Decreased swallowing function in the sarcopenic elderly, without clinical dysphagia: a case-control study

Abstract

Background Sarcopenia and dysphagia have both become pivotal issues due to the increased number of elderly people. However, it’s still in question that whether sarcopenia, defined by the reduced handgrip strength and/or reduced gait speed, would necessarily results in pathological effects on swallowing function. Studies that focus on the subclinical changes of swallowing function of the sarcopenic elderly are lacking. In this study, we aimed to evaluate the swallowing function of the sarcopenic elderly without dysphagia. Methods This was a case-control study and subjects were recruited from the community. 94 individuals aged 65 and older without dysphagia were divided into sarcopenia and non-sarcopenia group. Assessment of swallowing consisted of tongue pressure measurement, hyoid displacement and movement velocity measurement with submental ultrasonography, 100 ml water swallow test, and the 10-item Eating Assessment Tool (EAT-10). Results The average tongue pressure was 47.0 ± 13.7 kPa in sarcopenia group and 48.6 ± 11.5 kPa in non-sarcopenia group (p = 0.55). The average hyoid displacement during swallowing was 15.3 ± 4.4 mm in sarcopenia group and 13.0 ± 4.2 mm in non-sarcopenia group (p < 0.05). The average hyoid movement velocity during swallowing was 22.0 ± 9.1 mm/s in sarcopenia group and 17.4 ± 7.4 mm/s in non-sarcopenia group (p < 0.05). The time needed to consume 100 ml of water was 14.7 ± 10.5 seconds in sarcopenia group and 7.0 ± 3.9 seconds in non-sarcopenia group (p < 0.05). The average score of EAT-10 was 0.5 ± 0.6 in sarcopenia group and 0.1 ± 0.3 in non-sarcopenia group (p < 0.05). Conclusions Swallowing function was significantly diminished in elderly individuals with sarcopenia, before clinical symptoms became evident. However, tongue muscles seemed resistant to sarcopenia at an early stage. Compensative strategies, such as reduced swallowing speed and increased hyoid bone movement, were observed in the sarcopenic subjects.

Surface Electromyographic Activity of Submental Muscles During Swallow of Masticated Bolus Across Age and Gender

“…It is possible that the gradual sub mental relaxation (increased offslope) in older individuals observed in the current study is associated with slow hyolaryngeal descent as a preventive strategy against secondary aspiration associated with large solid bolus swallows (1 cookie). A recent exploration of swallow related performance in healthy aging population reported reduced hyo-laryngeal ascend velocity in older individuals compared to younger [44]. Though our research does not directly measure the hyo-laryngeal velocity, the statistically insigni cant difference in the onslope measure indicate the speed of hyolaryngeal ascent may not be very different across the two groups.…”

Effects of Rehabilitative Exercises on Swallowing Function in Elderly People: A Pilot Randomized Controlled Trial

“…For example, the study by Metheny et al has indicated that the risk of Aspiration increases due to sarcopenia, which reduces tongue propulsion (12). Also, some studies have demonstrated that older people have a reduction in laryngeal elevation, rotation, and forward movements which can delay airway closure and poor cough in the elderly (13)(14)(15).…”

“…Therapeutic techniques provided by speech therapists include the use of compensatory strategies (change of diet, change of position) and rehabilitative exercises (muscle strengthening exercises or swallowing maneuvers) (1). Because the muscles used for swallowing can become weaker with age, in recent years, some studies have surveyed the effects of muscle strengthening exercises as the most common rehabilitative exercises for dysphagia therapy in the elderly (15)(16)(17). Robbins et al studied the Effects of Lingual Exercise on swallowing in ten older adults, and the results indicated significantly increased isometric and swallowing pressures (18).…”