Changes in etiology and severity of dysphagia with aging
Key summary points
This study aimed to investigate the characteristics of dysphagia in the oldest-old population and the effect of aging on swallowing physiology.
Dysphagia in the oldest-old was more severe than in older persons. The etiology of dysphagia showed a lower proportion of CNS disorder ratio and a higher proportion of other diseases not related to dysphagia in the oldest-old. Additionally, lower BMI and a higher frailty index were found among the oldest old, compared to older persons.
Dysphagia can be caused by health conditions unrelated to swallowing, and tends to be more severe in the oldest-old than in the older population; malnutrition and frailty are positively correlated with dysphagia severity in older-aged people.
To investigate characteristics of dysphagia in the oldest-old population and the effect of aging on swallowing physiology.
418 (364 men, 54 women) patients who underwent videofluoroscopic swallow study (VFSS) for dysphagia were included. The patients were divided into an older group, group I (60–79 years old, n = 275) and the oldest-old group, group II (80–96 years old, n = 143). Sex, cognition, duration of symptoms, BMI (body mass index), frailty index derived from comprehensive geriatric assessment (FI-CGA), penetration aspiration scale (PAS), and videofluoroscopic dysphagia scale (VDS) scores and the etiologies of dysphagia were compared between the groups. The correlation analysis of BMI and FI-CGA with dysphagia severity and age was performed.
The proportion of males, K-MMSE scores, the duration of symptoms, BMI scores and FI-CGA were significantly greater in group I than II. The PAS and VDS scores were significantly higher in group II than I. The proportion of CNS disorders was significantly higher in group I than in group II. The proportion of poor general medical condition was significantly higher in group II than in group I. A negative correlation between BMI and dysphagia severity and a positive correlation between FI-CGA and dysphagia severity were observed.
Dysphagia tends to be more severe in the oldest-old, and can be caused by health conditions unrelated to swallowing. Malnutrition and frailty correlated positively with dysphagia severity, irrespective of age.
KeywordsAge Dysphagia Frailty Malnutrition Severity
This study was supported by a VHS Medical Center Research Grant, Republic of Korea (Grant No: VHSMC19009). We would like to acknowledge and thank VHS Medical Center Research Grant.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the Ethics Committees of the Veterans Health Service Medical Center Institutional Review Board (No. 2018-12-017). All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
All study participants provided informed consent.
- 1.Wang CM, Chen JY, Chuang CC, Tseng WC, Wong AM, Pei YC (2015) Aging-related changes in swallowing, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques. Geriatr Gerontol Int 15(6):736–744. https://doi.org/10.1111/ggi.12343 CrossRefPubMedGoogle Scholar
- 2.Muhammad Aslam M, Vaezi MF (2013) Dysphagia in the elderly. Gastroenterol Hepatol 9(12):784–795Google Scholar
- 13.Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T et al (2008) High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc 56(3):577–579. https://doi.org/10.1111/j.1532-5415.2008.01597.x CrossRefPubMedGoogle Scholar
- 15.Keeling WB, Hernandez JM, Lewis V, Czapla M, Zhu W, Garrett JR et al (2010) Increased age is an independent risk factor for radiographic aspiration and laryngeal penetration after thoracotomy for pulmonary resection. J Thorac Cardiovasc Surg 140(3):573–577. https://doi.org/10.1016/j.jtcvs.2010.02.049 CrossRefPubMedGoogle Scholar
- 16.Iinuma T, Hirata T, Arai Y, Takayama M, Abe Y, Fukumoto M et al (2017) Perceived swallowing problems and mortality risk in very elderly people >/=85 years old: results of the Tokyo Oldest Old Survey on Total Health study. Gerodontology 34(3):313–319. https://doi.org/10.1111/ger.12265 CrossRefPubMedGoogle Scholar
- 20.Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC (2012) Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 13(10):e437–e444. https://doi.org/10.1016/S1470-2045(12)70259-0 CrossRefGoogle Scholar
- 29.Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ et al (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 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Bales CW, Ritchie CS (2002) Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr 22:309–323. https://doi.org/10.1146/annurev.nutr.22.010402.102715 CrossRefPubMedGoogle Scholar
- 35.Chatindiara I, Allen J, Popman A, Patel D, Richter M, Kruger M et al (2018) Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission. BMC Geriatr 18(1):78. https://doi.org/10.1186/s12877-018-0771-x CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Aliasghari F, Izadi A, Khalili M, Farhoudi M, Ahmadiyan S, Deljavan R (2019) Impact of premorbid malnutrition and dysphagia on ischemic stroke outcome in elderly patients: a community-based study. J Am Coll Nutr 38(4):318–326. https://doi.org/10.1080/07315724.2018.1510348 CrossRefPubMedGoogle Scholar