Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly
- 420 Downloads
To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES).
Materials and methods
One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity.
Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003).
Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.
KeywordsPresbyphagia Stasis Dysphagia Swallowing disorders Older adults Fiber optic endoscopic evaluation of swallowing
Compliance with ethical standards
The authors received no financial support for this study.
Conflict of interest
All author and co-authors declare that they do not have conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional, CAAE 08674612.2.0000.5505 and it was approved (152.28) by UNIFESP-EPM.
Informed consent was obtained from all individual participants included in the study.
- 1.Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rösler A, Shaker R, Warnecke T, Sieber CC, Volkert D (2016) Oropharyngeal dysphagia in older persons—from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 11:189–208. https://doi.org/10.2147/CIA.S97481.eCollection2016 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Eibling DE, Coyle JL (2017) Dysphagia in the elderly. In: Carrau RL, Murry T, Howell RJ (eds) Comprehensive management of swallowing disorders, 2nd edn. Plural Publishing, San Diego, pp 489–497Google Scholar
- 4.Puisieux F, D’Andrea C, Baconnier P, Bui-Dinh D, Castaings-Pelet S, Crestani B, Desrues B, Ferron C, Franco A, Gaillat J, Guenard H, Housset B, Jeandel C, Jebrak G, Leymarie-Saddles A, Orvoen-Frija E, Piette F, Pinganaud G, Salle JY, Strubel D, Vernejoux JM, de Wazières B, Weil-Engerer S (2011) Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly. Rev Mal Respir 28:76–93. https://doi.org/10.1016/j.rmr.2011.09.007 CrossRefGoogle Scholar
- 7.Crary MA, Groher ME (2003) Introduction to adult swallowing disorders. Butterworth Heinemann, PhiladelphiaGoogle Scholar
- 9.Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M (2016) European Society for Swallowing Disorders—European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 11:1403–1428. https://doi.org/10.2147/CIA.S107750 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Carrau RL, Howell RJ (2017) The otolaryngologist’s perspective. In: Carrau RL, Murry T, Howell RJ (eds) Comprehensive management of swallowing disorders, 2nd edn. Plural Publishing, San Diego, pp 37–42Google Scholar
- 30.Aviv JE, Murry T (2005) Flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Plural Publishing, San Diego, pp 2–4Google Scholar