Age Related Swallowing

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Signs of Normal aging

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Reduced maximal laryngeal and hyoid anterior and vertical movement in the elders;Elders had reduced flexibility in cricopharyngeal opening (i.e., less change as volume increased);if weakened due to illnes, etc., they are at greater risk for swallowing problems;

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Aging and Senses

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Taste and smell sensations are reduced, with smell affected more so;Elderly may lose interest in nutritious food and may add salt or sugar; Elderly require less calories, but more nutrient rich foods (e.g., protein), thus this can lead to malnutrition; nMedication can leave a metallic taste in the mouth, making the problem worse

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Changes in oropharyngeal swallow over age 60

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Older individuals will hold the bolus on the floor of the mouth and pick it up with the tongue tip more frequently (‘dipper’ swallow); nOral stage is slightly longer, as well as the ‘normal’ delay in triggering the pharyngeal swallow; Small increase in frequency and extent of oral or pharyngeal residue; Penetration increases in frequency with age, but no increase in aspiration; Esophageal function deteriorates, increasing esophageal transit time

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Dentition in the elderly

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Number of chewing strokes increases when person has poor dentition

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Ossification

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Ossification in the thyroid and cricoid cartilages and hyoid bone increases, thus appearing more promin

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Age 70 and older

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Larynx can begin to lower (7th cervical vertebra); Cervical arthritis increases; These changes can decrease the flexibility of the pharyngeal wall; This in turn, can lead to reduced strength of pharyngeal contraction and a need to swallow 2x to clear residue post swallow

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Neurologic disorders

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Neurologic disorders such as stroke, Parkinson's disease, amyotrophic lateral sclerosis, Bell's palsy, or myasthenia

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Decrease in salivary flow

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Decrease in salivary flow can be due to Sjogren's syndrome, anticholinergics, antihistamines, or certain antihypertensives and can lead to incomplete processing of food bolus.

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Abnormality in oral mucosa

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Abnormality in oral mucosa such as from mucositis, aphthous ulcers, or herpetic lesions can interfere with bolus processing

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Mechanical obstruction

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Mechanical obstruction in the oropharynx may be due to malignancies, cervical rings or webs, or cervical osteophytes.

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Increased upper esophageal sphincter tone

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Increased upper esophageal sphincter tone can be due to Parkinson's disease which leads to incomplete opening of the UES. This may lead to formation of a Zenker's diverticulum.

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Pharyngeal pouches

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Pharyngeal pouches typically cause difficulty in swallowing after the first mouthful of food, with regurgitation of the pouch contents

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Infection

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Infection may cause pharyngitis which can prevent swallowing due to pain.

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Peptic stricture

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Peptic stricture, or narrowing of the esophagus, is usually a complication of acid reflux, most commonly due to gastroesophageal reflux

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Gastroesophageal Reflux Disease (GERD

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is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus[1].

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Esophageal cancer

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progressive mechanical dysphagia; usually occurs in the elderly

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Percentage of elderly population with dysphagia in elderly facility

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50% of population needing assistance with swallowing.

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deglutition

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Swallowing,

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common complaint of dysphagia

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food is getting stuck

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Danger of dysphagia in the elderly

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Poststroke patients and those with dementia may not have the cognitive skills to recognize or understand the danger dysphagia presents with regard to choking or aspiration.

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prevalence of dysphagia

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In people older than 60, the prevalence of dysphagia is 15% to 40%

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Consequences of dysphagia

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social isolation due to embarassment of choking and coughing at mealtimes.; Physical discomfort; esophageal injury due to medications

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Life threatening consequences of dysphagia

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malnutrition; silent aspiration; dehydration

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Treatment

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the goals are to identify and maintain safe swallowing techniques, prevent aspiration, and provide adequate nutritional support.

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Treatment cont.

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For patients with untreatable neuromuscular disorders, modifying the consistency of food may improve swallowing. Additional measures may include exercises to strengthen and improve the coordination of the tongue, learning a variety of swallowing techniques, and altering the position of the head while eating

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Treatment cont

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gastrostomy tube placement may be needed in those with severe dysphagia and recurrent aspiration.patients may need rehabilitation to retrain swallowing muscles. Patients with head and neck tumors usually require intervention such as surgery, radiation therapy, or chemotherapy; esophageal stricture may follow surgery or radiation therapy.