, Volume 33, Issue 6, pp 759–767 | Cite as

Swallow Event Sequencing: Comparing Healthy Older and Younger Adults

  • Erica G. HerzbergEmail author
  • Cathy L. Lazarus
  • Catriona M. Steele
  • Sonja M. Molfenter
Original Article


Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85–91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young (< 45) and old (> 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration–aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ2 = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.


Swallowing Deglutition Deglutition disorders Dysphagia Sequence Temporal Variation Aging Presbyphagia 



The authors would like to thank Shelby Norman for her assistance in reliability analysis for the healthy older dataset.


This study was funded by NIH National Institute on Deafness and Other Communication Disorders 1R21DC015067.

Compliance with Ethical Standards

Conflict of interest

This work was presented as a poster presentation at the 2018 Dysphagia Research Society Conference (DRS). No other conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Erica G. Herzberg
    • 1
    Email author
  • Cathy L. Lazarus
    • 2
  • Catriona M. Steele
    • 3
    • 4
  • Sonja M. Molfenter
    • 1
  1. 1.Department of Communicative Sciences and DisordersNYU SteinhardtNew YorkUSA
  2. 2.Mount Sinai Beth IsraelNew YorkUSA
  3. 3.Toronto Rehabilitation Institute - University Health NetworkTorontoCanada
  4. 4.Rehabilitation Sciences Institute, University of TorontoTorontoCanada

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