Dr. Roach: Drooling in older people has many causes

Keith Roach
To Your Health

Dear Dr. Roach: My friend is taking care of his 89-year-old mother. She has been drooling for the past two years or so. I read that aging causes muscles used for swallowing to become weaker and causes dysphagia, which in turn causes drooling. Is this true?

G.P.

Dear G.P.: Drooling in older people is a common problem that, in addition to being embarrassing, may lead to skin irritation, infection and dehydration. There are many causes, and it can be difficult in any given person to be certain. Many mediations can cause excess salivation, such as clonozapam (Klonopin) and clozapine (Clozaril). Some diseases can cause excess salivation as well, especially neuromuscular diseases like Parkinson’s, ALS and stroke. Gastroesophageal reflux disease can sometimes cause dramatic amounts of excess saliva.

Dr. Keith Roach

Weakness or loss of sensation around the mouth can promote drooling via a different mechanism. Instead of excess saliva, people cannot feel or control their mouth, leading to drooling.

Many people in their 80s or older lose some control of swallowing, leading to risk of aspiration -- inhalation of food, liquid or secretions, which can cause infection or chemical reaction in the lungs. Aging by itself does not necessarily lead to drooling. A speech and language pathologist can be extremely helpful to identify the likely causes and prescribe treatment.

Dear Dr. Roach: I live in Florida and the recent explosion of COVID cases -- where it seems 90% of cases are those who, for whatever reason, are not vaccinated -- got me to wondering about medical treatment specific to those situations. Should part of their course of medical treatment include getting one of the COVID vaccines? I’m not a scientist, but that seems to be a logical response to what often appears to be an illogical decision on the part of the hospitalized individual.

K.S.

Dear K.S.: I have certainly heard of people asking for the COVID-19 vaccine when they are admitted, or just before they are intubated, but by then it is too late.

All vaccines take time to work. Nearly all vaccines need to be given well before an exposure to be effective. There are two exceptions: Both the rabies vaccine and the smallpox vaccine are effective if given immediately after exposure. Unfortunately, once symptoms have started, vaccines are no longer effective, for any disease I know.

For COVID-19, a person is considered fully immunized two weeks after their second dose of the Pfizer or Moderna vaccine, or two weeks after their single-dose Johnson & Johnson vaccine.

While I agree with you that some people are making an illogical decision not to get vaccinated, many others are doing so based on misinformation. They may have heard something, usually passed on in good faith, that leads them to think the vaccine has more risk than getting COVID, but this is absolutely not true.

Further, more than a few people are falling victim to malicious and untrue information about the vaccine or the disease that is passed along either to profit someone who is selling unscrupulous treatments, or by people who simply want to cause chaos.

Many health care workers are physically, mentally and emotionally exhausted by nearly two years of the pandemic, and it is hard to continue to care for people who have, mostly, chosen not to get the vaccine and who are very ill or dying due to that decision. That’s why I continue to implore people to get the vaccine before they get sick. Today would be a good day if you haven’t yet done so.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.