Dysphagia in the elderly: management and nutritional considerations

Livia Sura,^1,2 Aarthi Madhavan,^1,3 Giselle Carnaby,^1,4 Michael A Crary^1,3

¹Swallowing Research Laboratory; ²Department of Epidemiology, College of Public Health and Health Professions; ³Department of Speech, Language, and Hearing Sciences, College of Public Health and Health Professions; ⁴Department of Behavioral Sciences and Community Health, College of Public Health and Health Professions, Gainesville, FL, USA

Abstract: Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that elderly community dwellers are also at risk for dysphagia and associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. In this manuscript, we review data describing age related changes in swallowing and discuss the relationship of dysphagia in patients following stroke, those with dementia, and in community dwelling elderly. Subsequently, we review basic approaches to dysphagia intervention including both compensatory and rehabilitative approaches. We conclude with a discussion on the positive impact of swallowing rehabilitation on malnutrition and pneumonia in elderly who either present with dysphagia or are at risk for dysphagia.

Keywords: dysphagia, aging, malnutrition, pneumonia, rehabilitation