Dysphagia in Older Adults

Abstract

Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient's history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia. If providers are diagnosing esophageal dysphagia, barium esophagraphy or esophagogastroduodenoscopy (EGD) can be used as part of the assessment. Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.

A Systematic Review of Oropharyngeal Dysphagia Models in Rodents

“…Dysphagia can be divided into three major phases: oral, pharyngeal, and esophageal. The oral and pharyngeal phases are generally classified together in the clinic as oropharyngeal dysphagia [ 48 ]. The oral phase is a voluntary process where food bolus is formed and transferred from the mouth to the pharynx.…”

“…The muscles used to swallow can be weakened with age. This can explain why swallowing difficulties are relatively common in the elderly [ 48 ]. Reparatory failure that makes it difficult to breathe properly affects swallowing ability.…”

Oropharyngeal Dysphagia in Older Patients

“…Dysphagia is associated with major nutritional and respiratory complications, particularly in older patients, resulting in multiple negative health consequences, most commonly increased risk of malnutrition and dehydration, frailty, asphyxiation, aspiration-related pneumonias and death. Depression, social isolation and poorer healthrelated quality of life are other established implications [1,[6][7][8][9][10][11]. Dysphagia is a growing geriatric syndrome of increasing frequency, impacting on morbidity, mortality and costs associated with hospital length of stay [11][12][13].…”

“…Depression, social isolation and poorer healthrelated quality of life are other established implications [1,[6][7][8][9][10][11]. Dysphagia is a growing geriatric syndrome of increasing frequency, impacting on morbidity, mortality and costs associated with hospital length of stay [11][12][13]. In many hospitals, an overt discrepancy exists between these factors and the associated nutritional and respiratory complications of oropharyngeal dysphagia and the limited availability of both human and material resources available to patients with dysphagia [1,8].…”

“…Swallowing screening has been previously defined as a minimally invasive evaluation that rapidly examines the following: (1) the likelihood of dysphagia, (2) the requirement for further swallowing assessment, (3) the safety of patient oral intake and (4) the requirement for alternative nutritional support. Whereas a swallowing assessment would usually include a case history (related to swallowing problems), an in-depth examination of oral, pharyngeal and laryngeal anatomy; sensory and motor function and behavioural, cognitive and language abilities; and an oral/feeding trial if appropriate [11,12].…”