The Impact of Aging and Progressive Neurological Disease on Swallowing: A Concise Overview

Parameters to Consider for Successful Medication Use in Older Adults - an AGePOP Review

Older adults are the main users of medicine and due to their multimorbidity are often faced/confronted with a complex medication management. This review article provides a brief overview on aspects of medication management such as maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging as well as preparation prior to use. The main focus however is on the drug intake itself and provides an overview about the current understanding of real life dosing conditions of older adults and geriatric patients. Furthermore, it elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by these patient populations. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms and the circumstances under which they manage their medications, will make the design of more patient-centric drug products possible.

A review of swallow timing in the elderly

Many studies evaluate dysphagia in elderly patients and compare their swallowing to younger controls to assess the degree of swallowing impairment. Previous research suggests that changes should be expected in swallowing due to aging, and these changes need to be considered when performing swallowing assessments. A systematic review was conducted to elucidate the timing of swallowing in healthy. A comprehensive multiengine literature search was conducted to find articles studying swallowing in the healthy elderly, which yielded 22,852 articles of which 11 were judged to be relevant. Only articles using videofluoroscopy as an assessment method for swallowing timing were included. The articles underwent detailed review for study quality and data extraction. The eleven studies contained data for 32 different parameters, and 10 of the 11 studies compared elderly subjects to a younger group. Timing measures from the studies were compiled for analysis. In general, bolus transit times do not appear to change with age. Of note, elderly subjects tended to have a significantly delayed swallow response times and longer duration of upper esophageal sphincter opening. Results showed a large degree of variability across studies for each of the timing measures. Confidence intervals for timing in healthy older participants were computed across studies. Potential sources of variation were identified, including methodological, stimulus-related and participant-related sources. The results suggests that aging affects only a few very specific swallowing timing parameters, and many parameters appear to be unaffected by aging. Therefore, significant differences from a young reference sample should be interpreted as dysphagia rather than normal changes due to aging.

Clinical applications of IDDSI framework for texture recommendation for dysphagia patients

Dysphagia is a highly prevalent eating and swallowing disorder among elderly people, impacting negatively on the health and well-being of those afflicted. With increasing populations of elderly people, food industries are under growing pressure to produce appropriately texture-modified food for safe consumption by these vulnerable populations. Recently published International Dysphagia Diet Standardisation Initiative (IDDSI) framework provides a new global guideline on texture modification and standardization for dysphagia patients. This work was designed to test the feasibility of IDDSI framework for clinical applications by assessing the correlation between swallowing capability of dysphagia patients and the IDDSI texture levels. Altogether 26 elderly subjects were recruited and assessed for their dysphagia grades using the Water Drinking Test. Subjects were provided with fluid samples constituted at different consistencies from a commercial product and swallowing performance (time of swallowing, number of swallows, and number of coughs) was monitored and recorded. Correlations among swallowing capability parameters were observed. Most importantly, results from this work clearly demonstrated that the severity of dysphagia by water-based swallow tests correlates positively with the IDDSI fluid thickness aimed at reducing dysphagia symptoms in those patients, confirming the reliability and feasibility of IDDSI framework for clinical applications.

PRACTICAL APPLICATIONS

Swallowing disorder or dysphagia occurs commonly among many elderly people and imposes negative impacts on their health and well-being. Medical professionals can diagnose eating and swallowing capability in a qualitative manner, but have difficulty in making diet recommendation because of the lack of texture guidance. This work confirmed the feasibility of IDDSI framework for clinical and bedside applications. The correlation between the capability grades of swallowing and IDDSI texture levels established in this work provides a useful measure for such applications.

The effect of aging on mastication and swallowing parameters according to the hardness change of solid food

As part of the aging process, multiple oral physiologic changes occur and these changes may cause individuals to reduce food intake or switch the types of food texture. Thus, the need to develop food products for the elderly has increased. To evaluate the suitability of the food products for the elderly, the evaluation method should be verified and it is important to identify the parameters of mastication and swallowing. Therefore, the purpose of this study was to compare the differences of mastication and swallowing parameters between the young adults and the elderly depending on the varying hardness of rice food product. Subjects included 20 young adults and 40 elderly and bolus transit times of video-fluoroscopic swallowing study (VFSS) were used. Four types of rice products with different hardness were provided including cooked rice, soft-boiled rice, rice gruel and thin rice gruel. In the elderly group, the chewing number, oral processing time, post-faucial aggregation time, valleculae aggregation time (VAT), first subsequence duration and total duration were significantly different according to the changes in food hardness. Of the bolus transit times, the VAT and the second subsequence duration (S-S2) were significantly different between the two groups. These results suggest that VAT and S-S2, key VFSS parameters, as well as the chewing number and total duration are useful tools for evaluating the effect of aging on mastication and swallowing of solid foods.

PRACTICAL APPLICATIONS

In Korea, the aging population is rapidly increasing. According to recent surveys, a large number of elderly Koreans have reported chewing difficulties and many of them are in the state of under-nutrition. As aging progresses, multiple physiologic changes occur in mastication and swallowing functions. These changes may cause individuals to reduce their food intake or switch to soft food products. Therefore, the development of texture-modified food products for the elderly is needed and they should be developed based on the understandings of the physiology of mastication and swallowing according to different rheological properties of food products consumed in Korea, which are quite different from those of the western countries. In this study, we compared the differences of mastication and swallowing parameters between the young adults and the elderly depending on the varying hardness of rice food product.