Lecture 2: Aging Swallow & Intro to Dysphagia Flashcards
Normal geriatric swallow
Presbyphagia: age related swallowing changes in people 65+
Decreased lingual movement, slower to initiate, longer transit through pharynx, upper esophageal sphincter stays open longer, laryngeal closure time is earlier and longer, intermittent penetration and aspiration is common, slowed esophageal motility.
these changes do not mean dysphagia is present
Sensation changes in TASTE
decreased saliva production, decreased # of taste buds, decreased thirst sensation, decreased sensory specific satiety, and sometimes inability to detect spoiled food
Sensation changes in SMELL
decreased smell receptors, starts to decline around age 40
this also impacts taste and can result in decreased oral intake
Sensation changes in VISION
Presbyopia: gradual loss of ability to focus on nearby objects
Decline in near vision, difficulty distinguishing colors, difficulty feeding self
Dental changes
missing or loose teeth, edentulous (missing teeth), dentures (weight loss - poor fit, decreased bite force), could need soft diet, poor oral hygiene –> increased bacteria (bad if aspirating!!)
Voice changes
Presbyphonia - age related changes to the voice
Decreased vocal fold adduction meaning decreased cough strength, volume, and vocal weakness
Respiratory system changes
Decreased…
muscle strength, cough strength, lung and chest wall elasticity, alveolar surface area, gas exchange
results in….
decreased:
tolerance of swallow apnea, breath/swallow coordination, ability to clear lungs of debris/mucous
increased…
risk microaspiration
GI system changes
Slowed esophageal and bowel motility, slowed gastric emptying (shrinking stomach lining, slower elimination of medications), increased risk for dehydration, malnutrition and constipation
Musculoskeletal changes
Decreased height, increase in weight until age 60, increased body fat mass, increased risk of decreased muscle strength
Sarcopenia
Gradual loss of muscle mass
Decreased functional reserve
Decreased remaining capacity of an organ or body part
Sarcopenia and decreased functional reserve result in
Frailty, loss of function, increased vulnerability to disease/death, increase risk for falls, worsening mobility, impaired ADLs, decreased nutrition/hydration, increased risk for failure to thrive
Impact on oral stage
Decreased lingual mobility and force, fewer swallows, decreased ability to discriminate various viscosities, dentition changes, decreased lingual pressure
Impact on pharyngeal stage
Decreased anterior laryngeal movement (hyolaryngeal excursion) which results in decreased PES opening, decreased or increased tension in upper esophageal sphincter, decreased in connective tissue, more pharyngeal residue, penetration is normal, intermittent aspiration occurs, longer airway closure time, slower pharyngeal transit time
Presbyphagia vs dysphagia
determine if actual dysphagia is present, prespyphagia in addition to acute or chronic illness, determine if diet modifications are needed in short term, low functional reserve to tolerate episodes of aspiration, important to follow up to return to normal diet, branded with dysphagia or aspiration/silent aspiration, there is a time and place for diet modifications, postural modifications first!
Dysphagia…
is difficulty swallowing, symptom of underlying disease, described by clinical characteristics, due to various etiologies.
is NOT a primary medical diagnosis
Special populations
- Stroke
- Head and neck cancer
- Progressive neurological disease
- Head injury
- Developmental disability
- Mental illness
- Phagophobia – fear of swallowing
- Premature/drug exposed infants
- Spinal cord injury
Medical consequences of dysphagia
o Dehydration
o Malnutrition
o Aspiration pneumonia
o Increased mortality risk
o Confusion
o Organ system failure
o Further decompensation of swallow function
o Decreased energy levels
o Compromised immune system
o Increased length of stay
Psychosocial consequences of dysphagia
o Social isolation
o fear
o Stress to achieve correct consistency
o Increased family burden
o Not pleasurable
o Cost
Management team
- SLP
- ENT
- Gastroenterologist
- Radiologist
- Neurologist
- Dentist
- Nurse
- Dietitian
- Occupational therapy
- Neurodevelopmental specialist
- Pulmonologist
- Respiratory therapist
Levels of care: patient needs extensive nursing care; unable to discharge home
Subacute/long term acute care
Vent weaning from trach tube or complex medical needs
Requires PT OT SLP to return to prior level
Levels of care: patient unable to safely discharge home
Inpatient rehab or skilled nursing
Requires PT OT SLP to return to prior level
rehab = endurance 3+ hours therapy
SN = decreased endurance under 3 hours
Patient able to safely discharge home and has reliable/safe transport for therapy
Outpatient or outpatient day treatment
Day treatment = 3+ hours daily
Outpatient = various disciplines 2-3 x week
Patient able to safely discharge home but med needs require home care
Home health
disciplines 1-2 times weekly
