Understanding the Complex Reasons Behind Spitting
Spitting saliva is a behavior that can be distressing and confusing for caregivers. Rather than being a willful or malicious act, it is almost always a symptom of an underlying medical, physical, or psychological issue related to the progression of dementia. The loss of cognitive function and control over bodily actions directly impacts oral motor skills, sensory perception, and the ability to communicate needs.
Neurological and Physical Factors
The most common and significant reasons for a person with dementia to spit involve physical changes within the body and brain.
Swallowing Difficulties (Dysphagia)
As dementia progresses, the part of the brain that coordinates swallowing can be damaged. This condition, known as dysphagia, means the person may not be able to effectively manage the saliva in their mouth. Instead of swallowing, their body might trigger a spitting reflex as a defensive mechanism to prevent choking or aspiration (saliva entering the lungs). The following signs can indicate dysphagia:
- Coughing or clearing the throat, especially after drinking
- A 'gurgly' voice after swallowing
- Pocketing food in the cheeks
- Fear or refusal of eating or drinking
Sensory Changes and Oral Discomfort
Another physical factor is the change in a person's oral sensations. Nerve damage can alter how the mouth feels, leading to hypersensitivity or a numb feeling. This can cause the person to feel a strange or unpleasant sensation from their own saliva, which they then try to expel. Furthermore, poor oral hygiene, dental pain, dry mouth (xerostomia), or ill-fitting dentures can cause significant discomfort. If a person cannot verbally express this pain, spitting may be a way to communicate their distress.
Behavioral and Psychological Triggers
Beyond the physical, a person's emotional state and ability to communicate can manifest as spitting.
Communication Breakdown
For individuals whose verbal skills have declined, spitting can become a non-verbal form of communication. It can signal frustration, anger, refusal, or a general feeling of being overwhelmed. For example, a person might spit out food they dislike, or spit when they are unable to express that they are full or in pain. It is a primitive, yet powerful, way to express a strong emotion or need that they can no longer articulate with words.
Anxiety, Fear, and Repetitive Behaviors
Anxiety can be a major trigger. A person with dementia may develop a fear of choking, causing them to spit out food or drink that they perceive as a threat. In other cases, repetitive spitting can be a coping mechanism for stress, a nervous habit, or simply a repetitive behavior (perseveration) that is common in dementia. This may also happen when the person is bored or seeking attention.
Medication Side Effects
Certain medications, particularly antipsychotics and others used to manage dementia symptoms, can have side effects that impact saliva production. Some cause dry mouth, which can lead to a compensatory increase in saliva (rebound effect), while others can cause hypersalivation. Both of these can lead to discomfort and the subsequent spitting of excess saliva.
Caregiving Strategies and Interventions
Addressing spitting requires patience, observation, and a multi-faceted approach. Here are some strategies caregivers can employ:
- Rule Out Medical Causes: Always start by consulting a healthcare professional to rule out serious medical issues like dysphagia, oral infections, or medication side effects. A Speech-Language Pathologist can provide a professional swallowing evaluation.
- Maintain Excellent Oral Hygiene: Ensure the person's mouth is clean and free of discomfort. Schedule regular dental check-ups, and if they wear dentures, ensure they fit properly.
- Create a Calm Environment: During meals, minimize distractions and create a peaceful, quiet setting. Rushing meals can increase anxiety and lead to spitting. Offer small, manageable portions.
- Observe and Identify Triggers: Keep a journal of when and where the spitting occurs. Does it happen at a certain time of day? During meals? When a particular person is present? This can help you identify a pattern and the root cause.
- Use Alternative Communication: If spitting is a form of communication, try to understand the message. Use simple language, visual cues, and be attentive to body language to interpret their needs.
Comparison of Potential Causes
Understanding the context is key to determining the cause and appropriate response.
| Cause | Behavioral Manifestation | Caregiver Action |
|---|---|---|
| Dysphagia | Spitting food or drink, drooling, coughing during meals. | Consult Speech-Language Pathologist, use thickened liquids if recommended. |
| Oral Discomfort | Refusal to eat, wincing, touching mouth, spitting. | Schedule a dental check-up, ensure oral hygiene is good. |
| Communication Need | Spitting when upset, refusing, or frustrated. | Observe triggers, use simple language, offer alternative communication methods. |
| Medication Side Effects | Persistent drooling or dryness, leading to spitting. | Discuss side effects with doctor, adjust medication if necessary. |
| Anxiety/Fear | Repetitive spitting, spitting during meals. | Create calm meal environment, offer reassurance, use distraction. |
Conclusion: A Symptom, Not a Choice
Understanding why do dementia patients spit saliva? fundamentally shifts the perspective from seeing it as a malicious action to recognizing it as a symptom of a deeper issue. It is a sign of a physical change, an emotional state, or a desperate attempt to communicate. By identifying the underlying cause, caregivers can approach the behavior with empathy, develop effective strategies, and improve the quality of life for the person with dementia. Seeking professional medical and dental advice is a critical first step. For more comprehensive information and support, a resource like the Alzheimer's Association can be invaluable.
