Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly

TLDR

Oropharyngeal dysphagia is common in older adults, causing malnutrition, dehydration, and aspiration pneumonia, and videofluoroscopy is the gold standard for assessing its mechanisms. The study seeks to use clinical screening to identify dysphagia and aspiration risk in older adults and to promote a multidisciplinary approach to diagnosis and management. Treatment involves adjusting bolus volume and viscosity and applying rehabilitation procedures to improve swallowing and prevent nutritional and respiratory complications. About 30 % of older dysphagic patients aspirate—half without cough—while 45 % exhibit oropharyngeal residue and 55 % are at risk of malnutrition.

Abstract

Oropharyngeal dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with oropharyngeal dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of dysphagia in older patients. Up to 30% of older patients with dysphagia present aspiration-half of them without cough, and 45%, oropharyngeal residue; and 55% older patients with dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of oropharyngeal dysphagia need a multidisciplinary approach.