elderly

Age-related Changes in the Central Processes

Overall slowing of CNS activities

Age-related Changes in the Oral Cavity: tongue

Increased fatty/connective tissue in the tongue

what does increased fatty/connective tissue do?

it is harder to contract the m.

Age-related Changes in the Oral Cavity vs Phayrnx: atrophy of _______

oral: alveolar bone

pharyngeal: muscles

atrophy of the bones causes what to happen easier?

fracture

Age-related Changes in the Oral Cavity: loss of _______

dentition (teeth)

Age-related Changes in the Oral Cavity: reduced ____________ strength

masticatory (chewing)

Age-related Changes in the Oral Cavity vs Pharyngeal Cavity: increased __________ thresholds

oral: increased discrimination thresholds

pharyngeal: Increased pharyngeal mechanical sensory threshold

need more sensory stimulation (temperature, taste)

Age-related Changes in the Oral Cavity vs Pharyngeal Cavity: reduced flow of _______

oral: secretions

pharyngeal: secretion in VFs

important to lubricate and break down food

Age-related Changes in the Pharynx: drop of ______ position (what is the position?)

laryngeal; from C5/C6 to C6/C7 becuase of gravity

Age-related Changes in the Pharynx: larynx and epiglottis

Ossification/calcification of laryngeal cartilages and epiglottis

Age-related Changes in the Pharynx: joints

Arthritic joints; osteoporosis; degenerative osteophytes and spurs

Age-related Changes in the Esophagus (3 things)

• Decreased esophageal muscle tone

• Slower mobility

• Slowed gastric emptying

Age-related Changes in Swallowing Physiology: Holding bolus slightly more

posteriorly; they hold back and bring it forward and then back again before swallow (slowing the oral prep stage)

____________ dysfunction is NOT uncommon in elderly

cricopharyngeus

Age-related Changes in Swallowing Physiology: what is slower?

• Slower swallows (all phases, oral prep is the slowest)

• A delay in triggering the pharyngeal swallowing

• Slower/reduced maximum laryngeal excursion (movement)

• Slower laryngeal descending

• 10% slower pharyngeal contraction

• Reduced speed/efficiency of VF closure (not tight)

• Slower cricopharyngeal opening

for the ederly, where is the pharyngeal swallow triggered?

triggered at the middle of BOT

what does slower/reduced maximum laryngeal excursion (movement) lead to?

laryngeal penetration (shallow penetration)

Age-related Changes in Swallowing Physiology: what is less efficient?

esophageal peristalsis

Age-related Changes in Swallowing Physiology: how is the UES changed?

• Slower UES relaxation

• Reduced UES pressure

Age-related Changes in Swallowing Physiology: what may be present after swallowing?

Mild residual accumulation may be present in the pharynx after swallowing, but it should be cleared with one or two subsequent swallows

% of elderly with normal deglutition (no symptoms of swallowing problems)

16%

% of elderly with oral differences (difficulty ingesting/controlling/delivering bolus relative to swallowing initiative; chew, breakdown food, initiate swallow)

63%

% of elderly with pharyngeal dysfunction (bolus retention, lingual propulsion/pharyngeal constrictor paresis)

25%

% of elderly with pharyngoesophageal segment abnormalities (cricopharyngeal muscle dysfunction)

39%

% of elderly with esophageal abnormalities (motor dysfunction)

36%

The conclusion is that approximately ___% of non-dysphagic elderly exhibit altered function without impairment (do show problems).

85%

can occasional aspiration occur without serious health/safety issues?

yes

the most common problem is…

oral sensorimotor incoordination (sensory loss)

Aslam & Vaezi (2013)
“In otherwise healthy elderly persons, the effects of aging on swallow remain _____________ without reaching a ____________.”

compensated; symptomatic level

do Aslam & Vaezi (2013) state that dysphagia can be attributed to normal aging alone?

NO

“Despite physiologic changes in the swallowing mechanism due to aging, dysphagia cannot be attributed to normal aging alone, and its presence suggests the need for further investigation to identify potentially treatable causes.”

T/F

Humbert & Robbins (2008)
We should be “more aware of the need to distinguish among dysphagia, presbyphagia and other related diagnoses to avoid over-diagnosing and over-treating dysphagia.

true; if a patient doesn’t have symptoms we don’t have to treat them

presbyphagia

an old yet healthy swallow

common cause of oropharyngeal dysphagia in the elderly

stroke, occurring in one-third of all stroke patients

common cause of esophageal dysphagia in the elderly

many motor or mechanical causes

common cause of functional dysphagia in the elderly

unknown

The elderly are susceptible to pharmacologic actions on the _____________, _________________, or ______ effects

central nervous system, neuromuscular transmission, or myotoxic effects

as a result of medications, inhibited muscle function often hampers ___________ and _____________

swallow activity and bolus transit

as a result of medications, reduced ____ esophageal sphincter tone likely increases the incidence and severity of _____ and __________.

lower; GERD and peptic structure

as a result of medications, drug-induced xerostomia may affect the ability to ________, __________, and ____ and ___________

chew foods, initiate swallows, and form and transport bolus

as a result of medications, the risk of __________ is higher

mouth infections

as a result of medications, ___________ may occur from medication-induced esophageal injury

pill esophagitis

when food or liquid leaks into the pharynx before the swallow reflex is triggered

premature spillage