Swallowing Changes in Community-Dwelling Older Adults

Association between swallowing function and depressive symptoms among community-dwelling older adults: A cross-sectional study in Central China

BACKGROUND

Swallowing dysfunction and depressive symptoms are prevalent among older adults. This study explored the association between swallowing function and depressive symptoms among community-dwelling older adults.

METHODS

This cross-sectional study included Chinese community-dwelling older adults (≥65 years old) in 2023, using cluster random sampling. Questionnaires were used to collect information on swallowing function (10-item Eating Assessment Tool), depressive symptoms (9-item Patient Health Questionnaire), sociodemographic characteristics, health status, and lifestyle. Multivariable logistic regression models and Directed Acyclic Graphs were used to identify factors associated with depressive symptoms. Propensity Score Matching (PSM) was used to explore the association between swallowing function and depressive symptoms.

RESULTS

Totally, 8388 participants were included. The prevalences of depressive symptoms and swallowing dysfunction were 16.40 % (95 % CI: 15.52 %-17.19 %) and 22.06 % (95%CI: 19.86 %-24.25 %), respectively. The multivariate regression model showed that swallowing function was one of the factors associated with depressive symptoms (OR = 1.699, 95 % CI = 1.448-1.995, P < 0.001). The risk ratio for depressive symptoms was significantly higher in the participants with swallowing dysfunction than those with normal swallowing function [(23.29 %, 431/1850) vs. (945/6538, 14.45 %), P < 0.001] There were 17 out 38 of variates enrolled in the PSM covariate set. A total of 1850 pairs of participants were matched and PSM revealed a 6.64 % difference in the risk ratio for depressive symptoms [(23.29 %, 431/1850) vs. (16.65 %, 308/1850), P < 0.001]. The PSM robustness test supported the stability and reliability of the results.

CONCLUSIONS

In Chinese community-dwelling older adults, swallowing dysfunction was positively associated with depressive symptoms.

Maximum Vocal Pitch Elevation and Swallowing: A Secondary Data Analysis Supporting Additional Shared Biomechanics and Potential Treatment Targets

PURPOSE

Reduced ability to raise vocal pitch has been associated with risk of aspiration in some populations. However, the mechanisms driving this association are understudied. This secondary data analysis aims to add to our knowledge on the shared and distinct biomechanics of swallowing and maximum vocal pitch elevation.

METHOD

We used existing data from the study of Venkatraman et al. (2020) on 10 healthy younger (age range: 19-23, M = 21) and eight older (age range: 65-79; M = 73) adults who completed maximum pitch elevation and swallow tasks under videofluoroscopy. A MATLAB tracking tool and computational analysis of swallowing mechanics was used to analyze five elements of pharyngeal swallowing biomechanics (anterior and superior hyoid excursion, laryngeal elevation, pharyngeal shortening, tongue base retraction, head/neck extension). Canonical variate analysis (CVA) determined differences associated with task and age. Post hoc discriminant function analyses (DFAs) compared the events between tasks in each group.

RESULTS

CVA revealed that 63.9% of variance was accounted for by task (D = 3.46, p < .0001) and 35.5% by age (D = 1.92, p < .0001). Across age, DFAs indicated similar anterior hyoid excursion and laryngeal elevation between tasks, but greater superior hyoid excursion during swallows, replicating earlier findings. We also found greater base of tongue retraction during swallows than maximum pitch and greater pharyngeal shortening during maximum pitch elevation compared to swallows across groups (D = 5.38, p < .0001).

CONCLUSIONS

Maximum pitch elevation and swallowing require similar anterior hyoid and laryngeal excursion. Added to the novel finding of greater pharyngeal shortening during pitch elevation, we indicate that pitch glides may be a mechanism for targeting pharyngeal dysphagia and warrant further investigation.

A Letter to the Editor on Presbyphagia: A Conceptual Analysis of Contemporary Proposals and their Influences on Clinical Diagnosis

The author identified three main operational definitions of presbyphagia in the specialized literature: (1) changes in healthy older people's swallowing, (2) a swallowing disorder compensated by physiological reserves, and (3) a synonym of dysphagia. As the author stated in the conclusion, presbyphagia should be considered an etiology of oropharyngeal dysphagia (OD). However, significant methodological flaws were found, including selecting only one person to screen and analyze articles in the systematic review, not using any keywords or MeSH terms in the search, not presenting a search strategy, limiting the search term to "presbyphagia", and omitting details about screening, inclusion, and exclusion criteria. The operational definitions describe that aging inherently causes swallowing impairment. However, they disregard age-related changes without significant functional impact, as found by a previous study, reviewed in the current research, but analyzed inconsistently by the author. This recent study showed that presbyphagia is the opposite of OD, framing both the "negative" aspects of swallowing and the "compensatory positives" as natural consequences of aging, consistent with the World Health Organization's concept of intrinsic capacity. This perspective positions aging as an adaptive process-not a disease or cause of disease-, although it may increase vulnerability due to cumulative factors. Since OD is a symptom, attributing it to aging frames aging itself as a disease, contradicting current geriatrics and gerontology paradigms.

Performance of swallowing function between older people with and without clinical complaints

PURPOSE

To compare the findings of speech-language-hearing evaluations, signs in fiberoptic endoscopic evaluation of swallowing, and nutritional risk between healthy older adults with and without self-reported swallowing difficulties and correlate the level of oral intake with the severity of pharyngeal residues and nutritional risk.

METHODS

This cross-sectional retrospective study included 71 older people and divided them into two groups based on the presence of swallowing complaints. Data were collected from speech-language-hearing evaluations, oral health status, and videoendoscopy signs with four food consistencies classified by the International Dysphagia Diet Standardisation Initiative (IDDSI) to compare the groups. Pharyngeal residues were analyzed and classified using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the level of oral intake was assessed using the Functional Oral Intake Scale (FOIS), and nutritional risk was evaluated using the Malnutrition Screening Tool (MST).

RESULTS

Differences were found in speech-language-hearing evaluations, as well as signs of posterior oral spillage and pharyngeal residues with levels 0, 2, and 4 consistencies and laryngeal penetration with level 0 consistency. The level of oral intake was moderately negatively correlated with the severity of pharyngeal residues and nutritional risk.

CONCLUSION

The group of older adults with complaints had differences in speech-language-hearing evaluations, posterior oral spillage, and pharyngeal residues with levels 0, 2, and 4 consistencies, and laryngeal penetration with level 0 consistency. The correlation indicated that the lower the level of oral intake, the greater the severity of pharyngeal residues and nutritional risk in the sample.

Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

Respiratory-swallow patterning and oropharyngeal swallowing impairment in patients undergoing evaluation for lung transplant

BACKGROUND

Although swallowing impairment is prevalent following lung transplantation, baseline respiratory and swallowing characteristics are often overlooked. Respiratory disease processes may predispose lung transplant candidates to altered respiratory-swallow patterning and swallowing impairment.

METHODS

This cross-sectional study included patients referred for a Modified Barium Swallow Study during lung transplant evaluation. Swallowing impairment was measured using the Modified Barium Swallow Impairment Profile and Penetration-Aspiration Scale. Respiratory plethysmographic signals synchronized with videofluoroscopy were analyzed to determine phase patterning, pause duration, and rate. Mixed-effects logistic regression was used to identify linkages between respiratory and swallowing measures.

KEY RESULTS

Fifty patients were included and demonstrated delayed swallow initiation (49/50), oral residue (37/50), incomplete pharyngoesophageal segment opening (35/50), and esophageal retention (43/50). Airway invasion occurred infrequently (10/50). Atypical respiratory patterning was significantly associated with impairment in pharyngeal swallow initiation (OR [95% CI] = 1.76 [1.16, 2.68], p = 0.009), laryngeal elevation (OR [95% CI] = 1.45 [1.01, 2.07], p = 0.044), and laryngeal vestibular closure (OR [95% CI] = 2.57 [1.48, 4.46], p < 0.001). Increased pause duration was associated with impaired initiation (OR [95% CI] = 2.24 [1.20, 4.16], p = 0.011), laryngeal elevation (OR [95% CI] = 1.18 [1.03, 1.36], p = 0.018), laryngeal closure (OR [95% CI] = 1.28 [1.9, 1.50], p = 0.003), and tongue base retraction (OR [95% CI] = 1.33 [1.13, 1.56], p < 0.001).

CONCLUSIONS & INFERENCES

Patients undergoing evaluation for lung transplant demonstrated impaired swallowing and phase patterning. Preliminary findings implicate the need for further evaluation of respiratory-swallow coordination and its potential role in swallowing impairment before and after lung transplantation.

Presbyphagia: A Conceptual Analysis of Contemporary Proposals and Their Influences on Clinical Diagnosis

Swallowing is an essential process to maintain homeostasis in the human body. With aging, changes occur in both central and peripheral structures, giving rise to presbyphagia, involving morphological and functional alterations in swallowing. However, there is a lack of consensus on the definition of presbyphagia and its relationship with dysphagia. The primary objective of this research is to analyze the proposed definitions for the term "presbyphagia" in specialized literature and, secondarily, to assess how these definitions can influence the diagnosis of oropharyngeal dysphagia (OD). A systematic review was conducted to analyze the proposed definitions of presbyphagia and their impact on dysphagia diagnosis. Three main approaches to the definitions of presbyphagia were identified: (1) presbyphagia as an alteration in the swallowing process in healthy older adults, (2) presbyphagia as a swallowing disorder compensated by the physiological potential of healthy older adults, and (3) presbyphagia as a synonym for dysphagia. This study addresses the need for a clear definition of presbyphagia in older adults. It is concluded that presbyphagia should be understood as the etiology of OD rather than a compensated disorder or a synonym. This has significant implications for the diagnosis and treatment of swallowing disorders in the aging population. Given the ongoing nature of scientific discussion in this field, further research is required.

The prevalence of presbyphagia in older adults: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Presbyphagia is defined as structural, physiological and innervational alterations in the swallowing process as a result of aging and is considered to be involved in the etiology of dysphagia. This systematic review and meta-analysis aimed to estimate the prevalence of presbyphagia in older adults without disease-related dysphagia.

METHODS

In this study five databases were searched in October 2023 with no time limitation. Combined effect sizes of presbyphagia prevalence were calculated using random effect models. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity. Egger's test and a funnel plot were employed to examine publication bias.

RESULTS

A total of 19 studies were selected for analysis. Overall, the prevalence of presbyphagia in older adults was 30.8% (95% confidence interval [CI] 24.8-36.7%). Publication bias was adjusted for using the fill-and-trim method and the corrected pooled prevalence of presbyphagia was 17.3% (95% CI 11.0-23.6%). In addition, the meta-regression findings revealed that the assessment tool had significant effects upon heterogeneity.

CONCLUSION

Although the pooled prevalence of presbyphagia in older adults was 17.3%, the lack of large representative studies limited the interpretation of these findings. In the future, further large studies that diagnose presbyphagia using standardized assessment tools would facilitate new avenues to reduce the risk of dysphagia in older adults.

Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM)

OBJECTIVE

The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions.

METHOD

One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM.

RESULTS

The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10.

CONCLUSION

Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.

Exploratory analysis of swallowing behaviour in community-dwelling older adults using a wearable device: Differences by age and ingestant under different task loads

Objective

To develop a new method of evaluating swallowing behaviour.

Methods

Sixty-nine healthy participants were divided into a younger (16 males and 16 females, mean age 39.09 ± 12.16 years) and older (18 males and 19 females, mean age 71.43 ± 5.50 years) group. The participants ingested water and yoghurt twice (directed and free swallowing) at rest and after performing simple daily life tasks (calculation and exercise). To measure swallowing frequency, we employed a smartphone-based, portable and neck-worn swallowing-sound-monitoring device. This device monitors swallowing behaviour continuously by collecting biological sounds from the neck without imposing behavioural restrictions. A neural network model of swallowing sound identification by deep learning was used for the subsequent evaluation. This device was used to obtain two types of saliva-swallowing sounds associated with different ingestants, at rest and after performing a stimulating task. Furthermore, we assessed the associated subjective psychological states.

Results

The younger group showed a higher directed swallowing frequency (for both water and yoghurt) than the older group did. Regarding the type of ingestant, the swallowing frequency for yoghurt was higher during free swallowing in both the young and the older groups. 'Feeling calm' was reported significantly more often in the older group after swallowing yoghurt following exercise.

Conclusions

Swallowing status in daily life was measured non-invasively using a wearable mobile device. It is important to consider the type of ingestant, daily living activities, and age when assessing swallowing.

Dysphagia following cerebellar stroke: analyzing the contribution of the cerebellum to swallowing function

Swallowing is essential for human health, and the cerebellum is crucial for motor movement regulation. Cerebellar strokes may cause dysphagia, but their exact effects remain unexplored in swallowing function. Therefore, the aim of this study was to analyze the precise clinical characteristics of the oral and pharyngeal phases of swallowing after cerebellar stroke and to critically discuss the cerebellum's contribution to swallowing. The study involved 34 participants with cerebellar strokes, gathered through convenience sampling. Neurologists diagnosed isolated strokes, and a speech and language pathologist examined swallowing ability using the Mann Assessment of Swallowing Ability. The study found that 52.9% of people experienced dysphagia after a cerebellar stroke. Dysphagia was significantly associated with a higher risk of aspiration. Age was also significantly correlated with dysphagia. No significant correlation was found between swallowing ability and sex. In conclusion, this study suggests isolated cerebellar stroke can adversely affect the motor and non-motor aspects of swallowing and cause severe dysphagia and aspiration risk. Thus, early diagnosis and timely management of dysphagia following a cerebellar stroke can help prevent serious consequences.

Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis

INTRODUCTION

Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact.

METHODS

The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]).

RESULTS

The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I² 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0).

CONCLUSION

One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.

The effect of taste on swallowing: A scoping and systematic review

Consuming foods and liquids for nutrition requires the coordination of several muscles. Swallowing is triggered and modified by sensory inputs from the aerodigestive tract. Taste has recently received attention as a potential modulator of swallowing physiology, function, and neural activation; additionally, taste impairment is a sequela of COVID-19. This review presents factors impacting taste and swallowing, systematically summarizes the existing literature, and assesses the quality of included studies. A search was conducted for original research including taste stimulation, deglutition-related measure(s), and human participants. Study design, independent and dependent variables, and participant characteristics were coded; included studies were assessed for quality and risk of bias. Forty-eight articles were included after abstract and full-text review. Synthesis was complicated by variable sensory components of stimuli (taste category and intensity, pure taste vs. flavor, chemesthesis, volume/amount, consistency, temperature), participant characteristics, confounding variables such as genetic taster status, and methods of measurement. Most studies had a high risk of at least one type of bias and were of fair or poor quality. Interpretation is limited by wide variability in methods, taste stimulation, confounding factors, and lower-quality evidence. Existing studies suggest that taste can modulate swallowing, but more rigorous and standardized research is needed.

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Background

“Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity.

Materials and methods

64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule.

Results

32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model.

Conclusions

Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.

Comparison of Lingual Pressure Generation Capacity in Parkinson Disease, Amyotrophic Lateral Sclerosis, and Healthy Aging

PURPOSE

The tongue plays a key role in bolus propulsion during swallowing, with reduced lingual pressure generation representing a risk factor for impaired swallowing safety and efficiency. We compared lingual pressure generation capacity in people with Parkinson disease (PwPD), people with amyotrophic lateral sclerosis (PwALS), and healthy older adults. We hypothesized that both patient cohorts would demonstrate reduced maximum anterior isometric pressure (MAIP) and regular effort saliva swallow (RESS) pressures compared with healthy controls, with the greatest reductions expected in the ALS cohort.

METHOD

We enrolled 20 PwPD, 18 PwALS, and 20 healthy adults over 60 years of age. The Iowa Oral Performance Instrument was used to measure MAIP, RESS, and lingual functional reserve (LFR, i.e., MAIP - RESS). Descriptive statistics were calculated; between-groups differences were explored using univariate analyses of variance and post hoc Sidak tests with alpha set at .05.

RESULTS

Mean MAIPs for the PD, ALS, and heathy cohorts were 54.7, 33.5, and 47.4 kPa, respectively. Significantly lower MAIP was found in PwALS compared with PwPD and healthy controls. RESS values did not differ significantly across groups. LFR was significantly higher in PwPD versus PwALS and healthy controls.

CONCLUSIONS

Lingual pressure generation capacity and functional reserve were reduced in PwALS, but not in PwPD, beyond changes seen with healthy aging. Both patient cohorts displayed preserved lingual pressure during saliva swallows. Future studies exploring longitudinal changes in tongue pressure generation on isometric and saliva swallowing tasks will be needed to confirm whether tongue pressure measures serve as noninvasive clinical biomarkers of swallowing impairment.

Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies

OBJECTIVES

Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study.

DESIGN

Cross-sectional study.

SETTING

Adult fluoroscopy suite in a metropolitan hospital at an academic center.

PARTICIPANTS

195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years.

MEASUREMENTS

17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile.

RESULTS

Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01).

CONCLUSION

Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.

Swallowing dysfunction and the onset of fever in older residents with special care needs: a thirteen-month longitudinal prospective study

A decline in swallowing function is frequently observed among older residents in nursing homes. We investigated whether swallowing dysfunction was related to the onset of fever in such individuals. Older residents aged ≥ 65 years from three nursing homes were included in this prospective study conducted from July 2017 to May 2019. The follow-up period was 13 months. The outcome was fever incidence in relation to the swallowing dysfunction. Baseline data on the activities of daily living, cognitive function, swallowing function, respiratory function, tongue pressure, and comorbidity conditions were collected. Dates on which the axillary temperature measured ay of participants was > 37.5 °C during the follow-up period were also recorded. For the statistical analyses, swallowing function assessed by the modified water swallow test (MWST) score was used to divide the participants into three groups: scores ≤ 3, 4, and 5. A total of 52 participants [median age, 89.5 years (67-104)] were enrolled. Kaplan-Meier analysis showed that the average periods until onset of fever in participants with MWST scores of ≤ 3, 4, and 5 were 8.0 (6.0-11.0), 10.0 (7.0-12.0), and 12.0 (10.0-13.0) months, respectively. Cox's proportional hazards regression model revealed that participants with an MWST score ≤ 3 were at a higher risk of fever than those with an MWST score of 5 (hazard ratio 11.5, 95% confidence interval 1.5-63.4, adjusted for possible confounders. The swallowing dysfunction correlated with the risk of fever in older residents of nursing homes.

Establishing Reference Values for Temporal Kinematic Swallow Events Across the Lifespan in Healthy Community Dwelling Adults Using High-Resolution Cervical Auscultation

Few research studies have investigated temporal kinematic swallow events in healthy adults to establish normative reference values. Determining cutoffs for normal and disordered swallowing is vital for differentially diagnosing presbyphagia, variants of normal swallowing, and dysphagia; and for ensuring that different swallowing research laboratories produce consistent results in common measurements from different samples within the same population. High-resolution cervical auscultation (HRCA), a sensor-based dysphagia screening method, has accurately annotated temporal kinematic swallow events in patients with dysphagia, but hasn't been used to annotate temporal kinematic swallow events in healthy adults to establish dysphagia screening cutoffs. This study aimed to determine: (1) Reference values for temporal kinematic swallow events, (2) Whether HRCA can annotate temporal kinematic swallow events in healthy adults. We hypothesized (1) Our reference values would align with a prior study; (2) HRCA would detect temporal kinematic swallow events as accurately as human judges. Trained judges completed temporal kinematic measurements on 659 swallows (N = 70 adults). Swallow reaction time and LVC duration weren't different (p > 0.05) from a previously published historical cohort (114 swallows, N = 38 adults), while other temporal kinematic measurements were different (p < 0.05), suggesting a need for further standardization to feasibly pool data analyses across laboratories. HRCA signal features were used as input to machine learning algorithms and annotated UES opening (69.96% accuracy), UES closure (64.52% accuracy), LVC (52.56% accuracy), and LV re-opening (69.97% accuracy); providing preliminary evidence that HRCA can noninvasively and accurately annotate temporal kinematic measurements in healthy adults to determine dysphagia screening cutoffs.

Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil

Several studies report that 40% to 60% of older people have some difficulty chewing and/or swallowing, which can lead to malnutrition, dehydration, weight loss, a lack of eating desire, etc. Identify older adults with swallowing difficulties in the city of Santos, Brazil, among users of the public healthcare system. A cross-sectional study was conducted with 100 individuals aged 60 to 90 years with no neurological disorders. Patient histories were taken, and stomatognathic evaluations were performed. The Mini Mental Health Examination (MMHE) and swallowing-related quality-of-life questionnaire (SWAL-QOL) were administered. The clinical swallowing assessment was performed with liquid, pasty and solid foods using two assessment protocols (Dysphagia Risk Evaluation Protocol and the Protocol for the Introduction and Transition of Foods)'. We found complaints of poorly adapted dentures among 49.3% of denture wearers and a high prevalence of hypofunction of oro-facial muscles. Sixty-five per cent of the respondents had facial muscle hypofunction, 51% exhibited lip hypofunction, and 49% exhibited tongue hypofunction. Moreover, 54% reported difficulty swallowing. On the SWAL-QOL questionnaire, 37% reported choking when eating food, 44% reported choking when drinking liquids, 29% reported coughing during meals, and 77% reported difficulty chewing. The present study revealed an important prevalence of complaints related to swallowing difficulties among older people in the city of Santos with structural and physiological changes characteristic of presbyphagia. The most prevalent conditions were poorly adapted dentures and hypofunction of oro-facial muscles, underscoring the importance of stomatognathic interventions in primary care.

Aspiration and severe exacerbations in COPD: a prospective study

Rationale

Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known.

Objectives

We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months.

Methods

Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months.

Measurements and main results

Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038).

Conclusions

Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD.

This study demonstrates that prandial aspiration occurs in ∼20% of patients with stable COPD and portends severe COPD exacerbations over the next 12 monthshttps://bit.ly/2Tx5btj

Which Physiological Swallowing Parameters Change with Healthy Aging?

Research suggests there are age-related changes in swallowing that do not constitute impairment ("presbyphagia"). The goal of this study was to explore the influence of age on quantitative measures of healthy swallowing by controlling for the effects of sex and sip volume in order to determine the specific characteristics of presbyphagia. Videofluoroscopy recordings of thin liquid swallows from 76 healthy adults (38 male), aged 21-82 were analysed. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were made using the ASPEKT method. Hierarchical regression models were used to determine the effects of age, sex, and sip-volume on swallowing. There were no age-related changes in sip volume, number of swallows per bolus, frequency or severity of penetration-aspiration, duration of the hyoid-burst (HYB)-to-upper-esophageal-sphincter (UES) opening interval, time-to-laryngeal-vestibule-closure (LVC), peak hyoid position, hyoid speed, or pharyngeal residue. Significant changes seen with increasing age included: longer swallow reaction time, UES opening duration and LVC duration; larger pharyngeal area at rest and maximum constriction; and wider UES diameter. Male participants had larger sip volume and pharyngeal area at rest. Larger sip volumes were associated with multiple swallows per bolus and shorter hyoid-burst-to-UES opening intervals. These results help to define presbyphagic changes in swallowing that can be expected in healthy older adults up to 80 years of age, and distinguish them from changes that represent impairment. Certain parameters showed changes that were opposite in direction to changes that are usually considered to reflect impairment: longer UES opening, longer LVC duration and wider UES opening. These changes may reflect possible compensations for slower bolus transit. Further research is needed to determine the points along the age continuum where observed age-related changes in swallowing begin to emerge.

The Dysphagia Handicap Index (DHI)-Normative Values. Systematic Review and Meta-Analysis

As the dysphagia handicap index (DHI) becomes more commonly used in clinical practice as a diagnostic tool, it is essential to establish the normative value of DHI. The main purpose of this study is to determine the normative value of DHI among subjects who had no history of dysphagia or neurological disease as well as no history of head or neck malignancy. A systematic literature search was performed using PubMed, Scopus and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics and report of outcomes. Data analysis were conducted using meta-analysis method. Five articles were included for the final analysis. The normative value of DHI was 2.49 with confidence interval of 0.51-4.48 for a group of 323 subjects, age range of 20-86 years.

Determining the Underlying Relationship Between Swallowing and Maximum Vocal Pitch Elevation: A Preliminary Study of Their Hyoid Biomechanics in Healthy Adults

Purpose Deficiencies in swallowing (aspiration) and in maximum vocal pitch elevation have been shown to correlate in dysphagia. However, the underlying mechanisms that may explain this relationship are not known. In this study, we compare hyoid kinematics between swallowing and maximum vocal pitch elevation in healthy adults. Method Ten young (M = 21 ± 1.33 years) and eight older (M = 72.85 ± 5.59 years) healthy adults completed trials of maximum vocal pitch elevation (vowels /a/ and /i/) and swallowing (thin liquid and pudding) under videofluoroscopy. Superior and anterior hyoid excursions were obtained using kinematic analysis. Two-way analyses of variance and Spearman rho correlations were used to examine differences and relationships between swallowing and maximum pitch elevation biomechanics. Results Superior hyoid excursion was significantly greater for liquid swallows compared to pitch elevation tasks (/a/ and /i/; p = .002; Cohen's d = 1.28; p = .0179, Cohen's d = 1.03, respectively) and for pudding swallows compared to pitch tasks (p = .000, Cohen's d = 1.64; p = .001, Cohen's d = 1.38, respectively). Anterior hyoid excursion was not significantly different between the two functions, but was overall reduced in the older group (p = .0231, Cohen's d = .90). Furthermore, there was a moderate positive correlation between the degree of superior excursion during liquid swallows and maximum pitch elevation for both vowels (r s = .601, p = .001; r s = .524, p = .003) in young adults, and between the degree of anterior excursion during liquid swallows and pitch elevation for both vowels (r s = .688, p = .001; r s = .530, p = .008) in older adults. Conclusions Swallowing and maximum pitch elevation require similar anterior, but not superior, hyoid excursion in healthy adults. Differential correlations between the two tasks for each age group may be associated with age-related muscle changes. We provide evidence of partially shared biomechanics between swallowing and maximum pitch elevation.

Relationship between tongue muscle quality and swallowing speed in community-dwelling older women

OBJECTIVE

The aim of this study was to investigate the relationship between tongue muscle quality index, which was represented as tongue muscle pressure divided by tongue muscle mass, and swallowing speed in community-dwelling older women.

METHODS

The inclusion criteria for this cross-sectional study were that participants be community-dwelling older women aged 65 years and above without dysphagia. The exclusion criteria were stroke and Parkinson's disease that directly cause dysphagia. We measured tongue muscle thickness and maximum tongue pressure and the tongue muscle quality index, which was defined as the maximum tongue pressure divided by tongue muscle thickness. We investigated swallowing speed via a 100 ml water swallowing test. To assess the relationship between tongue muscle characteristics and swallowing speed, we performed stepwise multiple regression analysis.

RESULTS

Ninety-three participants were enrolled in this study (mean age: 84.2 ± 4.7 years). A stepwise multiple regression analysis showed that age (β = - 0.292, p < 0.01) and tongue muscle quality index (β = 0.267, p < 0.01) were related to swallowing speed.

CONCLUSION

We found that tongue muscle quality index was related to swallowing speed in community-dwelling older women. According to our findings, it is possible that the tongue muscle quality index is a useful parameter for assessing swallowing speed in older women without dysphagia.

Oropharyngeal Swallowing Dynamic Findings in People with Asthma

Airflow obstruction in people with asthma, similar to COPD, may interfere with swallowing, increasing the risk of food or liquid entrance into the lower airways, and favoring the uncontrolled disease. To describe the complaints and findings of the oropharyngeal swallowing mechanisms in patients with mild and severe asthma, a cross-sectional study was performed. A total of 135 participants with asthma were studied, of whom 97 had severe asthma and 38 had mild asthma. All subjects answered a questionnaire with demographic information, disease exacerbations, Asthma Control Questionnaire 6 (ACQ6-Juniper 1999), GastroEsophageal Reflux Disease Symptoms Questionnaire (GERD-SQ-Fornari et al. 2004), and Eating Assessment Tool 10 (EAT-10-Gonçalves et al., 2013). The oral and pharyngeal swallowing assessment occurred via videofluoroscopic swallowing evaluation. The age range of the participants was from 19 to 80 years, with a predominance of females (78.6%). Uncontrolled asthma was observed in 50 (52%) of the patients with severe asthma and in 11 (29%) of the patients with mild asthma (ACQ6 > 1.5). The GERD-SQ and EAT-10 scores were similar in both groups. In the bivariate analysis, the group with severe asthma presented with more changes when compared to the group with mild asthma in the following events: atypical lingual movement during the swallowing of liquid in the volumes of 5 ml (p = 0.003) and 10 ml (p = 0.001), and solid (p = 0.009); oral transit time increased in swallowing of liquid in the volumes of 5 ml (p = 0.003) and 20 ml (p = 0.026); beginning of the pharyngeal swallowing phase below the mandibular ramus (p = 0.003); pharyngeal residue (p = 0.017) of solid consistency; laryngeal penetration of 5 ml (p = 0.050) and 20 ml (p = 0.032) of liquid; increased transition time between the oral and pharyngeal swallowing phases (p = 0.035) and increased pharyngeal transit time (p = 0.045) of solid consistency. Tracheal aspiration was observed only in the group with severe asthma. After the multivariate analysis, atypical tongue movement maintained a statistically significant difference between the two groups. Oropharyngeal swallowing alternations were frequent in the studied sample and more markedly present in patients with severe asthma. Multivariate regression revealed atypical lingual movement, which was greater in patients with severe asthma. The clinical significance of these findings should be further investigated.

Dysphagia in Myositis: A Study of the Structural and Physiologic Changes Resulting in Disordered Swallowing

OBJECTIVES

Dysphagia in patients with myositis is associated with an increased risk of aspiration pneumonia. However, the pathophysiology of dysphagia is poorly understood. The aim of this study was to understand how myositis affects swallowing physiology on videofluoroscopic swallow study.

DESIGN

This is a retrospective review of video fluoroscopic swallowing studies on 23 myositis patients with dysphagia from 2011 to 2016. Swallow studies were analyzed by timing of swallowing events and duration of swallowing events, diameter of upper esophageal sphincter opening, Modified Barium Swallow Impairment Profile, and Penetration-Aspiration Scale. The outcome measures for patients were compared with an archived videofluoroscopic swallow study from healthy, age-matched participants by Wilcoxon rank-sum tests.

RESULTS

Patients with myositis had a shorter duration of upper esophageal sphincter opening (P < 0.0001) and laryngeal vestibule closure (P < 0.0001) than healthy subjects. The diameter of upper esophageal sphincter opening did not differ between groups. Patients with myositis presented with higher scores on the MBSIMP than healthy subjects, indicating great impairment particularly during the pharyngeal phase of swallowing, and a higher frequency of penetration and aspiration.

CONCLUSIONS

Dysphagia in patients with myositis may be attributed to reduced endurance of swallowing musculature rather than mechanical obstruction of the upper esophageal sphincter.

Aging and Sex Effects on Mastication Performance in Healthy, Nondysphagic, Community-Dwelling Adults

Purpose This study investigated the impact of age and sex on mastication performance in healthy, nondysphagic, community-dwelling adults as observed during videofluoroscopy. Method Videofluoroscopic swallowing study imaging and mastication performance metrics (cycles, duration) were used to evaluate 185 healthy individuals (102 women, 83 men) aged 21-89 years. Results A significant effect of age on mastication cycles was not observed; however, a significant but weak effect of age on mastication duration was found. Female participants were observed to have significantly more mastication cycles and longer mastication durations compared to male participants. Three behavioral patterns of mastication performance emerged. Conclusions The results of this study contribute to normative data of mastication performance. An individual's sex was found to have a significant effect on mastication performance, although, in contrast to previous studies, age was not observed to significantly alter mastication performance. Differences in study methodologies likely explain the latter finding.

Late Dysphagia Following Radiotherapy After Nasopharyngeal Carcinoma: A Case Series

Purpose Standard treatment for nasopharyngeal carcinoma (NPC) is radiation therapy (RT); however, long-term effects of RT frequently include significant swallowing impairments (dysphagia; Gaziano, 2002; Hui, Chan, & Le, 2018). Our objective was to describe swallowing physiology in consecutive outpatients with a history of NPC following RT using standardized methods. Understanding dysphagia characteristics in this patient population could ultimately inform rehabilitation strategies and improve patient outcomes. Method We conducted a retrospective, observational, descriptive study of consecutive outpatients undergoing videofluoroscopic swallowing (VFS) exams at our clinic, from 2009 to 2014. We included those with a diagnosis of NPC treated with RT. Those with other cancer diagnoses; previous tracheostomy; acute neurological injury; and progressive, degenerative neurological conditions were excluded. Two registered MBSImP clinicians, blinded to each other, reviewed and scored the VFS exams according to previously published methods (Martin-Harris et al., 2008). Following unblinding, a single reviewer collected demographic data from the electronic medical record. We reported overall impairment and MBSImP component scores descriptively. Results Of 158 outpatients undergoing VFS, 6 (N) met our inclusion criteria. The median time from completion of RT to outpatient VFS was 21.0 years. Patients reported a variety of dysphagia symptoms. All patients had high oral and pharyngeal residue scores (scores ≥ 2) and high impairment scores on components contributing to bolus transport and airway closure. Conclusions All patients presented with impairments in oral-pharyngeal bolus transport and airway protection. Our results identify specific swallowing impairments for this patient group highlighting possible latent RT effects on swallowing. This population would benefit from dysphagia rehabilitation and maintenance programs informed by multimodal diagnostic approaches.

Aging Effects on Eating Assessment Tool-10 (EAT-10) Total Scores in Healthy, Community-Dwelling Adults

The purpose of this study was to examine how aging and sex impacted scores on the Eating Assessment Tool-10 in a large sample of healthy, non-dysphagic adults. Differences in Eating Assessment Tool-10 total normal (< 3) and abnormal (≥ 3) scores were examined across four age categories (21-39 years, 40-59 years, 60-79 years, 80 years and older) and between sexes. The mean (± SD) Eating Assessment Tool-10 total score for this healthy cohort of 167 individuals was 0.6 (± 1.6), with the majority of participants (75%) earning a score of zero. No significant differences were found in Eating Assessment Tool-10 total scores across age categories (p = .53) or between sexes (p = .79). Post-hoc analyses further explored relationships between Eating Assessment Tool-10 total scores and swallow performance measures as observed during videofluoroscopy. All participants (n = 15) scoring 3 and greater on the Eating Assessment Tool-10 passed an aspiration screen (i.e., 3-ounce water swallow challenge). Nine participants scoring less than 3 and failing the aspiration screen were not observed to have airway invasion as measured by the Penetration-Aspiration Scale during videofluoroscopy. A significant relationship was not observed between Eating Assessment Tool-10 total scores and highest Penetration-Aspiration Scale score. Eating Assessment Tool-10 total scores reported in the current study for patients with gastroesophageal reflux disease were significantly lower (p < .001) than total scores reported in the Eating Assessment Tool-10 validation study by Belafsky et al. (2008). In summary, aging or sex effects did not appear to impact self-report of dysphagia-related symptoms as measured by the Eating Assessment Tool-10. The Eating Assessment Tool-10, therefore, may not demonstrate the sensitivity needed to capture sub-clinical changes of the aging swallowing mechanism.

Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea: A randomized trial

BACKGROUND

Tongue strengthening exercise (TSE) is a remedial method for the training of swallowing-related muscles in the oropharyngeal phase. However, clinical evidence of its effectiveness is insufficient.

METHODS

To investigate the effect of TSE on the oropharyngeal muscles associated with swallowing in older adults, in this study, 40 elder adults living in the community were recruited and assigned to 2 groups. The experimental group performed a TSE with a 1-repetition maximum resistance level of 70%. The exercise was divided into an isometric and isotonic part. The control group did not perform an exercise. We measured the muscle strength and thickness of the tongue and suprahyoid muscles using an Iowa Oral Performance Instrument and ultrasonography.

RESULTS

The experimental group showed a statistically significant increase in tongue muscle strength and thickness in the oral phase (P = .001 and <.001, respectively). In the pharyngeal phase, the experimental group showed a statistically significant increase in the mylohyoid and digastric muscles (suprahyoid muscles) (P = .045 and .019, respectively). The control group showed no statistically significant changes.

CONCLUSION

TSE is effective in increasing the strength and thickness of the oropharyngeal muscles of elder adults and is recommended for those who are vulnerable to swallowing difficulties.

Validity and reliability of the French version of Eating Assessment Tool (EAT-10)

OBJECTIVE

To develop a French version of the Eating Assessment Tool (Fr EAT-10) and to assess its internal consistency, reliability and clinical validity.

METHODS

Fifty-six patients referred in the Swallowing Clinics of CHU Saint-Pierre Hospital (Brussels) and EpiCURA hospital (Ath, Belgium) for dysphagia were enrolled and completed fiberoptic endoscopic evaluation of swallowing and videofluoroscopy. Seventy-three asymptomatic subjects were included in the study. To assess reliability, Fr-EAT-10 was completed twice within a 7-day period. Validity was assessed by comparing Fr-EAT-10 scores with the scores of dysphagia handicap index (DHI) in all individuals. Normative value of EAT-10 was calculated and the receiver operating characteristic (ROC) curve was used to determine the best Fr-EAT-10 threshold associated with aspiration.

RESULTS

Fifty-two patients completed the study. Cronbach's alpha was 0.95 indicating a high internal consistency. Test-retest reliability was high in the entire cohort (rs = 0.921). The correlation between Fr-EAT-10 total scores and DHI was high (rs = 0.827) indicating a high external validity. Patients had a significant higher score of Fr-EAT-10 than the controls (p < 0.001) exhibiting a high internal validity. The analysis of normative data reported that a score of Fr-EAT-10 > 3 should be considered as abnormal. The correlation between Fr-EAT-10 and the occurrence of aspiration is significant (rs = 0.327, p < 0.05). According to the ROC curve; aspirations need to be highly suspected for patients with Fr-EAT-10 ≥ 17.

CONCLUSION

The Fr-EAT-10 developed in this study is a reliable and valid self-administered tool in the evaluation of dysphagia in French-speaking patients.

Taste Perception and Water Swallow Screen Results in Old-Old Women

Changes in both swallowing and taste commonly occur in advanced age, though the relationship between the two is unknown. This study examined the association between a water swallow screen test and taste identification and intensity rating. Participants included 47 community-dwelling women aged 85–94 years. Participants completed three trials of a water swallow screen and were observed for signs of aspiration, which, if present, indicated failure. Four pure taste stimuli at low and high concentrations and water were presented, and participants selected one of five taste labels and rated their intensity on the generalized Labeled Magnitude Scale. Ratios of intensity ratings were computed for each taste stimulus to compare the perception of low and high concentrations. The association between water swallow screen failure, correct taste identification, and taste intensity ratio was evaluated with logistic regression modeling, with mediating factors of frailty and number of comorbidities. Failure of three water swallow screen trials was associated with a higher taste intensity ratio for caffeine (bitter) and a lower taste intensity ratio for sucrose (sweet). Correct identification of taste, frailty, and number of comorbidities were not associated with failure of any number of water swallow screen trials. Intensity ratings of certain tastes may be associated with swallowing in old-old women. Heightened vigilance in this population may be necessary to prevent complications related to dietary intake.