Oropharyngeal dysphagia in elderly persons: Etiology, pathophysiology and symptomatology (original) (raw)
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Pathophysiology, Relevance and Natural History of Oropharyngeal Dysphagia among Older People
Nestlé Nutrition Institute Workshop Series, 2012
Oropharyngeal dysphagia (OD) is a very frequent condition among older people with a prevalence ranging from mild symptoms in 25% of the independently living to severe symptoms in more than 50% living in nursing homes. There are several validated methods of screening, and clinical assessment and videofluoroscopy are the gold standard for the study of the mechanisms of OD in the elderly. Oropharyngeal residue is mainly caused by weak bolus propulsion forces due to tongue sarcopenia. The neural elements of swallow response are also impaired in older persons, with prolonged and delayed laryngeal vestibule closure and slow hyoid movement causing oropharyngeal aspirations. OD causes malnutrition, dehydration, impaired quality of life, lower respiratory tract infections, aspiration pneumonia, and poor prognosis including prolonged hospital stay and enhanced morbidity and mortality in several phenotypes of older patients ranging from independently living older people, hospitalized older patients and nursing home residents. Enhancing bolus viscosity of fluids greatly improves safety of swallow in all these patients. We believe OD should be recognized as a major geriatric syndrome, and we recommend a policy of systematic and universal screening and assessment of OD among older people to prevent its severe complications.
Oropharyngeal Dysphagia in Elderly People
2018
The number of elderlies in the world is increasing and healthy aging has become a salient issue. A health threatening factor quite prevalent among the elderlies is dysphagia. Dysphagia causes severe complications and may have negative effects on the functional ability of patients; therefore, it is known as a geriatric syndrome. Oropharyngeal dysphagia is a difficulty or an inability of forming the bolus in the mouth and safely moving it from the mouth to the esophagus. It is also interrelated to other health problems such as malnutrition and oral health. Dysphagia, malnutrition and oral health disorders are likely to cause life-threatening aspiration pneumonia in patients. As a geriatric syndrome, dysphagia should be diagnosed and managed by a multidisciplinary team of professionals. Beside health care professionals, other groups such as policymakers, researchers and scientists, industries, health funders, and the society can have their own unique role to improve the quality of care...
Clinical Interventions in Aging, 2016
Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.
Pathophysiology of oropharyngeal dysphagia in the frail elderly
Neurogastroenterology & Motility, 2010
Background Oropharyngeal dysphagia is a major complaint among the elderly. Our aim was to assess the pathophysiology of oropharyngeal dysphagia in frail elderly patients (FEP). Methods A total of 45 FEP (81.5 ± 1.1 years) with oropharyngeal dysphagia and 12 healthy volunteers (HV, 40 ± 2.4 years) were studied using videofluoroscopy. Each subject's clinical records, signs of safety and efficacy of swallow, timing of swallow response, hyoid motion and tongue bolus propulsion forces were assessed. Key Results Healthy volunteers presented a safe and efficacious swallow, faster laryngeal closure (0.157 ± 0.013 s) upper esophageal sphincter opening (0.200 ± 0.011 s), and maximal vertical hyoid motion (0.310 ± 0.048 s), and stronger tongue propulsion forces (22.16 ± 2.54 mN) than FEP. By contrast, 63.63% of FEP presented oropharyngeal residue, 57.10%, laryngeal penetration and 17.14%, tracheobronchial aspiration. Frail elderly patients with impaired swallow safety showed delayed laryngeal vestibule (LV) closure (0.476 ± 0.047 s), similar bolus propulsion forces, poor functional capacity and higher 1-year mortality rates (51.7% vs 13.3%, P = 0.021) than FEP with safe swallow. Frail elderly patients with oropharyngeal residue showed impaired tongue propulsion (9.00 ± 0.10 mN), delayed maximal vertical hyoid motion (0.612 ± 0.071 s) and higher (56.0% vs 15.8%, P = 0.012) 1-year mortality rates than those with efficient swallow. Conclusion & Inferences Frail elderly patients with oropharyngeal dysphagia presented poor outcome and high mortality rates. Impaired safety of deglutition and aspirations are mainly caused by delayed LV closure. Impaired efficacy and residue are mainly related to weak tongue bolus propulsion forces and slow hyoid motion. Treatment of dysphagia in FEP should be targeted to improve these critical events.
Oropharyngeal Dysphagia in Older Patients
Perspectives in Nursing Management and Care for Older Adults, 2021
Dysphagia in older adults can have a profound adverse influence nutrition and hydration status, quality of life, morbidity, mortality and healthcare costs in adults. Identification and management of dysphagia in older adults are most effective when implemented by a team, including a nurse, physician, speech-language pathologist, dietitian and occupational therapist. However, each professional’s role may vary according to the standards, responsibilities and resources available in local settings.
Oropharyngeal Dysphagia in the Elderly
Clinics in Geriatric Medicine, 1992
Swallowing is one of the primary and most basic of the behaviors needed to sustain life. The ability to swallow and to transport food from the oral cavity to the gut is so essential to human survival that it is prewired at birth. Evidence has suggested that swallowing behavior is evident in the fetus while it is in the womb. The infant is able to suck and to handle food almost from the moment it exits the birth canal, soon after the first cry. Swallowing behavior can be sustained entirely by brain stem and cranial nerve activity in comatose or decerebrate individuals; it does not require active cortical control. Because swallowing is a basic reflex and requires minimal cognitive effort, is it a process that is spared over the life span? Does advanced age have any impact on this important basic behavior? This article describes the effects of normal and pathologic aging on swallowing. Some theories consider aging to be an irreversible process that slows down or alters function, whereas others speculate that deficits are associated only with diseases in an individual. A variety of chronic diseases appear in older persons causing them to take numerous medications that in combination produce side effects, such that cognition, neuromotor function, and independence may be altered. Consequently, more elderly persons require institutionalization and dysphagia is more prevalent in older institutionalized persons, specifically males over age 60.3,30 NORMAL SWALLOWING The healthy, mature individual prepares, ingests, and transports food materials from the mouth into the pharynx in approximately 1 to 2 seconds.35 The passage of this masticated bolus through the esophagus into the stomach takes another 8 to 10 seconds. The ingestion of food (the act of swallowing) is composed of several stages that may overlap or occur simultaneously. Swallowing consists of From the W.
The Annals of otology, rhinology, and laryngology, 2007
Epidemiological studies of dysphagia in the elderly are rare. A non-treatment-seeking, elderly cohort was surveyed to provide preliminary evidence regarding the prevalence, risks, and socioemotional effects of swallowing disorders. Using a prospective, cross-sectional survey design, we interviewed 117 seniors living independently in Utah and Kentucky (39 men and 78 women; mean age, 76.1 years; SD, 8.5 years; range, 65 to 94 years) regarding 4 primary areas related to swallowing disorders: lifetime and current prevalence, symptoms and signs, risk and protective factors, and socioemotional consequences. The lifetime prevalence of a swallowing disorder was 38%, and 33% of the participants reported a current problem. Most seniors with dysphagia described a sudden onset with chronic problems that had persisted for at least 4 weeks. Stepwise logistic regression identified 3 primary symptoms uniquely associated with a history of swallowing disorders: taking a longer time to eat (odds ratio...
Journal of Clinical Medicine
Background: This systematic review and meta-analysis aimed to estimate the pooled prevalence of dysphagia in older adults, subgrouping by recruitment settings and varying dysphagia assessment methods. Methods: Five major databases were systematically searched through January 2022. A random-effects model for meta-analysis was conducted to obtain the pooled prevalence. Results: Prevalence of dysphagia in the community-dwelling elderly screened by water swallow test was 12.14% (95% CI: 6.48% to 19.25%, I2 = 0%), which was significantly lower than the combined prevalence of 30.52% (95% CI: 21.75% to 40.07%, I2 = 68%) assessed by Standardized Swallowing Assessment (SSA) and volume-viscosity swallow test (V−VST). The dysphagia prevalence among elderly nursing home residents evaluated by SSA was 58.69% (95% CI: 47.71% to 69.25%, I2 = 0%) and by the Gugging Swallowing Screen test (GUSS) test was 53.60% (95% CI: 41.20% to 65.79%, I2 = 0%). The prevalence of dysphagia in hospitalized older ad...
Clinical Interventions in Aging, 2016
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.