From the Guidelines
Drooling in the elderly is best managed with anticholinergic agents as the first line of treatment, considering their relatively low cost and availability, as recommended by the American College of Chest Physicians 1. The management of drooling in the elderly involves a multifaceted approach, including non-pharmacological and pharmacological interventions.
Non-Pharmacological Management
Non-pharmacological management includes:
- Improving oral hygiene
- Postural adjustments, such as sitting upright during meals
- Speech therapy exercises to enhance swallowing
Pharmacological Management
For medication options, anticholinergics like glycopyrrolate or scopolamine patches are recommended as the initial treatment due to their efficacy in reducing saliva production 1.
- Glycopyrrolate can be administered at a dose of 1-2mg twice daily
- Scopolamine patches can be used at a dose of 1.5mg every three days Botulinum toxin injections into the salivary glands can provide temporary relief lasting 3-6 months, but the optimal dose is not well established due to variability in the literature 1.
Considerations
Management should be individualized, starting with the least invasive options and considering the patient's overall health status.
- Anticholinergics can cause side effects like confusion, urinary retention, and constipation in elderly patients
- The choice of treatment should prioritize minimizing morbidity, mortality, and improving quality of life.
- Recent studies, such as those published in 2025, focus on the standardization of pre-analytical variables for salivary biomarker studies in Alzheimer's disease research, but do not directly influence the management of drooling in the elderly 1.
- The most recent and highest quality study, published in 2023, guides the recommendation for anticholinergic agents as the first line of treatment 1.
From the FDA Drug Label
Glycopyrrolate oral solution is indicated to reduce chronic severe drooling in patients aged 3 to 16 years with neurologic conditions associated with problem drooling (e.g., cerebral palsy)
The FDA drug label does not answer the question regarding management of drooling in the elderly.
From the Research
Management of Drooling in the Elderly
Drooling in the elderly is a common issue that can be caused by various factors, including neurodegenerative diseases, poor oral and facial muscle control, and excess salivation. The management of drooling in the elderly requires a multidisciplinary approach, involving healthcare professionals from different fields.
Causes and Complications of Drooling
- Drooling can lead to irritation and excoriation of the skin around the mouth or chin, favoring infections and giving rise to speech or eating disorders 2.
- The estimated mean prevalence of drooling in elderly patients is 37% 2.
- Drooling can cause physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization 3.
Treatment Options for Drooling
- Conservative approaches, such as myofunctional therapy, behavioral change techniques, and postural changes, can be effective in managing drooling 2, 3.
- Anticholinergic medications, such as glycopyrrolate and scopolamine, can reduce drooling, but their use may be limited by side effects 3, 4, 5.
- Botulinum toxin injections can be safe and effective in controlling drooling, but the effects may fade after several months, requiring repeat injections 6, 3.
- Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, can provide a more permanent solution for significant sialorrhea 3.
Multidisciplinary Approach to Drooling Management
- A multidisciplinary team, including primary healthcare providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists, is essential for effective drooling management 6, 3.
- The team should work together to develop an individualized treatment plan, taking into account the patient's specific needs and circumstances 4.