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. 2013 Dec;9(12):784-95.

Dysphagia in the elderly

Muhammad Aslam  1 , Michael F Vaezi  1
Affiliations

Dysphagia in the elderly

Muhammad Aslam et al. Gastroenterol Hepatol (N Y). 2013 Dec.

Abstract

Elderly patients are inherently predisposed to dysphagia predominately because of comorbid health conditions. With the aging of the population in the United States, along with the increased prevalence of obesity and gastroesophageal reflux disease, healthcare providers will increasingly encounter older patients with either oropharyngeal or esophageal disease and complaints of dysphagia. Useful tests to evaluate dysphagia include the videofluoroscopic swallowing study and the fiberoptic endoscopic evaluation of swallowing. Swallow rehabilitation is useful to help patients compensate for swallowing difficulty and ultimately help strengthen the neuromusculature involved in swallowing.

Keywords: Esophageal dysphagia; aging; fiberoptic endoscopic evaluation of swallowing; oropharyngeal dysphagia; swallow function; videofluoroscopic swallowing study.

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Figures

Figure 1
Figure 1
Salient features of the normal swallowing mechanism. A: The transported portions of processed (solid) food keep accumulating on the pharyngeal surface of the tongue and in the valleculae, and the bolus in the oropharynx enlarges with each transport cycle. The duration of bolus aggregation may range from a fraction of a second to 10 seconds. B: During the pharyngeal phase, the nasal cavity oral cavity and larynx are sealed off, and the bolus is advanced through the pharynx and into the esophagus by pharyngeal peristalsis. C: Airway protection is an essential feature of swallowing and is multitiered. Airway protection includes adduction of the true vocal cords, vertical approximation of adducted arytenoids, tilting back of the epiglottis closing the laryngeal vestibule, tucking of the sealed airway under the base of the tongue away from the bolus path, and neuronal suppression of respiration while the bolus is passing through the pharynx. D: Once the bolus is passed on to the esophagus, the airway returns to its open state. The oropharyngeal phase of swallowing begins with adduction of the vocal cords and ends with a return to their normal position.
Figure 2
Figure 2
Clinical evaluation of esophageal dysphagia in the elderly. CVD, collagen vascular disease; Sx, symptoms.
Figure 3
Figure 3
Management of esophageal dysphagia in the elderly. DES, diffuse esophageal spasm; HTN-LES, hypertensive lower esophageal sphincter; IEMD, ineffective esophageal motility disorder; PPI, proton pump inhibitor; Rx, prescription.
See this image and copyright information in PMC

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