Dysphagia in the Elderly: Preliminary Evidence of Prevalence, Risk Factors, and Socioemotional Effects

Dept of Communication Sciences and Disorders, The University of Utah, 390 South 1530 East, Room 1219, Salt Lake City, UT 84112-0252, USA.
The Annals of otology, rhinology, and laryngology (Impact Factor: 1.09). 12/2007; 116(11):858-65. DOI: 10.1177/000348940711601112
Source: PubMed


Epidemiological studies of dysphagia in the elderly are rare. A non-treatment-seeking, elderly cohort was surveyed to provide preliminary evidence regarding the prevalence, risks, and socioemotional effects of swallowing disorders.
Using a prospective, cross-sectional survey design, we interviewed 117 seniors living independently in Utah and Kentucky (39 men and 78 women; mean age, 76.1 years; SD, 8.5 years; range, 65 to 94 years) regarding 4 primary areas related to swallowing disorders: lifetime and current prevalence, symptoms and signs, risk and protective factors, and socioemotional consequences.
The lifetime prevalence of a swallowing disorder was 38%, and 33% of the participants reported a current problem. Most seniors with dysphagia described a sudden onset with chronic problems that had persisted for at least 4 weeks. Stepwise logistic regression identified 3 primary symptoms uniquely associated with a history of swallowing disorders: taking a longer time to eat (odds ratio [OR], 9.5; 95% confidence interval [CI], 2.3 to 40.2); coughing, throat clearing, or choking before, during, or after eating (OR, 3.4; 95% CI, 1.1 to 10.2); and a sensation of food stuck in the throat (OR, 5.2; 95% CI, 1.8 to 10.0). Stroke (p = .02), esophageal reflux (p = .003), chronic obstructive pulmonary disease (p = .05), and chronic pain (p = .03) were medical conditions associated with a history of dysphagia. Furthermore, dysphagia produced numerous adverse socioemotional effects.
This study provides preliminary evidence to suggest that chronic swallowing disorders are common among the elderly, and highlights the need for larger epidemiological studies of these disorders.

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Available from: Nelson Roy, Mar 10, 2015
    • "Residents with dysphagia are at increased risk for inadequate food intake, leading to malnutrition [10]. Food intake may also be affected by eating-related fatigue [11] and this may be of particular concern in seniors with dysphagia, who are reported to take longer to eat [12]. "
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    ABSTRACT: As many as 74% of residents in long-term care (LTC) are anticipated to have swallowing difficulties (dysphagia). Low food intake is commonly reported in persons with swallowing problems, but food intake may also be affected by fatigue in the swallowing muscles. As fatigue sets in during mealtimes, the strength of the tongue may decline. Tongue strength is also known to decline with age but it is unclear how this functional change may influence food intake. In this pilot study, we explored the relationship between tongue strength and meal consumption in persons not previously diagnosed with dysphagia. The Iowa Oral Performance Instrument was used to collect maximum anterior isometric tongue-palate pressures from 12 LTC residents (5 male; mean age: 85, range 65-99). Residents were also screened for dysphagia with applesauce and a water swallow test. Each resident was observed at three different meals to record the length of time taken to eat the meal, amount of food consumed, and any indication of overt signs of swallowing difficulty (e.g. coughing). Residents who displayed observable swallowing difficulties at mealtimes had significantly lower tongue strength than those without swallowing difficulties (p < 0.01). Those with lower tongue strength took significantly longer to complete meals (p < 0.05) and consumed less food. Tongue strength was not predictive of performance on the water screen and the water swallow test was not a good predictor of which participants were observed to display mealtime difficulties. Among seniors in long term care, reduced tongue strength is associated with longer meal times, reduced food consumption, and the presence of observable signs of swallowing difficulty. Further exploration of these relationships is warranted. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
    Clinical nutrition (Edinburgh, Scotland) 08/2015; DOI:10.1016/j.clnu.2015.08.001 · 4.48 Impact Factor
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    • "In the United States, it is estimated that about 300,000–600,000 persons each year experience dysphagia, as a result of stroke or other neurological disorders (Mann et al., 2000; Paciaroni et al., 2004) and that up to 6 million adults are at risk for it (Sura et al., 2012). Dysphagia affects up to 68% of elderly nursing home residents (Steele et al., 1997), 30% of the elderly admitted to the hospital (Lee et al., 1999), 64% of stroke patients (Mann et al., 2000), and 13–38% of elderly who live independently (Kawashima et al., 2004; Roy et al., 2007). "
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    ABSTRACT: Objective Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up is critical for early diagnosis and management which can mitigate its complications and be cost-saving. Aims of this study are to provide a comprehensive investigation of the dysphagia limit in a large diverse cohort and to provide a longitudinal assessment of dysphagia in in a subset of subjects. Methods We developed a quantitative and non-invasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. Dysphagia Limit (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 1,278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia and 202 patients without dysphagia. One hundred and ninety two of all patients were also re-evaluated 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, non-invasive, 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.
    Clinical Neurophysiology 07/2014; 126(3). DOI:10.1016/j.clinph.2014.06.035 · 3.10 Impact Factor
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    • "In a group of 65–94-year-old community dwelling adults, prevalence of dysphagia was reported to be 37.6%.13 Of these, 5.2% reported the use of a feeding tube at some point in life, and 12.9% reported the use of nutritional supplements to reach an adequate daily caloric intake.13 "
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    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.
    Clinical Interventions in Aging 07/2012; 7:287-98. DOI:10.2147/CIA.S23404 · 2.08 Impact Factor
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