Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study

Abstract

Background: Sarcopenia and dysphagia are prevalent health issues as the elderly population continues to grow. However, whether sarcopenia, defined by either reduced handgrip strength or gait speed, would lead to pathological effects on swallowing function is still a matter of debate. Studies focusing on subclinical changes in the swallowing function in the sarcopenic elderly are lacking. This study evaluates the swallowing function in the sarcopenic elderly without dysphagia.Methods: A cross-sectional study was conducted including subjects recruited from the community. Ninety-four individuals aged 65 and older without dysphagia were divided into two groups: sarcopenia and nonsarcopenia. The swallowing assessment included tongue pressure measurement, hyoid displacement (HD), hyoid velocity (HV) measurement with submental ultrasonography, 100-ml water-swallowing test, and the 10-item Eating Assessment Tool (EAT-10).Results: The average tongue pressure was 47.0 ± 13.7 and 48.6 ± 11.5 kPa in the sarcopenia and nonsarcopenia groups, respectively (p = 0.55), whereas the average HD during swallowing was 15.3 ± 4.4 and 13.0 ± 4.2 mm in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of HV during swallowing was 19.5 (6.41–45.86) and 15.9 (3.7–39.7) mm/s in the sarcopenia and nonsarcopenia group (p < 0.05). The median of time needed for consuming 100 ml water was 12.43 (3.56–49.34) and 5.66 (2.07–19.13) seconds in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of the EAT-10 score was 0 (0–2) and 0 (0–1) in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05).Conclusions: In elderly individuals, swallowing function was significantly impaired with sarcopenia before clinical symptoms become clear. However, tongue muscles exhibited resistance to sarcopenia. We observed compensative strategies in patients with sarcopenia, such as reduced swallowing speed and increased hyoid bone movement.

Automated assessment of hyoid movement during normal swallow using ultrasound

“…The addition of a 20 mm deep gel acoustic standoff (SONOKIT soft 200 × 100 × 20 mm; Sonogel Vertriebs GmbH, Bad Camberg, Germany) between the probe and the submental surface reduced these blackouts but did not remediate the problem in all cases. Although a specially contoured layer of standoff material or water‐filled balloon (Chen et al., 2020; Kwong et al., 2020) might provide a better solution, this was not available at the time of recording. As a result, the 60 mm radius probe was set aside in favour of a smaller 20 mm radius 2–4 MHz probe.…”

“…This strategy was not observed for a larger bolus volume. A study of sarcopenic elderly also showed slightly increased hyoid displacement for small bolus swallows in individuals with reduced swallowing function compared with age‐matched control (Chen et al., 2020).…”