Presbyphagia: Dysphagia in the elderly

Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.     

Dysphagia and deformity after undetected odontoid fracture in elderly patients.

Trauma in elderly patients is often difficult to evaluate and neck injuries are probably more common than is documented. A case is described of a missed odontoid peg fracture with the unusual presentation of dysphagia and a rapidly developing cervicodorsal kyphos (head falling forward), which may well have been anticipated at several points in the management chain. The lessons to be learned are outlined, together with the subsequent management of this patient.     

Dysphagia

Dysphagia indicates an abnormality of pharyngeal or esophageal function due either to a motor abnormality or to organic narrowing of the lumen. As therapy differs for these two types of disorders, the physician's first responsibility is to establish the nature of the abnormality producing dysphagia. If the prognosis of cancer of the esophagus is to be improved, careful attention must be given to early symptoms of dysphagia.     

Dysphagia

Difficulty in swallowing may result from a motor disorder of the esophagus or an obstructing lesion. Dysphagia for liquids is characteristic of motor disorders, while symptoms on swallowing solid food point to mechanical obstruction. Difficulty initiating a swallow indicates oropharyngeal dysphagia, an abnormality of striated muscle. The major mechanical causes of dysphagia are peptic stricture, esophageal carcinoma and a mucosal ring.     

帕金森病对吞咽活动的影响

帕金森病是老年人常见的以震颤、肌强直、运动减少和姿势障碍为主要临床症状的神经系统疾病。随着认识的深入,困扰帕金森患者的消化道症状日益得到人们的重视,其中吞咽困难在帕金森患者中尤为常见,但其发病机制仍不十分清楚。深入了解帕金森病吞咽活动的病理生理不仅有助于改善治疗,提高帕金森患者的生活质量,而且对于进一步探索帕金森病的发病机制具有重要的意义。     

Dysphagia in Forestier's disease

Background. The purpose of the study is to present preliminary results of treatment of dysphagia in patients with Forestier's disease. Material and methods.3 patients with Forestier's disease were treated surgically due to increasing difficulties swallowing. The average age was 57 yrs. All three patients presented with cough and hoarseness. Results. Surgical intervention relieved the patients from dysphagia. All three regained the ability to swallow and obtained relief from hoarseness and cough within a few months after surgery. Conclusion. We observed that dysphagia due to skeletal hyperostosis may be the main symptom in Forestier's disease. Pharmacological treatment in the initial period of the disease decreases edema of the mucous membrane in the esophagus.     

Dysphagia in Huntington's disease

Although not the most obvious symptom of Huntington's disease (HD), difficulty swallowing, or dysphagia, is a common symptom and may be associated with fatal complications. Management of dysphagia requires an understanding of the process of normal food ingestion and how this process is impaired in HD. This article describes HD and how it interferes with food intake. An effective nursing approach to the management of dysphagia is presented.     

Dysphagia rehabilitation in Japan

This article describes the features of Japanese dysphagia rehabilitation, particularly where it differs from that in the United States. Many kinds of professionals participate in dysphagia rehabilitation; nurses and dental associates take important roles, and the Japanese insurance system covers that. Videofluorography and videoendoscopy are common and are sometimes done by dentists. Intermittent catheterization is applied to nutrition control in some cases. The balloon expansion method is applied to reduce pharyngeal residue after swallowing. If long-term rehabilitation does not work effectively in dysphagia due to brainstem disorder, the authors consider reconstructive surgery to improve function.     

Dysphagia in stroke patients

Practice profiles are reflective pieces written by nurses in practice and based on continuing professional development articles. This week Maria Rees discusses stroke and dysphagia. Article no. 489. Davies S (1999) Dysphagia in acute strokes.     

Dysphagia in Older Adults

Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient’s history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia. If providers are diagnosing esophageal dysphagia, barium esophagraphy or esophagogastroduodenoscopy (EGD) can be used as part of the assessment. Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.     

Dysphagia in the elderly--a management challenge for nurses

Dysphagia (swallowing difficulties) is relatively common in the general population, but the prevalence increases with age and poses particular problems in the older patient, potentially compromising nutritional status, complicating the administration of solid medications, increasing the risk of aspiration pneumonia and undermining the quality of life. The repercussions of dysphagia are not only physical but also emotional, affecting patient morale and leading to feelings of social isolation. There are various causes, including carcinoma, stroke and advanced Alzheimer's disease. The diverse range of causes may manifest in a number of different ways, but should always act as a warning sign, which requires further investigation. Management is multidisciplinary, depending on the underlying cause, extent of dysphagia and likely prognosis. This article examines the incidence, causes and management of dysphagia, based on a review of recent literature. The focus is on the nurse's role in the management of this challenging disorder with particular emphasis on the care of the elderly patient.     

Dysphagia complications of the minerva brace

The effects of cervical bracing on swallowing function have not been evaluated in neurologically intact individuals. An 83-year-old woman fell, striking her head, and suffered C1, odontoid, and C3 fractures. She had no neurologic deficits and was placed in a Minerva brace. Subsequently, she developed coughing during her meals, a low-grade fever, and transient hoarseness, and complained of stiffness in the facial muscles. Aspiration pneumonia in the left lower lobe was diagnosed. In the absence of any neurologic condition, this was attributed to the Minerva brace. Less than 1 week later, the brace was replaced with a halo-vest, and the dysphagia resolved. This case shows that dysphagia and aspiration pneumonia may be caused by wearing a cervical brace and illustrates the importance of assessing swallowing in individuals who wear such braces. Particular attention should be paid to swallowing and cervical bracing in patients with additional risk factors for dysphagia such as advanced age or neurologic deficits.     

Dysphagia in stroke and neurologic disease

Dysphagia is a common problem in neurologic disease. The authors describe rates of dysphagia in selected neurologic diseases, and the evaluation and treatment of dysphagia in this population. Applicable physiology and aspects of neural control are reviewed. The decision-making process to determine oral feeding versus alternative means of alimentation is examined.