Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting

Rainer Wirth, Rainer Dziewas, Anne Marie Beck, Pere Clavé, Shaheen Hamdy, Hans Juergen Heppner, Susan Langmore, Andreas Herbert Leischker, Rosemary Martino, Petra Pluschinski, Alexander Rösler, Reza Shaker, Tobias Warnecke, Cornel Christian Sieber, Dorothee Volkert, Rainer Wirth, Rainer Dziewas, Anne Marie Beck, Pere Clavé, Shaheen Hamdy, Hans Juergen Heppner, Susan Langmore, Andreas Herbert Leischker, Rosemary Martino, Petra Pluschinski, Alexander Rösler, Reza Shaker, Tobias Warnecke, Cornel Christian Sieber, Dorothee Volkert

Abstract

Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

Keywords: aspiration; dehydration; dysphagia; geriatric; malnutrition; older.

Figures

Figure 1
Figure 1
Factors associated with dysphagia in older persons. Note: ↓ Indicates decreased function. Modified from Muhle P, Wirth R, Glahn J, Dziewas R. [Age-related changes in swallowing. Physiology and pathophysiology]. Nervenarzt. 2015;86(4):440–451.
Figure 2
Figure 2
The role of dysphagia in the development of malnutrition and dehydration in older persons.

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