Neurological and physiological causes of throat clearing
As dementia progresses, the neurological pathways that control the complex act of swallowing are affected, leading to a condition called dysphagia. Throat clearing is often a compensatory behavior to deal with the resulting discomfort or sensation of something being stuck in the throat.
Dysphagia and aspiration risk
Dementia impairs the brain's ability to coordinate the muscles in the mouth and throat, leading to a delayed swallow reflex. This can cause food, liquid, or even saliva to not be cleared properly from the pharynx, triggering the throat-clearing reflex to protect the airway from potential aspiration. Aspiration, where material enters the lungs, can lead to serious health complications, such as aspiration pneumonia. Caregivers should watch for other signs of dysphagia, including coughing or choking during meals, a wet or gurgly voice, and pocketing food in the cheeks.
Other common physical factors
Besides dementia-specific swallowing issues, other age-related or common conditions can contribute to throat clearing:
- Gastroesophageal reflux disease (GERD): Acid reflux can cause throat irritation and a feeling of a lump in the throat, leading to persistent throat clearing.
- Decreased saliva production: Dry mouth, or xerostomia, can be a side effect of various medications commonly prescribed to older adults, including certain antidepressants and anxiety medications. A dry throat can cause irritation and the urge to clear it.
- Age-related changes: As people age, their sense of taste and smell can decrease, and the esophagus can lose some elasticity, making swallowing more difficult and leading to compensatory behaviors.
Psychological and behavioral reasons for repetitive throat clearing
For some dementia patients, repetitive throat clearing may not have a purely physical cause but can be linked to psychological and behavioral changes associated with the disease.
Anxiety and emotional distress
Repetitive behaviors are often a coping mechanism for individuals with dementia who feel anxiety, confusion, or insecurity. In an effort to regain a sense of control or express an unmet need, they may repeat certain actions or sounds, including throat clearing. This behavior can be triggered by unfamiliar environments, a change in routine, or overstimulation. Caregivers can address this by providing reassurance, maintaining a calm environment, and offering engaging but simple activities.
Repetition as communication
As verbal communication skills decline, repetitive actions can become a form of non-verbal communication. For example, the patient might be trying to express discomfort, signal that they are ready for the next step in eating, or draw attention to a physical sensation they cannot articulate. It is important for caregivers to look beyond the behavior itself and try to identify the underlying need or feeling.
Comparing causes: Physical vs. psychological
| Feature | Physical Causes (Dysphagia, etc.) | Psychological Causes (Anxiety, etc.) |
|---|---|---|
| Trigger | Swallowing attempt; food/liquid enters airway; acid reflux; medication side effect | Feelings of confusion, anxiety, insecurity; changes in routine or environment |
| Timing | Often occurs during or after eating/drinking, or in response to physical discomfort | Can occur at any time, especially during stressful or unfamiliar situations |
| Accompanying signs | Coughing, choking, wet voice, prolonged chewing, weight loss | Restlessness, fidgeting, repetitive questioning, agitation |
| Effective responses | Dietary modifications (soft foods, thickeners), proper positioning, swallow therapy | Reassurance, gentle redirection, structured routine, calm environment, reducing stimulation |
How to address throat clearing in dementia patients
Effective management requires a multi-pronged approach that addresses both the physical and psychological factors at play. Consultation with a healthcare professional, such as a doctor or speech-language pathologist (SLP), is the first crucial step to determine the primary cause of the behavior.
For suspected dysphagia:
- Modify diet: An SLP can recommend appropriate food textures and liquid consistencies. Often, soft, moist foods and thickened liquids are safer and easier to swallow. Avoid hard, dry, or sticky foods.
- Ensure proper positioning: The patient should be seated upright at a 90-degree angle during and for at least 30 minutes after meals. This helps with digestion and reduces the risk of aspiration.
- Provide small, paced sips and bites: Encourage the patient to take small amounts and allow plenty of time between bites. Using an empty spoon can sometimes help stimulate the swallow reflex.
- Promote hydration: Dry mouth can exacerbate swallowing issues. Offering sips of water or ice chips can help keep the throat moist.
For suspected psychological causes:
- Provide reassurance: Use a calm and gentle tone of voice. Acknowledge their feelings rather than focusing on the repetitive action. Phrases like, "It's okay, you are safe," can be helpful.
- Gently redirect: Engage the person in another simple, meaningful activity to break the cycle. Examples include folding laundry, listening to familiar music, or looking at a photo album.
- Maintain a routine: A predictable schedule can reduce anxiety and confusion. Consistency with mealtimes and daily activities can provide a sense of security.
Addressing other medical issues:
- Manage acid reflux: A doctor may recommend medication or lifestyle changes to manage GERD, which can significantly reduce throat irritation.
- Review medications: Ask a doctor to review all medications, as some may cause dry mouth as a side effect. Alternative medications or strategies for managing dry mouth can be explored.
Conclusion
Throat clearing in dementia patients is a common symptom with various potential causes, ranging from the physical and neurological changes of dysphagia to psychological factors like anxiety and repetitive behavior. It is vital for caregivers to recognize that this is not a deliberate or annoying habit but a signal that something is wrong. By working with healthcare professionals, adjusting mealtime strategies, and responding with patience and compassion, caregivers can address the underlying issues, minimize the behavior, and significantly improve the patient's safety and quality of life. Understanding the root cause, whether it's a compromised swallow reflex or a need for reassurance, is the key to providing effective and empathetic care. For further resources, the Alzheimer's Association offers extensive support and guidance for caregivers dealing with repetitive behaviors.
