Swallowing Changes in Community-Dwelling Older Adults

Abstract

Older adults may evidence changes in swallowing physiology. Our goals were to identify dysphagia risk in community-dwelling older adults with no history of dysphagia, and to compare swallowing physiology and safety between older and younger adults. Thirty-two older adults with no history of dysphagia were prospectively recruited and completed the Dysphagia Handicap Index (DHI), two trials of a 3 oz. swallow screen, and videofluoroscopy (VFSS). Self-ratings of swallowing function were compared to published norms by paired t tests, and multivariate logistic regression models were generated to determine whether these ratings and VFSS analysis of swallowing function were associated with failure of one or both swallow screen trials. Archived VFSS of 33 younger adults were compared to older adults with Wilcoxon rank-sum tests. The DHI scores of older adults were higher than published non-dysphagic adults but lower than dysphagic adults. Older participants with greater Oral Residue scores were more likely to fail both swallow screen trials. Older adults received higher median MBSImP™© scores for select pharyngeal components than younger adults. The two age groups did not differ on Penetration-Aspiration Scale scores, and no aspiration was observed. Measures of swallowing in older individuals may reflect age-related sensory and motor changes in the context of functional swallowing and adequate airway protection.

Which Physiological Swallowing Parameters Change with Healthy Aging?

“…Oropharyngeal dysphagia is characterized by two primary functional impairments: a) impaired swallowing safety, involving penetration or aspiration of material into the larynx and lower respiratory tract; and b) impaired swallowing efficiency, where poor bolus clearance leads to pharyngeal residue [8,9]. Although penetration-aspiration and residue are usually interpreted to represent impairment, several studies suggest that these phenomena may be seen in a small percentage of healthy adults on videofluoroscopic or endoscopic examination, with higher frequency in healthy older adults [10][11][12][13]. In order to better understand these apparent changes in swallowing function, it is also important to determine whether there are age-related changes in the underlying anatomy and physiology of swallowing.…”

Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea

“…[7,8] As a result, various problems can occur, such as lateral sulcus residue, poor bolus formation and mastication during the oral phase, and vallecular residue and aspiration during the pharyngeal phase. [6,9]…”

Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil

“…In the study conducted by Beyon 31 , 33.9% of the participants complained of swallowing difficulties and 39.8% reported having aspirated food. De Lima Alvarenga et al 32 found that 21% of interviewees experienced choking episodes and Mulheren et al 33 found that 29% of interviewees reported mild to moderate swallowing difficulty.…”