Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice

Abstract

Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed.

Nutritional Status as a Mediator of Fatigue and Its Underlying Mechanisms in Older People

“…The meal is a distressing and fatiguing moment for these persons, who require more time to eat. Additionally, changes in masticatory function (i.e., tooth loss), leading to the selection of soft and easy-to-chew foods due to muscular exhaustion [76], can further negatively affect the nutritional status. In fact, chewing problems and loss of teeth have been associated with both malnutrition [77,78] and fatigue in older people [79].…”

Randomized trial results of alerting primary clinicians to severe weight loss among older adults in the Low Indexes of Metabolism Intervention Trial part A

“…This sharp difference might be explained by a different response of these cardiovascular patients to similar clinical actions. Here is one speculative example: urging frail patients with vascular disease to eat more might raise rates of respiratory aspiration or postprandial hypotension and their complications . Another (and maybe simultaneous) possible explanation is a systematically different clinical action in response to the alert when these cardiovascular diagnoses pre‐exist.…”

Recent progress in the use of functional foods for older adults: A narrative review

“…Older adults may also experience dysphagia or difficulty swallowing foods that affect 7% to 10% of people over 50 years of age (Sura, Madhavan, Carnaby, & Crary, 2012). For older adults with dysphagia, the main recommendation is to modify texture (foams, soaking foods, or thickened ice), temperature, volume, or viscosity (Cichero, 2018;Payne & Morley, 2018). Other changes include degenerative changes of the mucous membrane, secretory glands, and muscle tissue of the digestive tract (Granic et al, 2018;Rémond et al, 2015).…”