what causes dysphagia in elderly

Full Answer

How is dysphagia treated in the elderly?

Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials.

Why do elderly get dysphagia?

Sometimes, dysphagia is just a normal sign of aging. As people get older, sometimes their mouth and throat muscles begin to weaken. This, in turn, can lead to swallowing difficulties.

What is the most frequent cause of dysphagia?

Acid reflux disease is the most common cause of dysphagia. People with acid reflux may have problems in the esophagus, such as an ulcer, a stricture (narrowing of the esophagus), or less likely a cancer causing difficulty swallowing.

What are 4 potential causes of dysphagia?

Dysphagia is usually caused by another health condition, such as: a condition that affects the nervous system, such as a stroke, head injury, multiple sclerosis or dementia. cancer – such as mouth cancer or oesophageal cancer. gastro-oesophageal reflux disease (GORD) – where stomach acid leaks back up into the ...

What are the 4 stages of dysphagia?

There are 4 phases of swallowing:The Pre-oral Phase. – Starts with the anticipation of food being introduced into the mouth – Salivation is triggered by the sight and smell of food (as well as hunger)The Oral Phase. ... The Pharyngeal Phase. ... The Oesophageal Phase.

What should a senior with dysphagia eat?

Cook foods so that they are moist and easily swallowed. Mash vegetables like potatoes or squash, using milk or cream. Moisten meat or poultry with gravy or broth. Cheese sauce can be used to moisten vegetables or rice.

How long can you live with dysphagia?

Overall Group Analysis. The median survival of the study population was 159 days (95% confidence interval [CI] 72, 276 days), estimated 30-day mortality was 27%, 90-day mortality 42%, and 1-year mortality 62%.

What are three disorders that cause dysphagia?

Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia. Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect the ability to swallow.

Does dysphagia go away?

Many cases of dysphagia can be improved with treatment, but a cure isn't always possible. Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques. changing the consistency of food and liquids to make them safer to swallow.

What foods should you avoid with dysphagia?

Foods with a fibrous or 'stringy' texture - e.g. celery, green beans, melted cheese or pineapple. Fruit or vegetables with thick skins, seeds or pips - e.g. baked beans, peas, grapes and tomatoes. Crunchy and crumbly items such as toasts, biscuits, crackers, crisps, pie crusts.

How do you treat dysphagia?

Try eating smaller, more frequent meals. Cut your food into smaller pieces, chew food thoroughly and eat more slowly. If you have difficulty swallowing liquids, there are products you can buy to thicken liquids. Trying foods with different textures to see if some cause you more trouble.

What are the stages of dysphagia?

Healthcare providers describe it in 3 phases:Oral preparatory phase. During this phase, you chew your food to a size, shape, and consistency that can be swallowed. ... Pharyngeal phase. Here, the muscles of your pharynx contract in sequence. ... Esophageal phase.

Is dysphagia a normal part of aging?

Dysphagia (swallowing difficulty) is a growing health concern in our aging population. Age-related changes in swallowing physiology as well as age-related diseases are predisposing factors for dysphagia in the elderly. In the US, dysphagia affects 300,000–600,000 persons yearly.

What stage of dementia is dysphagia?

Dementia progresses differently in each person, so it can be difficult to know what to expect and when. However, dysphagia often presents in late-stage dementia patients who tend to have difficulty communicating and may even be nonverbal.

Is dysphagia related to dementia?

As dementia progresses, swallowing difficulties (called dysphagia) become more common, although they will vary from person to person. Difficulties may include the person chewing continuously or holding food in their mouth. Swallowing difficulties can lead to weight loss, malnutrition and dehydration.

At what age does dysphagia most commonly affect someone?

The rising incidence of dysphagia for older people in hospitals, particularly those over 80 years of age (Leder and Suiter 2009) has many health implications including: malnutrition, dehydration, poor oral hygiene, choking, aspiration pneumonia, and increased need for institutionalised care (Marik and Kaplan 2003, Ney ...

What is dysphagia in older adults?

Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration.

What causes oropharyngeal dysphagia in older adults?

Common causes of oropharyngeal dysphagia in older adults include Alzheimer disease, Parkinson disease, dementia, and stroke. 18.

What is the difference between esophageal and oropharyngeal dysphagia?

Patients who describe difficulty swallowing liquids often are affected by oropharyngeal dysphagia, whereas those experiencing difficulty swallowing solids are often diagnosed as having esophageal dysphagia. Patients who experience swallowing difficulties with both liquids and solids are evident in all phases of dysphagia.

What is the esophageal swallowing process?

The esophageal swallowing process involves intrinsic nerve innervation with no major contribution made from the central nervous system. Esophageal dysphagia occurs when there is evidence of pathology along the esophageal tract (ie, peristalsis, tissue injury, etc). Common causes of esophageal dysphagia may be attributed to strictures, pill-induced esophagitis, and infectious etiologies.

What are the different types of dysphagia?

Dysphagia can be broadly classified into 3 major categories: oral, pharyngeal, and esophageal (oral and pharyngeal types are commonly classified together as oropharyngeal in clinical practice). The oral phase of swallowing consists of a voluntary process requiring attention and coordination. A person forms and moves the food bolus from the mouth to the pharynx. Oral dysphagia occurs when patients experience problems in this formation and movement process of a bolus to the pharynx region. The pharyngeal phase of swallowing is predominantly an involuntary process that involves the swallow reflex ranging from the pharynx to esophagus areas. Patients can experience dysphagia when there is an interruption of the swallowing reflex or within the muscles involved in the movement of bolus from the pharynx to the esophagus. Common causes of oropharyngeal dysphagia in older adults include Alzheimer disease, Parkinson disease, dementia, and stroke.

Why does dysphagia happen so often?

A sudden onset of dysphagia may be related to a stroke, food, or a foreign body impaction; a slow and progressive onset can be attributed to a neurodegenerative disease such as Alzheimer dementia. The frequency of dysphagia provides help; for example, patients with intermittent swallowing difficulties with solids are evidenced in esophageal webs. With longer duration, the patient may describe progressive solid food swallowing difficulty, which can be seen with peptic strictures or neoplasm.

What percentage of older adults have dysphagia?

Dysphagia is a geriatric syndrome that affects 10% to 33% of older adults.

What does it mean when food sticks to your throat?

Esophageal dysphagia refers to the sensation of food sticking or getting caught in the base of your throat or in your chest after you've started to swallow. Some of the causes of esophageal dysphagia include:

How do you know if you have dysphagia?

Signs and symptoms associated with dysphagia may include: Having pain while swallowing (odynophagia) Being unable to swallow. Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum) Drooling. Being hoarse. Bringing food back up (regurgitation) Having frequent heartburn.

Why does my stomach bring food back up?

Some of the causes of esophageal dysphagia include: Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat .

What causes oropharyngeal dysphagia?

Causes of oropharyngeal dysphagia include: Neurological disorders. Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia. Neurological damage. Sudden neurological damage , such as from a stroke or brain or spinal cord injury, can affect your ability to swallow.

Why is it so hard to swallow?

Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible. Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, ...

What is the esophagus?

Overview. The esophagus is a muscular tube that connects your mouth and your stomach. Rings of muscle (sphincters) in the upper and lower portions contract and relax to allow food and liquid to pass. Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach.

What causes a narrowed esophagus?

Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing.

Why is esophageal dysphagia common in the elderly?

Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause . The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status.

Is dysphagia a common problem in the elderly?

Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process.

What is swallowing dysphagia?

Any disruption in the swallowing process may be defined as dysphagia.4Person s with anatomical or physiologic deficits in the mouth, pharynx, larynx, and esophagus may demonstrate signs and symptoms of dysphagia.4In addition, dysphagia contributes to a variety of negative health status changes; most notably, increased risk of malnutrition and pneumonia. In this review, we will discuss how aging and disease impact swallowing physiology with a focus on nutritional status and pneumonia. We will conclude with a brief overview of dysphagia management approaches and consequences of dysphagia management on nutritional status and pneumonia in the elderly.

How prevalent is dysphagia in elderly?

In a group of 65–94-year-old community dwelling adults, prevalence of dysphagia was reported to be 37.6%.13Of these, 5.2% reported the use of a feeding tube at some point in life, and 12.9% reported the use of nutritional supplements to reach an adequate daily caloric intake.13In another cohort of independently living older persons, prevalent cases of malnutrition or those at risk for malnutrition were estimated at 18.6% of elderly adults with dysphagia, and 12.3% of adults without dysphagia. Significant differences in nutritional status were noted between these subgroups at 1-year follow-up.46These figures underscore the prevalence and importance of malnutrition and dysphagia among elderly individuals. Moreover, they suggest that dysphagic elderly living in the community are likely to present with an elevated risk of malnutrition.

What are the symptoms of dementia?

Dysphagia is a common symptom in dementia. It has been estimated that up to 45% of patients institutionalized with dementia have some degree of swallowing difficulty.39Different clinical presentations of dementia will result in different swallowing or feeding impairments.40–43Most commonly, patients with dementia demonstrate a slowing of the swallowing process.14Slowed swallow processes may increase time taken to finish a meal and subsequently increase the risk for poor nutritional status.14Furthermore, patients with dementia often have difficulties self-feeding. These difficulties may relate to cognitive impairment, motor deficits such as weakness or apraxia, loss of appetite, and/or food avoidance. As a result, patients with dementia may experience weight loss and increased dependency for feeding.14Subsequently, increased feeding dependency may lead to other dysphagia -related health problems, including pneumonia.14Weight loss can reflect decreased nutritional status which increases the patient’s risk of opportunistic infections such as pneumonia.44–46Pneumonia is a common cause of mortality in patients with dementia.47Thus, dementia, dysphagia, and related feeding impairments can lead to nutritional deficits which in turn contribute to pneumonia and mortality. Among elderly patients in particular, the presence of dementia is associated with higher hospital admission rates and overall higher mortality.48Moreover, elderly patients admitted to a hospital with dementia have a higher overall prevalence of both pneumonia and stroke, suggesting that aging significantly increases the risk for these negative health states.48

How common is dysphagia after stroke?

Dysphagia is highly prevalent following stroke with estimates ranging 30%–65%.9,10,18,19Specific to the US, the Agency for Healthcare Research and Quality estimates that about 300,000–600,000 persons experience dysphagia as a result of stroke or other neurological deficits.20Although many patients regain functional swallowing spontaneously within the first month following stroke,10some patients maintain difficulty swallowing beyond 6 months.9,21Complications that have been associated with dysphagia post-stroke include pneumonia,22,23malnutrition,24dehydration,10,24poorer long-term outcome,10,21increased length of hospital stay,25increased rehabilitation time and the need for long-term care assistance,26increased mortality,10,19,22and increased health care costs.10These complications impact the physical and social well being of patients, quality of life of both patients and caregivers, and the utilization of health care resources.20

How does swallowing affect the elderly?

In general, a subtle slowing of swallow processes occurs with advancing age. Oral preparation of food requires more time and material transits through the mechanism more slowly. Over time, these subtle but cumulative changes can contribute to increased frequency of swallowed material penetrating into the upper airway and greater post-swallow residue during meals.6Beyond subtle motor changes, age-related decrements in oral moisture, taste, and smell acuity may contribute to reduced swallowing performance in the elderly. Though sensorimotor changes related to healthy aging may contribute to voluntary alterations in dietary intake, the presence of age-related disease is the primary factor contributing to clinically significant dysphagia in the elderly.

What is dysphagia management?

Dysphagia management is a ‘team event’. Many professionals may contribute to the management of dysphagia symptoms in a given patient. Furthermore, no single strategy is appropriate for all elderly patients with dysphagia. Concerning behavioral management and therapy, speech-language pathologists (SLP) play a central role in the management of patients with dysphagia and related morbidities. SLP clinical assessment is often supplemented with imaging studies (endoscopy and/or fluoroscopy), and these professionals may engage in a wide range of interventions. Some intervention strategies, termed ‘compensations’, are intended to be utilized for short periods in patients who are anticipated to improve. Compensations are viewed as short-term adjustments to the patient, food and/or liquid, or environment, with the goal of maintaining nutrition and hydration needs until the patient can do so by themselves. Other patients require more direct, intense rehabilitation strategies to improve impaired swallow functions. A brief review of each general strategy with examples follows.

What is post stroke pneumonia?

Post-stroke pneumonia is a common adverse infection that affects up to one-third of acute stroke patients. 34,35Pneumonia is also a leading cause of mortality after stroke, accounting for nearly 35% of post-stroke deaths.36Most stroke-related pneumonias are believed to result from dysphagia and the subsequent aspiration of oropharyngeal material. Aspiration is defined as entry of food or liquid into the airway below the level of the true vocal cords,37and aspiration pneumonia is defined as entrance of swallowed materials into the airway that results in lung infection.4A recent systematic review reported that stroke patients with dysphagia demonstrate ≥3-fold increase in pneumonia risk with an 11-fold increase in pneumonia risk among patients with confirmed aspiration.22Along with this increased risk, the burden of aspiration pneumonia is high. Increased costs associated with longer hospitalization,10greater disability at 3 and 6 months,10,38and poor nutritional status during hospitalization10characterize aspiration pneumonia in stroke.

Overview

Symptoms

Causes

Risk Factors

• The following are risk factors for dysphagia: 1. Aging.Due to natural aging and normal wear and tear on the esophagus as well as a greater risk of certain conditions, such as stroke or Parkinson's disease, older adults are at higher risk of swallowing difficulties. But dysphagia isn't considered a normal sign of aging. 2. Certain health conditions....

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Complications

Prevention