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Background Dysphagia is associated with aspiration, pneumonia and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. Methods We conducted a comprehensive search of seven databases, including MEDLINE, EMBASE and Scopus, from each database’s earliest inception through June 5th, 2013. Studies reporting diagnostic performance of a bedside examination maneuver compared to a reference gold standard (videofluoroscopic swallow study [VFSS] or flexible endoscopic evaluation of swallowing with sensory testing [FEEST]) were included for analysis. From each study, data were abstracted based on the type of diagnostic method and reference standard study population and inclusion/exclusion characteristics, design and prediction of aspiration. Results The search strategy identified 38 articles meeting inclusion criteria. Overall, most bedside examinations lacked sufficient sensitivity to be used for screening purposes across all patient populations examined. Individual studies found dysphonia assessments, abnormal pharyngeal sensation assessments, dual axis accelerometry, and one description of water swallow testing to be sensitive tools, but none were reported as consistently sensitive. A preponderance of identified studies was in post-stroke adults, limiting the generalizability of results. Conclusions No bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several individual exam maneuvers demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols was not established. More research is needed to design an optimal protocol for dysphagia detection.

Swallowing problems, or dysphagia, are common as people age, and are associated with significant negative outcomes, including weight loss, pneumonia, dehydration, shortened life expectancy, reduced quality of life, and increased caregiver burden. In this article, we will discuss the complex process of swallowing in normal circumstances and with healthy aging, then review etiologies that contribute to dysphagia. We will discuss approaches to evaluating and treating dysphagia, providing relevant data where they are available. We highlight the desperate need for high‐quality research to guide best practices in treating dysphagia in older adults. J Am Geriatr Soc 67:2643–2649, 2019