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Abstract
Dysphagia, or difficulty swallowing, is a common problem in the elderly. Based on the initial clinical history and physical examination, the dysphagia is assessed as either primarily oropharyngeal or esophageal in origin. Most oropharyngeal dysphagia is of neurologic origin, and management is coordinated with a clinical swallow specialist in conjunction with an ear, nose, and throat (ENT) physician if warning signs imply malignancy. Several structural and functional esophageal disorders can cause dysphagia. If a patient has likely esophageal dysphagia, a video barium esophagram is a good initial test, and referral to a gastroenterologist is generally warranted leading to appropriate treatment.
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152
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Aydogdu I, Kiylioglu N, Tarlaci S, Tanriverdi Z, Alpaydin S, Acarer A, Baysal L, Arpaci E, Yuceyar N, Secil Y, Ozdemirkiran T, Ertekin C. Diagnostic value of "dysphagia limit" for neurogenic dysphagia: 17 years of experience in 1278 adults. Clin Neurophysiol 2014; 126:634-43. [PMID: 25088732 DOI: 10.1016/j.clinph.2014.06.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/26/2014] [Accepted: 06/28/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up are critical for early diagnosis and management which can mitigate its complications and be cost-saving. The aims of this study are to provide a comprehensive investigation of the dysphagia limit (DL) in a large diverse cohort and to provide a longitudinal assessment of dysphagia in a subset of subjects. METHODS We developed a quantitative and noninvasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. DL is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia, and 202 patients without dysphagia. A total of 192 of all patients were also reevaluated longitudinally over a period of 1-19 months. RESULTS DL has 92% sensitivity, 91% specificity, 94% positive predictive value, and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke, and movement disorders have the highest sensitivity (85-97%) and positive predictive value (90-99%). The clinical severity of dysphagia has significant negative correlation with DL (r=-0.67, p<0.0001). CONCLUSIONS We propose the DL as a reliable, quick, noninvasive, quantitative test to detect and follow both clinical and subclinical dysphagia and it can be performed in an EMG laboratory. SIGNIFICANCE Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions.
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Affiliation(s)
- Ibrahim Aydogdu
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey.
| | - Nefati Kiylioglu
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Sultan Tarlaci
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Zeynep Tanriverdi
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Sezin Alpaydin
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Ahmet Acarer
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Leyla Baysal
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Esra Arpaci
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Nur Yuceyar
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Yaprak Secil
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Tolga Ozdemirkiran
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
| | - Cumhur Ertekin
- Ege University Medical School Hospital, Departments of Neurology and Clinical Neurophysiology, Bornova, Izmir, Turkey
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153
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Lindroos E, Saarela RKT, Soini H, Muurinen S, Suominen MH, Pitkälä KH. Caregiver-reported swallowing difficulties, malnutrition, and mortality among older people in assisted living facilities. J Nutr Health Aging 2014; 18:718-22. [PMID: 25226112 DOI: 10.1007/s12603-014-0506-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living. DESIGN A cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality. SETTING Assisted living facilities in the Helsinki metropolitan area, Finland. PARTICIPANTS All residents (N=1466) in assisted living facilities. MEASUREMENTS Personal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents' nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers. RESULTS SWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinson's disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p < .001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p < .001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p < .010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p< .001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 -2.12). CONCLUSIONS SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.
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Affiliation(s)
- E Lindroos
- Eeva Lindroos, M.Sc, Helsinki Metropolia, University of Applied Sciences, Finland, Mannerheimintie 172, FIN-00300 Helsinki, Finland, tel. +358-50-5695677, E-mail address:
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154
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Fritz M, Cerrati E, Fang Y, Verma A, Achlatis S, Lazarus C, Branski RC, Amin M. Magnetic resonance imaging of the effortful swallow. Ann Otol Rhinol Laryngol 2014; 123:786-90. [PMID: 24916396 DOI: 10.1177/0003489414538607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The effortful swallow was designed to improve posterior mobility of the tongue base and increase intraoral pressures. We characterized the effects of this maneuver via dynamic magnetic resonance imaging (dMRI) in healthy patients. METHODS A 3-T scanner was used to obtain dMRI images of patients swallowing pudding using normal as well as effortful swallows. Ninety sequential images were acquired at the level of the oropharynx in the axial plane for each swallow; 3 series were obtained for each swallow type for each patient. Images were acquired every 113 ms during swallowing. The images were analyzed with respect to oropharyngeal closure duration, anteroposterior and transverse distance between the oropharyngeal walls, and oropharyngeal area before and after closure. RESULTS Preswallow reduced pharyngeal area was observed (P = .02; mean = 212.61 mm² for effortful, mean = 261.92 mm² for normal) as well as prolonged pharyngeal closure during the swallow (P < .0001; mean = 742.18 ms for effortful, mean = 437.31 ms for normal). No other differences were noted between swallow types. Interrater and intrarater reliability of all measurements was excellent. CONCLUSION This preliminary investigation is the first to evaluate the effects of effortful swallows via dMRI. In our cohort, consistent physiologic changes were elicited, consistent with clinical dogma regarding this maneuver.
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Affiliation(s)
- Mark Fritz
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Eric Cerrati
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Yixin Fang
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Avanti Verma
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Stratos Achlatis
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Cathy Lazarus
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, New York, New York, USA
| | - Ryan C Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Milan Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
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Goldberg LR, Heiss CJ, Parsons SD, Foley AS, Mefferd AS, Hollinger D, Parham DF, Patterson J. Hydration in older adults: the contribution of bioelectrical impedance analysis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:273-281. [PMID: 24521507 DOI: 10.3109/17549507.2014.882989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The sensory and gastrointestinal changes that occur with ageing affect older adults' food and liquid intake. Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of bioelectrical impedance analysis to measure hydration in 19 older women in residential care: 13 who viewed themselves as healthy and six with dysphagia. Mann-Whitney U analyses documented no significant between-group differences for Total Body Water (TBW), Fat Free Mass (FFM), Fat Mass (FM), and percentage Body Fat (%BF). However, when compared to previously published data for age-matched women, the TBW and FFM values of the two participant groups were notably less, and FM and %BF values were notably greater than expected. If results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.
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156
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Viscosity Differences Between Thickened Beverages Suitable for Elderly Patients with Dysphagia. Dysphagia 2014; 29:483-8. [DOI: 10.1007/s00455-014-9533-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
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157
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Dua KS, Surapaneni SN, Kuribayashi S, Hafeezullah M, Shaker R. Effect of aging on hypopharyngeal safe volume and the aerodigestive reflexes protecting the airways. Laryngoscope 2014; 124:1862-8. [PMID: 24281906 DOI: 10.1002/lary.24539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/05/2013] [Accepted: 11/25/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Studies on young volunteers have shown that aerodigestive reflexes are triggered before the maximum volume of fluid that can safely collect in the hypopharynx before spilling into the larynx is exceeded (hypopharyngeal safe volume [HPSV]). The objective of this study was to determine the influence of aging on HPSV and pharyngo-glottal closure reflex (PGCR), pharyngo-UES contractile reflex (PUCR), and reflexive pharyngeal swallow (RPS). STUDY DESIGN Comparison between two groups of different age ranges. METHODS Ten young (25 ± 3 standard deviation [SD] years) and 10 elderly (77 ± 3 SD years) subjects were studied. PGCR, PUCR, and RPS were elicited by perfusing water into the pharynx rapidly and slowly. HPSV was determined by abolishing RPS with pharyngeal anesthesia. RESULTS Frequency-elicitation of PGCR and PUCR were significantly lower in the elderly compared to the young during slow water perfusion (47% vs. 97% and 40% vs. 90%, respectively, P < .001). RPS was absent in five of the 30 (17%) slow injections in the elderly group. In these elderly subjects, HPSV was exceeded and laryngeal penetration of the water was seen. The threshold volume to elicit PGCR, PUCR, and RPS was significantly lower than the HPSV during rapid injections. Except for RPS, these volumes were also significantly lower than HPSV during slow injections. CONCLUSIONS PGCR, PUCR, and RPS reflexes are triggered at a threshold volume significantly lower than the HPSV in both young and elderly subjects. Lower frequency-elicitation of PGCR, PUCR, and RPS in the elderly can predispose them to the risks of aspiration.
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Affiliation(s)
- Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.; VA Medical Center, Milwaukee, Wisconsin, U.S.A
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158
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Lafer M, Achlatis S, Lazarus C, Fang Y, Branski RC, Amin MR. Temporal measurements of deglutition in dynamic magnetic resonance imaging versus videofluoroscopy. Ann Otol Rhinol Laryngol 2014; 122:748-53. [PMID: 24592577 DOI: 10.1177/000348941312201204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We undertook to provide data regarding temporal measurements of swallow function obtained by dynamic magnetic resonance imaging in a midsagittal plane and to compare these values to normative fluoroscopy data. METHODS Seventeen healthy female volunteers with no swallowing complaints underwent turbo-fast low-angle-shot magnetic resonance imaging with a 3-T scanner while swallowing liquid and pudding boluses delivered via syringe. Ninety sequential images were acquired with a temporal resolution of 113 ms per frame for each swallow. The imaging was performed in the midsagittal plane. The analyses focused on oral and pharyngeal transit times. RESULTS All subjects tolerated the protocol without complaints or adverse events. The mean (+/- SD) oral transit times for liquids and pudding were measured as 0.25 +/- 0.09 second and 0.25 +/- 0.13 second, respectively. This difference was not statistically significant (p = 0.74). The mean pharyngeal transit times for liquids and pudding were measured as 0.84 +/- 0.16 second and 1.11 +/- 0.21 seconds, respectively. This difference achieved statistical significance (p < 0.0001). The intrarater and inter-rater reliabilities for the measurements were excellent. CONCLUSIONS This sequence provided a high degree of temporal resolution of deglutition in the midsagittal plane. Furthermore, the temporal measurements acquired with dynamic magnetic resonance imaging were reliable and were relatively consistent with those of previous studies done with videofluoroscopy.
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Affiliation(s)
- Marissa Lafer
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Stratos Achlatis
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Cathy Lazarus
- Thyroid Head and Neck Research Center, Thyroid Head and Neck Cancer Foundation, Beth Israel Medical Center, New York, New York, USA
| | - Yixin Fang
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, USA
| | - Ryan C Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, USA
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159
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Wakabayashi H, Sashika H, Matsushima M. Head lifting strength is associated with dysphagia and malnutrition in frail older adults. Geriatr Gerontol Int 2014; 15:410-6. [DOI: 10.1111/ggi.12283] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
- Division of Clinical Epidemiology; Jikei University School of Medicine; Tokyo Japan
| | - Hironobu Sashika
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology; Jikei University School of Medicine; Tokyo Japan
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160
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Luo Q, Douglas M, Burkholder T, Sokoloff AJ. Absence of developmental and unconventional myosin heavy chain in human suprahyoid muscles. Muscle Nerve 2014; 49:534-44. [PMID: 23835800 DOI: 10.1002/mus.23946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Contradictory reports of the myosin heavy chain (MHC) composition of adult human suprahyoid muscles leave unresolved the extent to which these muscles express developmental and unconventional MHC. METHODS By immunohistochemistry, separation sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)-Coomassie, separation SDS-PAGE-Western blot, and mRNA PCR, we tested for conventional MHCI, MHCIIA, MHCIIX, developmental MHC embryonic and MHC neonatal, and unconventional MHC alpha-cardiac, MHC extraocular, and MHC slow tonic in adult human anterior digastric (AD), geniohyoid (GH), and mylohyoid (MH) muscles. RESULTS By separation SDS-PAGE-Coomassie and Western blot, only conventional MHC are present. By immunohistochemistry all muscle fibers are positive for MHCI, MHCIIA, or MHCIIX, and fewer than 4 fibers/mm(2) are positive for developmental or unconventional MHC. By PCR, mRNA of MHCI and MHCIIA dominate, with sporadically detectable MHC alpha-cardiac and without detectable mRNA of other developmental and unconventional MHC. CONCLUSIONS We conclude that human suprahyoid muscles AD, GH, and MH are composed almost exclusively of conventional MHC isoforms.
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Affiliation(s)
- Qingwei Luo
- Department of Physiology, Emory University, 615 Michael Street, Atlanta, Georgia, 30322, USA
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161
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Pergolizzi JV, Taylor R, Nalamachu S, Raffa RB, Carlson DR, Varanasi RK, Kopecky EA. Challenges of treating patients with chronic pain with dysphagia (CPD): physician and patient perspectives. Curr Med Res Opin 2014; 30:191-202. [PMID: 24117419 DOI: 10.1185/03007995.2013.854197] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Dysphagia--difficulty eating and swallowing--can significantly impair a patient's ability to maintain adequate nutritional and medication intake. There are a large number of patients with chronic pain, including pediatric, geriatric, and palliative care patients, who suffer from dysphagia and, therefore, have difficulty achieving optimal pain management with solid, oral formulations. The objective of this study was to survey physicians and patients in the US to understand their knowledge, attitudes, and clinical management/analgesic usage patterns in the treatment of patients with chronic pain with dysphagia (CPD). RESEARCH DESIGN AND METHODS Two separate surveys were administered to physicians and patients. The physician survey design was qualitative; physicians participated in a semi-structured phone interview. The patient survey design was quantitative; patients participated in a structured online survey. Purposive sampling was used to recruit participants into both studies. Physician participants were identified based on their specialty, prescribing practices, and geographic location. Patient participants were recruited through a consumer panel of pre-identified individuals who, for 3 months or longer, had chronic pain and were taking opioids. RESULTS Thirty-four physicians and 1021 patients were surveyed. Physicians indicated that 5-20% of their patients had difficulty swallowing. Treatment for CPD consisted of the fentanyl patch, immediate-release opioids, methadone liquid, or extended-release morphine products. Physicians were not satisfied with currently available treatment options. Twenty-nine per cent of patients surveyed had trouble swallowing or disliked swallowing pills. Eighty per cent of patients were not asked about their ability to swallow solid, oral dosage forms by their physician. To circumvent swallowing difficulties, some patients (16%) cut/crush/grind their medication to facilitate swallowing. Most of these patients (65%) did not know that altering tablets could potentially change the drug release (pharmacokinetic) characteristics of the tablet and lead to serious adverse events. LIMITATIONS Qualitative survey research can be influenced by responder bias as well as selection bias. The number of survey participants for both the physician and patient surveys was small, thus responses may not reflect those in the general population. CONCLUSION A proportion of patients with chronic pain have dysphagia and cannot swallow solid, oral dosage forms, which creates a serious treatment challenge for pain specialists and other healthcare providers. Currently available treatment options have limitations; new treatment options would be welcomed by both physicians and patients. Physician and patient education should be enhanced in order to promote awareness of the deleterious consequences associated with altering currently available analgesic formulations. Facilitating patient-physician communication on this topic may help to improve treatment outcomes.
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Affiliation(s)
- Joseph V Pergolizzi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA, Georgetown University School of Medicine, Washington, DC, USA, and Temple University School of Medicine , Philadelphia, PA , USA
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Mahboubi H, Verma SP. Swallowing Disorders in the Ambulatory Medical Setting. Otolaryngol Head Neck Surg 2014; 150:563-7. [DOI: 10.1177/0194599813518017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aims of this cross-sectional study were to explore the nationwide number and demographics of patient visits due to dysphagia and to investigate potential differences in their management between otolaryngologists and other physicians in the outpatient setting. Study Design Cross-sectional. Setting National Ambulatory Medical Care Survey. Subjects and Methods The data sets from 2007 to 2010 were queried to extract all cases with dysphagia as a reason for visit. Data regarding demographics, imaging studies, nonmedication therapies, diagnoses, medications, and patient disposition were compared between otolaryngologists, primary care physicians, and other specialists. Results Annually, 1,875,187 (95% confidence interval [CI], 1,443,876-2,307,204) outpatient visits were due to dysphagia, comprising 0.19% of all visits (95% CI, 0.14%-0.23%) and 1.55% (95% CI, 1.10%-2.0%) of the visits to otolaryngologists. The visits were mostly distributed between primary care physicians and other specialists, while 16.4% (95% CI, 11.3%-21.6%) visited an otolaryngology office. Otolaryngologists, primary care physicians, and other specialists ordered imaging studies in 22.8%, 10.2%, and 24.0% ( P = .02); performed aerodigestive-specific procedures in 20.8%, 4.0%, and 36.2% ( P < .0001); and referred the patient to another physician in 5.8%, 14.8%, and 2.8% ( P = .003) of the visits, respectively. Conclusions Almost 0.2% of office visits to physicians have a complaint of dysphagia. Otolaryngologists are involved in the care of a minority of these visits. The differences in the management of dysphagic patients may be due to different etiologies of the disease.
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Affiliation(s)
- Hossein Mahboubi
- University Voice and Swallowing Center, Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Sunil P. Verma
- University Voice and Swallowing Center, Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine, California, USA
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Park YH, Han HR, Oh S, Chang H. Validation of the Korean version of the standardized swallowing assessment among nursing home residents. J Gerontol Nurs 2014; 40:26-35; quiz 36-7. [PMID: 24550122 DOI: 10.3928/00989134-20131220-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/15/2013] [Indexed: 01/15/2023]
Abstract
Proper management and prevention of dysphagia is an urgent need of long-term care for older adults in Korea. However, no screening tools with high sensitivity and accessibility have been validated within Korean nursing home settings. The purpose of this study was to validate a screening tool for nurses to identify dysphagia and aspiration risk in nursing home residents. RNs screened 395 residents from two nursing homes in South Korea using the Korean version of the Standardized Swallowing Assessment (K-SSA). Results were validated against those from the Gugging Swallowing Screen (GUSS). Compared to results from the GUSS, with 9-point and 14-point cutoffs, the K-SSA had a sensitivity of 0.94 and specificity of 0.65 for screening dysphagia and 0.86 sensitivity and 0.71 specificity for screening aspiration risks. The K-SSA demonstrated excellent sensitivity and specificity for screening individuals at risk of dysphagia and aspiration when used by RNs in nursing homes.
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Via MA, Mechanick JI. Malnutrition, Dehydration, and Ancillary Feeding Options in Dysphagia Patients. Otolaryngol Clin North Am 2013; 46:1059-71. [DOI: 10.1016/j.otc.2013.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
SummaryDysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are well-established practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.
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Abstract
Love et al (2013) claim new findings linking intervention for hip fracture with dysphagia. This commentary reflects on whether this represents novel data or simply reiterates previously recognised patterns, not necessarily specific to surgical hip-repair. Issues are addressed in the context of prevalence of dysphagia in community and care-home living older people; effects of operative procedures on swallowing; methods for screening for dysphagia; and methodological decisions made by Love et al. The role of dysphagia screening policies is briefly considered.
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Affiliation(s)
- Nick Miller
- Institute of Health and Society, George VI Building, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
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Starmer HM, Riley LH, Hillel AT, Akst LM, Best SRA, Gourin CG. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery. Dysphagia 2013; 29:68-77. [PMID: 23943072 DOI: 10.1007/s00455-013-9482-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/01/2013] [Indexed: 12/26/2022]
Abstract
Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P < 0.001), advanced comorbidity (OR = 2.3 [2.0-2.6], P < 0.001), revision surgery (OR = 2.7 [2.3-3.1], P < 0.001), disc prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P < 0.001). Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P < 0.001), tracheostomy (OR = 2.3 [1.6-3.3], P < 0.001), gastrostomy (OR = 30.9 [25.3-37.8], P < 0.001), and speech therapy/dysphagia training (OR = 32.0 [15.4-66.4], P < 0.001). Aspiration pneumonia was significantly associated with in-hospital mortality (OR = 15.9 [11.0-23.1], P < 0.001). Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology intervention appears underutilized in this population.
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Affiliation(s)
- Heather M Starmer
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, 601 N. Caroline Street Suite 6260, Baltimore, MD, 21287, USA,
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168
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Amin MR, Achlatis S, Lazarus CL, Branski RC, Storey P, Praminik B, Fang Y, Sodickson DK. Dynamic magnetic resonance imaging of the pharynx during deglutition. Ann Otol Rhinol Laryngol 2013; 122:145-50. [PMID: 23577565 DOI: 10.1177/000348941312200301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We utilized dynamic magnetic resonance imaging to visualize the pharynx and upper esophageal segment in normal, healthy subjects. METHODS A 3-T scanner with a 4-channel head coil and a dual-channel neck coil was used to obtain high-speed magnetic resonance images of subjects who were swallowing liquids and pudding. Ninety sequential images were acquired with a temporal resolution of 113 ms. Imaging was performed in axial planes at the levels of the oropharynx and the pharyngoesophageal segment. The images were then analyzed for variables related to alterations in the area of the pharynx and pharyngoesophageal segment during swallowing, as well as temporal measures related to these structures. RESULTS All subjects tolerated the study protocol without complaint. Changes in the area of the pharyngeal wall lumen and temporal measurements were consistent within and between subjects. The inter-rater and intra-rater reliabilities for the measurement tool were excellent. CONCLUSIONS Dynamic magnetic resonance imaging of the swallow sequence is both feasible and reliable and may eventually complement currently used diagnostic methods, as it adds substantive information.
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Affiliation(s)
- Milan R Amin
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY 10016, USA
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Hoy M, Domer A, Plowman EK, Loch R, Belafsky P. Causes of Dysphagia in a Tertiary-Care Swallowing Center. Ann Otol Rhinol Laryngol 2013; 122:335-8. [DOI: 10.1177/000348941312200508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Dysphagia can be caused by a myriad of disease processes, and it has significant impacts on patients' quality of life, life expectancy, and economic burden. To date, the most common causes of dysphagia in outpatient tertiary-care swallowing centers are unknown. We undertook this study to determine these prevalences. We also describe the diagnostic techniques utilized to establish the diagnosis. Methods: The electronic charts of 100 consecutive patients who presented to an outpatient tertiary-care university swallowing center between January 2010 and April 2011 were retrospectively reviewed. Information regarding patient demographics, validated symptom surveys, diagnostic workups, and ultimate diagnoses was abstracted and tabulated into a central database. Descriptive statistics were used to evaluate the association between patient symptoms and diagnoses. Results: The mean age of the entire cohort was 62 ± 13.5 years, and 58% of the cohort was male. The most common identified causes of dysphagia were reflux (27%), postirradiation dysphagia (14%), and cricopharyngeus muscle dysfunction (11%). In 13% of cases, the cause of dysphagia was undetermined. The diagnostic tests utilized included flexible laryngoscopy (71%; 17% with endoscopic swallow evaluation), modified barium swallow study (45%), esophagoscopy (35%), barium esophagography (21%), manometry (10%), and ambulatory pH testing (2%). Conclusions: The most common causes of dysphagia in a tertiary-care swallowing center are reflux, postirradiation dysphagia, and cricopharyngeus muscle dysfunction. A precise cause for the symptom could not be identified in 13% of our cohort. Endoscopic visualization (laryngoscopy, flexible endoscopic evaluation of swallowing, and transnasal esophagoscopy) and fluoroscopic swallow studies were the investigations most often utilized. These techniques can be used to arrive at a diagnosis in 80% of cases.
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170
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Park YH, Han HR, Oh BM, Lee J, Park JA, Yu SJ, Chang H. Prevalence and associated factors of dysphagia in nursing home residents. Geriatr Nurs 2013; 34:212-7. [PMID: 23528180 DOI: 10.1016/j.gerinurse.2013.02.014] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 02/21/2013] [Accepted: 02/21/2013] [Indexed: 11/20/2022]
Abstract
Dysphagia is a major health care problem in nursing homes. It can lead to fatal complications including aspiration pneumonia and even death. The aims of this study were to evaluate the prevalence of dysphagia in nursing home residents in South Korea and to identify factors associated with dysphagia. The study was conducted in two urban nursing homes and a total of 395 older adults (aged 65-103 years old, 76.5% female) were enrolled. The presence of dysphagia was evaluated using the Gugging Swallowing Screen (GUSS) test. Out of 395 older adults, the prevalence of dysphagia was 52.7%. The following were all risk factors associated with dysphagia: Aged 75 years or older, male gender, history of dementia, feeding time longer than 20 min, severe dependent functional status, solid meal type, high nutritional risk, and underweight. To prevent complications from dysphagia in nursing home residents, systematic screening and evaluation programs for dysphagia are needed.
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Affiliation(s)
- Yeon-Hwan Park
- College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongro-gu, Seoul 110-799, South Korea
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171
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Russell JA, Ciucci MR, Hammer MJ, Connor NP. Videofluorographic assessment of deglutitive behaviors in a rat model of aging and Parkinson disease. Dysphagia 2013; 28:95-104. [PMID: 22763806 PMCID: PMC3554861 DOI: 10.1007/s00455-012-9417-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
Dysphagia is commonly associated with aging and Parkinson disease and can have a significant impact on a person's quality of life. In some cases, dysphagia may be life-threatening. Animal models may be used to study underlying mechanisms of dysphagia, but paradigms that allow adequate imaging of the swallow in combination with measurement of physiological variables have not been forthcoming. To begin development of methods that allow this, we used videofluorography to record the deglutition behaviors of 22 Fisher 344/Brown Norway rats in young adult (9 months old), old (32 months old), and parkinsonian (unilateral lesion to the medial forebrain bundle) groups. We hypothesized that the old and parkinsonian rats would manifest deficits in deglutition behaviors analogous to those found in human clinical populations. Our results supported our hypothesis in that the old group demonstrated reductions in bolus transport speeds and mastication rate while the parkinsonian rats showed impairments in oral processing. Interpretation of these results should consider the particular animal model, lesion type, and videofluorographic protocol used in this work. Future studies will link swallow imaging data of this kind with physiological and anatomical data in a manner not possible with human participants.
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Affiliation(s)
- John A Russell
- Otolaryngology Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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172
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Hansen T, Lambert HC, Faber J. Ingestive Skill Difficulties are Frequent Among Acutely-Hospitalized Frail Elderly Patients, and Predict Hospital Outcomes. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2012. [DOI: 10.3109/02703181.2012.736019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Tina Hansen
- 1Department of Occupational Therapy, Herlev University Hospital,
Herlev, Denmark
| | | | - Jens Faber
- 3Department of Medicine/Endocrinology, Herlev University Hospital, University of Copenhagen,
Herlev, Denmark
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Connor NP, Russell JA, Jackson MA, Kletzien H, Wang H, Schaser AJ, Leverson GE, Zealear DL. Tongue muscle plasticity following hypoglossal nerve stimulation in aged rats. Muscle Nerve 2012; 47:230-40. [PMID: 23169566 DOI: 10.1002/mus.23499] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Age-related decreases in tongue muscle mass and strength have been reported. It may be possible to prevent age-related tongue muscle changes using neuromuscular electrical stimulation (NMES). Our hypothesis was that alterations in muscle contractile properties and myosin heavy chain composition would be found after NMES. METHODS Fifty-four young, middle-aged, and old 344/Brown Norway rats were included in this study. Twenty-four rats underwent bilateral electrical stimulation of the hypoglossal nerves for 8 weeks and were compared with control or sham rats. Muscle contractile properties and myosin heavy chain (MHC) in the genioglossus (GG), styloglossus (SG), and hyoglossus (HG) muscles were examined. RESULTS Compared with unstimulated control rats, we found reduced muscle fatigue, increased contraction and half-decay times, and increased twitch and tetanic tension. Increased type I MHC was found, except for in GG in old and middle-aged rats. CONCLUSION Transitions in tongue muscle contractile properties and phenotype were found after NMES.
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Affiliation(s)
- Nadine P Connor
- Department of Surgery, Otolaryngology-Head and Neck Surgery, 600 Highland Avenue, Room K4/711, University of Wisconsin, Madison, Wisconsin 53792, USA.
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Miller KL, Baraldi CA. Geriatric gynecology: promoting health and avoiding harm. Am J Obstet Gynecol 2012; 207:355-67. [PMID: 22607665 DOI: 10.1016/j.ajog.2012.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 04/03/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
Age increases vulnerability, commonly accompanied by greater reliance on others and susceptibility to maltreatment. Physiologic processes become less resilient; the potential for harm from medical care increases. Awareness of frailty, functional, social, and potential maltreatment issues enables early referrals to help the patient maintain her independence. Health issues that may impede both gynecologic care and self-sufficiency include sensory deficits, physical disability, and cognitive impairment. Speaking slowly and providing contextual information enhance patient comprehension. Cancer screening depends on life expectancy. Osteoporosis treatment requires managing fall risk. Gynecologic symptoms more likely have multiple contributing factors than one etiology. Incontinence is a particularly complex issue, but invariably includes bladder diary assessment and pelvic floor muscle training. Function and frailty measures best predict perioperative morbidity. Communication with the patient, her family, other providers, and health care organizations is an important frontier in avoiding errors and adverse outcomes.
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175
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Cates D, Plowman EK, Mehdizadeh O, Yen K, Domer A, Gilden M, Belafsky PC. Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round. Laryngoscope 2012; 123:721-6. [PMID: 23042631 DOI: 10.1002/lary.23634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/28/2012] [Accepted: 07/09/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dysfunction of the upper esophageal sphincter (UES) is a common cause of oral-pharyngeal dysphagia (OPD). Dilation is a primary treatment, although current techniques are subject to a high rate of failure and recurrence. Devices available for UES dilation are cylindrical and were designed to distend the round lumen of the esophagus. Our objective was to determine the cross-sectional dimension of the UES in an ovine model of OPD and compare it with that of the cervical esophagus. STUDY DESIGN Prospective cadaveric animal study. METHODS Three-dimensional casts of the upper aerodigestive tract of 10 fresh cadaveric ewes were constructed using a platinum-cured liquid silicone polymer. Cross-sections at the level of the UES and cervical esophagus were digitized and mathematically compared using geometric morphometric shape analysis. RESULTS Consensus shape among all 10 animals revealed that the narrowest region of the maximally distended UES has a cross-sectional shape that resembles a kidney, whereas the cervical esophagus approximates a circle. The shape of the UES and cervical esophagus were significantly different (P < .0001), and surface area calculations demonstrated that an inscribed circle significantly underestimated the area implied by the kidney-shaped UES model. CONCLUSIONS Current dilators used to treat UES dysfunction are cylindrical and based on the assumption that the UES is round. This is the first report to empirically analyze the cross-sectional area of the UES utilizing an established ovine model. The data suggest that the cross-sectional area of the UES is shaped like a kidney, and currently available cylindrical dilators are suboptimal for UES distention.
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Affiliation(s)
- Daniel Cates
- Department of Otolaryngology/Head and Neck Surgery, University of California Davis, Sacramento, California 95817, USA
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176
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Discussion of prevalence and management of discomfort when swallowing pills: orodispersible tablets expand treatment options in patients with depression. Ther Deliv 2012; 2:611-22. [PMID: 22833978 DOI: 10.4155/tde.11.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many patients experience discomfort when trying to swallow tablets and capsules, but this issue is rarely discussed between patients and physicians. Discomfort when swallowing pills is common and arises due to the morphology of the oropharynx and esophagus, which are not well suited to swallowing rigid objects of small volume. Compliance with medication is poor in patients with chronic diseases such as depression. An inability or unwillingness to swallow medication can further reduce acceptance of and compliance with medication, which has an impact on effectiveness. Recognition that patient acceptance of prescribed medication is an important component of compliance has led to the development of pill-swallowing training programs and alternative formulations. Orodispersible tablets do not need to be taken with water and can be packaged discreetly in single doses. Orodispersible tablets have been shown to be effective in a number of therapy areas including depression.
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177
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Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging 2012; 7:287-98. [PMID: 22956864 PMCID: PMC3426263 DOI: 10.2147/cia.s23404] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Indexed: 11/23/2022] Open
Abstract
Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that elderly community dwellers are also at risk for dysphagia and associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. In this manuscript, we review data describing age related changes in swallowing and discuss the relationship of dysphagia in patients following stroke, those with dementia, and in community dwelling elderly. Subsequently, we review basic approaches to dysphagia intervention including both compensatory and rehabilitative approaches. We conclude with a discussion on the positive impact of swallowing rehabilitation on malnutrition and pneumonia in elderly who either present with dysphagia or are at risk for dysphagia.
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Affiliation(s)
- Livia Sura
- Swallowing Research Laboratory
- Department of Epidemiology, College of Public Health and Health Professions
| | - Aarthi Madhavan
- Swallowing Research Laboratory
- Department of Speech, Language, and Hearing Sciences, College of Public Health and Health Professions
| | - Giselle Carnaby
- Swallowing Research Laboratory
- Department of Behavioral Sciences and Community Health, College of Public Health and Health Professions, Gainesville, FL, USA
| | - Michael A Crary
- Swallowing Research Laboratory
- Department of Speech, Language, and Hearing Sciences, College of Public Health and Health Professions
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178
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Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm 2012; 430:197-206. [DOI: 10.1016/j.ijpharm.2012.04.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 01/03/2023]
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Amin MR, Lazarus CL, Pai VM, Mulholland TP, Shepard T, Branski RC, Wang EY. 3 Tesla turbo-FLASH magnetic resonance imaging of deglutition. Laryngoscope 2012; 122:860-4. [PMID: 22253090 DOI: 10.1002/lary.22496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/27/2011] [Accepted: 10/18/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS In this article we describe a methodology for obtaining high-quality dynamic magnetic resonance imaging (MRI) sequences of the swallow sequence in healthy volunteers. The study includes comparison to previous work done in our lab using a 1.5 Tesla (T) magnet. STUDY DESIGN Case series. METHODS Three healthy volunteers underwent turbo-fast low angle shot MRI at 3T while swallowing liquid boluses delivered via intravenous tubing to the oral cavity. Imaging was performed in the sagittal and axial planes. RESULTS Imaging provided by this sequence provided high temporal resolution, with the ability to depict deglutition in the axial and sagittal planes. Comparison with imaging at 1.5 T demonstrated benefits in temporal resolution and signal-to-noise. Anatomic information provided differed from comparative videofluoroscopy. CONCLUSIONS MRI of swallowing using the described technique is reliable and provides a unique evaluation of the swallowing sequence.
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Affiliation(s)
- Milan R Amin
- New York University Voice Center, Department of Otolaryngology/Head and Neck Surgery, New York University School of Medicine, New York, New York 10016, USA.
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181
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Desport JC, Jésus P, Fayemendy P, De Rouvray C, Salle JY. Évaluation et prise en charge des troubles de la déglutition. NUTR CLIN METAB 2011. [DOI: 10.1016/j.nupar.2011.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mandysova P, Skvrňáková J, Ehler E, Cerný M. Development of the Brief Bedside Dysphagia Screening Test in the Czech Republic. Nurs Health Sci 2011; 13:388-95. [PMID: 21883767 DOI: 10.1111/j.1442-2018.2011.00630.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In patients who are prone to impaired swallowing, dysphagia screening has been advocated. However, most dysphagia screening tests are lacking gold-standard validation and nurse screeners. The purpose of this study was to develop a nursing dysphagia screening test to determine the penetration or aspiration risk in patients with neurological and ear, nose, and throat conditions. Eighty-seven Czech patients underwent a bedside assessment by nurse screeners. A comparison of the results to the gold standard, flexible endoscopic examination of swallowing, identified eight "important" or "marginal" assessment items, which were combined into one test, called the Brief Bedside Dysphagia Screening Test: "ability to clench the teeth"; "symmetry/strength of the tongue"; "symmetry/strength of the facial muscles"; "symmetry/strength of the shoulder shrug"; "dysarthria"; "thick liquid: choking"; "thick liquid: dripping from the mouth"; and "thick liquid: cough". The sensitivity, specificity, and negative predictive value of the Brief Bedside Dysphagia Screening Test were: 87.1%, 30.4%, and 81%, respectively, in all patients; 95.2%, 27.5%, and 93.3%, respectively, in patients with neurological conditions; and 60%, 60%, and 42.9%, respectively, in patients with ear, nose, and throat conditions. The test is more suitable for patients with neurological conditions than for more heterogeneous patient populations.
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Affiliation(s)
- Petra Mandysova
- Faculty of Health Studies, University of Pardubice, Pardubice Regional Hospital, Pardubice, Czech Republic.
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183
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Johnson AM, Connor NP. Effects of electrical stimulation on neuromuscular junction morphology in the aging rat tongue. Muscle Nerve 2011; 43:203-11. [PMID: 21254085 DOI: 10.1002/mus.21819] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Alterations in neuromuscular junction (NMJ) structure in cranial muscles may contribute to age-related deficits in critical sensorimotor actions such as swallowing. Neuromuscular electrical stimulation (NMES) is used in swallowing therapy, but it is unclear how NMJ structure is affected or if NMJ morphology is best measured in two or three dimensions. Two- and three-dimensional measurements of NMJ morphology in the genioglossus muscle were compared in rats that had undergone 8 weeks of hypoglossal nerve stimulation vs. untreated controls. The relationship between motor endplate volume and nerve terminal volume had a mean positive slope in 90% of the young adult controls, but it was positive in only 50% of the old controls; 89% of NMES old rats had a positive slope. NMJ measurements were more accurate when measured in three dimensions. In the NMJ, aging and NMES are associated with changes in the pre- and post-synaptic relationship.
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Affiliation(s)
- Aaron M Johnson
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
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Furkim AM, Duarte ST, Hildebrandt PT, Rodrigues KA. A instituição asilar como fator potencializador da disfagia. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010000600006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: verificar se as condições referentes à estrutura geral dos asilos, recursos humanos e rotinas diárias de alimentação em instituições asilares, podem potencializar alterações da dinâmica da deglutição em idosos. MÉTODOS: foi aplicado questionário aos dirigentes de cinco instituições asilares do município do Rio de Janeiro, no qual constavam perguntas em relação aos recursos materiais, humanos e rotina alimentar. RESULTADOS: o asilo do sistema privado foi o único a aproximar-se das condições ideais da estrutura geral para o atendimento do idoso. Em relação aos recursos humanos existentes, nenhum dos asilos possuía todos os profissionais exigidos pela portaria nº810/89. Em relação às rotinas diárias de alimentação, em uma das instituições pesquisadas, cuja maioria dos residentes não faziam uso de próteses dentárias, não havia restrição na consistência alimentar oferecida. Outro fator significativo diz respeito à negligência referente à higiene bucal, favorecendo a colonização de bactérias na cavidade oral, podendo agravar infecções pulmonares no caso de microaspirações. O fato dos idosos deitarem para dormir logo após o término das refeições, como ocorrido em três das instituições pesquisadas, tem grande importância na medida em que favorece a ocorrência de episódios de refluxo gastroesofágico. CONCLUSÃO: foram observados que em todas as instituições pesquisadas há fatores que podem potencializar um distúrbio de deglutição, como problemas em relação à estrutura geral e ou aos recursos humanos e ou relativos à rotina alimentar estabelecida.
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Affiliation(s)
- Ana Maria Furkim
- Universidade Tuiuti do Paraná; Universidade Federal de São Paulo
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Kays SA, Hind JA, Gangnon RE, Robbins J. Effects of dining on tongue endurance and swallowing-related outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:898-907. [PMID: 20689047 PMCID: PMC3077124 DOI: 10.1044/1092-4388(2009/09-0048)] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE The purpose of this study was to test the hypothesis that eating a meal reduces tongue strength and endurance in healthy old and young adults. It was predicted that older adults would show greater declines in tongue endurance while demonstrating higher perceived effort, longer meal durations, and clinical signs of swallowing difficulty. METHOD Twenty-two healthy adults were enrolled into 2 groups (ages 20-35 years and ages 65-82 years; 5 males and 6 females each). Maximum tongue strength (Pmax) and endurance (duration 50% of Pmax could be maintained) were measured twice at baseline and once postmeal. Subjects consumed half of a bagel with peanut butter, carrot sticks, and milk between measures. RESULTS All subjects demonstrated reduced tongue strength and endurance postmeal. Young adults showed a greater decline in anterior tongue endurance compared with older adults (p=.05). There was no evidence that changes in tongue strength, perceived effort, or meal duration varied by age or gender. The 3 oldest subjects reported the highest effort and displayed signs of difficulty swallowing while dining. CONCLUSIONS Young and old adults demonstrated reduced tongue strength and endurance after dining, but younger subjects showed greater declines in anterior tongue endurance, whereas older adults exhibited signs of swallowing difficulty.
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Affiliation(s)
- Stephanie A Kays
- William S. Middleton Memorial VA Hospital, GRECC (11G), 2500 Overlook Terrace, and University of Wisconsin-Madison, Madison, WI 53705, USA
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Vent J, Preuss SF, Eslick GD. Dysphagia as a cause of chest pain: an otolaryngologist's view. Med Clin North Am 2010; 94:243-57. [PMID: 20380954 DOI: 10.1016/j.mcna.2010.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dysphagia is an important alarm symptom, commonly associated with chest pain; it is often associated with reflux disease, xerostomia, or tumors of the head and neck. However, simple diagnoses such as aspiration of a foreign body can be overseen and may result in major complications, such as perforation and mediastinitis. It is thus of crucial importance that a thorough gastrointestinal, cardiac, and radiologic examination precede a rigid esophagoscopy by an otolaryngologist. In this article the differential diagnoses of dysphagia are discussed, and the otolaryngologist's approach to diagnosis and therapy are explained.
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Affiliation(s)
- Julia Vent
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Hospital Cologne, Kerpener Street 62, Cologne 50924, Germany
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188
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Connolly MJ. Of proverbs and prevention: aspiration and its consequences in older patients. Age Ageing 2010; 39:2-4. [PMID: 20015854 DOI: 10.1093/ageing/afp214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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189
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Consumo de analgésicos de formulación oral y adecuación de las formas galénicas en pacientes mayores: estudio de base poblacional. FARMACIA HOSPITALARIA 2009. [DOI: 10.1016/s1130-6343(09)71158-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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190
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Gross RD, Atwood CW, Ross SB, Olszewski JW, Eichhorn KA. The Coordination of Breathing and Swallowing in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2009; 179:559-65. [DOI: 10.1164/rccm.200807-1139oc] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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191
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Kaux JF, Ongena F, Wang F, Crielaard JM, Foidart-Dessalle M. Sudden dysphagia in an elderly, quadriparetic patient. Ann Phys Rehabil Med 2009; 52:59-65. [PMID: 19419659 DOI: 10.1016/j.rehab.2008.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 11/20/2008] [Indexed: 11/25/2022]
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192
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Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg 2009; 140:33-6. [DOI: 10.1016/j.otohns.2008.10.010] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 09/19/2008] [Accepted: 10/06/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVES: 1) Evaluate the prevalence and quality-of-life impact of voice and swallowing problems in the elderly; 2) determine treatment trends and barriers to treatment. STUDY DESIGN: Cross-sectional study of independent-living residents in two retirement communities. Prevalence of dysphonia and dysphagia, voice-related quality of life (VRQOL), 7-point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES-D) scale, and barriers to treatment were collected. Spearman correlation and ANOVA statistics were performed. RESULTS: A total of 248 residents responded with a mean age of 82.4 years; 19.8 percent had dysphonia, 13.7 percent dysphagia, and 6 percent both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL ( P = 0.04, Spearman correlation = −0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES-D score 15.5 vs 9.9, P = 0.009, ANOVA, P < 0.05, Bonferroni t test). Only 22.4 percent and 20.6 percent had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options and viewing voice and swallowing trouble as a normal part of aging were the most common reasons for not seeking treatment. CONCLUSIONS: Voice and swallowing problems are common in the elderly, but they are not realizing potential treatment benefits.
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193
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Humbert IA, Fitzgerald ME, McLaren DG, Johnson S, Porcaro E, Kosmatka K, Hind J, Robbins J. Neurophysiology of swallowing: effects of age and bolus type. Neuroimage 2008; 44:982-91. [PMID: 19010424 DOI: 10.1016/j.neuroimage.2008.10.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 09/25/2008] [Accepted: 10/07/2008] [Indexed: 11/26/2022] Open
Abstract
This study examined age-related changes in swallowing from an integrated biomechanical and functional imaging perspective in order to more comprehensively characterize changes in swallowing associated with age. We examined swallowing-related fMRI brain activity and videoflouroscopic biomechanics of three bolus types (saliva, water and barium) in 12 young and 11 older adults. We found that age-related neurophysiological changes in swallowing are evident. The group of older adults recruited more cortical regions than young adults, including the pericentral gyri and inferior frontal gyrus pars opercularis and pars triangularis (primarily right-sided). Saliva swallows elicited significantly higher BOLD responses in regions important for swallowing compared to water and barium. In separate videofluoroscopy sessions, we obtained durational measures of supine swallowing. The older cohort had significantly longer delays before the onset of the pharyngeal swallow response and increased residue of ingested material in the pharynx. These findings suggest that older adults without neurological insult elicit more cortical involvement to complete the same swallowing tasks as younger adults.
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Affiliation(s)
- Ianessa A Humbert
- William S Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA.
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194
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Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia 2008; 24:1-6. [PMID: 18368451 DOI: 10.1007/s00455-008-9156-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
Abstract
Dysphagia is an important problem for the elderly. While well characterized in acutely ill populations, the prevalence and quality-of-life changes associated with dysphagia remain poorly defined in the community geriatric population. This study recruited individuals 65 years and older from an independent-living facility. Two validated questionnaires were used: the M.D. Anderson Dysphagia Inventory (MDADI) and the general health Short Form-12 survey (SF-12v2). Each participant also answered two questions: "Do you have difficulties with swallowing?" and "Do you think that swallowing difficulties are a natural part of aging?" Fifteen percent of subjects reported difficulties with swallowing. Of these, over half suffered substantial quality-of-life impairment in one or more domains of the MDADI. With respect to the second question, 23.4% of subjects believed dysphagia to be a normal part of aging, 37.4% did not. The SF-12v2 only weakly correlated with the MDADI in this population. In conclusion, there is a relatively high prevalence of dysphagia in the community-based geriatric population; significant quality-of-life impairment is a frequent finding. General health measures do not appear to be sensitive to swallowing-related quality of life. Finally, individuals may inaccurately ascribe swallowing problems to normal aging, supporting the role of community education about dysphagia in the elderly.
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195
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Abstract
This review opens with an outline definition of dysphagia, its causes, and why it is vital that people involved in the health care of older people should be aware of it. A brief consideration of prevalence is followed by an overview of assessment options. We conclude with a section on management.
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