Abstract
New-onset swallowing difficulties in older patients during unrelated hospital admissions are well recognized and may result in prolonged hospital stay and increased morbidity. Presbyphagia denotes age-related swallowing changes which do not necessarily result in pathological effects. The trajectory from presbyphagia to dysphagia is not well understood. This retrospective observational study compared quantitative videofluoroscopic measures in hospitalized older adults aged 70–100 years, reporting new dysphagia symptoms during admission (n = 52), to healthy asymptomatic older (n = 56) and younger adults (n = 43). Significant physiological differences seen in hospitalized older adults but not healthy adults, were elevated pharyngeal area (p < 0.001) and pharyngeal constriction ratio (p < 0.001). Significantly increased penetration (p < 0.001), aspiration (p < 0.001) and pharyngeal residue (p < 0.001) were also observed in the hospitalized older cohort. Reasons for onset of new swallow problems during hospitalization are likely multifactorial and complex. Alongside multimorbidity and polypharmacy, a combination of factors during hospitalization, such as fatigue, low levels of alertness, delirium, reduced respiratory support and disuse atrophy, may tip the balance of age-related swallowing adaptations and compensation toward dysfunctional swallowing. To optimize swallowing assessment and management for our aging population, care must be taken not to oversimplify dysphagia complaints as a characteristic of aging.
Highlights
Successful aging is a process of adaptation [1]
Length of hospital stay was less than 10 days for 12 patients (23.1%) and 10 or more days for 40 patients
Two patients passed away during admission and six patients were excluded from mortality rate as the time of videofluoroscopic study of swallowing (VFSS) was less than 2 months before data collection
Summary
Successful aging is a process of adaptation [1]. Aging involves a kaleidoscope of physical, psychosocial, environmental, and disease-related factors. Medical advancements have contributed to increased life expectancy and our globally aging population. Age can be just a number until age-related changes coincide with emergence of disease states or deconditioning. This tips the balance and outstrips physiologic reserve, often resulting in rapid decline. Social events play an essential role in enjoyment for older adults, typically centered around eating and drinking. Dysphagia (swallowing difficulties) can lead to serious social and emotional consequences [2], in addition to increased risk of dehydration, malnutrition [3] and aspiration pneumonia [4]. Well known reasons for swallowing dysfunction are stroke [5], traumatic brain injury [6], progressive neurological disease [7,8,9]
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