in Dementia

Food pocketing, or holding food in the mouth's cheek pockets without swallowing, is a common and concerning behavior in individuals with dementia. It is not a deliberate act of defiance but rather a symptom of the disease's progression that can lead to serious health risks if not managed properly. Understanding the root causes is the first step toward effective management.

Why Pocketing Occurs

• Cognitive Decline: As dementia progresses, cognitive function related to eating can decline. A patient may forget how to chew or swallow, or may not recognize the food in their mouth as something that needs to be consumed.
• Dysphagia: Neurological changes can lead to dysphagia, or difficulty swallowing. This can make the physical act of swallowing feel challenging, painful, or unsafe, causing the person to avoid it by holding food in their cheeks.
• Oral Discomfort: Ill-fitting dentures, mouth sores, or dental pain can make chewing uncomfortable. Pocketing food may be an unconscious response to the desire to avoid pain.
• Sensory and Environmental Factors: Overstimulation from noise, bright lights, or a cluttered table can be overwhelming. This confusion can lead to a patient getting distracted and forgetting to swallow. Loss of taste and smell can also make food less appealing.

Creating a Supportive Mealtime Environment

Mealtime should be a calm, positive experience. A stressful or chaotic environment increases confusion and anxiety, exacerbating eating difficulties. Simple adjustments can make a significant difference.

• Establish a Consistent Routine: Serve meals at the same time each day in the same location. This predictability can reduce anxiety and help the person anticipate mealtime.
• Minimize Distractions: Turn off the television and radio during meals. Keep the table clear of unnecessary items like mail or magazines. A calm, quiet atmosphere promotes focus on the task of eating.
• Use Visual Cues: Use high-contrast plates and placemats to help the food stand out. For example, serving light-colored food on a dark plate can make it easier to see.
• Create a Comfortable Seating Position: Ensure the patient is seated upright at a 90-degree angle, with their head tilted slightly forward. This position can make swallowing easier and safer.

Modifying Diet and Food Preparation

For many, pocketing is a response to food that is difficult to chew or swallow. Adjusting the diet is often a primary strategy for treatment.

Texture and Consistency Adjustments

• Soft, Moist Foods: Offer foods that are naturally soft or have been moistened with gravy, sauce, or broth. Good options include scrambled eggs, yogurt, cottage cheese, and well-cooked vegetables.
• Bite-Sized Pieces: Cut all food into small, manageable, bite-sized pieces. This is especially helpful for tougher meats or vegetables.
• Finger Foods: When using utensils becomes difficult, finger foods like cheese cubes, small sandwiches, or fruit slices can promote independence and make eating less intimidating.
• Avoid Problematic Textures: Eliminate sticky, dry, or chewy foods that are hard to manage. This includes things like peanut butter, dry crackers, and raw carrots.

Comparison of Food Types

Type of Food	Easy-to-Swallow Examples	Difficult-to-Swallow Examples
Protein	Moist fish, shredded chicken, eggs, soft tofu	Tough steak, dry jerky, chewy bacon
Vegetables	Mashed potatoes, steamed carrots, pureed spinach	Raw carrots, hard-cooked broccoli
Fruits	Applesauce, ripe bananas, melons, canned fruit	Raw apples, dried fruit, pineapple
Grains/Starches	Oatmeal, soft bread soaked in milk, pasta with sauce	Dry toast, crusty bread, dry crackers
Snacks	Yogurt, pudding, smoothies, soup	Nuts, hard pretzels, caramel candies

Implementing Effective Feeding Techniques

Patient, compassionate interaction during mealtimes is crucial. Rushing or pressuring a person with dementia can lead to resistance and worsen the pocketing behavior.

1. Offer Small, Manageable Bites: Use a small spoon to offer only a small amount of food at a time. This prevents the mouth from being overwhelmed and makes swallowing easier.
2. Provide Gentle Reminders: Use simple, positive verbal cues like, “Take a bite,” “Chew slowly,” or “Now swallow.” You can also model the behavior by chewing and swallowing your own food clearly.
3. Check for Swallowing: Before offering the next bite, wait for the patient to swallow completely. Look for movement in their throat or check their mouth discreetly for any remaining food.
4. Use Hydration: Offer sips of a beverage between bites to help wash food down and prevent dryness. For those with dysphagia, thickened liquids may be recommended by a professional.
5. Address Oral Hygiene: Regular mouth checks and good oral hygiene are important. Leftover food can cause oral infections or be a choking hazard later. Use a moistened swab to gently clean the mouth after meals.

When to Seek Professional Guidance

Caregivers should not feel that they have to manage these challenges alone. A healthcare team can offer specialized support.

• Consult a Speech-Language Pathologist (SLP): An SLP can assess swallowing function, recommend safe food textures and positioning, and provide strategies for managing dysphagia.
• Talk to a Registered Dietitian: A dietitian can help create a nutrition plan that ensures adequate calorie and nutrient intake, especially if a patient is losing weight.
• Work with a Geriatric or Palliative Care Team: In later stages of dementia, a palliative approach focuses on comfort and dignity. These teams can provide guidance on when it may be time to prioritize comfort over aggressive nutrition.

Potential Complications of Unmanaged Pocketing

Ignoring food pocketing can lead to serious health problems:

• Aspiration Pneumonia: If food or liquid is accidentally inhaled into the lungs, it can cause a lung infection known as aspiration pneumonia.
• Malnutrition and Dehydration: The person may not be consuming enough calories or fluids, leading to weight loss and dehydration.
• Choking: Holding a large amount of food in the mouth increases the risk of choking.
• Oral Infections: Lingering food in the mouth can harbor bacteria, increasing the risk of cavities, gum disease, and other oral infections.

Conclusion

Addressing food pocketing in dementia patients requires a multifaceted approach focused on patience, safety, and a deep understanding of the person's changing needs. By creating a calm environment, adapting food textures, and employing effective feeding techniques, caregivers can significantly improve mealtime experiences. For ongoing or severe issues, seeking professional help from a speech-language pathologist or dietitian is highly recommended. The goal is to provide compassionate care that ensures nutrition while preserving the dignity and comfort of the individual. For more caregiver resources, visit the National Institute on Aging website.

Frequently Asked Questions

What are the first steps to take when you notice a dementia patient is pocketing food?

First, remain calm and do not panic. Gently remind the person to chew and swallow. Then, discreetly check their mouth for food and ensure they are sitting upright. Observe for potential triggers, such as distractions or difficult-to-chew foods, and adjust the environment and meal accordingly.

What type of food is best for dementia patients who pocket food?

Soft, moist foods are best. Think pureed foods like applesauce, smoothies, and mashed potatoes, or naturally soft items like scrambled eggs, yogurt, and soft cheeses. Avoid hard, dry, or sticky foods that are difficult to chew and swallow.

How can I check if a dementia patient has swallowed all their food?

You can check by gently asking the person to open their mouth. You can also look for a swallow reflex in their throat. If you observe any leftover food, you can gently offer a sip of a drink to help clear it, but avoid forcing them.

When should I consider seeing a speech-language pathologist for food pocketing?

You should seek professional help if pocketing is a persistent problem, if the patient is losing weight, or if you notice signs of dysphagia, such as coughing or a wet-sounding voice during or after meals. An SLP can provide a detailed swallowing assessment.

Does pocketing food mean a dementia patient is ready for hospice care?

Not necessarily. While pocketing indicates a progression of the disease and can point to declining physical ability, it is not an immediate sign of imminent death. It does, however, signal that a discussion with a healthcare provider about quality of life and future care planning may be appropriate.

How can I maintain a patient's dignity during mealtimes while managing pocketing?

Focus on creating a calm and respectful atmosphere. Avoid scolding or showing frustration. Encourage independence with manageable finger foods if possible. Sit with the person and engage in conversation, making mealtime a social and positive experience rather than a medical task.

Is it better to offer three large meals or several small ones?

Offering several smaller, more frequent meals and snacks throughout the day is often more effective. This can prevent the person from feeling overwhelmed by a large portion and helps maintain energy levels and nutrition.