What to do if someone is pocketing food? A comprehensive guide for caregivers

According to research, food pocketing in older adults is often a symptom of underlying conditions like dysphagia or cognitive decline, particularly dementia. Knowing what to do if someone is pocketing food is crucial for ensuring their safety and nutritional health, and this guide provides the necessary steps for caregivers.

Quick Summary

Dealing with food pocketing requires a sensitive, methodical approach focused on safety and identifying the root cause. Key steps include assessing for swallowing difficulties, modifying food textures, adjusting the mealtime environment, and using gentle reminders to prompt swallowing, helping to mitigate serious risks like choking or aspiration.

Key Points

• Identify the Cause: Pocketing is often a symptom of dysphagia, dementia, or oral discomfort, not a willful act.

• Prioritize Safety: Risks include choking, aspiration pneumonia, and oral infections; take immediate steps to ensure food is swallowed or removed.

• Modify Food Textures: Adjust food to be soft, moist, or pureed to make chewing and swallowing easier and safer.

• Create a Calm Environment: Reduce noise and distractions to help the person focus on eating and swallowing.

• Use Gentle Reminders: Use verbal cues or demonstrations to prompt swallowing, but avoid forcing or rushing the process.

• Know When to Seek Help: Consult a speech-language pathologist, dentist, or occupational therapist for expert evaluation and tailored strategies.

• Practice Patience: Maintain a calm, empathetic approach, understanding that the behavior is involuntary and focusing on comfort over consumption.

Understanding the Causes of Food Pocketing

Food pocketing, the act of holding food in the cheeks or roof of the mouth without swallowing, is not a behavioral problem but rather a sign of an underlying issue, particularly in aging individuals. The causes are varied and often interconnected.

Cognitive and Neurological Factors

• Dementia and Alzheimer's Disease: As these diseases progress, individuals may forget the complex process of chewing and swallowing. Changes in the brain can also affect the recognition of hunger or the sensory awareness of food remaining in the mouth.
• Stroke and Parkinson's Disease: These conditions can cause dysphagia (difficulty swallowing) due to nerve and muscle damage, impairing the coordinated muscle movements required for a proper swallow.
• End-of-Life Processes: Near the end of life, the body’s metabolic needs decrease, and eating becomes too exhausting. Food pocketing may occur as a result of fatigue and a decreased appetite.

Oral and Sensory Issues

• Oral Discomfort: Ill-fitting dentures, painful gums, or other dental problems can make chewing and swallowing painful, leading the person to avoid it by holding food in their mouth.
• Sensory Decline: A diminished sense of taste or smell can make food less appealing, leading to a loss of interest in eating. Conversely, some individuals with sensory processing differences may be overwhelmed by certain textures.

Immediate Actions to Take During a Meal

When you notice someone pocketing food, it's important to respond calmly and safely. Avoid showing frustration, which can increase their anxiety.

Step-by-Step Response

1. Stay Calm and Gentle: A panicked reaction can cause the person distress. Use a soothing voice and gentle body language.
2. Offer a Sip of a Drink: A small sip of water or a preferred beverage can help stimulate the swallowing reflex and wash down the food. This is often more effective than directly asking them to swallow.
3. Use Verbal and Visual Cues: Gently remind them by saying, “Time to swallow,” or “All gone now.” You can also model the action of swallowing yourself.
4. Perform a Mouth Sweep: After the meal, or if they are no longer eating, gently ask them to open their mouth so you can check for leftover food. Using a moist, soft-bristled toothbrush or finger sweep can help ensure all food is removed.

Long-Term Strategies for Managing Pocketing

Addressing the root causes requires implementing long-term strategies that focus on consistency and mealtime environment modification.

Modifying Food and Environment

• Modify Food Texture: Serve foods that are soft, moist, and easy to chew and swallow. Avoid dry, crumbly, or sticky foods that can easily get lodged. Pureed foods, soups, and casseroles are good options.
• Use Visual Contrasts: Serve food on plates that contrast in color with the food itself. For example, use a bright red plate for mashed potatoes so the food is more visible.
• Create a Calm Environment: Reduce distractions by turning off the TV and background noise. A calm setting helps the individual focus on the task of eating.
• Serve Smaller, More Frequent Meals: Large meals can be overwhelming. Offer several smaller meals or nutrient-dense snacks throughout the day.

Comparison of Caregiver Techniques

Technique	Application	Pros	Cons
Verbal Cues	Gentle reminders: "Swallow this bite."	Simple to implement, non-invasive.	May be ignored if cognitive decline is significant.
Visual Cues	Pointing to your throat while swallowing.	Provides a clear, non-verbal instruction.	Requires the person to follow the visual cue.
Food Modification	Switching to soft, moist foods or purees.	Directly addresses chewing/swallowing difficulties.	Can reduce variety and pleasure of eating.
Environmental Changes	Reducing noise and using contrasting plates.	Reduces confusion and sensory overload.	May not address the physical swallowing issue itself.
Hydration Between Bites	Offering sips of water throughout the meal.	Helps wash down food and prompt swallowing.	Requires consistent prompting and monitoring.

Potential Risks and When to Consult a Professional

Leaving food pocketing unaddressed can lead to serious health complications.

Health Risks

• Choking: Food lodged in the mouth can become dislodged and block the airway.
• Aspiration Pneumonia: Food or liquid entering the lungs can lead to a dangerous infection.
• Oral Infections and Dental Decay: Leftover food provides a breeding ground for bacteria, increasing the risk of gum disease and cavities.
• Malnutrition and Dehydration: Inadequate food and fluid intake can lead to weight loss and nutritional deficiencies.

When to Seek Professional Help

• Speech-Language Pathologist (SLP): An SLP can evaluate the swallowing mechanism (dysphagia) and provide targeted exercises and recommendations for safe eating.
• Dentist: A dental check-up can rule out or address issues like ill-fitting dentures or oral pain.
• Occupational Therapist: An OT can suggest adaptive equipment or feeding techniques to promote independent eating.

The Role of Patience and Compassion

Dealing with food pocketing can be emotionally and physically taxing for caregivers. It is essential to approach the situation with patience and compassion, recognizing that the person is not intentionally being difficult. Focus on comfort and safety rather than pressuring them to eat more.

For more insights on managing challenging behaviors in dementia and caregiving, the Alzheimer's Association offers a wealth of resources on daily care and support: https://www.alz.org/help-support/caregiving/daily-care/food-eating.

Conclusion

Food pocketing is a complex issue requiring a compassionate and multi-faceted approach. By understanding the potential causes, implementing immediate and long-term strategies, and knowing when to seek professional help, caregivers can significantly improve mealtime safety and the overall well-being of their loved one. Consistency, patience, and a focus on safety are your most valuable tools.

Frequently Asked Questions

What is the primary reason an elderly person might start pocketing food?

The primary reason is often an underlying medical condition, such as cognitive decline from dementia or a physical swallowing difficulty known as dysphagia. These conditions can cause a person to forget to swallow or lose the muscular coordination to do so.

Are there specific foods that should be avoided if someone is pocketing food?

Yes, it is best to avoid dry, crumbly, or sticky foods that can easily become lodged. Foods with mixed textures can also be confusing. Focus instead on soft, moist, or pureed options.

How can I gently remind someone to swallow their food without causing distress?

Instead of focusing on the pocketing, offer a small sip of water or another preferred beverage to help prompt the swallowing reflex. You can also use gentle verbal cues like, 'Time to take a drink,' or model the swallowing action yourself.

What are the biggest risks if food pocketing is left unmanaged?

The most significant risks include choking, aspiration pneumonia (when food enters the lungs), oral health problems like infections or dental decay, and poor nutrition leading to weight loss and dehydration.

Should I manually remove pocketed food from their mouth?

After the person has finished eating, you can gently ask them to open their mouth for a quick check. If they are willing, a mouth sweep with a moist, soft-bristled toothbrush can help. Avoid sticking your fingers deep into their mouth, as this can increase the risk of choking.

Does medication cause food pocketing?

While medication doesn't directly cause pocketing, certain drugs can have side effects that impact appetite or cause a dry mouth, which can indirectly contribute to eating difficulties and pocketing.

When is it time to involve a professional like a Speech-Language Pathologist?

If pocketing is a frequent issue, especially if accompanied by coughing, gagging, or weight loss, it's time to consult an SLP. They can properly assess swallowing function and provide expert guidance.