Swallowing is a complex process and dysphagia is very common with advancing age. This is something we see and treat frequently as speech-language therapists. Dysphagia, which can sometimes be asymptomatic, can arise from widely varied etiologies. A useful review article (Christmas C, Rogus-Pulia N. Swallowing Disorders in the Older Population. J Am Geriatr Soc. 2019 Dec;67(12):2643-2649. doi: 10.1111/jgs.16137) from the Divisions of Geriatric Medicine and General Internal Medicine at Johns Hopkins outlines these, and is well worth reading from the perspective of clinical intervention.
We treat it because it often contributes to significant reductions in quality of life for patients and caregivers, with discomfort in eating, elevated risks of pneumonia and dehydration, and weight loss and debility. For patients with stroke and dementia, dysphagia is highly associated with reduced survival rates.
Evidence to support the way we evaluate and treat dysphagia in older adults is still limited, lacking large cohorts and robust study design. Coming research will need to focus on underlying mechanisms and the results of specific interventions. It has been shown conclusively that swallowing dysfunction begins early in Alzheimer’s-type dementia, for instance. Whether direct interventions to strengthen and improve swallowing function in early stage dementia, when the patient is cognitively able to participate in therapy, is currently under particular research scrutiny. The impact of swallowing evaluation and treatment on broader health outcomes, such as pneumonia and nutritional status, in older adults also requires elucidation.
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