Advertisement

Changes in etiology and severity of dysphagia with aging

  • Da Hyun Ahn
  • Hea Eun YangEmail author
  • Hyo Jung Kang
  • Kyung Hee Do
  • Seok Cheol Han
  • Soo Woong Jang
  • Jang Ho Lee
Research Paper

Key summary points

Aim

This study aimed to investigate the characteristics of dysphagia in the oldest-old population and the effect of aging on swallowing physiology.

Findings

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.

Message

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.

Abstract

Purpose

To investigate characteristics of dysphagia in the oldest-old population and the effect of aging on swallowing physiology.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Age Dysphagia Frailty Malnutrition Severity 

Notes

Acknowledgements

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.

Ethical approval

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.

Informed consent

All study participants provided informed consent.

References

  1. 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. 2.
    Muhammad Aslam M, Vaezi MF (2013) Dysphagia in the elderly. Gastroenterol Hepatol 9(12):784–795Google Scholar
  3. 3.
    Sonies BC (1992) Oropharyngeal dysphagia in the elderly. Clin Geriatr Med 8(3):569–577CrossRefGoogle Scholar
  4. 4.
    Logemann JA, Curro FA, Pauloski B, Gensler G (2013) Aging effects on oropharyngeal swallow and the role of dental care in oropharyngeal dysphagia. Oral Dis 19(8):733–737.  https://doi.org/10.1111/odi.12104 CrossRefPubMedGoogle Scholar
  5. 5.
    Logemann JA (1990) Effects of aging on the swallowing mechanism. Otolaryngol Clin North Am 23(6):1045–1056PubMedGoogle Scholar
  6. 6.
    Ekberg O, Feinberg MJ (1991) Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. AJR Am J Roentgenol 156(6):1181–1184.  https://doi.org/10.2214/ajr.156.6.2028863 CrossRefPubMedGoogle Scholar
  7. 7.
    Bhattacharyya N (2014) The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg 151(5):765–769.  https://doi.org/10.1177/0194599814549156 CrossRefPubMedGoogle Scholar
  8. 8.
    Roy N, Stemple J, Merrill RM, Thomas L (2007) Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 116(11):858–865.  https://doi.org/10.1177/000348940711601112 CrossRefPubMedGoogle Scholar
  9. 9.
    Kawashima K, Motohashi Y, Fujishima I (2004) Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia 19(4):266–271CrossRefGoogle Scholar
  10. 10.
    Altman KW (2011) Dysphagia evaluation and care in the hospital setting: the need for protocolization. Otolaryngol Head Neck Surg 145(6):895–898.  https://doi.org/10.1177/0194599811415803 CrossRefPubMedGoogle Scholar
  11. 11.
    Andrade PA, Santos CAD, Firmino HH, Rosa COB (2018) The importance of dysphagia screening and nutritional assessment in hospitalized patients. Einstein (Sao Paulo) 16(2):eAO4189.  https://doi.org/10.1590/s1679-45082018ao4189 CrossRefGoogle Scholar
  12. 12.
    Shoji H, Nakane A, Omosu Y, Sawashima K, Teranaka S, Umeda Y et al (2014) The prognosis of dysphagia patients over 100 years old. Arch Gerontol Geriatr 59(2):480–484.  https://doi.org/10.1016/j.archger.2014.04.009 CrossRefPubMedGoogle Scholar
  13. 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
  14. 14.
    Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH (2000) Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res 43(5):1264–1274CrossRefGoogle Scholar
  15. 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. 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
  17. 17.
    Dent E, Kowal P, Hoogendijk EO (2016) Frailty measurement in research and clinical practice: a review. Eur J Intern Med 31:3–10.  https://doi.org/10.1016/j.ejim.2016.03.007 CrossRefPubMedGoogle Scholar
  18. 18.
    Ozawa T (1998) Comprehensive geriatric assessment. Nihon Ronen Igakkai Zasshi 35(1):1–9.  https://doi.org/10.3143/geriatrics.35.1 CrossRefPubMedGoogle Scholar
  19. 19.
    Chen X, Mao G, Leng SX (2014) Frailty syndrome: an overview. Clin Interv Aging 9:433–441.  https://doi.org/10.2147/CIA.S45300 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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
  21. 21.
    Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA et al (2014) Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 63(8):747–762.  https://doi.org/10.1016/j.jacc.2013.09.070 CrossRefPubMedGoogle Scholar
  22. 22.
    Jones DM, Song X, Rockwood K (2004) Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 52(11):1929–1933.  https://doi.org/10.1111/j.1532-5415.2004.52521.x CrossRefPubMedGoogle Scholar
  23. 23.
    Kim J, Oh BM, Kim JY, Lee GJ, Lee SA, Han TR (2014) Validation of the videofluoroscopic dysphagia scale in various etiologies. Dysphagia 29(4):438–443.  https://doi.org/10.1007/s00455-014-9524-y CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11(2):93–98CrossRefGoogle Scholar
  25. 25.
    Steele CM, Grace-Martin K (2017) Reflections on clinical and statistical use of the penetration–aspiration scale. Dysphagia 32(5):601–616.  https://doi.org/10.1007/s00455-017-9809-z CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Han TR, Paik NJ, Park JW, Kwon BS (2008) The prediction of persistent dysphagia beyond six months after stroke. Dysphagia 23(1):59–64.  https://doi.org/10.1007/s00455-007-9097-0 CrossRefPubMedGoogle Scholar
  27. 27.
    Kim DH, Choi KH, Kim HM, Koo JH, Kim BR, Kim TW et al (2012) Inter-rater reliability of videofluoroscopic dysphagia scale. Ann Rehabil Med 36(6):791–796.  https://doi.org/10.5535/arm.2012.36.6.791 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Hiramatsu T, Kataoka H, Osaki M, Hagino H (2015) Effect of aging on oral and swallowing function after meal consumption. Clin Interv Aging 10:229–235.  https://doi.org/10.2147/CIA.S75211 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 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
  30. 30.
    Feng X, Todd T, Lintzenich CR, Ding J, Carr JJ, Ge Y et al (2013) Aging-related geniohyoid muscle atrophy is related to aspiration status in healthy older adults. J Gerontol A Biol Sci Med Sci 68(7):853–860.  https://doi.org/10.1093/gerona/gls225 CrossRefPubMedGoogle Scholar
  31. 31.
    Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabre M et al (2010) Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil 22(8):851–858.  https://doi.org/10.1111/j.1365-2982.2010.01521.x CrossRefPubMedGoogle Scholar
  32. 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
  33. 33.
    Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D et al (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51(4):451–458CrossRefGoogle Scholar
  34. 34.
    Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E (2014) Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci 6:192.  https://doi.org/10.3389/fnagi.2014.00192 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 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. 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
  37. 37.
    Bahat G, Yilmaz O, Durmazoglu S, Kilic C, Tascioglu C, Karan MA (2019) Association between dysphagia and frailty in community dwelling older adults. J Nutr Health Aging 23(6):571–577.  https://doi.org/10.1007/s12603-019-1191-0 CrossRefPubMedGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  • Da Hyun Ahn
    • 1
  • Hea Eun Yang
    • 1
    Email author
  • Hyo Jung Kang
    • 1
  • Kyung Hee Do
    • 1
  • Seok Cheol Han
    • 1
  • Soo Woong Jang
    • 1
  • Jang Ho Lee
    • 1
  1. 1.Department of Rehabilitation MedicineVeterans Health Service Medical Center SeoulGangdong-guRepublic of Korea

Personalised recommendations