101
|
Brochier CW, Hugo FN, Rech RS, Baumgarten A, Hilgert JB. Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care. Gerodontology 2018; 35:333-338. [PMID: 29882353 DOI: 10.1111/ger.12345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study evaluated the association of the sociodemographic, behavioural variables and the oral conditions with the presence of oropharyngeal dysphagia in long-term care older persons. BACKGROUND Due to the influence of ageing, swallowing may be altered both in people with natural teeth and in those who have dentures or tooth loss. MATERIALS AND METHODS This cross-sectional study evaluated 115 individuals older than 60 years, living in long-term care institutions of the State of Rio Grande do Sul in 2016. The diagnosis of dysphagia happen using a clinical speech evaluation, based on the research of signals and symptoms of alterations during deglutition, and on an oral sensory-motor evaluation. The dental clinical evaluation examined the oral cavity, teeth and dental prostheses, including a Xerostomia assessment. Poisson Regressions with robust variance was calculated were used to estimate crude and adjusted Prevalence Ratios(PR) and their IC95%. RESULTS The sample was mostly comprised of older women (67.0%), with more than 81 years of age (44.3%) and edentulous (54.3%). Diagnosis of oropharyngeal dysphagia was verified in 60.9% of the participants. In the final model, older persons who presented no pair (PR=1.52(CI95%=1.02-2.40)) had a highest prevalence of oropharyngeal dysphagia, when compared to older persons who presented 8 to 14 mixed pairs, as well as those older persons who had more complaints related to symptoms of Xerostomia (PR=2.86(CI95% 1.58-5.18)). CONCLUSION Institutionalised older persons with a poor oral health condition are associated with a higher prevalence of oropharyngeal dysphagia, as well as with the presence of Xerostomia.
Collapse
Affiliation(s)
| | - Fernando Neves Hugo
- Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Center of Community Dental Health Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafaela Soares Rech
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Baumgarten
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
102
|
Chiba Y, Sano D, Ikui Y, Nishimura G, Yabuki K, Arai Y, Tanabe T, Ikemiyagi H, Hyakusoku H, Oridate N. Predictive value of the Hyodo score in endoscopic evaluation of aspiration during swallowing. Auris Nasus Larynx 2018; 45:1214-1220. [PMID: 29685505 DOI: 10.1016/j.anl.2018.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/06/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Hyodo scoring system during the endoscopic procedure has been proposed as a new tool for evaluating oral intake feasibility. However, the effectiveness of the information obtained from this procedure in predicting aspiration is not fully elucidated. The aim of this study was to assess the significance of clinical factors, including Hyodo scores, for predicting the risk of aspiration. METHODS Five hundred and twenty-eight endoscopic swallowing examinations were performed. Clinical factors, including age, sex, disease type, history of aspiration pneumonia, cognitive function, presence of tracheostomy, presence of vocal cord paralysis, consciousness level on the Japan Coma Scale, ECOG Performance Status, serum albumin level and Hyodo score, were obtained for each examination. The relationship between each of these factors and the presence of aspiration during endoscopic procedure was evaluated. RESULTS Three hundred and thirty-two patients (62.9%) were scored less than 5, 153 (29.0%) were scored between 5 and 8, and 43 (8.1%) were scored above 8. The number of patients with aspiration was 133 (25.2%). ROC analysis revealed that a cut-off point of 6 for Hyodo score was effective for predicting aspiration, with a sensitivity of 0.65 and a specificity of 0.86. History of aspiration pneumonia (OR 1.87, P<0.001), vocal cord paralysis (OR 2.23, P<0.001), PS≥3 (OR 2.47, P<0.001) and Hyodo score>6 (OR 9.08, P<0.001) were found to be independent predictive factors for aspiration. CONCLUSION The Hyodo scoring method was easy for otolaryngologists to perform and the scores were useful for predicting aspiration with moderate sensitivity and high specificity. Hyodo score>6, history of aspiration pneumonia, vocal cord paralysis, and PS≥3 were independent predictive factors for aspiration and that a Hyodo score above 6 was the statistically strongest predictor for aspiration.
Collapse
Affiliation(s)
- Yoshihiro Chiba
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
| | - Daisuke Sano
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan; Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukiko Ikui
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Goshi Nishimura
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan; Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kenichiro Yabuki
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Yasuhiro Arai
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Teruhiko Tanabe
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Hidetaka Ikemiyagi
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Hiroshi Hyakusoku
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhiko Oridate
- Department of Otorhinolaryngology - Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan; Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
103
|
Magalhães Junior HV, Pernambuco LDA, Lima KC, Ferreira MAF. Screening for oropharyngeal dysphagia in older adults: A systematic review of self-reported questionnaires. Gerodontology 2018; 35:162-169. [PMID: 29611876 DOI: 10.1111/ger.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia is a swallowing disorder with signs and symptoms which may be present in older adults, but they are rarely noticed as a health concern by older people. The earliest possible identification of this clinical condition is needed by self-reported population-based screening questionnaire, which are valid and reliable for preventing risks to nutritional status, increased morbidity and mortality. OBJECTIVE The aim of this systematic review was to identify self-reported screening questionnaires for oropharyngeal dysphagia in older adults to evaluate their methodological quality for population-based studies. METHODS An extensive search of electronic databases (PubMed (MEDLINE), Ovid MEDLINE(R), Scopus, Cochrane Library, CINAHL, Web of Science (WOS), PsycINFO (APA), Lilacs and Scielo) was conducted in the period from April to May 2017 using previously established search strategies by the two evaluators. The methodological quality and the psychometric properties of the included studies were evaluated by the COSMIN (Consensus based Standards for the selection of health Measurement Instruments) checklist and the quality criteria of Terwee and colleagues, respectively. RESULTS The analysed information was extracted from three articles which had conducted studies on the prevalence of oropharyngeal dysphagia by self-reported screening questionnaires, showing poor methodological quality and flaws in the methodological description to demonstrate its psychometric properties. CONCLUSION This study did not find any self-reported screening questionnaires for oropharyngeal dysphagia with suitable methodological quality and appropriate evidence in its psychometric properties for elders. Therefore, the self-reported questionnaires within the diagnostic proposal require greater details in its process for obtaining valid and reliable evidence.
Collapse
Affiliation(s)
- Hipólito V Magalhães Junior
- Department of Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Leandro de Araújo Pernambuco
- Department of Speech, Language and Hearing Sciences, Federal University of Paraíba (UFPB), João Pessoa, Paraiba, Brazil
| | - Kenio C Lima
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Maria Angela F Ferreira
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
104
|
Rech RS, Baumgarten A, Colvara BC, Brochier CW, de Goulart B, Hugo FN, Hilgert JB. Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration. Oral Dis 2018; 24:664-672. [PMID: 29164750 DOI: 10.1111/odi.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/25/2017] [Accepted: 11/16/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate whether the oral functionality and the oral sensorimotor alterations are associated with oropharyngeal dysphagia in community-dwelling older persons and long-term care older residents. METHODS An exploratory study with 265 independent older persons of the southern state of Brazil. The diagnosis of dysphagia, as well as the condition of the oral sensorimotor system, was assessed by a speech-language therapist and the oral health status by a dentist. Poisson Regression with robust variance was used to calculate the crude and adjusted Prevalence Ratios (PR) and their respective confidence intervals of 95%. RESULTS The mean age was 73.5 (±8.9) years, women represented 59.2% of the sample. The frequency of dysphagia in the studied population was 45.3% (n = 120), being more frequent in the long-term care older residents (62.5%; n = 75) than in the community-dwelling older persons (37.5%; n = 45). Individuals with four or more oral sensorimotor alterations (PR = 2.01; 95% CI 1.27-3.18), as well as those who presented a non-functional oral status (PR = 1.61; 95% CI 1.02-2.54) presented a higher frequency of dysphagia. Subgroup analysis indicates the same trend of results, when stratified by community-dwelling older persons and long-term older residents. CONCLUSION A non-functional oral health status and oral sensorimotor alterations are associated with a higher prevalence of oropharyngeal dysphagia.
Collapse
Affiliation(s)
- R S Rech
- Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A Baumgarten
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - B C Colvara
- Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - C W Brochier
- Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bng de Goulart
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Health and Human Communication, Institute of Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - F N Hugo
- Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Center of Community Dental Health Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J B Hilgert
- Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Preventive and Social Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
105
|
Krekeler BN, Leverson G, Connor NP. Tongue exercise and ageing effects on morphological and biochemical properties of the posterior digastric and temporalis muscles in a Fischer 344 Brown Norway rat model. Arch Oral Biol 2018; 89:37-43. [PMID: 29438907 DOI: 10.1016/j.archoralbio.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 01/26/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study sought to examin effects of age and tongue exercise on the posterior digastric (opener) and the temporalis (closer). We hypothesized 1) age would result in differing morphological (cross sectional area) and biochemical (myosin heavy chain isoform) components of these muscles; 2) tongue exercise would result in coactivation of these muscles inducing a decrease in age-related differences between age groups. DESIGN Young adult (9 months) and old (32 months) Fischer 344 Brown Norway rats were randomized into a tongue exercise or control group. Post-training, posterior digastric and temporalis muscles were harvested and analyzed using: 1) Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) to assess percent myosin heavy chain (MyHC) content; 2) Immunohistochemical staining to determine cross sectional area (CSA). RESULTS A larger proportion of slowly contracting MyHC isoforms in the posterior digastric and temporalis muscles were found in old. No significant main effects for age or exercise in fiber size were found in posterior digastric muscle. An interaction between age and exercise for temporalis cross sectional area indicated the old exercise group had smaller average cross sectional area than all other groups. CONCLUSIONS FINDINGS: suggest that: 1) Increasing age induces biochemical changes in muscles of the jaw, specifically showing an increase the proportion of slower contracting MyHC isoforms; 2) Increasing age and tongue exercise induce a reduction in muscle fiber cross sectional area in the temporalis muscle only. However, continued study of these cranial muscle systems is warranted to better understand these changes that occur with age and exercise.
Collapse
Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, Goodnight Hall, 1975 Willow Drive, Madison, WI, 53706, United States; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, K4/7 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, United States.
| | - Glen Leverson
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, K4/7 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, United States
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, Goodnight Hall, 1975 Willow Drive, Madison, WI, 53706, United States; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, K4/7 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, United States
| |
Collapse
|
106
|
Cordier R, Speyer R, Schindler A, Michou E, Heijnen BJ, Baijens L, Karaduman A, Swan K, Clavé P, Joosten AV. Using Rasch Analysis to Evaluate the Reliability and Validity of the Swallowing Quality of Life Questionnaire: An Item Response Theory Approach. Dysphagia 2018; 33:441-456. [PMID: 29392474 DOI: 10.1007/s00455-017-9873-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/21/2017] [Indexed: 02/08/2023]
Abstract
The Swallowing Quality of Life questionnaire (SWAL-QOL) is widely used clinically and in research to evaluate quality of life related to swallowing difficulties. It has been described as a valid and reliable tool, but was developed and tested using classic test theory. This study describes the reliability and validity of the SWAL-QOL using item response theory (IRT; Rasch analysis). SWAL-QOL data were gathered from 507 participants at risk of oropharyngeal dysphagia (OD) across four European countries. OD was confirmed in 75.7% of participants via videofluoroscopy and/or fiberoptic endoscopic evaluation, or a clinical diagnosis based on meeting selected criteria. Patients with esophageal dysphagia were excluded. Data were analysed using Rasch analysis. Item and person reliability was good for all the items combined. However, person reliability was poor for 8 subscales and item reliability was poor for one subscale. Eight subscales exhibited poor person separation and two exhibited poor item separation. Overall item and person fit statistics were acceptable. However, at an individual item fit level results indicated unpredictable item responses for 28 items, and item redundancy for 10 items. The item-person dimensionality map confirmed these findings. Results from the overall Rasch model fit and Principal Component Analysis were suggestive of a second dimension. For all the items combined, none of the item categories were 'category', 'threshold' or 'step' disordered; however, all subscales demonstrated category disordered functioning. Findings suggest an urgent need to further investigate the underlying structure of the SWAL-QOL and its psychometric characteristics using IRT.
Collapse
Affiliation(s)
- Reinie Cordier
- School of Occupational Therapy and Social Work, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia.
| | - Renée Speyer
- School of Occupational Therapy and Social Work, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia.,James Cook University, Port Douglas, Australia.,Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Laura Baijens
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Katina Swan
- School of Occupational Therapy and Social Work, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
| | - Pere Clavé
- Hospital de Mataró, Mataró, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annette Veronica Joosten
- School of Occupational Therapy and Social Work, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
| |
Collapse
|
107
|
Carrión S, Costa A, Ortega O, Verin E, Clavé P, Laviano A. Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia. Dysphagia 2018. [DOI: 10.1007/174_2017_168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
108
|
Gilheaney Ó, Zgaga L, Harpur I, Sheaf G, Kiefer L, Béchet S, Walshe M. The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Dysphagia 2017; 32:587-600. [PMID: 28508937 DOI: 10.1007/s00455-017-9808-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/10/2017] [Indexed: 01/03/2023]
Abstract
Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.
Collapse
Affiliation(s)
- Órla Gilheaney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland
| | - Isolde Harpur
- Library of Trinity College Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Greg Sheaf
- Library of Trinity College Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Liss Kiefer
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Sibylle Béchet
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| |
Collapse
|
109
|
Matsuo H, Yoshimura Y. Calf circumference is associated with dysphagia in acute-care inpatients. Geriatr Nurs 2017; 39:186-190. [PMID: 28939287 DOI: 10.1016/j.gerinurse.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/25/2022]
Abstract
The aim of the study was to determine the association between decreased muscle mass and dysphagia in older acute-care patients. A cross-sectional study was performed on 103 patients aged ≥65 years who were consecutively admitted to acute-care wards. Muscle mass and strength were evaluated by assessing calf circumference (CC) and handgrip strength, respectively. Dysphagia and swallowing difficulty were assessed using the Dysphagia Severity Scale (DSS). Univariate and multivariate analyses were used to determine whether CC was associated with dysphagia. There were 58 women and 45 men (mean age, 80 ± 8 years) with a mean CC of 28.2 ± 4.4 cm, and a mean HG of 11.8 kg. Dysphagia was observed in eight patients (8%). Based on the multivariate analysis, CC was independently associated with DSS after adjusting for possible confounders. Future studies to evaluate dysphagia in acute-care older patients with low skeletal muscle mass (i.e., sarcopenia) are required.
Collapse
Affiliation(s)
- Haruyo Matsuo
- Department of Nursing, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| |
Collapse
|
110
|
Kletzien H, Hare AJ, Leverson G, Connor NP. Age-related effect of cell death on fiber morphology and number in tongue muscle. Muscle Nerve 2017; 57:E29-E37. [PMID: 28440544 DOI: 10.1002/mus.25671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/30/2017] [Accepted: 04/17/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Multiple pathways may exist for age-related tongue muscle degeneration. Cell death is one mechanism contributing to muscle atrophy and decreased function. We hypothesized with aging, apoptosis, and apoptotic regulators would be increased, and muscle fiber size and number would be reduced in extrinsic tongue muscles. METHODS Cell death indices, expression of caspase-3 and Bcl-2, and measures of muscle morphology and number were determined in extrinsic tongue muscles of young and old rats. RESULTS Significant increases in cell death, caspase-3, and Bcl-2 were observed in all extrinsic tongue muscles along with reductions in muscle fiber number in old rats. DISCUSSION We demonstrated that apoptosis indices increase with age in lingual muscles and that alterations in apoptotic regulators may be associated with age-related degeneration in muscle fiber size and number. These observed apoptotic processes may be detrimental to muscle function, and may contribute to degradation of cranial functions with age. Muscle Nerve 57: E29-E37, 2018.
Collapse
Affiliation(s)
- Heidi Kletzien
- University of Wisconsin-Madison, Department of Biomedical Engineering, Madison, Wisconsin, USA
| | - Allison J Hare
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Madison, Wisconsin, USA
| | - Glen Leverson
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Madison, Wisconsin, USA
| | - Nadine P Connor
- University of Wisconsin-Madison, Department of Communication Sciences and Disorders, Madison, Wisconsin, USA
| |
Collapse
|
111
|
Kendall KA. Evaluation of airway protection: Quantitative timing measures versus penetration/aspiration score. Laryngoscope 2017; 127:2314-2318. [DOI: 10.1002/lary.26653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/10/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
|
112
|
Logrippo S, Ricci G, Sestili M, Cespi M, Ferrara L, Palmieri GF, Ganzetti R, Bonacucina G, Blasi P. Oral drug therapy in elderly with dysphagia: between a rock and a hard place! Clin Interv Aging 2017; 12:241-251. [PMID: 28203065 PMCID: PMC5293185 DOI: 10.2147/cia.s121905] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Demographic indicators forecast that by 2050, the elderly will account for about one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are administered as solid oral solid dosage forms, as they are by far the most common formulations on the market. However, this population tends to suffer difficulties with swallowing. Caregivers in hospital geriatric units routinely compound in solid oral dosage forms for dysphagic patients by crushing the tablets or opening the capsules to facilitate administration. The manipulation of a tablet or a capsule, if not clearly indicated in the product labeling, is an off-label use of the medicine, and must be supported by documented scientific evidence and requires the patient's informed consent. Compounding of marketed products has been recognized as being responsible for an increased number of adverse events and medical errors. Since extemporaneous compounding is the rule and not the exception in geriatrics departments, the seriousness and scope of issues caused by this daily practice are probably underestimated. In this article, the potential problems associated with the manipulation of authorized solid oral dosage forms are discussed.
Collapse
Affiliation(s)
| | | | - Matteo Sestili
- Italian National Research Centers on Ageing (INRCA), Ancona, Italy
| | | | - Letizia Ferrara
- Italian National Research Centers on Ageing (INRCA), Ancona, Italy
| | | | - Roberta Ganzetti
- Italian National Research Centers on Ageing (INRCA), Ancona, Italy
| | | | | |
Collapse
|
113
|
Park Y, Oh S, Chang H, Bang HL. Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents. J Gerontol Nurs 2017; 41:30-9. [PMID: 26505245 DOI: 10.3928/00989134-20151015-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/27/2015] [Indexed: 11/20/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents" found on pages 30-39, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Explain the development and testing of the Evidence-Based Nursing Care Algorithm of Dysphagia (ENCAD) in long-term care settings. 2. Review the outcome of implementing the ENCAD for dysphagia management in a nursing home. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Standardized nursing care protocols for dysphagia management have not been established in nursing home settings in Korea. The purpose of the current study was to examine the effect of the Evidence-Based Nursing Care Algorithm of Dysphagia (ENCAD) on risk of dysphagia, oral health, and dysphagia-specific quality of life among nursing home residents. The ENCAD was administered to 40 residents in one nursing home in urban South Korea for 6 months. A control-intervention, time-series design was used, under which participants served as their own controls. Oral health, risk of aspiration, and dysphagia-specific quality of life were measured at baseline, post-control, and post-intervention. Findings showed that risk of aspiration (p < 0.01) and dysphagia-related quality of life (p < 0.001) improved significantly after the ENCAD was applied, whereas oral health status did not change over time (p = 0.06). Results suggest that implementing the ENCAD contributed to a reduction in the risk of aspiration and an improvement in the quality of life in nursing home residents.
Collapse
|
114
|
Influence of mixed gel structuring with different degrees of matrix inhomogeneity on oral residence time. Food Hydrocoll 2016. [DOI: 10.1016/j.foodhyd.2016.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
115
|
Matsuo H, Yoshimura Y, Ishizaki N, Ueno T. Dysphagia is associated with functional decline during acute-care hospitalization of older patients. Geriatr Gerontol Int 2016; 17:1610-1616. [PMID: 27910255 DOI: 10.1111/ggi.12941] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
AIM Physical function is considered to be associated with dysphagia: however, there is little data regarding the association between dysphagia and functional decline during hospitalization among older patients. The aim of the present study was to investigate the prevalence of dysphagia, and the association between dysphagia and functional status during hospitalization in older acute-care patients. METHODS A total of 103 older patients without present or prior history of diseases that could directly impair swallowing and cause dysphagia (45 men and 58 women; mean age 80.5 years) hospitalized in acute-care wards were included in the present study. Dysphagia or difficulty swallowing was assessed by using the 10-item Eating Assessment Tool. Functional and nutritional status, such as Barthel Index (BI), Mini-Nutritional Assessment short form, body mass index, calf circumference, handgrip strength and dysphagia, were analyzed to evaluate their relationships. RESULTS Dysphagia, as assessed using the 10-item Eating Assessment Tool, was noted in 26.2% of the participants. Multivariate analysis showed that dysphagia, handgrip strength and BI on admission were independently associated with poor BI gain during hospitalization after adjustment for age, sex, causative disease for admission, premorbid ADL, length of hospital stay, Mini-Nutritional Assessment short form, handgrip strength and BI. CONCLUSIONS Dysphagia, as assessed by the 10-item Eating Assessment Tool, was common in older patients. In addition, dysphagia was independently associated with poorer functional recovery during acute-care hospitalization of older patients. Geriatr Gerontol Int 2017; 17: 1610-1616.
Collapse
Affiliation(s)
- Haruyo Matsuo
- Department of Nursing, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Naoki Ishizaki
- Department of Surgery, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Tsuyoshi Ueno
- Department of Anesthesiology, Kagoshima City Hospital, Kagoshima, Japan
| |
Collapse
|
116
|
Sundstedt S, Nordh E, Linder J, Hedström J, Finizia C, Olofsson K. Swallowing Quality of Life After Zona Incerta Deep Brain Stimulation. Ann Otol Rhinol Laryngol 2016; 126:110-116. [PMID: 27831516 DOI: 10.1177/0003489416675874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The management of Parkinson's disease (PD) has been improved, but management of signs like swallowing problems is still challenging. Deep brain stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing-specific quality of life before and after caudal zona incerta DBS (cZI DBS) in comparison with a control group. METHODS Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to 9 controls. Median ages were 53 years (range, 40-70 years) for patients and 54 years (range, 42-72 years) for controls. RESULTS No significant differences were found between the pre- or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. The PD patients reported significantly lower scores in the burden subscale and the symptom scale. CONCLUSIONS Patients with PD selected for cZI DBS showed good self-reported swallowing-specific quality of life, in many aspects equal to controls. The cZI DBS did not negatively affect swallowing-specific quality of life in this study.
Collapse
Affiliation(s)
- Stina Sundstedt
- 1 Department of Clinical Sciences, Division of Otorhinolaryngology, Umeå University, Sweden
| | - Erik Nordh
- 2 Department of Pharmacology and Clinical Neurosciences, Division Neurophysiology, Umeå University, Sweden
| | - Jan Linder
- 3 Department of Pharmacology and Clinical Neurosciences, Division of Neurology, Umeå University, Sweden
| | - Johanna Hedström
- 4 Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Caterina Finizia
- 4 Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Katarina Olofsson
- 1 Department of Clinical Sciences, Division of Otorhinolaryngology, Umeå University, Sweden
| |
Collapse
|
117
|
Baijens LW, 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. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
Collapse
Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
118
|
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. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 383] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
Collapse
Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
119
|
Byeon H. Analysis of dysphagia risk using the modified dysphagia risk assessment for the community-dwelling elderly. J Phys Ther Sci 2016; 28:2507-2509. [PMID: 27799680 PMCID: PMC5080162 DOI: 10.1589/jpts.28.2507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The elderly are susceptible to dysphagia, and complications can be minimized if
high-risk groups are screened in early stages and properly rehabilitated. This study
provides basic material for the early detection and prevention of dysphagia by
investigating the risks of dysphagia and related factors in community-dwelling elders.
[Subjects and Methods] Participants included 325 community-dwelling elderly people aged 65
or older. The modified dysphagia risk assessment for the community-dwelling elderly was
used to assess dysphagia risk. [Results] Approximately 52.6% (n=171) of participants
belonged to the high-risk group for dysphagia. After adjusting for confounding variables,
people aged 75+, who used dentures, and who needed partial help in daily living had a
significantly higher risk of dysphagia. [Conclusion] It is necessary to develop guidelines
for dysphagia for early detection and rehabilitation.
Collapse
Affiliation(s)
- Haewon Byeon
- Department of Speech Language Pathology, Nambu University, Republic of Korea
| |
Collapse
|
120
|
Sokoloff AJ, Douglas M, Rahnert JA, Burkholder T, Easley KA, Luo Q. Absence of morphological and molecular correlates of sarcopenia in the macaque tongue muscle styloglossus. Exp Gerontol 2016; 84:40-48. [PMID: 27566374 DOI: 10.1016/j.exger.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Equivocal decline of tongue muscle performance with age is compatible with resistance of the tongue to sarcopenia, the loss of muscle volume and function that typically occurs with aging. To test this possibility we characterized anatomical and molecular indices of sarcopenia in the macaque tongue muscle styloglossus (SG). METHODS We quantified myosin heavy chain (MHC), muscle fiber MHC phenotype and size and total and phosphorylated growth- and atrophy-related proteins by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), immunoblot and immunohistochemistry (IHC) in the SG in twenty-four macaque monkeys (Macaca rhesus, age range 9months to 31years) categorized into Young (<8years of age), Middle-aged (15-21years of age) and Old (>22years of age) groups. RESULTS In Young, Middle and Old age groups, by SDS-PAGE MHCI comprised ~1/3 and MHCII ~2/3 of total MHC. MHCI relative frequency was lower and MHCII higher in Middle versus Young (p=0.0099) and Middle versus Old (p=0.052). Relative frequencies of MHC fiber phenotype were not different by age but were different by phenotype (rates 233, 641 and 111 per 1000 fibers for MHCI, MHCII and MHCI-II respectively, p=0.03). Few or no fibers were positive for developmental MHC. Mean cross-sectional area (CSA) was not different among the three age groups for MHCII and MHCI-II; however MHCI fibers tended to be larger in Middle versus Old and Young (mean=2257μm2,1917μm2 (p=0.05) and 1704μm2 (p=0.06), respectively). For each age group, mean CSA increased across MHC phenotype (lowest mean CSA for MHCI and highest mean CSA for MHCII). Spearman analysis demonstrated age-related increases in total p70 ribosomal protein S6 kinase (P70), phosphorylated P70421/424, phosphorylated P38 mitogen-activated protein kinase and muscle atrophy F-Box, a trend to age-related decrease in total extracellular signal-regulated kinase (ERK), and no age-related change in total protein kinase B (Akt/PKB), phosphorylated Akt, phosphorylated ERK, phosphorylated c-Jun N-terminal kinase (JNK46) and phosphorylated P70389. CONCLUSION Common anatomical and molecular indices of sarcopenia are absent in our sample of macaque SG. Relative frequencies of MHCII protein and phenotype are preserved with age. Although MAFbx expression increases with age, this is not associated with fiber atrophy, perhaps reflecting compensatory growth signaling by p70. The resistant nature of the styloglossus muscle to sarcopenia may be related to routine activation of tongue muscles in respiration and swallowing and the preservation of hypoglossal motoneuron number with age.
Collapse
Affiliation(s)
- Alan J Sokoloff
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States.
| | - Megan Douglas
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jill A Rahnert
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Thomas Burkholder
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Qingwei Luo
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
121
|
An Epidemiologic Study on Ageing and Dysphagia in the Acute Care Geriatric-Hospitalized Population: A Replication and Continuation Study. Dysphagia 2016; 31:619-25. [PMID: 27384436 DOI: 10.1007/s00455-016-9714-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/17/2016] [Indexed: 12/22/2022]
Abstract
United States census data project dramatic increases in the geriatric population ageing demographics by 2060 with concomitant health-care consequences. The purpose of this replication and continuation study was to collect new 2014 demographic data relative to ageing, swallow evaluation referral rates, and oral feeding status in geriatric-hospitalized patients for comparison with published data from 2000 to 2007. This was a planned data acquisition study of consecutive hospitalized patients referred for swallow assessments. Swallow evaluation referral rates for 2014 were described according to inpatient discharges, age range 60-105 years grouped by decade, gender, admitting diagnostic category, results of swallow evaluations, and oral feeding status. Determination of aspiration risk status was made with the Yale Swallow Protocol and diagnosis of dysphagia made with fiberoptic endoscopic evaluation of swallowing (FEES). There were 1348 referrals and 961 patients ≥60 years of age participated. Overall swallow evaluation referral rates increased an average of 63 % between the comparison years 2007 and 2014 with consistent increases corresponding to the decades, i.e., 60-69 (46 %), 70-79 (68 %), 80-89 (53 %), and 90+ (222 %). A total of 75 % of participants resumed oral alimentation and oral medications. Swallow evaluation referral rates increased by 63 % for 60-90+ year-old acute care geriatric-hospitalized participants despite only a 23 % increase in inpatient discharges for the years 2007 versus 2014. This corroborated previously reported increases for individual years from 2000 to 2007. For timely, safe, and successful initiation of oral alimentation, it is important to perform a reliable swallow screen for aspiration risk assessment with the Yale Swallow Protocol and, if failed, instrumental testing with FEES. More dysphagia specialists are needed through 2060 and beyond due to projections of continued population ageing resulting in ever increasing referral rates for swallow assessments.
Collapse
|
122
|
Robles-Bykbaev V, López-Nores M, García-Duque J, Pazos-Arias JJ, Arévalo-Lucero D. Evaluation of an Expert System for the Generation of Speech and Language Therapy Plans. JMIR Med Inform 2016; 4:e23. [PMID: 27370070 PMCID: PMC4947192 DOI: 10.2196/medinform.5660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/10/2016] [Accepted: 06/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Speech and language pathologists (SLPs) deal with a wide spectrum of disorders, arising from many different conditions, that affect voice, speech, language, and swallowing capabilities in different ways. Therefore, the outcomes of Speech and Language Therapy (SLT) are highly dependent on the accurate, consistent, and complete design of personalized therapy plans. However, SLPs often have very limited time to work with their patients and to browse the large (and growing) catalogue of activities and specific exercises that can be put into therapy plans. As a consequence, many plans are suboptimal and fail to address the specific needs of each patient. OBJECTIVE We aimed to evaluate an expert system that automatically generates plans for speech and language therapy, containing semiannual activities in the five areas of hearing, oral structure and function, linguistic formulation, expressive language and articulation, and receptive language. The goal was to assess whether the expert system speeds up the SLPs' work and leads to more accurate, consistent, and complete therapy plans for their patients. METHODS We examined the evaluation results of the SPELTA expert system in supporting the decision making of 4 SLPs treating children in three special education institutions in Ecuador. The expert system was first trained with data from 117 cases, including medical data; diagnosis for voice, speech, language and swallowing capabilities; and therapy plans created manually by the SLPs. It was then used to automatically generate new therapy plans for 13 new patients. The SLPs were finally asked to evaluate the accuracy, consistency, and completeness of those plans. A four-fold cross-validation experiment was also run on the original corpus of 117 cases in order to assess the significance of the results. RESULTS The evaluation showed that 87% of the outputs provided by the SPELTA expert system were considered valid therapy plans for the different areas. The SLPs rated the overall accuracy, consistency, and completeness of the proposed activities with 4.65, 4.6, and 4.6 points (to a maximum of 5), respectively. The ratings for the subplans generated for the areas of hearing, oral structure and function, and linguistic formulation were nearly perfect, whereas the subplans for expressive language and articulation and for receptive language failed to deal properly with some of the subject cases. Overall, the SLPs indicated that over 90% of the subplans generated automatically were "better than" or "as good as" what the SLPs would have created manually if given the average time they can devote to the task. The cross-validation experiment yielded very similar results. CONCLUSIONS The results show that the SPELTA expert system provides valuable input for SLPs to design proper therapy plans for their patients, in a shorter time and considering a larger set of activities than proceeding manually. The algorithms worked well even in the presence of a sparse corpus, and the evidence suggests that the system will become more reliable as it is trained with more subjects.
Collapse
Affiliation(s)
- Vladimir Robles-Bykbaev
- Grupo de Investigación en Inteligencia Artificial y Tecnologías de Asistencia, Universidad Politécnica Salesiana, Cuenca, Ecuador.
| | | | | | | | | |
Collapse
|
123
|
Movahedi F, Kurosu A, Coyle JL, Perera S, Sejdic E. Anatomical Directional Dissimilarities in Tri-axial Swallowing Accelerometry Signals. IEEE Trans Neural Syst Rehabil Eng 2016; 25:447-458. [PMID: 27295677 DOI: 10.1109/tnsre.2016.2577882] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Swallowing accelerometry is a noninvasive approach currently under consideration as an instrumental screening test for swallowing difficulties, with most current studies focusing on the swallowing vibrations in the anterior-posterior (A-P) and superior-inferior (S-I) directions. However, the displacement of the hyolaryngeal structure during the act of swallowing in patients with dysphagia involves declination of the medial-lateral (M-L), which suggests that the swallowing vibrations in the M-L direction have the ability to reveal additional details about the swallowing function. With this motivation, we performed a broad comparison of the swallowing vibrations in all three anatomical directions. Tri-axial swallowing accelerometry signals were concurrently collected from 72 dysphagic patients undergoing videofluoroscopic evaluation of swallowing (mean age: 63.94 ± 12.58 years period). Participants swallowed one or more thickened liquids with different consistencies including thin-thick liquids, nectar-thick liquids, and pudding-thick liquids with either a comfortable self-selected volume from a cup or a controlled volume by the examiner from a 5-ml spoon. Swallows were grouped based on the viscosity of swallows and the participant's stroke history. Then, a comprehensive set of features was extracted in multiple signal domains from 881 swallows. The results highlighted inter-axis dissimilarities among tri-axial swallowing vibrations including the extent of variability in the amplitude of signals, the degree of predictability of signals, and the extent of disordered behavior of signals in time-frequency domain. First, the upward movement of the hyolaryngeal structure, representing the S-I signals, were actually more variable in amplitude and showed less predictable behavior than the sideways and forward movements, representing the A-P and M-L signals, during swallowing. Second, the S-I signals, which represent the upward movement of the hyolaryngeal structure, behaved more disordered in the time-frequency domain than the sideways movement, M-L signals, in all groups of study except for the pudding swallows in the stroke group. Third, considering the viscosity and the participant's pathology, thin liquid swallows in the nonstroke group presented the most directional differences among all groups of study. In summary, despite some directional dissimilarities, M-L axis accelerometry characteristics are similar to those of the two other axes. This indicates that M-L axis characteristics, which cannot be observed in videofluoroscopic images, can be adequately derived from the A-P and S-I axes.
Collapse
|
124
|
Krekeler BN, Connor NP. Age-related changes in mastication are not improved by tongue exercise in a rat model. Laryngoscope 2016; 127:E29-E34. [PMID: 27260802 DOI: 10.1002/lary.26045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/07/2016] [Accepted: 03/28/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES/HYPOTHESIS Aging results in progressive changes in deglutitive functions, which may be due in part to alterations in muscle morphology and physiology. Mastication is a critical component of bolus formation and swallowing, but aging effects on masticatory function have not been well studied. STUDY DESIGN The purpose of this study was to 1) quantify the effects of aging on mastication, and 2) determine the effects of tongue exercise on mastication in young adult and old rats. We hypothesized that there would be significant differences in mastication characteristics (number of bites, interval between bites, time to eat) as a function of age, and that tongue exercise would resolve preexercise differences between age groups. METHODS We expanded the established model of progressive, 8-week tongue exercise to include a mastication measurement: acoustic recordings of vermicelli pasta biting from 17 old and 17 young adult rats, randomized into exercise and control groups. RESULTS We found the following: 1) Mastication characteristics were impacted by age. Specifically in older rats, there was an increase in time to eat and number of bites and intervals between bites decreased, suggesting increased oral motor-processing requirements for bolus formation. 2) tongue exercise did not impact mastication behaviors in young adult or old rats. CONCLUSION Tongue exercise may not have been specific enough to result in behavioral changes in mastication or exercise dose may not have been sufficient. Nevertheless, results were noteworthy in expanding the established rat model of aging and have relevant clinical implications for future translation to human populations. LEVEL OF EVIDENCE NA Laryngoscope, 127:E29-E34, 2017.
Collapse
Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A
| |
Collapse
|
125
|
Ghannouchi I, Speyer R, Doma K, Cordier R, Verin E. Swallowing function and chronic respiratory diseases: Systematic review. Respir Med 2016; 117:54-64. [PMID: 27492514 DOI: 10.1016/j.rmed.2016.05.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The precise coordination between breathing and swallowing is an important mechanism to prevent pulmonary aspiration. Factors that alter breathing patterns and ventilation, such as chronic respiratory diseases, may influence that precise coordination of breathing and swallowing. PURPOSE The purpose of this systematic literature review is to examine the effects of chronic respiratory diseases on swallowing function. METHOD Literature searches were performed using the electronic databases PubMed and Embase. All articles meeting the eligibility criteria up to March 2016 were included. RESULTS All articles included studied Chronic Obstructive Pulmonary Diseases (COPD) or Obstructive Sleep Apnea (OSA); no studies involving other respiratory diseases were found. A total of 1069 abstracts were retrieved, of which twenty-six studies met the inclusion criteria; eleven studies dealt with OSA and fifteen studies dealt with COPD. CONCLUSION The outcome data indicate that chronic respiratory diseases increase the prevalence of oropharyngeal dysphagia (OD) in patients. However, the relative small number of studies, differences in selection criteria, definitions and assessment techniques used for diagnosing OSA, COPD, and OD point to the need for further research.
Collapse
Affiliation(s)
- Ines Ghannouchi
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Tunisia; EA 3880 (Research Group on Ventilator Handicap), Rouen University, France.
| | - Renée Speyer
- Speech Pathology, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia; Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenji Doma
- Clinical Exercise Physiology and Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Reinie Cordier
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
| | - Eric Verin
- EA 3880 (Research Group on Ventilator Handicap), Rouen University, France; Rouen University Hospital, Pole 3R Rehabilitation Department, Rouen University, France
| |
Collapse
|
126
|
Ohira M, Ishida R, Maki Y, Ohkubo M, Sugiyama T, Sakayori T, Sato T. Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults. Geriatr Gerontol Int 2016; 17:561-567. [PMID: 27195778 DOI: 10.1111/ggi.12755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/23/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
AIM Dysphagia is common in dependent older adults. Thus, a method of evaluating eating and swallowing functions that can be used to diagnose and manage dysphagia in a simple and robust manner is required. In 2002, the Mann Assessment of Swallowing Ability (MASA) was introduced to identify dysphagia in acute-stage stroke patients. As the MASA enables easy screening, it might also be applicable to dependent older adults if appropriate MASA cut-off values and the most useful assessment items could be determined. In the present study, we attempted to determine suitable MASA cut-off values, and the most useful assessment items for predicting aspiration and pharyngeal retention in dependent older adults. METHODS Using the MASA, we evaluated the eating and swallowing functions of 50 dependent older adults with dysphagia. All of the patients also underwent videoendoscopic-based swallowing evaluations to detect aspiration and pharyngeal retention. The participants' characteristics and the utility of each assessment item were compared between various groups. Using the patients' videoendoscopic findings as a reference, receiver operating characteristic curve analysis was carried out to determine appropriate cut-off values for predicting aspiration and pharyngeal retention in dependent older adults. RESULTS The optimal MASA cut-off values for predicting aspiration and pharyngeal retention were 122 points and 151 points, respectively. A total of 17 of the 24 clinical items assessed by the MASA were found to be associated with aspiration in dependent older adults. CONCLUSIONS The MASA is a useful screening tool for evaluating eating and swallowing functions in dependent older adults. Geriatr Gerontol Int 2017; 17: 561-567.
Collapse
Affiliation(s)
- Mariko Ohira
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | - Ryo Ishida
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | - Yoshinobu Maki
- Tokyo Dental College Department of Social Dentistry, Chiba, Japan
| | - Mai Ohkubo
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | - Tetsuya Sugiyama
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | | | - Toru Sato
- Tokyo Dental College Department of Crown & Bridge Prosthodontics, Tokyo Dental College, Chiba, Japan
| |
Collapse
|
127
|
Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology 2016; 34:121-128. [DOI: 10.1111/ger.12234] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ji-Su Park
- Department of Rehabilitation Science; Graduate School of Inje University; Gimhae Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy; Kyungdong University; Wonju Korea
| | - Moon-Young Chang
- Department of Occupational Therapy; College of Biomedical Science and Engineering; Inje University; Gimhae Korea
| |
Collapse
|
128
|
Seçil Y, Arıcı Ş, İncesu TK, Gürgör N, Beckmann Y, Ertekin C. Dysphagia in Alzheimer's disease. Neurophysiol Clin 2016; 46:171-8. [PMID: 26924307 DOI: 10.1016/j.neucli.2015.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's disease. METHODS Forty Alzheimer's disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded. RESULTS Dysphagia was found in 30/40 (75%) of Alzheimer's disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer's disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer's disease patients. CONCLUSIONS Alzheimer's disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mild or moderate Alzheimer's disease.
Collapse
Affiliation(s)
- Yaprak Seçil
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey.
| | - Şehnaz Arıcı
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Tülay Kurt İncesu
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Nevin Gürgör
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Yeşim Beckmann
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Cumhur Ertekin
- Department of Clinical Neurophysiology, Ege University Medical School Hospital, Izmir, Turkey
| |
Collapse
|
129
|
Tsukamoto M, Manabe N, Kamada T, Hirai T, Hata J, Haruma K, Inoue K. Number of Gastrointestinal Symptoms is a Useful Means of Identifying Patients with Cancer for Dysphagia. Dysphagia 2016; 31:547-54. [DOI: 10.1007/s00455-016-9712-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
|
130
|
Lepore JR, Sims CA, Gal NJ, Dahl WJ. Acceptability and Identification of Scooped Versus Molded Puréed Foods. CAN J DIET PRACT RES 2016; 75:145-7. [PMID: 26066819 DOI: 10.3148/cjdpr-2014-004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Although puréed foods are commonly recommended for individuals with dysphagia and the acceptability of these foods is often a concern, few sensory studies on puréed foods have been carried out. The aim of this study was to evaluate the impact of serving style (i.e., scooped vs molded), on identification and acceptability of puréed foods in younger and older adults. METHODS Acceptability of scooped versus molded puréed meats and vegetables was evaluated using the hedonic general Labeled Magnitude Scale. The younger adult panelists (n = 97; 55 F, 42 M) were recruited from the University of Florida staff and students, and the older adult panelists (n = 70; 59 F, 11 M) were recruited from the community. RESULTS The younger panelists correctly identified a higher percentage of puréed foods than did the older panelists. Scooped puréed foods were more acceptable than molded. CONCLUSIONS The results suggest that puréed foods may be more acceptable and identifiable when served without molding for both younger and older adults.
Collapse
Affiliation(s)
- Jamila R Lepore
- a Food Science and Human Nutrition Department, University of Florida/IFAS, Gainesville, FL
| | - Charles A Sims
- a Food Science and Human Nutrition Department, University of Florida/IFAS, Gainesville, FL
| | - Nancy J Gal
- b Marion County Extension Service, University of Florida/IFAS, Ocala, FL
| | - Wendy J Dahl
- a Food Science and Human Nutrition Department, University of Florida/IFAS, Gainesville, FL
| |
Collapse
|
131
|
Shune SE, Moon JB, Goodman SS. The Effects of Age and Preoral Sensorimotor Cues on Anticipatory Mouth Movement During Swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:195-205. [PMID: 26540553 PMCID: PMC4972007 DOI: 10.1044/2015_jslhr-s-15-0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/31/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim of this study was to investigate the effects of preoral sensorimotor cues on anticipatory swallowing/eating-related mouth movements in older and younger adults. It was hypothesized that these cues are essential to timing anticipatory oral motor patterns, and these movements are delayed in older as compared with younger adults. METHOD Using a 2 × 2 repeated-measures design, eating-related lip, jaw, and hand movements were recorded from 24 healthy older (ages 70-85 years) and 24 healthy younger (ages 18-30 years) adults under 4 conditions: typical self-feeding, typical assisted feeding (proprioceptive loss), sensory-loss self-feeding (auditory and visual loss/degradation), and sensory-loss assisted feeding (loss/degradation of all cues). RESULTS All participants demonstrated anticipatory mouth opening. The absence of proprioception delayed lip-lowering onset, and sensory loss more negatively affected offset. Given at least 1 preoral sensorimotor cue, older adults initiated movement earlier than younger adults. CONCLUSIONS Preoral sensorimotor information influences anticipatory swallowing/eating-related mouth movements, highlighting the importance of these cues. Earlier movement in older adults may be a compensation, facilitating safe swallowing given other age-related declines. Further research is needed to determine if the negative impact of cue removal may be further exacerbated in a nonhealthy system (e.g., presence of dysphagia or disease), potentially increasing swallowing- and eating-related risks.
Collapse
|
132
|
Kappelle WFW, Siersema PD, Bogte A, Vleggaar FP. Challenges in oral drug delivery in patients with esophageal dysphagia. Expert Opin Drug Deliv 2016; 13:645-58. [DOI: 10.1517/17425247.2016.1142971] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Wouter F. W. Kappelle
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, The Netherlands
| | - Peter D. Siersema
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, The Netherlands
| | - Auke Bogte
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, The Netherlands
| | - Frank P. Vleggaar
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, The Netherlands
| |
Collapse
|
133
|
Abstract
Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.
Collapse
Affiliation(s)
- Nathalie Rommel
- KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, B-3000 Leuven, Belgium
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford M6 8HD, UK
| |
Collapse
|
134
|
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; 20:806-815. [PMID: 27709229 DOI: 10.1007/s12603-016-0712-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This review clarifies current information regarding the prevalence of and risk factors associated with dysphagia (swallowing disorders) in the community dwelling elderly (CDE). A better understanding of prevalence and characteristics of dysphagia in the CDE will help to determine the scope of this problem. Understanding the scope of dysphagia is a critical first step towards early identification, management, and prevention of dysphagia related morbidities in the CDE. METHODS Studies identified from multiple electronic databases (MEDLINE (Pubmed), PsychInfo, Google Scholar, EBSCO, PROQUEST, Web of Science and WorldCat dissertations and theses) evaluating prevalence and risk factors for dysphagia in the CDE were reviewed. Data from all eligible studies were abstracted by the first author and independently reviewed by two raters, using the Newcastle-Ottawa scale (NOS). RESULTS 15 studies (n = 9947 participants) were eligible for inclusion. Studies included were all observational: 14 cross-sectional and 1 prospective cohort. Significant heterogeneity was observed in methodology among studies of dysphagia in the CDE. The average NOS study quality rating was 4.54 points (SD: 0.9), with a mode of 4 points (range 3-6). Only 6 of the 15 studies were identified as high quality research studies, with a mean of 5.33 points (SD: 0.47). Among reviewed studies, the prevalence of swallowing difficulty in the CDE ranged from 5% to 72%. However, the average prevalence of dysphagia estimated from the 6 high quality studies was 15%. Reported risk factors associated with dysphagia include advancing age; history of clinical disease; and physical frailty, including reduced ability to carry out activities of daily living. CONCLUSION Research on dysphagia in CDE is modest and consists mostly of observational studies with diverse methodology. However, prevalence rate of 15% from the high quality research suggests a significant public health impact of this impairment. Identification of specific risk factors that cause dysphagia in the CDE is premature, given the rigor of published studies. Future research efforts should focus on developing a valid definition and assessment of dysphagia in this population before clarifying causative risk factors.
Collapse
Affiliation(s)
- A Madhavan
- Aarthi Madhavan, Department of Speech, Language, and Hearing Sciences, University of Florida, PO Box 100174, Gainesville, FL 32610,
| | | | | | | | | |
Collapse
|
135
|
Acoustic analysis of oropharyngeal swallowing using Sonar Doppler. Braz J Otorhinolaryngol 2015; 82:39-46. [PMID: 26718958 PMCID: PMC9444651 DOI: 10.1016/j.bjorl.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 02/27/2015] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION During the aging process, one of the functions that changes is swallowing. These alterations in oropharyngeal swallowing may be diagnosed by methods that allow both the diagnosis and biofeedback monitoring by the patient. One of the methods recently described in the literature for the evaluation of swallowing is the Sonar Doppler. OBJECTIVE To compare the acoustic parameters of oropharyngeal swallowing between different age groups. METHODS This was a field, quantitative, study. Examination with Sonar Doppler was performed in 75 elderly and 72 non-elderly adult subjects. The following acoustic parameters were established: initial frequency, first peak frequency, second peak frequency; initial intensity, final intensity; and time for the swallowing of saliva, liquid, nectar, honey, and pudding, with 5- and 10-mL free drinks. RESULTS Objective, measurable data were obtained; most acoustic parameters studied between adult and elderly groups with respect to consistency and volume were significant. CONCLUSION When comparing elderly with non-elderly adult subjects, there is a modification of the acoustic pattern of swallowing, regarding both consistency and food bolus volume.
Collapse
|
136
|
Noble E, Jones D, Miller N. Perceived changes to swallowing in people with Parkinson's disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.12.573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Emma Noble
- Deceased, Formerly Research Associate, Institute of Health and Society, Newcastle University, UK
| | - Diana Jones
- Reader, School of Sport, Exercise and Rehabilitation, Northumbria University, UK
| | - Nick Miller
- Professor of Motor Speech Disorders and Speech language clinician, Institute of Health and Society and Newcastle University Institute for Ageing, UK
| |
Collapse
|
137
|
Swallowing Disorders in Sjögren's Syndrome: Prevalence, Risk Factors, and Effects on Quality of Life. Dysphagia 2015; 31:49-59. [PMID: 26482060 DOI: 10.1007/s00455-015-9657-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/03/2015] [Indexed: 12/14/2022]
Abstract
This epidemiological investigation examined the prevalence, risk factors, and quality-of-life effects of swallowing disorders in Sjögren's syndrome (SS). One hundred and one individuals with primary or secondary SS (94 females, 7 males; mean age 59.4, SD = 14.1) were interviewed regarding the presence, nature, and impact of swallowing disorders and symptoms. Associations among swallowing disorders and symptoms, select medical and social history factors, SS disease severity, and the M.D. Anderson Dysphagia Inventory (MDADI) and Short Form 36 Health Survey (SF-36) were examined. The prevalence of a current self-reported swallowing disorder was 64.4 %. SS disease severity was the strongest predictor of swallowing disorders, including significant associations with the following swallow symptoms: taking smaller bites, thick mucus in the throat, difficulty placing food in the mouth, and wheezing while eating (p < .05). Additional swallowing disorder risk factors included the presence of a self-reported voice disorder, esophageal reflux, current exposure to secondary tobacco smoke, frequent neck or throat tension, frequent throat clearing, chronic post-nasal drip, and stomach or duodenal ulcers. Swallowing disorders did not differ on the basis of primary or secondary SS. Swallowing disorders and specific swallowing symptoms were uniquely associated with reduced quality of life. Among those with swallowing disorders, 42 % sought treatment, with approximately half reporting improvement. Patient-perceived swallowing disorders are relatively common in SS and increase with disease severity. Specific swallowing symptoms uniquely and significantly reduce swallow and health-related quality of life, indicating the need for increased identification and management of dysphagia in this population.
Collapse
|
138
|
Vickers Z, Damodhar H, Grummer C, Mendenhall H, Banaszynski K, Hartel R, Hind J, Joyce A, Kaufman A, Robbins J. Relationships Among Rheological, Sensory Texture, and Swallowing Pressure Measurements of Hydrocolloid-Thickened Fluids. Dysphagia 2015; 30:702-13. [PMID: 26289079 DOI: 10.1007/s00455-015-9647-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to examine the relationships among three categories of measurements (rheological, sensory texture, and swallowing pressure) from fluids thickened to two different viscosities with 15 different hydrocolloids. Fluids at viscosities of 300 and 1500 cP (at 30 s(-1)) were targeted because these are the viscosities corresponding to the barium standards used in radiographic dysphagia diagnosis. Within the low viscosity (nectar) fluids (300 cP), the sensory properties thickness, stickiness, adhesiveness, mouth coating, and number of swallows were highly positively correlated with each other and highly positively correlated with the flow behavior index, n value (an indicator of shear-thinning behavior). Within the higher viscosity (thin honey) fluids (1500 cP), the sensory textures of adhesiveness, stickiness, mouth coating, and number of swallows correlated positively with rheological measures of n value. Swallowing pressures measured in the anterior oral cavity correlated negatively with the consistency coefficient k [shear stress/(shear rate) (n) ]. Samples that were more shear thinning (lower n values, higher k values) were generally perceived as less thick, with less adhesive properties (stickiness, adhesiveness, mouthcoating, and number of swallows). This information can be useful for selecting thickeners for people with dysphagia. A desirable thickener for many dysphagic patients would be one that allowed for a safe swallow by being viscous enough to reduce airway penetration, yet pleasant to drink, having the minimal perceived thickness and mouthcoating associated with greater shear thinning.
Collapse
Affiliation(s)
- Z Vickers
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, 55112, USA.
| | - H Damodhar
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, 55112, USA
| | - C Grummer
- Department of Food Science, University of Wisconsin, Madison, WI, 53706, USA
| | - H Mendenhall
- Department of Food Science, University of Wisconsin, Madison, WI, 53706, USA
| | - K Banaszynski
- Department of Food Science, University of Wisconsin, Madison, WI, 53706, USA
| | - R Hartel
- Department of Food Science, University of Wisconsin, Madison, WI, 53706, USA
| | - J Hind
- Department of Medicine, University of Wisconsin, Madison, WI, 53706, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, 53706, USA
| | - A Joyce
- Department of Medicine, University of Wisconsin, Madison, WI, 53706, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, 53706, USA
| | - A Kaufman
- Department of Medicine, University of Wisconsin, Madison, WI, 53706, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, 53706, USA
| | - J Robbins
- Department of Medicine, University of Wisconsin, Madison, WI, 53706, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, 53706, USA
| |
Collapse
|
139
|
Namasivayam AM, Steele CM, Keller H. The effect of tongue strength on meal consumption in long term care. Clin Nutr 2015; 35:1078-83. [PMID: 26321499 DOI: 10.1016/j.clnu.2015.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE As many as 74% of residents in long-term care (LTC) are anticipated to have swallowing difficulties (dysphagia). Low food intake is commonly reported in persons with swallowing problems, but food intake may also be affected by fatigue in the swallowing muscles. As fatigue sets in during mealtimes, the strength of the tongue may decline. Tongue strength is also known to decline with age but it is unclear how this functional change may influence food intake. In this pilot study, we explored the relationship between tongue strength and meal consumption in persons not previously diagnosed with dysphagia. METHODS The Iowa Oral Performance Instrument was used to collect maximum anterior isometric tongue-palate pressures from 12 LTC residents (5 male; mean age: 85, range 65-99). Residents were also screened for dysphagia with applesauce and a water swallow test. Each resident was observed at three different meals to record the length of time taken to eat the meal, amount of food consumed, and any indication of overt signs of swallowing difficulty (e.g. coughing). RESULTS Residents who displayed observable swallowing difficulties at mealtimes had significantly lower tongue strength than those without swallowing difficulties (p < 0.01). Those with lower tongue strength took significantly longer to complete meals (p < 0.05) and consumed less food. Tongue strength was not predictive of performance on the water screen and the water swallow test was not a good predictor of which participants were observed to display mealtime difficulties. CONCLUSION Among seniors in long term care, reduced tongue strength is associated with longer meal times, reduced food consumption, and the presence of observable signs of swallowing difficulty. Further exploration of these relationships is warranted.
Collapse
Affiliation(s)
- Ashwini M Namasivayam
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2, Canada; Speech-Language Pathology, University of Toronto, 500 University Avenue, Toronto, ON M5G1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G1V7, Canada.
| | - Catriona M Steele
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2, Canada; Speech-Language Pathology, University of Toronto, 500 University Avenue, Toronto, ON M5G1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G1V7, Canada; Institute for Biomaterials and Biomedical Engineering, University of Toronto, Canada; Bloorview Research Institute, Canada
| | - Heather Keller
- Schlegel Research Chair, Nutrition & Aging, Schelgel-University of Waterloo Research Institute for Aging, University of Waterloo, Canada
| |
Collapse
|
140
|
Kletzien H, Russell JA, Connor NP. The effects of treadmill running on aging laryngeal muscle structure. Laryngoscope 2015; 126:672-7. [PMID: 26256100 DOI: 10.1002/lary.25520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/06/2015] [Accepted: 06/25/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Age-related changes in laryngeal muscle structure and function may contribute to deficits in voice and swallowing observed in elderly people. We hypothesized that treadmill running, an exercise that increases respiratory drive to upper airway muscles, would induce changes in thyroarytenoid muscle myosin heavy chain (MHC) isoforms that are consistent with a fast-to-slow transformation in muscle fiber type. STUDY DESIGN Randomized parallel group controlled trial. METHODS Fifteen young adult and 14 old Fischer 344/Brown Norway rats received either treadmill running or no exercise (5 days/week/8 weeks). Myosin heavy chain isoform composition in the thyroarytenoid muscle was examined at the end of 8 weeks. RESULTS Significant age and treatment effects were found. The young adult group had the greatest proportion of superfast-contracting MHCIIL isoform. The treadmill running group had the lowest proportion of MHCIIL and the greatest proportion of MHCIIx isoforms. CONCLUSION Thyroarytenoid muscle structure was affected both by age and treadmill running in a fast-to-slow transition that is characteristic of exercise manipulations in other skeletal muscles. LEVEL OF EVIDENCE NA. Laryngoscope, 126:672-677, 2016.
Collapse
Affiliation(s)
- Heidi Kletzien
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, U.S.A
| | - John A Russell
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, U.S.A
| | - Nadine P Connor
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, U.S.A
| |
Collapse
|
141
|
Abstract
Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.
Collapse
|
142
|
O’Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N. Bedside diagnosis of dysphagia: a systematic review. J Hosp Med 2015; 10:256-65. [PMID: 25581840 PMCID: PMC4607509 DOI: 10.1002/jhm.2313] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/02/2014] [Accepted: 12/07/2014] [Indexed: 11/10/2022]
Abstract
Dysphagia is associated with aspiration, pneumonia, and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. We conducted a comprehensive search of 7 databases, including MEDLINE, Embase, and Scopus, from each database's earliest inception through June 9, 2014. Studies reporting diagnostic performance of a bedside examination maneuver compared to a reference gold standard (videofluoroscopic swallow study or flexible endoscopic evaluation of swallowing with sensory testing) were included for analysis. From each study, data were abstracted based on the type of diagnostic method and reference standard study population and inclusion/exclusion characteristics, design, and prediction of aspiration. The search strategy identified 38 articles meeting inclusion criteria. Overall, most bedside examinations lacked sufficient sensitivity to be used for screening purposes across all patient populations examined. Individual studies found dysphonia assessments, abnormal pharyngeal sensation assessments, dual axis accelerometry, and 1 description of water swallow testing to be sensitive tools, but none were reported as consistently sensitive. A preponderance of identified studies was in poststroke adults, limiting the generalizability of results. No bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several individual exam maneuvers demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols was not established. More research is needed to design an optimal protocol for dysphagia detection.
Collapse
Affiliation(s)
| | | | | | | | - Nasia Safdar
- Corresponding author. Nasia Safdar, MD, PhD, University of Wisconsin Madison, MFCB 5221 Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53705, , Phone: 608 263-1545, Fax: 608 263-4464
| |
Collapse
|
143
|
Neural representation of swallowing is retained with age. A functional neuroimaging study validated by classical and Bayesian inference. Behav Brain Res 2015; 286:308-17. [PMID: 25771712 DOI: 10.1016/j.bbr.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/27/2015] [Accepted: 03/04/2015] [Indexed: 11/20/2022]
Abstract
We investigated the neural representation of swallowing in two age groups for a total of 51 healthy participants (seniors: average age 64 years; young adults: average age 24 years) using high spatial resolution functional magnetic resonance imaging (fMRI). Two statistical comparisons (classical and Bayesian inference) revealed no significant differences between subject groups, apart from higher cortical activation for the seniors in the frontal pole 1 of Brodmann's Area 10 using Bayesian inference. Seniors vs. young participants showed longer reaction times and higher skin conductance response (SCR) during swallowing. We found a positive association of SCR and fMRI-activation only among seniors in areas processing sensorimotor performance, arousal and emotional perception. The results indicate that the highly automated swallowing network retains its functionality with age. However, seniors with higher SCR during swallowing appear to also engage areas involved in attention control and emotional regulation, possibly suggesting increased attention and emotional demands during task performance.
Collapse
|
144
|
Fleming AB, Carlson DR, Varanasi RK, Grima M, Mayock SP, Saim S, Kopecky EA. Evaluation of an Extended-Release, Abuse-Deterrent, Microsphere-in-Capsule Analgesic for the Management of Patients with Chronic Pain With Dysphagia (CPD). Pain Pract 2015; 16:334-44. [DOI: 10.1111/papr.12280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/07/2014] [Accepted: 11/18/2014] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | - Said Saim
- Collegium Pharmaceutical, Inc.; Canton MA U.S.A
| | | |
Collapse
|
145
|
Russell JA, Connor NP. Effects of age and radiation treatment on function of extrinsic tongue muscles. Radiat Oncol 2014; 9:254. [PMID: 25472556 PMCID: PMC4269095 DOI: 10.1186/s13014-014-0254-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Radiation treatment for head and neck cancer often results in difficulty swallowing. Muscle weakness and fibrosis have been identified clinically as possible etiologies for swallowing problems following radiation. Aging may compound the effects of radiation on swallowing because radiation-induced damage to muscles and other tissues critical for the oropharyngeal swallow is overlaid on a declining sensorimotor system. However, there have been no investigations of the manner in which aging and radiation treatment effects combine to impact tongue muscles, which are critical effectors of the oropharyngeal swallow. Methods Thirty-seven male Fisher 344/Brown Norway rats were divided into four groups; young adults (9 month old), old (32 months old), young radiation (9 months), and old radiation (32 months old). Two fractions of 11 Gy on consecutive days was delivered by external beam radiation to the ventral side of the rat’s body over the anterior portion (20 X 30 mm area) of the anterior digastric muscle. Two-way analysis of variance (ANOVA) was used to examine the effects of age and radiation and their interaction on muscle contractile properties. Post-hoc testing was completed using Fisher’s least significant differences (LSD). Results Radiation was associated with a significant decrease in tongue force production and reduced speed of tongue muscle contraction. However, radiation treatment did not lead to muscle atrophy and fibrosis formation in the GG muscle. Radiation treatment did not exacerbate atrophic changes observed with aging, or lead to additional fibrosis formation in the GG muscle from that observed in the other groups. Conclusions The purpose of this research was to determine the effect of radiation on muscles of the tongue and to determine whether aging altered the extent of radiation injury to tongue muscles. Radiation was associated with a significant decrease in tongue force production and reduced speed of tongue muscle contraction, and the reduction in the speed of tongue muscle contraction was exacerbated in the aged-rat tongue. This work provides a foundation for future investigations of treatments for concurrent effects of aging and radiation on muscles of the tongue and swallowing.
Collapse
Affiliation(s)
- John A Russell
- University of Wisconsin School of Medicine and Public Health, Otolaryngology Head and Neck Surgery, Madison, WI, 53706, USA.
| | - Nadine P Connor
- University of Wisconsin School of Medicine and Public Health, Otolaryngology Head and Neck Surgery, Madison, WI, 53706, USA. .,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA.
| |
Collapse
|
146
|
Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014; 5:269-77. [PMID: 25223471 PMCID: PMC4248414 DOI: 10.1007/s13539-014-0162-x] [Citation(s) in RCA: 251] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022] Open
Abstract
Malnutrition and sarcopenia often occur in rehabilitation settings. The prevalence of malnutrition and sarcopenia in older patients undergoing rehabilitation is 49-67 % and 40-46.5 %, respectively. Malnutrition and sarcopenia are associated with poorer rehabilitation outcome and physical function. Therefore, a combination of both rehabilitation and nutrition care management may improve outcome in disabled elderly with malnutrition and sarcopenia. The concept of rehabilitation nutrition as a combination of both rehabilitation and nutrition care management and the International Classification of Functioning, Disability and Health guidelines are used to evaluate nutrition status and to maximize functionality in the elderly and other people with disability. Assessment of the multifactorial causes of primary and secondary sarcopenia is important because rehabilitation nutrition for sarcopenia differs depending on its etiology. Treatment of age-related sarcopenia should include resistance training and dietary supplements of amino acids. Therapy for activity-related sarcopenia includes reduced bed rest time and early mobilization and physical activity. Treatment for disease-related sarcopenia requires therapies for advanced organ failure, inflammatory disease, malignancy, or endocrine disease, while therapy for nutrition-related sarcopenia involves appropriate nutrition management to increase muscle mass. Because primary and secondary sarcopenia often coexist in people with disability, the concept of rehabilitation nutrition is useful for their treatment. Stroke, hip fracture, and hospital-associated deconditioning are major causes of disability, and inpatients of rehabilitation facilities often have malnutrition and sarcopenia. We review the concept of rehabilitation nutrition, the rehabilitation nutrition options for stroke, hip fracture, hospital-associated deconditioning, sarcopenic dysphagia, and then evaluate the amount of research interest in rehabilitation nutrition.
Collapse
Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama city, Japan, 232-0024,
| | | |
Collapse
|
147
|
Argoff CE, Kopecky EA. Patients with chronic pain and dysphagia (CPD): unmet medical needs and pharmacologic treatment options. Curr Med Res Opin 2014; 30:2543-59. [PMID: 25244248 DOI: 10.1185/03007995.2014.967388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND For properly selected patients experiencing chronic pain, extended-release opioid formulations may represent an appropriate pain management choice. For the many adults, elderly, and children who have medical conditions that make swallowing solid, oral-dose formulations difficult (dysphagia) or painful (odynophagia), this option may be limited. The combination of chronic pain with dysphagia (CPD) presents a challenge to physicians and patients alike when oral opioid analgesia is needed to control pain, but patients are unable to swallow solid, oral dosage forms. METHODS A Medline search was performed (1990 to 2013) using the search terms swallowing difficulties, dysphagia, odynophagia, adults, pediatrics, elderly, chronic pain, pain, and opioids. The following websites were searched: American Dysphagia Network, Dysphagia Research Society, World Health Organization, American Pain Society, International Association for the Study of Pain, American Academy of Pain Medicine, and American Society of Interventional Pain Physicians. Chronic pain guidelines from the following professional organizations were searched: American Pain Society, National Comprehensive Cancer Network, American Society of Interventional Pain Physicians, British Geriatric Society, European Society of Medical Oncology, World Health Organization, and the European Association for Palliative Care. FINDINGS There is an unmet medical need for greater recognition of dysphagia, awareness of potential problems with medication administration in these patients, recognition of alternative drug formulations that are available for use in CPD, and an appreciation that there are new, solid, oral-dose, opioid formulations in development that can mitigate these issues associated with swallowing difficulty while still providing practical, effective analgesia. Current pharmacologic treatments have limitations; new, prospective opioid formulations in clinical development may offer physicians and patients with CPD effective treatment options while mitigating accidental exposure and abuse liability. CONCLUSIONS The number of patients with CPD may be larger than is currently anticipated by healthcare providers. Physicians should proactively include a discussion of dysphagia as part of the patient examination. CPD is an unmet medical need. There are novel opioid formulations in clinical development that address the limitations of current opioid treatments. This manuscript reviews the problems associated with dysphagia on medication administration and adherence, currently available treatment options, and opioid analgesic formulations currently in clinical development.
Collapse
|
148
|
Kocdor P, Siegel ER, Giese R, Tulunay-Ugur OE. Characteristics of dysphagia in older patients evaluated at a tertiary center. Laryngoscope 2014; 125:400-5. [PMID: 25196400 DOI: 10.1002/lary.24917] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/08/2014] [Accepted: 08/11/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine laryngoscopic and videofluoroscopic swallowing study (VFSS) findings in geriatric patients with dysphagia; to evaluate management. STUDY DESIGN Retrospective chart review. METHODS Patients over 65 years old complaining of dysphagia, seen at a tertiary laryngology clinic, were included. Head and neck cancer and stroke patients were excluded. Demographics, laryngoscopic findings, swallowing studies, and treatment modalities were reviewed. RESULTS Sixty-five patients were included. Mean age was 75 years old (range = 66-97) with female predominance of 67.6%. Weight loss was seen in 9.2% of the patients. Whereas 52.3% of the patients complained of solid food dysphagia, 53.8% were choking on food. On laryngoscopy, 15.3% of the patients had pooling in the pyriform sinuses, 30.7% had glottic gap, 18.4% had vocal fold immobility, and 3% had hypomobility. VFSS showed that 38.4% of the patients had pharyngoesophageal dysphagia, 20% had oropharyngeal dysphagia, 20% had pharyngeal dysphagia, and 20% had a normal study. In addition, 41.5% of the patients showed laryngeal penetration and 18.4% showed aspiration. Surgical intervention was employed in 29.2% of the patients in the form of botulinum toxin injection, esophageal dilatation, cricopharyngeal myotomy, vocal fold injection, diverticulectomy, and percutaneous endoscopic gastrostomy. Whereas 21.5% of the patients received swallowing therapy, 61.5% underwent diet modification. As a result, 80% of the patients needed some type of treatment. CONCLUSIONS Swallowing problems in older patients are not uncommon. The clinician needs to be diligent to inquire about dysphagia because a large number of these patients will require treatment. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Pelin Kocdor
- Department of Otolaryngology Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | | | | | | |
Collapse
|
149
|
Abstract
OBJECTIVE To determine the prevalence of dysphagia, reported etiologies, and impact among adults in the United States. STUDY DESIGN Cross-sectional analysis of a national health care survey. SUBJECTS AND METHODS The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was assessed. RESULTS An estimated 9.44 ± 0.33 million adults (raw N = 1554; mean age, 52.1 years; 60.2% ± 1.6% female) reported a swallowing problem (4.0% ± 0.1%). Overall, 22.7% ± 1.7% saw a health care professional for their swallowing problem, and 36.9% ± 0.1.7% were given a diagnosis. Women were more likely than men to report a swallowing problem (4.7% ± 0.2% versus 3.3% ± 0.2%, P < .001). Of the patients, 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422,000 ± 77,000; 11.2% ± 1.9%), followed by other neurologic cause (269,000 ± 57,000; 7.2% ± 1.5%) and head and neck cancer (185,000 ± 40,000; 4.9% ± 1.1%). The mean number of days affected by the swallowing problem was 139 ± 7. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without a swallowing problem (contrast, +8.1 lost workdays, P < .001). CONCLUSION Swallowing problems affect 1 in 25 adults, annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.
Collapse
Affiliation(s)
- Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
150
|
Rogus-Pulia NM, Pierce M, Mittal BB, Zecker SG, Logemann J. Bolus effects on patient awareness of swallowing difficulty and swallow physiology after chemoradiation for head and neck cancer. Head Neck 2014; 37:1122-9. [PMID: 24841209 DOI: 10.1002/hed.23720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 12/23/2013] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patients treated for head and neck cancer frequently develop dysphagia. Bolus characteristics are altered during fluoroscopic swallowing studies to observe the impact on swallowing function. The purpose of this study was to determine bolus volume and consistency effects on oropharyngeal swallowing physiology and patient awareness of swallowing difficulty. METHODS Twenty-one patients with head and neck cancer were assessed pre-chemoradiation and post-chemoradiation. The Modified Barium Swallow Study (MBSS) was utilized to examine swallow physiology. Each patient provided perceptual ratings of swallowing difficulty after each swallow of varying bolus types. RESULTS Oral transit times were significantly longer with pudding boluses. There were trends for higher residue percentages as well as perceptual ratings for pudding and cookie boluses. One correlation between perceptual ratings and physiology was significant. CONCLUSION Patient awareness of swallowing difficulty and aspects of swallowing physiology vary with bolus consistency. Patient awareness does not correlate with observed changes in swallowing physiology.
Collapse
Affiliation(s)
- Nicole M Rogus-Pulia
- William S. Middleton Memorial Veterans Hospital, University of Wisconsin-Madison, Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, Madison, Wisconsin
| | - Margaret Pierce
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bharat B Mittal
- Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Steven G Zecker
- Northwestern University, Department of Communication Sciences and Disorders, Evanston, Illinois
| | - Jeri Logemann
- Northwestern University, Department of Communication Sciences and Disorders, Evanston, Illinois
| |
Collapse
|