Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art

Ortega, Omar; Martín-Martínez, Alberto; Clavé, Père

doi:10.1016/j.jamda.2017.02.015

Cited by 223 publications

(147 citation statements)

References 84 publications

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“…In Parkinson's disease sensory, pharyngeal nerves are directly affected by the Lewy pathology, which is associated with dysphagia . In geriatric patients with dysphagia, age‐related reduced pharyngeal sensation is an important contributing factor . In intensive care, intubation‐induced mucosal damage often leads to laryngeal sensory deficits and can result in post‐extubation dysphagia .…”

Section: Introductionmentioning

confidence: 99%

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

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Background Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. Methods A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue‐dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. Key Results The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = −3.82; P = .001), 0.3 mL (t = −4.65; P < .000), 0.4 mL (t = −5.77; P < .000), and 0.5 mL (t = −3.49; P = .005). Conclusion and Inferences Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.

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Section: Introductionmentioning

confidence: 99%

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

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show abstract

“…Dysphagia is known to be associated with aspiration pneumonia, malnutrition and dehydration, and leads to reduced quality of life . Numerous studies have reported that neurological disorders, such as stroke, neurodegenerative diseases, and head and neck cancer, can cause dysphagia . Additionally, in recent years, a new concept, related to a decline in muscle mass and strength of the swallowing muscle, has been recognized as another dysphagia etiology, called sarcopenic dysphagia .…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have reported that neurological disorders, such as stroke, neurodegenerative diseases, and head and neck cancer, can cause dysphagia . Additionally, in recent years, a new concept, related to a decline in muscle mass and strength of the swallowing muscle, has been recognized as another dysphagia etiology, called sarcopenic dysphagia . Several previous studies have shown the relationship between swallowing ability and loss of skeletal muscle mass and muscle strength .…”

Section: Introductionmentioning

confidence: 99%

“…3 Additionally, in recent years, a new concept, related to a decline in muscle mass and strength of the swallowing muscle, has been recognized as another dysphagia etiology, called sarcopenic dysphagia. [3][4][5] Several previous studies have shown the relationship between swallowing ability and loss of skeletal muscle mass and muscle strength. [6][7][8][9][10][11] Furthermore, rehabilitation, including dysphagia training and nutritional intervention, might be considered an effective treatment for sarcopenic dysphagia.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 In dysphagia rehabilitation patients, texture-modified diets (TMD) and thickened liquids are often used to facilitate and increase oral intake. 3,14 TMD are provided to long-term care patients at a rate of 15-30%. 15 However, TMD consist of lower energy and protein compared with normal diets.…”

Section: Introductionmentioning

confidence: 99%

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Texture‐modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward

Shimizu

Maeda

Tanaka

et al. 2017

Geriatrics Gerontology Int

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Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Makhnevich,

Perrin,

Talukder

et al. 2024

JAMA Intern Med

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ImportanceOropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes.ObjectivesTo determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia.Design, Setting, and ParticipantsThis cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium).Main Outcomes and MeasuresHospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS).ResultsOf 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91).Conclusions and RelevanceThis cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.

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Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art

Cited by 223 publications

References 84 publications

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Texture‐modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

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