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Eating, drinking and swallowing in the context of older age
Published in Rebecca Allwood, Working with Communication and Swallowing Difficulties in Older Adults, 2022
Age-related swallowing changes are sometimes termed as ‘presbyphagia’, which sets it apart from disease-related dysphagia. However, given the increased prevalence of disease-related dysphagia in older age, both presbyphagia and disease-related dysphagia will co-occur in many older adults. For the purpose of clarity in this book, age-related swallowing changes will be referred to as age-related swallowing changes or impairment, with pathological swallowing impairments referred to as dysphagia.
Physiology of Swallowing
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Joanne M. Patterson, Stephen McHanwell
Presbyphagia is defined as normal age-related changes in swallowing in healthy adults. Sarcopenia is the term used to describe the age-related decrease in muscle mass, strength and coordination. As a consequence of this process, older people have generally weaker oral phase movements, including reduced tongue strength.69 Although still able to achieve adequate lingual pressures for swallowing, these pressures are generated more slowly than in younger people.70, 71 Loss of dentition is common, reducing the number of opposing dental units for biting and grinding. Ill-fitting dentures may further hamper the oral preparatory phase. Changes to smell and taste also occur as part of the ageing process, impacting on the pleasure of eating and appetite. The pharyngeal phase is often longer in duration, with prolonged hyolaryngeal excursion. The pharyngeal wall can thin over time, creating a larger vault at rest, consequently reducing maximal constriction and pharyngeal pressure generation.72–76 Sensory changes may account for a slower swallowing response time.70
Dysphagia in Older Adults and Its Management
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Presbyphagia refers to normal age-related changes that occur in the swallowing mechanism and may place an older adult at risk for dysphagia. Age-related changes include the loss of dentition and increased lingual atrophy with decreased lingual strength (6,15), delays in pharyngeal transit time (29,31), and delays in the closing of the laryngeal vestibule during the swallow, resulting in the bolus being adjacent to an open airway (23,37). Normal aging can also result in decreased taste, smell, lingual pressure, and enlarged cervical osteophytes that impinge on the pharyngeal wall. Age-related changes to the swallowing mechanism may place the older adult at a higher risk for dysphagia especially in the presence of other factors such as decreased cognition, multiple-morbidities, polypharmacy, and frailty.
Profiles of polypharmacy in older adults and medication associations with signs of aspiration
Published in Expert Review of Clinical Pharmacology, 2021
Dai Pu, Michael C.H. Wong, Edwin M.L. Yiu, Karen M.K. Chan
In univariate analysis, laxatives, proton pump inhibitors, and supplements also showed associations with signs of aspiration. Although they did not emerge as significant in multivariate analysis, they will be briefly discussed here. Use of laxatives may be associated with swallowing difficulties that are causing reduced oral intake of foods that are high in fiber to aid in stool elimination. However, the prevalence of constipation that requires laxatives also increases with age [47], so its association with signs of aspiration in univariate analysis may simply be reflective of this. Proton pump inhibitors are typically used to reduce stomach acid and manage gastro-esophageal reflux disorder (GERD). GERD can cause dysphagia [48], and those who suffer from GERD often report symptoms of dysphagia [49], which includes signs of aspiration. Finally, supplements were used by more than 30% of the older adults in this study, which may reflect frailty in this group. Frailty is associated with presbyphagia (age-related changes in swallowing function). A more detailed examination of the types of supplements that were used and whether they were medically recommended may yield more information.
Swallowing and ageing
Published in Speech, Language and Hearing, 2019
Swallowing is a complex biomechanical event involving motor and sensory function. It is known that swallow function declines with age (Baijens et al., 2016; Molfenter, Brates, Hertzberg, Noorani, & Lazarus, 2018; Namasivayam-MacDonald, Barbon, & Steele, 2018; Omari et al., 2014) and many older people experience some disruption to swallow function in the absence of any other underlying disease (Ekberg & Feinberg, 1991). This is called presbyphagia. Robbins, Levine, Wood, Roecker, and Luschei (1995) suggest that age-related changes in swallowing occur after 60 years. With age comes a range of different factors that independently impact on eating, drinking and swallowing. These include increased medication use and polypharmacy, decreased appetite and frailty. There is also a risk of developing conditions that are known to give rise to significant dysphagia. These include neurodegenerative diseases such as dementia, as well as stroke, progressive neurological conditions, respiratory disease and cancer. Baijens et al. (2016) argue that oropharyngeal dysphagia is a ‘geriatric syndrome’ in that it is a clinical condition prevalent in older age, is associated with multiple comorbidities and poor patient outcomes. Epidemiology statistics for dysphagia in older healthy people vary between 15% (Madhavan, LaGorio, Crary, Dahl, & Carnaby, 2016) and 35% (Lindgren & Janzon, 1991). However, these figures are influenced by both the definition of dysphagia used, methods employed to determine its presence and methodological limitations of studies including small sample sizes.
Predictive value of laryngeal adductor reflex testing in patients with dysphagia due to a cerebral vascular accident
Published in International Journal of Speech-Language Pathology, 2019
Megan E. Cuellar, Jennine Harvey
Swallowing involves an intricate pattern of sequential movements that require both voluntary and involuntary neuromuscular control. Although strong and coordinated motor function is an important contributing factor to safe swallowing, normal sensory processing is also essential. Impaired laryngopharyngeal sensation is frequently associated with increased risk of aspiration (Aviv et al. 1997, 2002; Kidd, Lawson, Nesbitt, & MacMahon, 1993; Langmore, 1998; Rees, 2006). Specifically, pharyngeal phase sensory impairments can lead to a variety of sensory deficits such as a delayed trigger of the pharyngeal swallow, decreased responsiveness to pharyngeal secretions and/or residue and decreased responsiveness to penetrated or aspirated material (Langmore, 2001; Logemann, 1998). In addition, taste, temperature and tactile sensory thresholds decrease with age, particularly in the oral cavity and laryngopharynx (Humbert & Robbins, 2008; Lin, Watson, & Wu, 2010). As a result, decreased airway protection, as well as dehydration and malnutrition may occur, particularly in individuals that suffer from presbyphagia (Lin et al., 2010; Ney, Weiss, Kind, & Robbins, 2009; Shune, Moon, & Goodman, 2016). According to incidence and prevalence studies, oropharyngeal dysphagia is one of the leading causes of pneumonia (Marik & Kaplan, 2003; Paik, 2011), dehydration (Garcia, Chambers, Clark, Helverson, & Matta, 2010; Rofes, Arreola, Cabre, Campins, & Garcia-Peris, 2011) and malnutrition (Ney et al., 2009; Rofes et al., 2011) in older individuals. Such pulmonary and nutritional complications often exacerbate the functional decline of individuals with dysphagia, and are associated with poor prognoses, prolonged hospital admissions and increased mortality rates (Altman, 2011; Finlayson, Kapral, Hall, Asllani, Selchen & Saposnik, 2011; Ney et al., 2009; Paik, 2011).