Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people

Oropharyngeal dysphagia (OD) is a very frequent condition among older people with a prevalence ranging from mild symptoms in 25% of the independently living to severe symptoms in more than 50% living in nursing homes. There are several validated methods of screening, and clinical assessment and vide...

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Published inNestle Nutrition Institute workshop series Vol. 72; p. 57
Main Authors Clavé, Pere, Rofes, Laia, Carrión, Silvia, Ortega, Omar, Cabré, Mateu, Serra-Prat, Mateu, Arreola, Viridiana
Format Journal Article
LanguageEnglish
Published Switzerland 01.01.2012
Subjects
Aged
Deglutition - physiology
Deglutition Disorders - complications
Deglutition Disorders - diagnosis
Deglutition Disorders - epidemiology
Deglutition Disorders - physiopathology
Geriatric Assessment
Humans
Mass Screening
Pharynx - physiopathology
Prevalence
Prognosis
Respiratory Aspiration - prevention & control
Safety
Viscosity
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Summary:Oropharyngeal dysphagia (OD) is a very frequent condition among older people with a prevalence ranging from mild symptoms in 25% of the independently living to severe symptoms in more than 50% living in nursing homes. There are several validated methods of screening, and clinical assessment and videofluoroscopy are the gold standard for the study of the mechanisms of OD in the elderly. Oropharyngeal residue is mainly caused by weak bolus propulsion forces due to tongue sarcopenia. The neural elements of swallow response are also impaired in older persons, with prolonged and delayed laryngeal vestibule closure and slow hyoid movement causing oropharyngeal aspirations. OD causes malnutrition, dehydration, impaired quality of life, lower respiratory tract infections, aspiration pneumonia, and poor prognosis including prolonged hospital stay and enhanced morbidity and mortality in several phenotypes of older patients ranging from independently living older people, hospitalized older patients and nursing home residents. Enhancing bolus viscosity of fluids greatly improves safety of swallow in all these patients. We believe OD should be recognized as a major geriatric syndrome, and we recommend a policy of systematic and universal screening and assessment of OD among older people to prevent its severe complications.
ISSN:1664-2155
DOI:10.1159/000339986