Common Causes of Pocketing and Hiding Food
When an older adult begins pocketing food—holding it in their cheeks—or hiding food, it is a significant warning sign that requires attention. This is not simply a fussy eating habit but a behavior often linked to underlying medical conditions.
Cognitive Impairment (Dementia)
For individuals with Alzheimer's or other forms of dementia, memory and cognitive function decline can directly impact eating habits.
- Forgetting to Swallow: The brain's ability to coordinate the chewing and swallowing process can become impaired. The person may chew but then forget the next step, leaving food in their mouth.
- Sense of Scarcity: Past memories, such as experiencing scarcity during the Great Depression, can resurface, causing a person to save food for later out of fear of not having enough.
- Loss of Control: As people with dementia lose control over many aspects of their lives, hoarding food may be an attempt to regain a sense of control and security.
- Paranoia: Some may believe their food will be stolen, prompting them to hide it in various places around the house.
Physical and Neurological Issues
Beyond cognitive decline, several physical conditions can lead to pocketing food.
- Dysphagia (Difficulty Swallowing): This condition can stem from degenerative diseases like Parkinson's disease or a stroke. It causes the muscles and nerves involved in swallowing to weaken, making the process difficult or painful. To avoid the discomfort, the person may simply hold the food in their mouth.
- Sensory Decline: A diminished sense of taste or smell can make food less appealing, leading to a loss of appetite. When food is no longer enjoyable, it may be left uneaten or held in the mouth.
- Dental Problems: Poorly fitting dentures, sore gums, or tooth pain can make chewing uncomfortable. An elderly person may hold food in their cheeks to avoid painful chewing.
Psychological Factors
Emotional and environmental factors can also contribute to this behavior.
- Anxiety: Stress or anxiety, perhaps related to the eating process itself or other life changes, can make mealtime overwhelming.
- Boredom: In some cases, a person may hide items, including food, simply out of boredom or a need for engagement.
Comparison of Causes for Pocketing and Hiding Food
| Reason | Related Condition | Signs & Symptoms | Risks | Management Strategy |
|---|---|---|---|---|
| Memory Impairment | Alzheimer's, Dementia | Forgetting to swallow, hiding food in unusual places, anxiety over future food supply. | Malnutrition, food poisoning from eating spoiled food. | Gentle redirection, establishing a routine, accessible snacks, 24/7 supervision. |
| Dysphagia (Swallowing Issues) | Parkinson's disease, Stroke | Food held in cheeks, coughing or gagging during meals, refusing certain food textures. | Choking, aspiration pneumonia (food entering lungs). | Speech-language pathology evaluation, softer foods, thickened liquids, smaller bites. |
| Anxiety/Control | Generalized Anxiety Disorder, Dementia | Saving food for later, distrust of caregivers, feeling overwhelmed by mealtime. | Malnutrition, social isolation. | Calm eating environment, pre-portioned meals, reassurance about food availability. |
| Dental Problems | Poor oral health, ill-fitting dentures | Refusal to chew, only eating soft foods, oral discomfort or pain. | Malnutrition, poor oral hygiene. | Dental examination, soft/moist food modifications, pain management. |
The Serious Risks of Pocketing Food
The consequences of pocketing food extend far beyond messy mealtimes. If not addressed, this behavior can lead to severe health complications.
- Choking: Food left in the mouth can be a significant choking hazard, especially if the person becomes distracted or falls asleep with food still in their mouth.
- Aspiration Pneumonia: This is a serious condition where food or liquid enters the lungs, causing an infection. Pocketing increases the risk of aspiration, as unswallowed food can be inhaled.
- Malnutrition and Dehydration: When food is not properly swallowed, the person is not receiving adequate nutrition. This can lead to weight loss, a weakened immune system, muscle weakness, and overall frailty.
- Oral Health Issues: Leftover food in the cheeks or gums creates a breeding ground for bacteria, increasing the risk of mouth infections, gum disease, and tooth decay.
Effective Strategies for Caregivers
If you are caring for an elderly person who is pocketing food, patience and a systematic approach are essential.
Adapt the Mealtime Environment
- Create a Calm Atmosphere: Reduce background noise and distractions like the television to help the person focus on eating.
- Use Visual Cues: Serve meals on plates with contrasting colors to make the food more visible and appealing. For instance, white fish on a blue plate.
Adjust Food and Feeding Techniques
- Smaller, Frequent Meals: Offer small, bite-sized portions of food rather than large, overwhelming meals.
- Modify Food Texture: Serve soft, moist, or pureed foods that are easier to chew and swallow. Add sauces or gravies to dry foods.
- Gentle Reminders: Provide gentle verbal prompts, such as "Now chew" or "Time to swallow," to guide them through the eating process.
- Check for an Empty Mouth: Wait until the person has swallowed before offering the next bite. Ask them to take a sip of a drink to clear their mouth.
Addressing the Psychological Causes
- Provide Reassurance: If the person is hiding food out of fear of scarcity, provide reassurance that there is enough food. A designated snack area filled with pre-portioned snacks can help them feel secure.
- Engage and Distract: Boredom can be a factor in hiding items. Ensure the person has enjoyable activities and social interactions to keep them occupied.
When to Seek Professional Help
It is crucial to involve a healthcare professional, especially a speech-language pathologist (SLP), if pocketing or swallowing issues are persistent. An SLP can conduct a swallowing assessment (dysphagia) and provide tailored recommendations. For dementia-related behaviors, a doctor can help rule out other medical issues and provide guidance on managing symptoms. For more information on managing dementia-related behaviors, the National Institute on Aging is a valuable resource.
Conclusion
When an elderly person starts pocketing food, it is a complex behavior with various potential causes, ranging from cognitive decline and swallowing difficulties to anxiety and a need for control. Rather than becoming frustrated, caregivers should approach the situation with patience and a focus on safety. By understanding the root causes and implementing practical strategies like adjusting mealtime routines and food textures, you can manage the risks of choking, malnutrition, and aspiration pneumonia. Consulting with healthcare professionals, such as a speech-language pathologist, is vital for a comprehensive assessment and personalized care plan. Prioritizing comfort, safety, and addressing the underlying issues is the most effective way to protect your loved one's health and well-being.
