European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

Abstract

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

Patient Adherence to Dysphagia Recommendations: A Systematic Review

“…As a result, nonadherence to these recommendations could increase the likelihood of developing negative health outcomes, including malnutrition,(16) dehydration, and aspiration related pneumonia,(17) that increase mortality and decrease quality of life. (15, 18)…”

Validation of the Hebrew Version of the Eating Assessment Tool-10 (H-EAT-10)

“…Dysphagia poses a risk for malnutrition, dehydration, aspiration pneumonia, and upper airway obstruction [2, 6, 7]. These complications are associated with increased health-care costs, especially as the population ages, and may result in death [8, 9].…”

“…Early treatment of dysphagia is important to prevent associated morbidity and mortality, yet the majority of patients with swallowing difficulties often are not diagnosed or treated [7]. The goal of screening is to identify patients with dysphagia who need further clinical and/or instrumental assessment.…”

Evaluation of Oropharyngeal Dysphagia in Patients Who Underwent Percutaneous Endoscopic Gastrostomy: Stratification Risk of Pneumonia

“…Fibreoptic endoscopic evaluation of swallowing (FEES) is widely used by speech‐language pathologists and otolaryngologists . FEES enables direct observation of the test food accumulating in the pyriform sinuses or entering below the vocal cords.…”