Pocketing Food Elderly: Prevent, Treat, Manage!

Pocketing food in the elderly is a condition where food is held in the mouth, especially in the cheeks, without being swallowed. This behavior is more than just an eating quirk; it’s a significant health concern. 

It often occurs in individuals with cognitive challenges like dementia or physical issues such as dysphagia.

As a Registered Dietitian with almost a decade experience working with people with Dysphagia, I’m here to give you my top tips on how to recognize and manage the condition.

The implications of pocketing food in the elderly are serious, including choking hazards and aspiration pneumonia. This condition can lead to food particles being inhaled into the lungs, causing infections. 

But importantly it often results in nutritional deficiencies due to inadequate food intake.

Addressing the issue of pocketing food in the elderly is crucial for their health and well-being. Recognizing and managing it can greatly improve the quality of life and safety of older adults. 

It’s a vital aspect of elderly care that caregivers and healthcare professionals need to be aware of.

elderly man appearing to choke on food with a care giver standing beside him looking concerned.

Causes of Pocketing Food in Elderly

Dementia and cognitive decline are primary factors leading to pocketing food in the elderly. As cognitive abilities deteriorate, the elderly may forget the process of chewing and swallowing, leading to food being retained in the mouth. 

This is especially common in advanced stages of dementia, where the coordination between eating and swallowing is significantly impaired.  At this point they are at serious risk of malnutrition and other nutrient deficiencies if not managed properly.

Physical causes also play a crucial role, with dysphagia being a common issue. This condition, characterized by difficulty in swallowing, makes it challenging for the elderly to process food normally. 

There are other physical factors such as dental problems, missing teeth or ill-fitting dentures, can make the ability to chew properly, resulting in pocketing.

Psychological factors, including depression and anxiety, can affect eating habits in the elderly. These conditions may lead to a lack of interest in food or neglect in following proper eating techniques. As a result, food may be pocketed unconsciously, further complicating the act of eating.

Risks and Complications

Choking hazards are a significant risk associated with pocketing food in the elderly. When food is not properly chewed and swallowed, it can obstruct the airway, leading to choking incidents. 

This risk is heightened in the elderly due to weakened muscle control and delayed reflexes.  This can ultimately lead to early mortality.  

Aspiration pneumonia is another serious complication. This occurs when food particles are inhaled into the lungs rather than being swallowed into the stomach. It can lead to lung infections and is particularly dangerous for the elderly, whose immune systems are often compromised.

Nutritional deficiencies are a common consequence of pocketing food. Older adults with pocketing behaviours and swallowing difficulty are 4.8 times more likely to have undernutrition.

When the elderly pocket food instead of swallowing it, they miss out on essential nutrients. This can lead to various health issues, including weight loss, weakened immunity, and overall decline in health. 

Addressing pocketing food is vital to ensure adequate nutrition and maintain the health of elderly individuals.

Identifying Signs of Pocketing Food

Behavioural indicators are key in identifying pocketing food in the elderly. 

Signs include:

  • Prolonged meal times 
  • Reluctance to eat
  • Remnants of food in the mouth
  • Needing reminders to chew and swallow

These all may suggest difficulty with swallowing or managing food in the mouth. Anyone monitoring them while eating should be alert to changes in eating habits, as these can be early warnings.

Regular checks during and after meals can help in early detection of this behaviour.

If pocketing food is accompanied by weight loss, choking incidents, or frequent coughing during meals, it’s time to consult a healthcare professional. Early intervention can prevent complications and improve the quality of life for the elderly individual.

You can also read this article and find a screening tool to catch swallowing difficulty early.

Managing and Preventing Pocketing Food

Dietary Modifications

Texture adjustments are a vital aspect of dietary modifications for the elderly who pocket food. Switching to the right diet texture and changing fluids to be thicker can make swallowing easier and reduce the risk of choking. 

These modifications ensure that food is easier to manage, decreasing the likelihood of pocketing.  There are many diet levels, so its important to not automatically jump to pureed texture if unnecessary.  You can read all about diet textures here for advice on the different ones.

Serving bite-sized portions is another effective strategy. Smaller pieces of food are easier to chew and swallow, which can significantly help those with swallowing difficulties. 

This approach also allows for better control of food intake, ensuring that the elderly receive adequate nutrition without the risk of pocketing.

Hydration strategies play a crucial role in managing pocketing food. Ensuring that the elderly are adequately hydrated helps maintain saliva production, which is essential for proper swallowing. 

Offering regular sips of water or other suitable liquids during meals can facilitate smoother swallowing and reduce the tendency to pocket food.

Eating Environment and Techniques

Creating a distraction-free environment is crucial for elderly individuals prone to pocketing food. Reducing background noise and visual distractions can help them focus on the act of eating. A calm and quiet dining area encourages concentration on chewing and swallowing, reducing the likelihood of pocketing food.

Proper positioning and posture during meals play a significant role. Ensuring that the elderly are seated comfortably and upright can facilitate easier swallowing. The right posture helps in aligning the throat and digestive tract, making the swallowing process more efficient and reducing the risk of pocketing.

Encouraging mindful eating is also beneficial. This involves teaching the elderly to be more aware of each bite, chew thoroughly, and swallow before taking the next bite. Mindful eating practices can help them better manage their food intake, reducing the chances of pocketing and improving overall mealtime experiences.

Professional Interventions and Support

The Registered Dietitian is typically for the first line of support when pocketing or swallowing issues arise.  The Dietitian can alter the diet texture and consult with a Speech Therapist in order to have them fully assessed.  The Dietitian is also critical in ensuring that the individual can maintain optimal nutrition and prevent weight loss.

Speech therapists also play a crucial role in addressing pocketing food in the elderly. They can assess swallowing difficulties and provide specialised exercises and techniques to improve the swallowing process. Their guidance is invaluable in developing strategies tailored to individual needs, helping to reduce the risk of pocketing food.

Regular dental assessments are also essential. Dental professionals can identify and treat issues like missing teeth or ill-fitting dentures, which can contribute to pocketing. Proper dental care ensures that the elderly can chew food effectively, minimizing the chances of pocketing.

Caregiver training and support are key components of managing pocketing food. Caregivers need to be equipped with the right knowledge and skills to assist the elderly during meals. Training in proper feeding techniques, recognizing signs of pocketing, and emergency procedures for choking can significantly enhance the care provided to the elderly.

Closing Thoughts

Effectively managing pocketing food in the elderly requires awareness, appropriate dietary modifications, and a supportive eating environment.

Professional interventions, including the expertise of dietitians, speech therapists and dental care, along with informed caregiver support, play a pivotal role. Addressing this issue not only improves the safety and nutritional health of the elderly but also enhances their overall quality of life.

By understanding and implementing these strategies, caregivers and healthcare professionals can provide better care, ensuring that meal times are both safe and enjoyable for the elderly.

Frequently Asked Questions

What does pocketing food indicate?

We typically see this when someone is having trouble chewing and swallowing the meal. They have discomfort with swallowing so they hold food in their cheeks in order to prevent swallowing and difficulty. It can also be the sign of a serious health condition, Dysphagia.

Why do dementia people pocket their food?

The connection between the brain and the muscles in the throat weaken as people age, and as cognitive difficulties arise, like those with dementia. Dementia overtime can lead to the brain not sending a signal to the throat muscles to push food down, causing chewing and swallowing difficulty and pocketing of food.

Other Articles You May Find Helpful

Pros and Cons of Thickened Liquids.

Top Dysphagia Foods to Avoid!

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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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