What does it mean when an elderly person starts to drool?

According to the Mayo Clinic, dysphagia, or difficulty swallowing, affects between 10% and 33% of older adults. When an elderly person starts to drool, it often indicates an underlying issue affecting their ability to manage saliva, which can be caused by a variety of health factors.

Quick Summary

This article explains that excessive drooling, or sialorrhea, in older adults is frequently a symptom of an underlying health condition rather than a normal part of aging. It could stem from neurological disorders, medication side effects, or dental problems, all of which can affect muscle control or saliva production. Understanding the possible causes is the first step toward effective management and ensuring the senior's well-being.

Key Points

• Symptom of Underlying Issues: Drooling in the elderly is not a normal sign of aging but a symptom of an underlying health problem, often related to poor muscle control or excessive saliva production.

• Common Causes Include Neurological Conditions: Diseases such as Parkinson's, stroke, and dementia can impair the muscles needed for swallowing and lip closure, leading to drooling.

• Medications Can Be a Factor: Several prescription drugs, including those for psychiatric conditions, can cause hypersalivation as a side effect.

• Dysphagia is a Major Concern: Difficulty swallowing (dysphagia) is a primary reason for drooling and, if untreated, can increase the risk of aspiration pneumonia.

• Treatment is Cause-Dependent: Management strategies range from lifestyle adjustments and speech therapy to medication and botox injections, depending on the specific cause.

• When to See a Doctor: Seek medical advice for persistent or new-onset drooling to receive a proper diagnosis and prevent serious complications.

Drooling in the Elderly: Understanding the Underlying Causes

While occasional drooling during sleep is common at any age, persistent or new-onset drooling in an elderly person is often a cause for concern. The medical term for this is sialorrhea. It's crucial to understand that drooling is not a disease in itself but a symptom of an underlying condition that is interfering with the normal process of swallowing or managing saliva. This section will delve into the primary reasons behind this issue, from neurological disorders to medication side effects.

The Role of Neurological Conditions

Many neurological diseases that affect the elderly can impair the muscle control necessary for swallowing and keeping the mouth closed. In these cases, the issue isn't typically overproduction of saliva, but rather an inability to swallow it effectively.

Parkinson's Disease

Drooling, or sialorrhea, is a common symptom in people with Parkinson's disease. The disease affects the nerves and muscles that control the mouth and throat, leading to reduced swallowing frequency and impaired facial muscle control. This can cause saliva to pool in the mouth and spill out unintentionally. As the disease progresses, this symptom can become more pronounced.

Stroke

Following a stroke, an elderly person may suddenly start drooling due to weakened facial muscles or nerve damage. A stroke can disrupt the neural pathways that regulate saliva flow and swallowing, leading to an immediate change in the person's ability to manage saliva.

Dementia and Alzheimer's Disease

Dysphagia, or swallowing difficulty, is very common in people with dementia, particularly in the later stages. The cognitive decline can affect the person's ability to recognize the need to swallow or remember the process. This can lead to a buildup of saliva and subsequent drooling.

The Impact of Medications and Dental Issues

Medications and dental health are two other major contributors to drooling in the elderly. Addressing these factors can often lead to significant improvement.

Medication Side Effects

Many prescription drugs can cause excessive salivation (hypersalivation) or reduce muscle tone in the mouth, leading to drooling. Medications used to treat psychiatric conditions, certain tranquilizers, and even some hypertension and allergy drugs can have this side effect. It is essential for caregivers to review all medications with a healthcare provider to identify any potential culprits.

Dental and Oral Health Problems

Poor dental health can irritate the mouth and lead to increased saliva production. Common issues include:

• Poorly fitting dentures: Ill-fitting dentures can irritate the gums and make it difficult to maintain proper mouth closure, leading to leakage of saliva.
• Dental infections: Cavities, gum disease, and other oral infections can stimulate the salivary glands.
• Missing teeth: Gaps in dentition can disrupt the normal swallowing process and affect tongue placement, contributing to drooling.

Other Health Conditions

Several other medical issues can also contribute to drooling in older adults.

• Gastroesophageal Reflux Disease (GERD): When stomach acid flows back into the esophagus, the body's natural defense mechanism is to produce more saliva to neutralize the acid. This can result in hypersalivation and drooling.
• Sinus infections: Clogged nasal passages due to infection can force a person to breathe through their mouth, which can lead to drooling, especially during sleep.

Managing and Treating Drooling in Seniors

Management of drooling depends heavily on its underlying cause. A healthcare professional, such as a speech-language pathologist, can conduct an evaluation to determine the best course of action.

Non-Pharmacological Strategies

• Postural adjustments: Encourage the senior to sit upright, with their head forward, especially during mealtimes. Supporting their head with cushions can also help prevent saliva from pooling.
• Swallowing exercises: A speech-language pathologist can provide specific exercises to strengthen the muscles of the mouth and throat.
• Improved oral hygiene: Regular dental check-ups and good oral hygiene can address irritants that may be causing excess saliva production.
• Swallow prompting: Using a reminder app or setting a simple timer can encourage more frequent swallowing.

Pharmacological Interventions

• Anticholinergic medications: Drugs like glycopyrrolate can be prescribed to reduce saliva production. However, they may have side effects and should be carefully considered, especially in elderly patients.
• Botulinum toxin injections: In some cases, botulinum toxin can be injected into the salivary glands to temporarily paralyze them and reduce saliva production. The effects can last for several months.

Comparison of Drooling Causes and Management

Cause	Mechanism	Key Symptoms	Management Strategies
Neurological Disorders (e.g., Parkinson's, ALS)	Impaired muscle control for swallowing and lip closure.	Difficulty swallowing, speech changes, tremors.	Speech therapy, botox injections, medication, posture adjustments.
Medication Side Effects	Increased saliva production (hypersalivation).	Dry mouth (sometimes paradoxical), drowsiness.	Review and adjust medication with a doctor.
Dental Issues (e.g., dentures, infections)	Irritation leading to excess saliva; mouth closure issues.	Poor oral hygiene, discomfort, chewing difficulties.	Dental check-ups, new dentures, regular cleaning.
Gastroesophageal Reflux Disease (GERD)	Body produces extra saliva to neutralize stomach acid.	Heartburn, chest pain, bad taste in mouth.	Medication for GERD, dietary changes.
Sleep Apnea / Sinus Issues	Breathing through the mouth while sleeping.	Snoring, dry mouth upon waking, nasal congestion.	Address underlying respiratory issues, adjust sleep position.

When to See a Doctor

While some lifestyle adjustments can help, it is vital to consult a healthcare professional for a proper diagnosis. A doctor can determine the root cause and recommend the most effective treatment plan. Ignoring persistent drooling can lead to more severe complications, such as aspiration pneumonia.

Conclusion

Persistent drooling in an elderly person is not a benign sign of aging but a red flag that an underlying health issue needs attention. Whether it is a neurological disorder impacting muscle control, a side effect of medication, or a dental problem, understanding the cause is the first step toward effective management. By working closely with a healthcare team, caregivers can help improve the senior's comfort, quality of life, and overall health. For further information, the Parkinson's Foundation offers valuable insights into managing drooling associated with Parkinson's disease.

Frequently Asked Questions

What is the medical term for drooling?

The medical term for unintentional drooling is sialorrhea, also known as ptyalism.

Can drooling in the elderly be a sign of a stroke?

Yes, a sudden onset of drooling can be a symptom of a recent stroke, especially if it is accompanied by other signs like facial weakness or difficulty speaking.

Why does a person with Parkinson's disease drool?

Drooling in Parkinson's is often due to the disease's effect on facial muscle control and a reduced frequency of swallowing, rather than an overproduction of saliva.

Can dentures cause drooling in an elderly person?

Poorly fitting dentures can cause irritation and make it difficult for a senior to close their mouth properly, contributing to drooling.

What is the link between GERD and excessive saliva?

The body can produce extra saliva as a natural defense mechanism to neutralize stomach acid that comes up into the esophagus due to gastroesophageal reflux disease (GERD).

How can speech therapy help with drooling?

A speech-language pathologist can provide exercises to improve swallowing, strengthen oral and facial muscles, and help with techniques for better saliva management.

Is drooling in dementia patients different from other causes?

Drooling in dementia patients is often linked to cognitive decline affecting their ability to consciously swallow and remember to close their mouth, as opposed to purely muscle-related issues.