13 Swallow Function in Advanced Age
Age-related changes in swallow function are observed starting at approximately age 60; by age 80, most individuals will experience some degree of age-related swallow changes (presbyphagia) (Iannuzzi-Sucich, Prestwood, & Kenny, 2002). As an individual ages, there are alterations in sensory function, the musculoskeletal system, and the neural system. These age-related changes may impact swallow function. However, a healthy elderly individual can produce a functional swallow despite presbyphagia. Regardless, these changes put an older individual at risk for dysphagia. Box 1.50 shows a VFES of a healthy elderly individual. Box 1.51 displays areas of decline associated with advanced age.
Box 1.50 External Link
Normal elderly swallow via VFES
Image??
Box 1.51
Schematic of the impact of advanced age on swallow function
Image
Anatomically, changes in dentition, ossification of cartilage, presence of arthritis, or loss of muscle fibers, muscle tone, or muscle strength are all associated with advanced age. These anatomical alterations impact swallow physiology. Identification of these age-related changes must be teased out from a population with an increased risk of diseases (co-morbidities) that may be related to dysphagia. Further, the healthy aging adult may not report alterations to swallow function due to the slow rate at which these changes occur. Thus, age-related physiologic changes to swallow function might be detectable only to the professional or with instrumental evaluation, especially if there is no obvious impact on general nutrition or hydration.
Clinical Note:
The geriatric population as a whole, not just those with dysphagia, are at risk for dehydration due to changes in the thirst response and decline in kidney function (Mentes, 2006). Elderly individuals should be reminded that good hydration correlates with better health, including improved outcomes in orthopedic rehabilitation (Mukand, Cai, Zielinski, Danish, & Berman, 2003).
Dentition
Dentition can change with respect to the number of teeth, or the general health and condition of teeth. The number of permanent teeth present in the mouth of a geriatric patient can range from full to partial dentition, to complete absence of teeth (edentulous). Although poor dentition may be compensated for with partial or full prosthetic dentures, these cover the gum tissue reducing sensory input. When prosthetics are used, the fitting can vary from well-fitted to free-floating. Dentures that are poorly supported due to periodontal disease or inadequate oral bone structure may not aide mastication and swallowing as effectively as intended. Altered dentition, which is common in geriatric individuals, can impact eating habits, food selection, mastication, and bolus control during the oral phase of the swallow (Fucile et al., 1998; Shtereva, 2006; Yoshikawa et al., 2006).
Clinical Note:
Poorly fitted dentures can cause difficulty with mastication and bolus control. Dent