Factors influencing bolus dwell times in healthy older adults assessed endoscopically

Abstract

Objectives/Hypothesis Scant data exist on normal bolus dwell time assessed during Flexible Endoscopic Evaluation of Swallowing (FEES). The purpose of this study was to examine bolus dwell time in healthy older adults. Since it has been previously reported that some healthy older adults aspirate, we also sought to determine if bolus dwell time varied as function of aspiration status. Study Design Prospective Methods Seventy-six healthy volunteers from the 7th, 8th, and 9th decades of life participated. Dwell times were analyzed via FEES as a function of pharyngeal location, liquid type, delivery method, purée type, viscosity, age, and gender. Results Longer dwell times were evidenced with the eldest participants, straw delivery, and the smallest volume. Adults in the 9th decade were 4.8 (p = 0.01) and 3.8 (p = 0.02) times more likely to have longer dwell times at the vallecula and 7.1 (p = 0.002) and 3.8 (p = 0.02) at the pyriform sinus than those in the 7th and 8th decades, respectively. Longer dwell times at the vallecula and pyriform sinuses were 2 and 2.38 times (p < 0.0001) more likely for straw than cup delivery, respectively. Five ml boluses were 1.5 times (p < 0.05) more likely to result in longer dwell times than larger volumes. Bolus dwell times did not significantly differ as a function of aspiration status. Conclusions Advanced age, straw delivery, and small volumes yielded longer dwell times. These variables should be considered before diagnosing an abnormal bolus dwell time in elder patients.

Swallowing dysfunction in healthy older people using pharyngeal pressure‐flow analysis

“…Examination of individual swallow parameters suggested UES opening diameter may be reduced (high UES Zn) and bolus dwell time prolonged (longer flow interval) in older individuals. Broadly, our findings are consistent with previous reports reliant upon the standard methods of swallow assessment that are resource intensive and complex to analyze . We argue that AIM analysis may be more amenable to patient/subject screening because the objective measures, which can be accurately derived by experts and non‐experts alike, appear to be very meaningful in terms of assessing swallowing function/dysfunction.…”

Preliminary Investigation of the Effect of Pulse Rate on Judgments of Swallowing Impairment and Treatment Recommendations

“…Diet recommendation categories were: Regular Diet/Thin, Nectar or Honey Liquid; Mechanical Soft Diet/Thin, Nectar, or Honey Liquid; Puree/Thin, Nectar, or Honey Liquid; All liquids; Thin liquids only; Nectar liquids only; Honey liquids only; or NPO. Compensatory or treatment strategy categories were: Mendelsohn maneuver[13], Supraglottic swallow/super supraglottic swallow[14], Chin tuck[15], Effortful swallow[16], Cough[17], Masako maneuver[18], Clearance of oral residue[19], Range of motion exercises[20], Shaker chin lifts[21], Additional swallows per bolus[22], Use of straw[23], Head turn[24], and Bolus hold[10]. Prognostic categories for recovery of swallow function included: Good, Fair, or Poor.…”

Pharyngeal swallowing in older adults: Kinematic analysis using three‐dimensional dynamic computed tomography

“…A higher prevalence of abnormal swallowing in older adults has also been described. This is likely the result of two factors: increased prevalence of diseases associated with dysphagia and increased risk of dysphagia as a result of the physiologic changes associated with normal ageing …”