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Swallowing Problems In Elderly

Normal Swallowing

Swallowing is a complex process where each processes interact with each other. A lot of physical activities and brain responses are taking place during swallowing process.

There are four inter-related swallowing phases which are pre-oral, oral, pharyngeal and esophageal phases.

Elderly

Changes from baby into adulthood and further into elderly caused subtle physical and physiological deviations over a period of time. Some physical changes that take place are;

  • Reduce skin firmness
  • Reduce muscle strength
  • Reduction in memorization

Besides physical changes, there are also physiological changes;

  • Delay wound healing
  • Reduce immune system
  • Increase number of problem with swallowing ability.

Among the elderly complaints regarding their swallowing/eating process are;

  • They do not have appetite
  • They have difficulty to chew
  • They feel food stuck in their throat.

A person who has difficulty to swallow can also know as have dysphagia. Any complaints on dysphagia should be given appropriate attention to avoid other health complications.

Swallowing Problem in Elderly

The United States of America estimates that about seven to ten percent of their elderly are having dysphagia. The number of cases are increasing, thus health care professional are looking more serious into this matter (Spieker, M.R. 2000)


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One of the effects of ageing is memory loss. Serious memory loss and decrease in cognitive function like dementia can affect normal swallowing function. It can affect the safety and also the affectivity of swallowing. Among the diseases that show symptoms of dementia is Alzheimer. Moreover, number of dysphagia cases among the elderly is increasing as the incidence of dementia and stroke is getting higher.

Dementia Effects on Swallowing

The consequences of dementia and decrease cognitive function on swallowing can be observed on pre-oral and oral phases. The airway protection mechanism should takes place at the same time as the swallowing happens.  Hence, the disruption of oral phase can negatively affect the safety of pharyngeal phase as the food can easily go into the trachea.

Furthermore, dysphagia also occur when the swallowing process become slower. When this happens, there is a delay in airway protection, thus lead to the spillage of food/liquid into the trachea.

  • Lung Infection (AspirationPneumonia)
    The implication of dysphagia is very dangerous, especially to the older people due to the decline in their health condition. Aspiration pneumonia can easily happen when food falls into the airway passage when they are consuming their meal, either when they are eating themselves or when somebody is helping them with the food. Aspiration pneumonia is also a common cause of death among the elderly patient.
  • Malnutrition
    Besides pneumonia, dysphagia can also intervene with their appetites, which in turn make them consume less food. This will cause them to suffer from other illness, such as dehydration and malnutrition. Moreover, the Alzheimer patient will always give reasons to avoid consuming foods, such as saying that they have ‘no appetite’, ‘feel full’ though in fact they are not. This is not a good attitude, because after certain period of time, they will experience other problems such as losing weight, becoming weak and need other people assistance.
  • Feeding Tube
    Patient and families of elderly with dysphagia need to give attention what are the type of food is safe for them to eat. The consistency of the food depends on the diagnosis and the severity of the dysphagia.
    Some patients are unsafe to take it orally as they are experiencing aspirating food. Those patients will need nasogastric tube/ryle’s tube for feeding purposes. They have to use it till they improve and become more healthy and safe to resume oral feeding.

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    Generally, there are two types of tubes;

    • Nasogastric tube: it is place through the nose
    • Percutaneous (Percutaneous Endoscopic Gastrostomy): a small operation to insert the tube at the bottom of the stomach)

    Patients and their families will usually reject the idea of having a tube to eat at first. There are many reports highlighting the impact on using tube feeding. The impacts also cover psychological effect such as depression and limitation in social activity. Therefore, it is important for the patient and their family to discuss with the expert before deriving any action.

Overcoming and Treating Dysphagia

An interdisciplinary professional team is a mandatory to manage cases of elderly with dysphagia. The teams usually consist of Speech-Language Therapist, geriatrician and dietitian.

The Speech-Language Therapist roles are:

  • Conduct non-instrumental assessment (oral-motor structure and function examination)
  • Conduct instrumental assessment of swallowing. E.g.: Flexible Endoscopy Evaluation of Swallowing and Videoflouroscopy of Swallowing Study (hyperlink artikel, 2015 Ujian Instumentasi/Peralatan Berteknologi Tinggi Penelanan)
  • Explain the best dysphagia intervention based on the assessment.
  • Helps the families and patient gone through swallowing rehabilitation (hyperlink artikel 2015, Behavioral Feeding Management)

A geriatrician is vital to take care of the patients’ medical condition. Meanwhile, dietitian is the person that will monitor whether the patient has enough/balance diet for their daily activity.

Conclusion

Elderly patient with dysphagia and their family members are recommended to discuss with the interdisciplinary team before making any decision related to their feeding condition, especially when the situation is critical and might be affecting their live.

References

  1. Age-Related Physiological Changes and Their Clinical Significance: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273316/  (Boss & Seegmiller, 1981)
  2. British Geriatrics Soceity. Dysphagia Management for Older People Towards the End of Life. www.bgs.org.uk/index.php/topresources/publicationfind/goodpractice/2328-bpgdysphagia
  3. Spieker, M.R. (2000). Evaluating Dysphagia . Am Fam Physician Jun 15;61 (12): 3639-3648. Retrieved from www.aafp.org/afp/2000/0615/p3639.html on 11/9/2015
  4. Sura et. al (2012). Dysphagia in the elderly: management and nutritional considerations http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426263/
  5. World Health Organization. Definition of an older or elderly person http://www.who.int/healthinfo/survey/ageingdefnolder/en/
Last Reviewed : 10 March 2016
Writer / Translator : Maryam bt. Aizudddin
Accreditor : Nurshahira bt. Razali