Presbyphagia and dysphagia in old age

Abstract

Although presbyphagia is a clinically relevant problem among elderly population, possibly leading to dysphagia in old age, it remains a still underestimated health condition. The present review analyzes swallowing related anatomical and functional changes during aging, both in healthy people and in those affected by dysphagia. First of all, dysphagia in old people must not be confused with presbyphagia. To distinguish these two different conditions, a correct definition of both should be considered. Subsequently, a comprehensive evaluation including instrumental analysis should be carried out. The aim of this narrative review is to analyze the current knowledge of this clinical condition and to provide the state of art to clinicians. A systematic PubMed research on dysphagia in the elderly was conducted and most relevant and most recent references were manually screened and selected. The aim of a correct diagnosis is to enable the choice of a correct intervention in order to prevent and treat complications of dysphagia, such as ab ingestis pneumonia and malnutrition. Moreover, the assessment, diagnosis and therapy of dysphagia/ presbyphagia should include the intervention of different specialists.

Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H

“…In addition, conditions such as Parkinson disease, myotonic dystrophy, and myasthenia gravis; infectious conditions such as candida; some connective tissue diseases; multiple comorbidities; multiple drug therapy (polypharmacy); and the use of swallowing-related drugs can cause both OPD and ED. 6 , 48 , 49 )…”

“…Almost all studies in older adults have reported changes in eating habits (reduced volume, changed consistency, and increased meal times) with increasing age. 6 , 38 , 48 , 52 ) Bolus formation and chewing ability especially decrease owing to age-related changes in swallowing function, in addition to changes in the choice of food consistency. 11 ) Therefore, we accepted that the symptom of changes in eating habits and difficulty with solid foods/liquids, especially in older adults, may be appropriate screening questions for the diagnosis of geriatric dysphagia.…”

“…Videofluoroscopy (VF) and flexible fiberoptic endoscopic evaluation of swallowing (FEES) are the most widely studied and recommended gold standard methods in the diagnosis of OPD. 2 , 48 , 58 ) The choice of method depends on the advantages and disadvantages. 43 ) We recommended both FEES and VF as first-line methods for OPD diagnosis.…”

“…Thus, the first-line treatment is the elimination of factors that can cause dysphagia before using rehabilitation modalities. 45 , 48 ) In OPD, first-line modalities include surgery (in the presence of tumors and cervical osteophytes), medical treatment (in cases such as myasthenia gravis and oral candidiasis), and botulinum injection (in the presence of sialorrhea and dystonia). 23 , 43 ) Similarly, the use of antiviral, antifungal, and antibiotic drugs in infectious esophagitis causing ED and medical treatment of GER and gastroparesis are first-line treatment modalities.…”

“… 11 , 68 ) Combination therapy has been recommended in both older people and patients with OPD. 2 , 11 , 12 , 25 , 48 ) For example, in patients who cannot be fed orally, nutritional support may be provided using alternative feeding methods; however, oral stimulation and salivary swallowing exercises may also be combined with this therapy to stimulate swallowing function. Moreover, in patients who can be partially orally fed, a combination of compensatory methods such as diet and postural modification may be used, while both compensatory and therapeutic methods may form the treatment components in patients who can be fully orally fed.…”