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Javorszky SM, Palli C, Domkar S, Iglseder B. Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review. BMC Geriatr 2024; 24:445. [PMID: 38773449 DOI: 10.1186/s12877-024-05070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.
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Affiliation(s)
- Susanne M Javorszky
- Institute of Nursing Science and Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria.
| | - Christoph Palli
- FH Joanneum, Institute of Health and Nursing, Alte Post Straße 149, 8020, Graz, Austria
| | - Susanne Domkar
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
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2
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Sun Y, Zhao W, Kang X, Wang X, Kim H, Wan Q, Ge T, Xie Q. Speech Acoustic Parameters for Predicting Presbyphagia: A Preliminary Study in the Elderly Shanghainese Population. J Voice 2024:S0892-1997(24)00001-8. [PMID: 38233249 DOI: 10.1016/j.jvoice.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE Age is a high-risk factor for dysphagia. Speech and swallowing share the same anatomical and neurophysiological basis. Their functions are closely related; hence, speech assessment can predict the risk of dysphagia. This study aimed to investigate the factors influencing presbyphagia in a normal elderly Shanghainese population by analyzing speech acoustic parameters. METHODS Relevant speech acoustic parameters were compared between 15 people with dysphagia and 15 without dysphagia. After extracting sensitive speech acoustic parameters related to swallowing, changes in sensitive parameters were compared at different ages to analyze the relevant factors influencing presbyphagia in the normal elderly population. RESULTS Eight speech acoustic parameters related to swallowing, including maximum phonation time (MPT), max F0, /ʔʌ/Jitter, /ʔʌ/L-DDK, /hʌ/L-DDK, /pataka/DDK, F1/a/, and vowel space area, were extracted after comparing the relevant data between the two groups. Analyzing the changes in each of these parameters between different age groups (age 18-39, 40-64, and 65 and above), we discovered that three speech acoustic parameters, including MPT, /hʌ/L-DDK, and /pataka/DDK, had statistical differences, with a decreasing trend in their mean values with increasing age. CONCLUSIONS The elderly group had significantly lower MPT, /hʌ/L-DDK, and /pataka/DDK than the young and middle-aged groups. We hypothesized that reduced respiratory support and control, decreased range of mouth movements and coordination, closed control of the vocal cords, and inadequate airflow control in vocal cord abduction are risk factors for presbyphagia in the elderly Shanghainese population.
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Affiliation(s)
- Yuxin Sun
- Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, Shanghai 200062, China; Department of Rehabilitation Medicine, Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China
| | - Wensheng Zhao
- Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, Shanghai 200062, China
| | - Xiaoxi Kang
- Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, Shanghai 200062, China
| | - Xiaoyu Wang
- Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, Shanghai 200062, China
| | - Hakyung Kim
- Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, Shanghai 200062, China.
| | - Qin Wan
- Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, Shanghai 200062, China.
| | - Tong Ge
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China
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Agnes CS, Nayak S, Devadas U. Prevalence of oropharyngeal dysphagia symptoms in community-dwelling older adults: A community survey. Indian J Gastroenterol 2023:10.1007/s12664-023-01476-z. [PMID: 38105373 DOI: 10.1007/s12664-023-01476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Dysphagia is a common clinical condition in older adults with significant implications for health and quality of life (QOL). However, its prevalence and associated factors in the Indian community-dwelling older adults remain understudied. The present study aims at identifying the prevalence of oropharyngeal dysphagia symptoms in Indian community-dwelling older adults and identifying the age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia in this population. METHODS Total 384 community-dwelling older adults (60 years of age or older) who were independent in performing daily activities were included in the present study. The Malayalam version of the Eating Assessment Tool-10 (EAT-10) questionnaire was used to assess individuals at risk for dysphagia. Additionally, they also completed a self-report questionnaire addressing age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia. RESULT Using the Malayalam version of the EAT-10, the present study identified the prevalence of oropharyngeal dysphagia symptoms in 9.9% of community-dwelling older adults. Among the EAT-10 symptoms, cough while/after swallowing, difficulty swallowing solids and difficulty swallowing liquids were the most prevalent symptoms reported by participants. Increase in age and age-related comorbidities such as tooth loss, history of heart failure and digestive diseases were found to be significantly associated with the reporting of risk for dysphagia symptoms. CONCLUSION As dysphagia symptoms significantly impact the social, psychological and QOL of community-dwelling older adults, it is important to develop awareness about these symptoms among older adults, caretakers and physicians. Early detection and appropriate management of community-dwelling older adults at risk for dysphagia can contribute to better health outcomes and improved QOL.
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Affiliation(s)
- C S Agnes
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Srikanth Nayak
- Department of Audiology and Speech-Language Pathology, Yenepoya Medical College, Yenepoya University (Deemed to Be University), Mangalore, 575 018, India
| | - Usha Devadas
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576 104, India.
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Baqué J, Huret O, Rayneau P, Schleich M, Morinière S. Acoustic Analysis of Swallowing of an Experimental Meal of Three Food Textures: A Comparative Aging Study. Dysphagia 2023:10.1007/s00455-023-10629-3. [PMID: 37979004 DOI: 10.1007/s00455-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
Swallowing disorders in the elderly represent a public health problem, their detections are a medico-economic issue. The acoustic analysis of swallowing has the advantages of being non-invasive with no radiation, compared to videofluoroscopy or fiberoptic swallowing assessments. Acoustic analysis of swallowing has been tested in many studies but only on small food boluses. The aim of this study was to compare the acoustic swallowing parameters of two groups of healthy subjects, before and after 70 years old, during the intake of a series of 3 food textures. A laryngophone was used to record the pharyngeal phase of swallowing. The experimental meal was composed of 100 ml of mashed potatoes, 100 ml of water, and 100 ml of yogurt. Group 1 (50-70 years old) comprised 21 subjects and group 2 (over 70 years old) 23 subjects. Acoustic parameters analyzed were the number of swallows, average duration of swallowing, average duration of inter-swallowing, meal duration, and the average frequency of swallowing per minute. These parameters for groups 1 and 2 were compared. The average duration of inter-swallowing and the meal duration were significantly higher in the older group (p < 0.001), with a mean duration of inter-swallowing that was 2.4 s longer than the younger group. The average swallowing frequency per minute was higher in the younger group (11.3 vs 7.9; p < 0.001). This study demonstrated that acoustic analysis of an experimental meal of three food textures generated usable data on swallowing. In the over 70 age group, there was a decrease in swallowing frequency, indicating a slowdown in food intake. A reduced swallowing frequency could become a criteria to assess presbyphagia.
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Affiliation(s)
- Jean Baqué
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France.
| | - Océane Huret
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Pierre Rayneau
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Marianne Schleich
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Sylvain Morinière
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
- Francois-Rabelais University of Tours, University Hospital of Tours, 10 Boulevard Tonnelé, 37032, Tours, France
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Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
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Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
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Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases 2023; 11:2363-2373. [PMID: 37123321 PMCID: PMC10131003 DOI: 10.12998/wjcc.v11.i11.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.
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Affiliation(s)
- Hai-Yang Feng
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
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Nakajima J, Karaho T, Kawahara K, Hayashi Y, Nakamura M, Matsuura N, Kohno N. Latent changes in the pharyngeal stage of swallowing in non-aspirating older adults. Eur Geriatr Med 2022. [PMID: 35091892 DOI: 10.1007/s41999-021-00604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The characteristic changes in the swallowing mechanism with aging are collectively termed presbyphagia. Although several studies have investigated presbyphagia in older adults, few have assessed oldest-old adults. We aimed to characterize the latent changes of swallowing function in oldest-old adults and to consider risk ages for presbyphagia. METHODS We analyzed the records of 85 individuals (44 males and 41 females, aged 25-101 years) who underwent videofluoroscopic swallowing studies. The included participants had penetration and aspiration scores of ≤ 2 and no history of aspiration, pneumonia, or diseases that affect swallowing. They were divided into four age groups: 25-64 years (non-older), 65-74 years (young-old), 75-84 years (middle-old), and ≥ 85 years (oldest-old). We analyzed and compared the pharyngeal delay time (PDT), duration of tongue base and posterior pharyngeal wall contact, duration and dimension of upper esophageal sphincter opening (UES-O), and maximal hyoid bone displacement between the age groups. RESULTS Among the older groups, the oldest-old showed significantly longer PDT than younger-old adults, and the UES-O tended to be wider in the former. However, no other remarkable differences were found between the oldest-old and other old groups. Statistical comparisons between the < 75 and ≥ 75-year age groups revealed significant age-related changes in the PDT and duration and dimension of UES-O. CONCLUSION On videofluoroscopic evaluation, physiological changes with aging affected few parameters of swallowing in our cohort. These findings indicate that in non-aspirating oldest-old adults, any deterioration may be adjusted for by compensatory changes to maintain swallowing function.
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Chen YT, Chen LY, Renn TY, Cheng MS, Wang CT, Klimenkov IV, Sudakov NP, Liao WC, Chen YJ, Chang HM. Olfactory Stimulation Successfully Improves Swallowing Function of Aged Rats through Activating Central Neuronal Networks and Downstream DHPR-RyR-mediated Neuromuscular Activities. J Gerontol A Biol Sci Med Sci 2021; 77:235-242. [PMID: 34378774 DOI: 10.1093/gerona/glab229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Indexed: 11/13/2022] Open
Abstract
Presbyphagia is age-related changes in swallowing function, which imposes a high risk of aspiration in older adults. Considering olfactory stimulation (OS) can influence behavioral activities by modulating neuronal excitability, the present study aims to determine whether OS could improve the swallowing function of aged rats through activating the central neuronal networks and downstream muscular activities participated in the control of swallowing. Aged male Wistar rats received OS by inhaling a mixture of plant-based volatile molecules twice a day for 12 days were subjected to functional magnetic resonance imaging (fMRI) and c-fos, choline acetyltransferase (ChAT) immunostaining to detect the neuronal activities of the orbitofrontal cortex (OFC) and medullary nuclei engaged in swallowing control, respectively. The functional effects of OS on downstream pharyngeal muscle activity were examined by evaluating the dihydropyridine receptor-ryanodine receptor (DHPR-RyR) mediated intra-muscular Ca2 + expression, and analyzing the amplitude/frequency of muscle contraction, respectively. In untreated rats, only moderate signal of fMRI and mild c-fos/ChAT expression was detected in the OFC and medullary nuclei, respectively. However, following OS, intense signals of fMRI and immunostaining were clearly expressed in the orbitofronto-medullary networks. Functional data corresponded well with above findings in which OS significantly enhanced DHPR-RyR-mediated intra-muscular Ca2 + expression, effectively facilitated a larger amplitude of pharyngeal muscle contraction, and exhibited better performance in consuming larger amounts of daily dietary. As OS successfully activates the neuromuscular activities participated in the control of swallowing, applying OS may serve as an effective, easy, and safe strategy to greatly improve the swallow function of aging populations.
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Affiliation(s)
- Yea-Tzy Chen
- Department of Speech Language Pathology and Audiology, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan.,Department of Special Education, University of Taipei, Taipei 100234, Taiwan
| | - Li-You Chen
- Department of Anatomy, College of Medicine, Chung Shan Medical University, Taichung 402367, Taiwan
| | - Ting-Yi Renn
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Meng-Shan Cheng
- Department of Speech Language Pathology and Audiology, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
| | - Chi-Te Wang
- Department of Special Education, University of Taipei, Taipei 100234, Taiwan.,Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei 220050, Taiwan
| | - Igor V Klimenkov
- Department of Cell Ultrastructure, Limnological Institute, Siberian Branch of the Russian Academy of Sciences, Irkutsk 664033, Russia
| | - Nikolay P Sudakov
- Department of Cell Ultrastructure, Limnological Institute, Siberian Branch of the Russian Academy of Sciences, Irkutsk 664033, Russia
| | - Wen-Chieh Liao
- Department of Anatomy, College of Medicine, Chung Shan Medical University, Taichung 402367, Taiwan
| | - Yea-Jyh Chen
- School of Nursing, College of Health and Human Services, University of North Carolina at Wilmington, Wilmington 28403, NC, USA
| | - Hung-Ming Chang
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
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Donohue C, Khalifa Y, Mao S, Perera S, Sejdić E, Coyle JL. Establishing Reference Values for Temporal Kinematic Swallow Events Across the Lifespan in Healthy Community Dwelling Adults Using High-Resolution Cervical Auscultation. Dysphagia 2021; 37:664-675. [PMID: 34018024 DOI: 10.1007/s00455-021-10317-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Few research studies have investigated temporal kinematic swallow events in healthy adults to establish normative reference values. Determining cutoffs for normal and disordered swallowing is vital for differentially diagnosing presbyphagia, variants of normal swallowing, and dysphagia; and for ensuring that different swallowing research laboratories produce consistent results in common measurements from different samples within the same population. High-resolution cervical auscultation (HRCA), a sensor-based dysphagia screening method, has accurately annotated temporal kinematic swallow events in patients with dysphagia, but hasn't been used to annotate temporal kinematic swallow events in healthy adults to establish dysphagia screening cutoffs. This study aimed to determine: (1) Reference values for temporal kinematic swallow events, (2) Whether HRCA can annotate temporal kinematic swallow events in healthy adults. We hypothesized (1) Our reference values would align with a prior study; (2) HRCA would detect temporal kinematic swallow events as accurately as human judges. Trained judges completed temporal kinematic measurements on 659 swallows (N = 70 adults). Swallow reaction time and LVC duration weren't different (p > 0.05) from a previously published historical cohort (114 swallows, N = 38 adults), while other temporal kinematic measurements were different (p < 0.05), suggesting a need for further standardization to feasibly pool data analyses across laboratories. HRCA signal features were used as input to machine learning algorithms and annotated UES opening (69.96% accuracy), UES closure (64.52% accuracy), LVC (52.56% accuracy), and LV re-opening (69.97% accuracy); providing preliminary evidence that HRCA can noninvasively and accurately annotate temporal kinematic measurements in healthy adults to determine dysphagia screening cutoffs.
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Affiliation(s)
- Cara Donohue
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Biomedical Informatics, School of Medicine Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA. .,Department of Otolaryngology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15260, USA.
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Mehraban-Far S, Alrassi J, Patel R, Ahmad V, Browne N, Lam W, Jiang Y, Barber N, Mortensen M. Dysphagia in the elderly population: A Videofluoroscopic study. Am J Otolaryngol 2021; 42:102854. [PMID: 33482586 DOI: 10.1016/j.amjoto.2020.102854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/22/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the impact of age and underlying comorbid conditions on swallowing in elderly patients with dysphagia. METHODS Charts of consecutive patients aged >64 studied by Videofluoroscopic swallowing study (VFSS) between 2010 and 2018 at our institution were reviewed (n = 731). Patients were categorized based on age into young old (aged 65-74), older old (aged 75-84) and oldest old (aged 85+). The underlying comorbidities and VFSS results were compared between different age groups. RESULTS Dysphagia was more likely to be caused by presbyphagia (p < 0.01) and dementia (p < 0.0001) in the oldest old, whereas, head and neck cancers (p < 0.0001) were more common in the young old cohort. In the absence of organic disease (e.g. cancer, stroke, dementia), aging was associated with prolonged oral transit time (OTT) (p < 0.05) and aspiration after swallow (p < 0.05). Compared to those with presbyphagia, patients with organic disease were more likely to have delayed pharyngeal swallow response (p < 0.05) and aspiration during swallow (p < 0.005). CONCLUSION There are significant differences in the etiology of dysphagia between different age cohorts amongst the dysphagic elderly population. In addition, organic diseases affect swallowing differently than does mere aging. The rate of prolonged OTT and post-swallow aspiration increase with aging in patients with presbyphagia, likely due to age-related sarcopenia of the swallowing muscles. Whereas, those with organic diseases have a higher rate of delayed pharyngeal swallow response and aspiration during swallow, likely due to sensorineural impairment. Thus, it is important to view the elderly as a heterogeneous group when evaluating patients with dysphagia.
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Affiliation(s)
- Sina Mehraban-Far
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA.
| | - James Alrassi
- SUNY Downstate Health Sciences University, Department of Otolaryngology, Brooklyn, NY, USA
| | - Rushil Patel
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Verdah Ahmad
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Nicholas Browne
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Wai Lam
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Yujie Jiang
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Nathaniel Barber
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Melissa Mortensen
- Albany Medical College, Department of Otolaryngology, Albany, NY, USA
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Lin CH, Chung SY, Lin CT, Hwu YJ. Effect of tongue-to-palate resistance training on tongue strength in healthy adults. Auris Nasus Larynx 2020; 48:116-123. [PMID: 32727703 DOI: 10.1016/j.anl.2020.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Tongue strength is crucial for safe and efficient oropharyngeal swallowing. This study examined the effect of tongue-to-palate resistance training (TPRT) on anterior and posterior tongue strength by conducting a prospective, randomized, parallel allocation trial. METHODS Ninety-one healthy adults were recruited in this study and were randomly assigned to an experimental group (n = 44) or a control group (n = 47). The experimental group performed TPRT for 8 weeks (5 days per week), whereas the control group performed the usual daily activities. Tongue strength was measured using the Iowa Oral Performance Instrument (IOPI) before and after the practice program was conducted at weeks 2, 4, 6, and 8, to evaluate the feasibility of the developed training protocol. RESULTS This experimental group demonstrated more improvements in both anterior tongue strength (p < .05) and posterior tongue strength (p < .05). The positive effects of the intervention on tongue strength appeared at 8 weeks for the anterior region and 2 weeks for the posterior region. CONCLUSIONS These findings illustrate that TPRT can improve tongue strength. It is suggested that people integrate this exercise protocol into their daily life, positive change in tongue strength may prevent or halt presbyphagia.
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Affiliation(s)
- Chun-Hao Lin
- Department of Internal Medicine, Dali Jen-Ai Hospital, Taichung, Taiwan, ROC.
| | - Shu-Ying Chung
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC.
| | - Chi-Te Lin
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC.
| | - Yueh-Juen Hwu
- College of Nursing, Central Taiwan University of Science and Technology, NO.666, Buzih Rd., Beitun District, Taichung 40601, Taiwan, ROC.
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Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles. Clin Transl Radiat Oncol 2019; 18:16-22. [PMID: 31341972 PMCID: PMC6610668 DOI: 10.1016/j.ctro.2019.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/05/2023] Open
Abstract
Age at treatment for OPSCC is a strong predictor of chronic radiation associated dysphagia (RAD). For swallowing regions of interest (ROIs), dose to ROI and age impact patients’ risk of chronic RAD. For patients at high risk for RAD more intense prophylactic swallowing therapies may be warranted.
Objectives We sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal squamous cell cancer (OPSCC) as a function of age and dose to non-target swallowing muscles. Methods We reviewed 300 patients with T1-T4 N0-3 M0 OPSCC given definitive IMRT with concurrent chemotherapy. Chronic RAD was defined as aspiration or stricture on videoflouroscopy/endoscopy, gastrostomy tube, or aspiration pneumonia at ≥12 months after IMRT. Doses to autosegmented regions of interest (ROIs; inferior, middle and superior constrictors, anterior and posterior digastrics, mylo/geniohyoid complex, intrinsic tongue, and gengioglossus) were obtained from DICOM-RT plans and dose-volume histograms. The probability of chronic RAD as a function of mean ROI dose, stratified by age (<50, 50–59, 60–69, or ≥70 years), was estimated with logistic probability models and subsequent unsupervised nonlinear curves. Results Chronic RAD was observed in 34 patients (11%). Age was a significant correlate of chronic RAD, both independently and with dose for all muscle groups examined. Distinct muscle-specific dose–response profiles were observed as a function of age (e.g., 5% of patients in their 50 s [but 20% of those 70 + ] who received 60 Gy to the superior constrictor had chronic RAD). This effect was stable across all observed muscle ROIs, with a false discovery rate-corrected p < 0.05, for all dose/muscle/age models, suggesting that including age as a covariate improves modeling of chronic RAD. Conclusions Age at treatment moderates the probability of chronic RAD after chemo-IMRT for OPSCC, with aging muscles showing lower dose thresholds. Uniform dose constraints may not predict toxicity in older patients.
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Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res 2019; 31:799-805. [PMID: 30671866 DOI: 10.1007/s40520-019-01128-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023]
Abstract
Aging is accompanied by several changes which may affect swallowing function. The beginning of these changes, termed presbyphagia, still captures a preserved swallowing function, although burdened by the consequences of the physiological aging process. Several stressors (including diseases and medications) can easily trigger the disruption of this (increasingly weak) equilibrium and lead to overt dysphagia. It is noteworthy that the swallowing dysfunction may be aggravated by the sarcopenic process, characterizing the so-called "sarcopenic dysphagia", potentially responsible for several health-related negative outcomes. The assessment and management of sarcopenic dysphagia largely rely on the evaluation and integrated treatment of both constituting conditions (i.e., sarcopenia and dysphagia). The management of dysphagia requires a multidimensional approach and can be designed as either compensatory (aimed at producing immediate benefit for the patient through postural adjustments, swallowing maneuvers, and diet modifications) or rehabilitative. Interestingly, some evidence suggests that resistance training traditionally applied to tackle the lower extremity in sarcopenia may be simultaneously beneficial for sarcopenic dysphagia. If these preliminary results (discussed in the present review article) will be confirmed, the systemic beneficial effects of physical exercise will be indirectly demonstrated. This will also support the need of promoting healthy lifestyle in all sarcopenic individuals (thus potentially at risk of dysphagia).
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Affiliation(s)
- Domenico Azzolino
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Bertagnoli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Tiziano Lucchi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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14
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Warnecke T, Dziewas R, Wirth R, Bauer JM, Prell T. Dysphagia from a neurogeriatric point of view : Pathogenesis, diagnosis and management. Z Gerontol Geriatr 2019; 52:330-5. [PMID: 31139962 DOI: 10.1007/s00391-019-01563-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Dysphagia is becoming increasingly more common in aging societies and, like the classical geriatric syndromes, it is a relevant functional impairment. The prevalence of dysphagia is highest in the group of old patients with neurological disorders, particularly in patients with stroke, dementia and Parkinson's disease. In the various neurological diseases of older people disease-specific factors often have a decisive influence on the clinical management of dysphagia. In addition, the concept of primary and secondary presbyphagia plays an important role in understanding age-related dysphagia. Whereas at the organ level of the International Classification of Functioning, Disability and Health (ICF) model, the diagnosis and treatment of dysphagia in neurogeriatrics have already made progress, more research is needed on the levels of activity/mobility, social environment, personal factors and the environment. This article summarizes the pathophysiological aspects as well as the current evidence for diagnosis and treatment of neurogeriatric dysphagia. Due to its high clinical relevance dysphagia should be added to the geriatric syndromes as "impaired swallowing".
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Muhle P, Suntrup-Krueger S, Wirth R, Warnecke T, Dziewas R. [Swallowing in the elderly : Physiological changes, dysphagia, diagnostics and treatment]. Z Gerontol Geriatr 2019; 52:279-289. [PMID: 30968223 DOI: 10.1007/s00391-019-01540-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/31/2019] [Accepted: 03/19/2019] [Indexed: 02/05/2023]
Abstract
Increasing age leads to a number of physiological as well as disease-related pathological changes that among others also affect structures involved in swallowing. These changes not only increase the risk of developing dysphagia but as a result can lead to pneumonia, malnutrition, exsiccosis, a relevant impairment of the quality of life and increased mortality. To evaluate the nature and extent of dysphagia, clinical swallowing tests as well as instrumental approaches, such as the endoscopic evaluation of swallowing are available. Depending on the findings from these examinations, the underlying disease and estimation of the individual patient prognosis, several treatment approaches ranging from diet adaptation, logopedic exercises and compensatory maneuvers up to tube feeding are available. The optimal treatment requires close cooperation of all disciplines involved.
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Affiliation(s)
- P Muhle
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland. .,Institut für Biomagnetismus und Biosignalanalyse, Universitätsklinikum Münster, Münster, Deutschland.
| | - S Suntrup-Krueger
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.,Institut für Biomagnetismus und Biosignalanalyse, Universitätsklinikum Münster, Münster, Deutschland
| | - R Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - T Warnecke
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - R Dziewas
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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16
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Herzberg EG, Lazarus CL, Steele CM, Molfenter SM. Swallow Event Sequencing: Comparing Healthy Older and Younger Adults. Dysphagia 2018; 33:759-767. [PMID: 29687354 PMCID: PMC6201283 DOI: 10.1007/s00455-018-9898-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85-91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young (< 45) and old (> 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration-aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ2 = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.
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Affiliation(s)
- Erica G Herzberg
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York, NY, USA.
| | | | - Catriona M Steele
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York, NY, USA
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17
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Lee ML, Kim JU, Oh DH, Park JY, Lee KJ. Oropharyngeal swallowing function in patients with presbyphagia. J Phys Ther Sci 2018; 30:1357-1358. [PMID: 30464364 PMCID: PMC6220106 DOI: 10.1589/jpts.30.1357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the characteristics of oropharyngeal swallowing
function in patients with presbyphagia. [Participants and Methods] Data for 25 patients
with presbyphagia were retrospectively analyzed. The oropharyngeal swallowing function was
evaluated using VDS based on videofluoroscopic swallowing study. [Results] Lip closure,
mastication, laryngeal elevation, and aspiration showed a relative decrease in function.
[Conclusion] This study showed a reduction in oropharyngeal swallowing in patients with
presbyphagia. Our results may help in the diagnosis and treatment of presbyphagia.
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Affiliation(s)
- Myung-Lyeol Lee
- Department of Emergency Medical Services, Kyungdong University: 815 Gyeonhwon-ro, Munmak-eup, Wonju-si, Gangwon-do, Republic of Korea
| | - Jin-Uk Kim
- Department of Emergency Medical Services, Kyungdong University: 815 Gyeonhwon-ro, Munmak-eup, Wonju-si, Gangwon-do, Republic of Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy, Kyungdong University, Republic of Korea
| | - Jae-Young Park
- Department of Physical Therapy, Kyungwoon University, Republic of Korea
| | - Kui-Ja Lee
- Department of Emergency Medical Services, Kyungdong University: 815 Gyeonhwon-ro, Munmak-eup, Wonju-si, Gangwon-do, Republic of Korea
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18
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Mulheren RW, Azola AM, Kwiatkowski S, Karagiorgos E, Humbert I, Palmer JB, González-Fernández M. Swallowing Changes in Community-Dwelling Older Adults. Dysphagia 2018; 33:848-56. [PMID: 29948259 DOI: 10.1007/s00455-018-9911-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
Abstract
Older adults may evidence changes in swallowing physiology. Our goals were to identify dysphagia risk in community-dwelling older adults with no history of dysphagia, and to compare swallowing physiology and safety between older and younger adults. Thirty-two older adults with no history of dysphagia were prospectively recruited and completed the Dysphagia Handicap Index (DHI), two trials of a 3 oz. swallow screen, and videofluoroscopy (VFSS). Self-ratings of swallowing function were compared to published norms by paired t tests, and multivariate logistic regression models were generated to determine whether these ratings and VFSS analysis of swallowing function were associated with failure of one or both swallow screen trials. Archived VFSS of 33 younger adults were compared to older adults with Wilcoxon rank-sum tests. The DHI scores of older adults were higher than published non-dysphagic adults but lower than dysphagic adults. Older participants with greater Oral Residue scores were more likely to fail both swallow screen trials. Older adults received higher median MBSImP™© scores for select pharyngeal components than younger adults. The two age groups did not differ on Penetration-Aspiration Scale scores, and no aspiration was observed. Measures of swallowing in older individuals may reflect age-related sensory and motor changes in the context of functional swallowing and adequate airway protection.
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Abstract
Dysphagia in older adults is a challenging problem and necessitates a team approach. The key to effective management is recognition. Patients tend to dismiss their symptoms as normal aging; therefore, early diagnosis depends on the diligence of the primary care doctors. No diagnostic technique can replace the benefits of a thorough history, with a detailed understanding of nutritional status and aspiration risk. Although one of the main goals in management is to ensure safe swallowing, the impact of a nonoral diet on the quality of life of patients should not be underestimated.
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Affiliation(s)
- Samia Nawaz
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 543, Little Rock, AR 72205, USA
| | - Ozlem E Tulunay-Ugur
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 543, Little Rock, AR 72205, USA.
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20
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de Lima Alvarenga EH, Dall'Oglio GP, Murano EZ, Abrahão M. Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol 2018; 275:443-9. [PMID: 29124360 DOI: 10.1007/s00405-017-4801-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity. RESULTS Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003). CONCLUSIONS Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.
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21
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Lee DH, Park JS, Lee SW, Choi JB. Effects of electrical stimulation combined with dysphagia therapy in elderly individual with oropharyngeal dysphagia: a case study. J Phys Ther Sci 2017; 29:556-557. [PMID: 28356653 PMCID: PMC5361032 DOI: 10.1589/jpts.29.556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/24/2016] [Indexed: 01/05/2023] Open
Abstract
[Purpose] The purpose of the present study was to investigate the effects of dysphagia
therapy in an old man with difficulty swallowing in the oral and pharyngeal phases.
[Subjects and Methods] The subject was a 72-year-old man with no history of neurological
disorders. He was admitted to local hospital because of the complaint of swallowing
difficulty. The interventions performed were electrical stimulation and conventional
dysphagia therapy. We assessed the tongue and lip muscle strengths. Swallowing function
was evaluated by using the videofluoroscopic dysphagia and penetration-aspiration scales.
[Results] After the intervention, the tongue and lip muscle strengths increased from 35 to
39 kPa and from 18 to 23 kPa, respectively. Moreover, the oral and pharyngeal phases of
the videofluoroscopic dysphagia scale were improved. Furthermore, aspiration decreased
from 4 to 2 points in the penetration-aspiration scale. [Conclusion] Our results suggest
that electrical stimulation and conventional dysphagia therapy were effective in improving
the swallowing function in an elderly individual with dysphagia.
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Affiliation(s)
- Doo-Ho Lee
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Ji-Su Park
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Seung-Woong Lee
- Department of Biomedical Health Science, Graduate School, Dong-Eui University, Republic of Korea
| | - Jong-Bae Choi
- Department of Occupational Therapy, Kyung Hee Medical Center, Republic of Korea
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Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, Langmore SE, Leischker A, Martino R, Pluschinski P, Roesler A, Shaker R, Warnecke T, Sieber CC, Volkert D, Wirth R. Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century. Dysphagia 2017; 32:78-82. [PMID: 27571768 DOI: 10.1007/s00455-016-9746-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 08/16/2016] [Indexed: 12/02/2022]
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Di Pede C, Mantovani ME, Del Felice A, Masiero S. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res 2016; 28:607-17. [PMID: 26589905 DOI: 10.1007/s40520-015-0481-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/17/2015] [Indexed: 11/25/2022]
Abstract
Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental exams, and identification of the risk of aspiration. Long-standing individual abilities and impairments determine the goals of an ad hoc rehabilitation program. Currently there are no standard algorithmic approaches for the management of dysphagia in the elderly. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. This narrative review summarizes the current rehabilitation approaches for dysphagia in the elderly. The aim is to inform the treating health care professionals, whether caring physician, physical medicine doctor, speech/swallowing therapist or nurse, on the state-of-the-art and stimulate discussion in the scientific community.
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Affiliation(s)
- C Di Pede
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - M E Mantovani
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - A Del Felice
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - S Masiero
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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Reginelli A, D'Amora M, Del Vecchio L, Monaco L, Barillari MR, Di Martino N, Barillari U, Motta G, Cappabianca S, Grassi R. Videofluoroscopy and oropharyngeal manometry for evaluation of swallowing in elderly patients. Int J Surg 2016; 33 Suppl 1:S154-8. [PMID: 27392720 DOI: 10.1016/j.ijsu.2016.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Presbyphagia represents the physiological aging evolution of the swallowing function. It is related to the natural changes of the anatomical structures involved in the swallowing process. These age-related modifications can be asymptomatic in the early stages of life, but in the late stages, they could lead to dysphagia, aspiration pneumonia, dehydration, or malnutrition, reducing the quality of life. Videofluoromanometry (VFM) is the combined study of videofluoroscopy (VFS) and oropharyngeal manometry that allows simultaneous identification of functional and morphological features of the presbyphagia, also in asymptomatic otherwise healthy elderly adults. This study retrospectively evaluated the effectiveness of the VFM and the role of a multidisciplinary team of specialists in the analysis of a large cohort of old patients with presbyphagia, with the objective of achieving early diagnosis of the disease and the best therapy to delay the development of complications such as aspiration pneumonia, malnutrition, and dehydration.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Marilina D'Amora
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Lucia Del Vecchio
- Department of Anesthesiological, Surgical and Emergency Sciences Department, Second University of Naples, Italy.
| | - Luigi Monaco
- Department of General Surgery, Second University of Naples, Italy.
| | - Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | | | - Umberto Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy.
| | - Gaetano Motta
- Department of Anesthesiological, Surgical and Emergency Sciences Department, Second University of Naples, Italy.
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
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