Why do you drool as you get older? Causes, effects, and management

While often associated with infancy, drooling, or sialorrhea, can affect up to 10% of older adults, indicating underlying physiological changes. If you are asking why do you drool as you get older?, it is important to understand the various causes to find an appropriate solution and regain comfort and confidence.

Quick Summary

Chronic drooling in older adults is typically not caused by excess saliva, but rather by impaired motor control of the oral muscles, reduced swallowing frequency, or side effects from medication, particularly in those with neurological conditions.

Key Points

• Muscle Weakness: As we age, facial and swallowing muscles can weaken, making it harder to control saliva and keep lips sealed.

• Medication Side Effects: Certain medications, especially for neurological or mental health issues, can increase saliva production or affect swallowing.

• Reduced Swallowing Reflex: Older adults may swallow less frequently, particularly during sleep, leading to a build-up of saliva that can escape the mouth.

• Neurological Conditions: Diseases like Parkinson's or the effects of a stroke can impair the motor skills needed for effective swallowing.

• Oral Health Problems: Issues such as ill-fitting dentures or dental pain can interfere with proper mouth closure and swallowing, contributing to drooling.

• Management is Possible: Treatments range from simple posture adjustments and exercises to medication or Botox injections, depending on the cause.

The Physiological Reasons Behind Senior Drooling

Drooling as a senior is rarely a matter of producing too much saliva. Instead, it is usually the result of the body's natural aging process affecting the muscles and nerves that control swallowing. The proper medical term for this condition is sialorrhea. As we age, the muscles in and around the mouth, jaw, and throat can lose strength and coordination. This muscular weakening can make it more difficult to keep the mouth closed and swallow effectively, allowing saliva to pool and spill out. Similarly, the frequency of spontaneous swallowing decreases with age, especially during sleep. For many people, this is the primary cause of nighttime drooling.

Weakened Facial Muscles

As the years pass, the muscles in the face and neck, including the perioral muscles that control the lips, can become less toned. This can result in lips that do not seal tightly, providing an easy escape route for saliva. The tongue, which plays a crucial role in pushing saliva to the back of the throat for swallowing, may also lose some of its strength and agility. This combination of weaker lips and a less efficient tongue can significantly impair the body's natural ability to manage saliva.

Reduced Swallowing Reflex

Swallowing is a complex reflex involving over 50 pairs of muscles and several nerves. With age, the reflex can become less frequent, particularly when an individual is relaxed or asleep. A typical person swallows saliva about 600 times a day, but this number can decrease dramatically in older age. This is especially true for people who sleep on their backs, where gravity naturally pulls saliva forward, or for those with certain neurological conditions that affect the swallowing center in the brainstem.

Neurological and Medical Conditions

Drooling in older adults is not just a simple matter of aging. It can also be a significant symptom of underlying neurological disorders that affect motor function and coordination. Conditions like Parkinson's disease, stroke, and amyotrophic lateral sclerosis (ALS) can all impact the muscles used for swallowing, leading to sialorrhea.

Parkinson’s Disease

Parkinson's disease is a progressive disorder of the central nervous system that primarily affects motor skills. One of its lesser-known but common symptoms is a reduced ability to swallow, leading to a build-up of saliva in the mouth. The combination of slow movements and facial muscle stiffness characteristic of Parkinson's can also inhibit the natural swallowing reflex, resulting in more prominent drooling.

Stroke and Other Neurological Events

A stroke can cause localized brain damage that affects the nerves controlling the facial muscles and throat. Depending on the area of the brain affected, a stroke survivor may experience a weakened swallowing reflex or facial paralysis, making it difficult to control saliva. Rehabilitation and therapy can often help manage these symptoms, but for some, drooling can be a lasting effect.

Medications and Oral Health

Beyond physiological changes and neurological conditions, external factors like medication and poor oral health can also contribute to or exacerbate drooling. It's essential to review all medications and oral hygiene practices when investigating the cause of persistent sialorrhea.

Common Medications

Certain medications are known to increase saliva production as a side effect. Antipsychotic drugs and some medications used to treat Alzheimer's disease and other forms of dementia are common culprits. The list also includes some anti-seizure medications and drugs used to treat gastroesophageal reflux disease (GERD). If a new medication coincides with the onset of drooling, a consultation with a healthcare provider is warranted to discuss potential alternatives or dosage adjustments.

Dentures and Oral Hygiene

Oral health problems can also play a role. Ill-fitting dentures can interfere with a proper lip seal and swallowing. Similarly, dental issues, mouth sores, or infections can cause pain or discomfort that makes a person reluctant to swallow, leading to a build-up of saliva. Maintaining good oral hygiene and ensuring dentures are properly fitted are crucial steps in managing and preventing drooling.

Management and Treatment Options

Fortunately, there are many strategies for managing drooling, ranging from simple lifestyle adjustments to more advanced medical interventions. The best approach depends heavily on the underlying cause, so a professional diagnosis is key.

Lifestyle Adjustments and Therapy

1. Posture: For those who drool at night, sleeping with the head elevated can help reduce the flow of saliva out of the mouth. Using an extra pillow or a wedge pillow can be effective.
2. Hydration: Maintaining proper hydration can help thin saliva, making it easier to swallow.
3. Oral Exercises: Speech and physical therapists can provide exercises to strengthen the facial and oral muscles, improving lip closure and swallowing control.
4. Oral Appliances: Some dentists can create custom-fitted oral appliances that help improve lip posture and support better swallowing.

Medical and Clinical Treatments

For more severe cases, or when lifestyle changes aren't enough, medical treatments may be considered. These should always be discussed with a qualified healthcare professional.

• Anticholinergic Medications: These drugs, such as scopolamine or glycopyrrolate, work by reducing overall saliva production. They can be very effective but may have side effects like dry mouth, constipation, and blurred vision.
• Botox Injections: Botulinum toxin (Botox) can be injected into the salivary glands to temporarily paralyze the nerves that stimulate saliva production. This is often a highly effective and targeted treatment.
• Radiation Therapy: In rare, severe cases, low-dose radiation therapy to the salivary glands can be used to permanently reduce saliva production. This is typically a last-resort option.

Comparison of Drooling Causes in Seniors

Cause	Mechanism	Examples	Management Strategies
Muscle Weakness	Age-related loss of muscle tone in the lips, tongue, and jaw.	General aging, facial muscle atrophy.	Oral muscle exercises, improved posture, lifestyle adjustments.
Reduced Swallowing	Infrequent or inefficient swallowing, especially during sleep.	Natural aging, sleep habits.	Elevated head posture during sleep, mindfulness of swallowing frequency.
Neurological Conditions	Impaired nerve control affecting muscles of the mouth and throat.	Parkinson's disease, post-stroke effects, ALS.	Speech therapy, medication management, targeted treatments.
Medication Side Effects	Increased saliva production triggered by pharmaceutical drugs.	Antipsychotics, some Alzheimer's drugs.	Discuss medication alternatives or dosage with a healthcare provider.
Oral Health Issues	Obstructions or pain in the mouth affecting swallowing or lip seal.	Ill-fitting dentures, mouth sores, dental pain.	Dental checkups, proper denture fitting, improved oral hygiene.

When to Seek Professional Help

While occasional drooling is not always cause for alarm, persistent or heavy drooling, especially if it coincides with other new symptoms, should be evaluated by a healthcare provider. It is vital to rule out any serious underlying conditions, such as a new neurological issue or medication side effect. A doctor can perform a full examination and determine the best course of action. It's also important to address the social and emotional impact of drooling. Many individuals may feel embarrassed or withdrawn, and seeking help can improve their quality of life significantly.

For more information on broader oral health issues, resources like the American Dental Association or Mayo Clinic's Oral Health Information can provide additional guidance and context.

Conclusion

Drooling as you get older is a multifaceted issue with several potential causes, from normal physiological changes to underlying medical conditions or medication side effects. It's not a condition to be embarrassed about but rather a symptom that warrants attention. With a proper diagnosis and the right management strategy, whether through simple lifestyle changes or medical intervention, seniors can effectively address this problem and maintain their comfort and dignity. Consulting with a healthcare provider is the most important first step toward understanding the specific cause and finding the best path forward.

Frequently Asked Questions

Is it normal to drool as you get older?

While it's a common issue, affecting a significant portion of the senior population, it is not a normal or inevitable part of aging. It's often a symptom of an underlying cause that can and should be addressed.

What is the medical term for drooling?

The medical term for excessive drooling is sialorrhea. In older adults, it's typically caused by an inability to retain or swallow saliva, not by producing too much of it.

Can medication cause drooling in seniors?

Yes, many medications can cause or worsen drooling. Some antipsychotics, anti-seizure drugs, and certain medications for Alzheimer's can increase saliva production or interfere with swallowing. Discussing this with a doctor is essential.

What kind of doctor should I see for drooling?

You should start by consulting your primary care physician. They can help determine the cause and may refer you to a specialist, such as a neurologist if a neurological condition is suspected, or a dentist if oral health is the issue.

Can drooling be a sign of a more serious condition?

Yes, drooling can sometimes be a symptom of a neurological disorder like Parkinson's disease, a recent stroke, or other conditions affecting muscle control. It is important to get a professional medical evaluation to rule out serious causes.

Are there exercises that can help with drooling?

Yes, speech and physical therapists can teach oral-motor exercises to strengthen the muscles of the mouth, jaw, and tongue. These exercises can improve swallowing and lip control, helping to manage drooling.

How can I reduce drooling at night?

Sleeping with your head elevated, using an extra pillow, or a wedge pillow can use gravity to your advantage, making it harder for saliva to pool and escape your mouth during sleep.