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Oropharyngeal Dysphagia in the Elderly: Evaluation and Prevalence

  • Geriatric Otolaryngology (K Kost, Section Editor)
  • Published:
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Abstract

Purpose of Review

Several age-related sensory and motor changes impact swallow function in the elderly. Dysphagia is a common and growing concern as the geriatric population expands and is associated with emotional, physical, and financial consequences. However, it is underdiagnosed and undertreated, especially in community-dwelling independent older adults who do not report issues with swallowing.

Recent Findings

Otherwise healthy older adults may have senescent swallowing that remains functional until it is disrupted by triggers and becomes dysphagia. Evaluating for dysphagia in the elderly is important, because it is frequently missed until complications requiring hospitalization develop. The evaluation of dysphagia in the independently living elderly relies on screening tests, clinical swallowing evaluations, and instrumental exams. However, limitations exist with the current data, including the lack of consistent swallowing evaluation tools used during screening.

Summary

Dysphagia is a significant problem in the elderly, leading to increased morbidity and cost of care. Further research is necessary to define the prevalence and impact of dysphagia in this population.

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References

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  1. International classification of disease [database on the Internet]2010. Available from: http://www.who.int/classifications/icd/en/. Accessed: 7/17/19.

  2. Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9. https://doi.org/10.1177/0194599814549156.

    Article  PubMed  Google Scholar 

  3. Barczi SR, Sullivan PA, Robbins J. How should dysphagia care of older adults differ? Establishing Optimal Practice Patterns. Semin Speech Lang. 2000;21(4):0347–64. https://doi.org/10.1055/s-2000-8387.

    Article  CAS  Google Scholar 

  4. Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia. 1997;12(1):43–50. https://doi.org/10.1007/pl00009517.

    Article  CAS  PubMed  Google Scholar 

  5. Lee A, Sitoh YY, Lieu PK, Phua SY, Chin JJ. Swallowing impairment and feeding dependency in the hospitalised elderly. Ann Acad Med Singap. 1999;28(3):371–6.

    CAS  PubMed  Google Scholar 

  6. Vincent GK, Velkoff VA. The next four decades: the older population in the United States: 2010 to 2050. 2010.

    Google Scholar 

  7. Namasivayam-MacDonald AM, Barbon CEA, Steele CM. A review of swallow timing in the elderly. Physiol Behav. 2018;184:12–26. https://doi.org/10.1016/j.physbeh.2017.10.023.

    Article  CAS  PubMed  Google Scholar 

  8. Barikroo A, Carnaby G, Crary M. Effects of age and bolus volume on velocity of hyolaryngeal excursion in healthy adults. Dysphagia. 2015;30(5):558–64. https://doi.org/10.1007/s00455-015-9637-y.

    Article  PubMed  Google Scholar 

  9. Wang CM, Chen JY, Chuang CC, Tseng WC, Wong AM, Pei YC. Aging-related changes in swallowing, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques. Geriatr Gerontol Int. 2015;15(6):736–44. https://doi.org/10.1111/ggi.12343.

    Article  PubMed  Google Scholar 

  10. Ihle A, Jopp DS, Oris M, Fagot D, Kliegel M. Investigating discontinuity of age relations in cognitive functioning, general health status, activity participation, and life satisfaction between young-old and old-old age. Int J Environ Res Public Health. 2016;13(11). https://doi.org/10.3390/ijerph13111092.

    Article  PubMed Central  Google Scholar 

  11. Cohen-Mansfield J, Shmotkin D, Blumstein Z, Shorek A, Eyal N, Hazan H, et al. The old, old-old, and the oldest old: continuation or distinct categories? An examination of the relationship between age and changes in health, function, and wellbeing. Int J Aging Hum Dev. 2013;77(1):37–57. https://doi.org/10.2190/AG.77.1.c.

    Article  PubMed  Google Scholar 

  12. Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27(1):2–9. https://doi.org/10.1007/s00455-011-9328-2.

    Article  PubMed  Google Scholar 

  13. Vanderwegen J, Guns C, Van Nuffelen G, Elen R, De Bodt M. The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy belgian adults. Dysphagia. 2013;28(2):159–66. https://doi.org/10.1007/s00455-012-9425-x.

    Article  PubMed  Google Scholar 

  14. AARP. Across the states: profiles of long-term services and supports. https://www.aarp.org/content/dam/aarp/ppi/2018/08/across-the-states-profiles-of-long-term-services-and-supports-full-report.pdf2018.

  15. Robbins J, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology. 1992;103(3):823–9. https://doi.org/10.1016/0016-5085(92)90013-o.

    Article  CAS  PubMed  Google Scholar 

  16. Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24(3):395–413. https://doi.org/10.1177/0884533609332005.

    Article  PubMed  PubMed Central  Google Scholar 

  17. McCoy Yvette M, Varindani DR. Presbyphagia versus dysphagia: identifying age-related changes in swallow function. Perspectives of the ASHA Special Interest Groups. 2018;3(15):15–21. https://doi.org/10.1044/persp3.SIG15.15.

    Article  Google Scholar 

  18. Walshe M. Swallowing and ageing. Speech Lang Hear. 2019;22(1):2–8. https://doi.org/10.1080/2050571X.2019.1567898.

    Article  Google Scholar 

  19. Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, et al. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55(11):M634–40. https://doi.org/10.1093/gerona/55.11.m634.

    Article  CAS  PubMed  Google Scholar 

  20. Affoo RH, Foley N, Garrick R, Siqueira WL, Martin RE. Meta-analysis of salivary flow rates in young and older adults. J Am Geriatr Soc. 2015;63(10):2142–51. https://doi.org/10.1111/jgs.13652.

    Article  PubMed  Google Scholar 

  21. Laguna L, Aktar T, Ettelaie R, Holmes M, Chen J. A comparison between young and elderly adults investigating the manual and oral capabilities during the eating process. J Texture Stud. 2016;47(4):361–72. https://doi.org/10.1111/jtxs.12205.

    Article  Google Scholar 

  22. Hara K, Tohara H, Kenichiro K, Yamaguchi K, Ariya C, Yoshimi K, et al. Association between tongue muscle strength and masticatory muscle strength. J Oral Rehabil. 2019;46(2):134–9. https://doi.org/10.1111/joor.12737.

    Article  PubMed  Google Scholar 

  23. Ekberg O, Feinberg MJ. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. AJR Am J Roentgenol. 1991;156(6):1181–4. https://doi.org/10.2214/ajr.156.6.2028863.

    Article  CAS  PubMed  Google Scholar 

  24. Molfenter SM, Amin MR, Branski RC, Brumm JD, Hagiwara M, Roof SA, et al. Age-related changes in pharyngeal lumen size: a retrospective MRI analysis. Dysphagia. 2015;30(3):321–7. https://doi.org/10.1007/s00455-015-9602-9.

    Article  PubMed  Google Scholar 

  25. De Lima Alvarenga EH, Dall’Oglio GP, Murano EZ, Abrahão M. Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol. 2018;275(2):443–9. https://doi.org/10.1007/s00405-017-4801-7.

    Article  PubMed  Google Scholar 

  26. Molfenter SM, Lenell C, Lazarus CL. Volumetric changes to the pharynx in healthy aging: consequence for pharyngeal swallow mechanics and function. Dysphagia. 2019;34(1):129–37. https://doi.org/10.1007/s00455-018-9924-5.

    Article  PubMed  Google Scholar 

  27. • Cock C, Omari T. Systematic review of pharyngeal and esophageal manometry in healthy or dysphagic older persons (>60 years). Geriatrics (Basel). 2018;3(4). https://doi.org/10.3390/geriatrics3040067. Recent systematic review on manometry findings in elderly.

    Article  PubMed Central  Google Scholar 

  28. •• Baijens LW, Clave P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for Swallowing Disorders—European Union geriatric medicine society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–28. https://doi.org/10.2147/CIA.S107750. Comprehensive review on implications of dysphagia in older adults.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly. Drugs Aging. 2005;22(2):115–30. https://doi.org/10.2165/00002512-200522020-00003.

    Article  PubMed  Google Scholar 

  30. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 2000;10(5):380–6. https://doi.org/10.1159/000016094.

    Article  CAS  PubMed  Google Scholar 

  31. Ikeda M, Brown J, Holland AJ, Fukuhara R, Hodges JR. Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2002;73(4):371. https://doi.org/10.1136/jnnp.73.4.371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kalf JG, De Swart BJM, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–5. https://doi.org/10.1016/j.parkreldis.2011.11.006.

    Article  CAS  PubMed  Google Scholar 

  33. Millsop JW, Wang EA, Fazel N. Etiology, evaluation, and management of xerostomia. Clin Dermatol. 2017;35(5):468–76. https://doi.org/10.1016/j.clindermatol.2017.06.010.

    Article  PubMed  Google Scholar 

  34. Barbe AG. Medication-induced xerostomia and hyposalivation in the elderly: culprits, complications, and management. Drugs Aging. 2018;35(10):877–85. https://doi.org/10.1007/s40266-018-0588-5.

    Article  PubMed  Google Scholar 

  35. Rogus-Pulia NM, Gangnon R, Kind A, Connor NP, Asthana S. A pilot study of perceived mouth dryness, perceived swallowing effort, and saliva substitute effects in healthy adults across the age range. Dysphagia. 2018;33(2):200–5. https://doi.org/10.1007/s00455-017-9846-7.

    Article  PubMed  Google Scholar 

  36. Clave P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259–70. https://doi.org/10.1038/nrgastro.2015.49.

    Article  PubMed  Google Scholar 

  37. Smukalla SM, Dimitrova I, Feintuch JM, Khan A. Dysphagia in the elderly. Curr Treat Options Gastroenterol. 2017;15(3):382–96. https://doi.org/10.1007/s11938-017-0144-0.

    Article  PubMed  Google Scholar 

  38. • Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res. 2019;31(6):799–805. https://doi.org/10.1007/s40520-019-01128-3. Table 1 nicely summarizes the main differences between presbyphagia and dysphagia.

    Article  PubMed  Google Scholar 

  39. Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116(11):858–65. https://doi.org/10.1177/000348940711601112.

    Article  PubMed  Google Scholar 

  40. Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;300(6726):721–2. https://doi.org/10.1136/bmj.300.6726.721.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50-79-year-old men and women in an urban population. Dysphagia. 1991;6(4):187–92.

    Article  CAS  PubMed  Google Scholar 

  42. Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia. 2004;19(4):266–71.

    Article  PubMed  Google Scholar 

  43. Chen PH, Golub JS, Hapner ER, Johns MM 3rd. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24(1):1–6. https://doi.org/10.1007/s00455-008-9156-1.

    Article  PubMed  Google Scholar 

  44. Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24(7):476–80. https://doi.org/10.1111/j.1442-2050.2011.01182.x.

    Article  CAS  PubMed  Google Scholar 

  45. Serra-Prat M, Hinojosa G, Lopez D, Juan M, Fabre E, Voss DS, et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc. 2011;59(1):186–7. https://doi.org/10.1111/j.1532-5415.2010.03227.x.

    Article  PubMed  Google Scholar 

  46. Chen MY, Lin LC. Nonimaging clinical assessment of impaired swallowing in community-dwelling older adults in Taiwan. J Nurs Res. 2012;20(4):272–80. https://doi.org/10.1097/jnr.0b013e31827364ec.

    Article  PubMed  Google Scholar 

  47. Mann T, Heuberger R, Wong H. The association between chewing and swallowing difficulties and nutritional status in older adults. Aust Dent J. 2013;58(2):200–6. https://doi.org/10.1111/adj.12064.

    Article  CAS  PubMed  Google Scholar 

  48. Yang EJ, Kim MH, Lim JY, Paik NJ. Oropharyngeal dysphagia in a community-based elderly cohort: the korean longitudinal study on health and aging. J Korean Med Sci. 2013;28(10):1534–9. https://doi.org/10.3346/jkms.2013.28.10.1534.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gonzalez-Fernandez M, Humbert I, Winegrad H, Cappola AR, Fried LP. Dysphagia in old-old women: prevalence as determined according to self-report and the 3-ounce water swallowing test. J Am Geriatr Soc. 2014;62(4):716–20. https://doi.org/10.1111/jgs.12745.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Okamoto N, Morikawa M, Yanagi M, Amano N, Tomioka K, Hazaki K, et al. Association of tooth loss with development of swallowing problems in community-dwelling independent elderly population: the Fujiwara-kyo study. J Gerontol A Biol Sci Med Sci. 2015;70(12):1548–54. https://doi.org/10.1093/gerona/glv116.

    Article  PubMed  Google Scholar 

  51. Molfenter SM, Brates D, Herzberg E, Noorani M, Lazarus C. The swallowing profile of healthy aging adults: comparing noninvasive swallow tests to videofluoroscopic measures of safety and efficiency. J Speech Lang Hear Res. 2018;61(7):1603–12. https://doi.org/10.1044/2018_JSLHR-S-17-0471.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Mulheren RW, Azola AM, Kwiatkowski S, Karagiorgos E, Humbert I, Palmer JB, et al. Swallowing changes in community-dwelling older adults. Dysphagia. 2018;33(6):848–56. https://doi.org/10.1007/s00455-018-9911-x.

    Article  PubMed  Google Scholar 

  53. Igarashi K, Kikutani T, Tamura F. Survey of suspected dysphagia prevalence in home-dwelling older people using the 10-Item Eating Assessment Tool (EAT-10). PLoS One. 2019;14(1):e0211040. https://doi.org/10.1371/journal.pone.0211040.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Madhavan A, LaGorio LA, Crary MA, Dahl WJ, Carnaby GD. Prevalence of and risk factors for dysphagia in the community dwelling elderly: a systematic review. J Nutr Health Aging. 2016;20(8):806–15. https://doi.org/10.1007/s12603-016-0712-3.

    Article  CAS  PubMed  Google Scholar 

  55. Wallace KL, Middleton S, Cook IJ. Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology. 2000;118(4):678–87. https://doi.org/10.1016/s0016-5085(00)70137-5.

    Article  CAS  PubMed  Google Scholar 

  56. Szczesniak MM, Maclean J, Zhang T, Liu R, Cook IJ. The normative range for and age and gender effects on the Sydney swallow questionnaire (SSQ). Dysphagia. 2014;29(5):535–8. https://doi.org/10.1007/s00455-014-9541-x.

    Article  PubMed  Google Scholar 

  57. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24. https://doi.org/10.1177/000348940811701210.

    Article  PubMed  Google Scholar 

  58. Cheney DM, Siddiqui MT, Litts JK, Kuhn MA, Belafsky PC. The ability of the 10-item eating assessment tool (EAT-10) to predict aspiration risk in persons with dysphagia. Ann Otol Rhinol Laryngol. 2015;124(5):351–4. https://doi.org/10.1177/0003489414558107.

    Article  PubMed  Google Scholar 

  59. Kumbhari V, Azola AA, Tieu AH, Sachdeva R, Saxena P, Messallam AA, et al. Iatrogenic pharyngoesophageal perforations treated with fully covered self-expandable metallic stents (with video). Surg Endosc. 2015;29(4):987–91. https://doi.org/10.1007/s00464-014-3767-4.

    Article  PubMed  Google Scholar 

  60. Perry L. Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses. J Clin Nurs. 2001;10(4):463–73.

    Article  CAS  PubMed  Google Scholar 

  61. •• Clave P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806–15. https://doi.org/10.1016/j.clnu.2008.06.011. Describes a new screening tool for pre-clinical dysphagia.

    Article  PubMed  Google Scholar 

  62. Madhavan A, Carnaby GD, Chhabria K, Crary MA. Preliminary development of a screening tool for pre-clinical dysphagia in community dwelling older adults. Geriatrics (Basel). 2018;3(4). https://doi.org/10.3390/geriatrics3040090.

    Article  PubMed Central  Google Scholar 

  63. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91. https://doi.org/10.1111/j.1532-5415.2007.01156.x.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–36. https://doi.org/10.1378/chest.124.1.328.

    Article  PubMed  Google Scholar 

  65. Reza Shariatzadeh M, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J Am Geriatr Soc. 2006;54(2):296–302. https://doi.org/10.1111/j.1532-5415.2005.00608.x.

    Article  CAS  PubMed  Google Scholar 

  66. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clave P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2010;39(1):39–45. https://doi.org/10.1093/ageing/afp100.

    Article  PubMed  Google Scholar 

  67. DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care. 2015;30(1):40–8. https://doi.org/10.1016/j.jcrc.2014.07.011.

    Article  PubMed  Google Scholar 

  68. Almirall J, Rofes L, Serra-Prat M, Icart R, Palomera E, Arreola V, et al. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur Respir J. 2013;41(4):923–8. https://doi.org/10.1183/09031936.00019012.

    Article  Google Scholar 

  69. Verdonschot R, Baijens LWJ, Vanbelle S, van de Kolk I, Kremer B, Leue C. Affective symptoms in patients with oropharyngeal dysphagia: a systematic review. J Psychosom Res. 2017;97:102–10. https://doi.org/10.1016/j.jpsychores.2017.04.006.

    Article  PubMed  Google Scholar 

  70. Namasivayam-MacDonald AM, Shune SE. The burden of dysphagia on family caregivers of the elderly: a systematic review. Geriatrics (Basel). 2018;3(2). https://doi.org/10.3390/geriatrics3020030.

    Article  PubMed Central  Google Scholar 

  71. Payne MA, Morley JE. Dysphagia: a new geriatric syndrome. J Am Med Dir Assoc. 2017;18(7):555–7. https://doi.org/10.1016/j.jamda.2017.03.017.

    Article  PubMed  Google Scholar 

  72. Patel DA, Krishnaswami S, Steger E, Conover E, Vaezi MF, Ciucci MR, et al. Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus. 2018;31(1):1–7. https://doi.org/10.1093/dote/dox131.

  73. Westmark S, Melgaard D, Rethmeier LO, Ehlers LH. The cost of dysphagia in geriatric patients. Clinicoecon Outcomes Res. 2018;10:321–6. https://doi.org/10.2147/CEOR.S165713.

    Article  PubMed  PubMed Central  Google Scholar 

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Abu-Ghanem, S., Chen, S. & Amin, M.R. Oropharyngeal Dysphagia in the Elderly: Evaluation and Prevalence. Curr Otorhinolaryngol Rep 8, 34–42 (2020). https://doi.org/10.1007/s40136-020-00258-x

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