Dysphagia: implications for older people

Abstract

Dysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are wellestablished practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.

Perceived changes to swallowing in people with Parkinson's disease

“…In the case of surgery, effects may be none or even adverse (Troche et al 2013). Nevertheless, straightforward advice and behavioural therapies directed at diet and modification of eating and drinking may bring significant improvements in health and quality of life (Miller and Patterson 2014). For these reasons it is important to ascertain the presence and degree of dysphagia in people with Parkinson's.…”

“…The utility of combined clinical screening and rating of functional changes has been established (Clarke et al 1998, Manor et al 2007, Lam et al 2007). Only Clarke et al (1998) employed healthy comparators for their screening questions, a notable omission from other studies given that swallowing efficiency declines naturally with age and neurologically unaffected older people may evidence swallowing difficulties (SerraPrat et al 2012, Miller and Patterson 2014, Roy et al 2007, Nogueira and Reis 2013.…”

Measuring elderly dysphagic patients' performance in eating – a review

“…Dysphagia is prevalent in the geriatric population [2,3] and may be caused by agerelated physiologic changes in the aero-digestive tract in conjunction with various medical conditions, e.g. cerebrovascular accidents, degenerative central nervous system diseases, anatomical disorders, chronic obstructive pulmonary disease or medications [2][3][4][5].…”

“…Dysphagia can result in aspiration pneumonia, malnutrition and dehydration [4,5]. In addition, dysphagic patients may be unable to maintain quality in performance in eating or to fulfil normative expectations for appropriate mealtime behaviour [6].…”

“…As dysphagia has devastating health implications [2][3][4][5] and social consequences [7][8][9], it is of striking importance to use a comprehensive multidisciplinary assessment process ensuring adequate nutrition and hydration, adequate airway protection [5,6] and safe and satisfactory participation in meals and relevant contexts [7][8][9].…”