Table of Contents Author Guidelines Submit a Manuscript
Gastroenterology Research and Practice
Volume 2011, Article ID 818979, 13 pages
http://dx.doi.org/10.1155/2011/818979
Review Article

Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly

1Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, 08036 Barcelona, Spain
2Unidad de Exploraciones Funcionales Digestivas, Hospital de Mataró, 08304 Mataró, Spain
3Unidad de Cuidados Intensivos, Hospital de Mataró, 08304 Mataró, Spain
4Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, 07110 Mallorca, Spain
5Unidad Geriátrica de Adultos, Hospital de Mataró, 08304 Mataró, Spain
6Servicio de Farmacia, Hospital de Mataró, 08304 Mataró, Spain
7Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
8Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
9Comprehensive Cancer Centre West, 2316 XB Leiden, The Netherlands

Received 15 February 2010; Accepted 13 April 2010

Academic Editor: Rémy Meier

Copyright © 2011 Laia Rofes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. P. Clavé, A. Verdaguer, and V. Arreola, “Oral-pharyngeal dysphagia in the elderly,” Medicina Clinica, vol. 124, no. 19, pp. 742–748, 2005. View at Publisher · View at Google Scholar · View at Scopus
  2. P. Clavé, R. Terré, M. de Kraa, and M. Serra, “Approaching oropharyngeal dysphagia,” Revista Espanola de Enfermedades Digestivas, vol. 96, no. 2, pp. 119–131, 2004. View at Google Scholar · View at Scopus
  3. O. Ekberg, S. Hamdy, V. Woisard, A. Wuttge-Hannig, and P. Ortega, “Social and psychological burden of dysphagia: its impact on diagnosis and treatment,” Dysphagia, vol. 17, no. 2, pp. 139–146, 2002. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  4. J. Robbins, S. Langmore, J. A. Hind, and M. Erlichman, “Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001,” Journal of Rehabilitation Research and Development, vol. 39, no. 4, pp. 543–547, 2002. View at Google Scholar · View at Scopus
  5. J. M. Flacker, “What is a geriatric syndrome anyway?” Journal of the American Geriatrics Society, vol. 51, no. 4, pp. 574–576, 2003. View at Publisher · View at Google Scholar · View at Scopus
  6. P. J. Kahrilas, S. Lin, J. Chen, and J. A. Logemann, “Oropharyngeal accommodation to swallow volume,” Gastroenterology, vol. 111, no. 2, pp. 297–306, 1996. View at Publisher · View at Google Scholar · View at Scopus
  7. A. Jean, “Brain stem control of swallowing: neuronal network and cellular mechanisms,” Physiological Reviews, vol. 81, no. 2, pp. 929–969, 2001. View at Google Scholar · View at Scopus
  8. S. Hamdy, J. C. Rothwell, D. J. Brooks, D. Bailey, Q. Aziz, and D. G. Thompson, “Identification of the cerebral loci processing human swallowing with H2O15 PET activation,” Journal of Neurophysiology, vol. 81, no. 4, pp. 1917–1926, 1999. View at Google Scholar · View at Scopus
  9. M. Nagaya and Y. Sumi, “Reaction time in the submental muscles of normal older people,” Journal of the American Geriatrics Society, vol. 50, no. 5, pp. 975–976, 2002. View at Publisher · View at Google Scholar · View at Scopus
  10. P. Clavé, M. de Kraa, V. Arreola, M. Girvent, R. Farré, E. Palomera, and M. Serra-Prat, “The effect of bolus viscosity on swallowing function in neurogenic dysphagia,” Alimentary Pharmacology and Therapeutics, vol. 24, no. 9, pp. 1385–1394, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  11. P. J. Kahrilas, S. Lin, A. W. Rademaker, and J. A. Logemann, “Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism,” Gastroenterology, vol. 113, no. 5, pp. 1457–1464, 1997. View at Publisher · View at Google Scholar · View at Scopus
  12. I. K. Teismann, O. Steinsträter, T. Warnecke et al., “Tactile thermal oral stimulation increases the cortical representation of swallowing,” BMC Neuroscience, vol. 10, article 71, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  13. I. K. Teismann, O. Steinstraeter, K. Stoeckigt, S. Suntrup, A. Wollbrink, C. Pantev, and R. Dziewas, “Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing,” BMC Neuroscience, vol. 8, article 62, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  14. R. Turley and S. Cohen, “Impact of voice and swallowing problems in the elderly,” Otolaryngology-Head and Neck Surgery, vol. 140, no. 1, pp. 33–36, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  15. M. A. Nicosia and J. Robbins, “The fluid mechanics of bolus ejection from the oral cavity,” Journal of Biomechanics, vol. 34, no. 12, pp. 1537–1544, 2001. View at Publisher · View at Google Scholar · View at Scopus
  16. J. Robbins, R. E. Gangnon, S. M. Theis, S. A. Kays, A. L. Hewitt, and J. A. Hind, “The effects of lingual exercise on swallowing in older adults,” Journal of the American Geriatrics Society, vol. 53, no. 9, pp. 1483–1489, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  17. P. E. Marik and D. Kaplan, “Aspiration pneumonia and dysphagia in the elderly,” Chest, vol. 124, no. 1, pp. 328–336, 2003. View at Publisher · View at Google Scholar · View at Scopus
  18. J. Almirall, M. Cabré, and P. Clavé, “Aspiration pneumonia,” Medicina Clinica, vol. 129, no. 11, pp. 424–432, 2007. View at Publisher · View at Google Scholar · View at Scopus
  19. P. Clave, J. Almirall, A. Esteve, A. Verdaguer, M. Berenguer, and M. Serra-Prat, “Oropharyngeal dysphagia—a team approach to prevent and treat complications,” Hospital Healthcare Europe 2005/2006. Campden Publishing, London N5-N8, 2005.
  20. C. Gordon, R. Langton Hewer, and D. T. Wade, “Dysphagia in acute stroke,” British Medical Journal, vol. 295, no. 6595, pp. 411–414, 1987. View at Google Scholar · View at Scopus
  21. K. L. DePippo, M. A. Holas, and M. J. Reding, “Validation of the 3-oz water swallow test for aspiration following stroke,” Archives of Neurology, vol. 49, no. 12, pp. 1259–1261, 1992. View at Google Scholar · View at Scopus
  22. K. M. Nathadwarawala, J. Nicklin, and C. M. Wiles, “A timed test of swallowing capacity for neurological patients,” Journal of Neurology Neurosurgery and Psychiatry, vol. 55, no. 9, pp. 822–825, 1992. View at Google Scholar · View at Scopus
  23. A. Westergren, “Detection of eating difficulties after stroke: a systematic review,” International Nursing Review, vol. 53, no. 2, pp. 143–149, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  24. D. G. Smithard, P. A. O'Neill, and P. A. O'Neill, “Can bedside assessment reliably exclude aspiration following acute stroke?” Age and Ageing, vol. 27, no. 2, pp. 99–106, 1998. View at Publisher · View at Google Scholar · View at Scopus
  25. L. B. Palmer, K. Albulak, S. Fields, A. M. Filkin, S. Simon, and G. C. Smaldone, “Oral clearance and pathogenic oropharyngeal colonization in the elderly,” American Journal of Respiratory and Critical Care Medicine, vol. 164, no. 3, pp. 464–468, 2001. View at Google Scholar · View at Scopus
  26. G. J. J. W. Bours, R. Speyer, J. Lemmens, M. Limburg, and R. de Wit, “Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review,” Journal of Advanced Nursing, vol. 65, no. 3, pp. 477–493, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  27. I. J. Cook and P. J. Kahrilas, “AGA technical review on management of oropharyngeal dysphagia,” Gastroenterology, vol. 116, no. 2, pp. 455–478, 1999. View at Publisher · View at Google Scholar · View at Scopus
  28. S. E. Langmore, K. Schatz, and N. Olson, “Endoscopic and videofluoroscopic evaluations of swallowing and aspiration,” Annals of Otology, Rhinology and Laryngology, vol. 100, no. 8, pp. 678–681, 1991. View at Google Scholar · View at Scopus
  29. J. A. Logemann, Manual for the Videofluorographic Study of Swallowing, Pro-Ed, Austin, Tex, USA, 2nd edition, 1993.
  30. W. B. Baine, W. Yu, and J. P. Summe, “Epidemiologic trends in the hospitalization of elderly medicare patients for pneumonia, 1991–1998,” American Journal of Public Health, vol. 91, no. 7, pp. 1121–1123, 2001. View at Google Scholar · View at Scopus
  31. D. Volkert, Y. N. Berner, and Y. N. Berner, “ESPEN Guidelines on Enteral Nutrition: Geriatrics,” Clinical Nutrition, vol. 25, no. 2, pp. 330–360, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  32. A. Leibovitz, Y. Baumoehl, E. Lubart, A. Yaina, N. Platinovitz, and R. Segal, “Dehydration among long-term care elderly patients with oropharyngeal dysphagia,” Gerontology, vol. 53, no. 4, pp. 179–183, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  33. A. Bhalla, S. Sankaralingam, R. Dundas, R. Swaminathan, C. D. A. Wolfe, and A. G. Rudd, “Influence of raised plasma osmolality on clinical outcome after acute stroke,” Stroke, vol. 31, no. 9, pp. 2043–2048, 2000. View at Google Scholar · View at Scopus
  34. B. Vellas, Y. Guigoz, P. J. Garry, F. Nourhashemi, D. Bennahum, S. Lauque, and J.-L. Albarede, “The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients,” Nutrition, vol. 15, no. 2, pp. 116–122, 1999. View at Publisher · View at Google Scholar · View at Scopus
  35. M. Cabre, M. Serra-Prat, E. Palomera, J. Almirall, R. Pallares, and P. Clavé, “Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia,” Age and Ageing, vol. 39, no. 1, pp. 39–45, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  36. A. C. Milne, A. Avenell, and J. Potter, “Meta-analysis: Protein and energy supplementation in older people,” Annals of Internal Medicine, vol. 144, no. 1, pp. 37–48, 2006. View at Google Scholar · View at Scopus
  37. M. Dennis, “Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial,” The Lancet, vol. 365, no. 9461, pp. 755–763, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  38. M. B. Loeb, M. Becker, A. Eady, and C. Walker-Dilks, “Interventions to prevent aspiration pneumonia in older adults: a systematic review,” Journal of the American Geriatrics Society, vol. 51, no. 7, pp. 1018–1022, 2003. View at Publisher · View at Google Scholar · View at Scopus
  39. J. Schmidt, M. Holas, K. Halvorson, and M. Reding, “Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke,” Dysphagia, vol. 9, no. 1, pp. 7–11, 1994. View at Google Scholar · View at Scopus
  40. W. R. Addington, R. E. Stephens, and K. A. Gilliland, “Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison,” Stroke, vol. 30, no. 6, pp. 1203–1207, 1999. View at Google Scholar · View at Scopus
  41. J. A. Logemann, “Dysphagia: evaluation and treatment,” Folia Phoniatrica et Logopaedica, vol. 47, no. 3, pp. 140–164, 1995. View at Google Scholar · View at Scopus
  42. R. Speyer, L. Baijens, M. Heijnen, and I. Zwijnenberg, “Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review,” Dysphagia, vol. 25, no. 1, pp. 40–65, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  43. M. Bülow, R. Olsson, and O. Ekberg, “Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction,” Dysphagia, vol. 16, no. 3, pp. 190–195, 2001. View at Publisher · View at Google Scholar · View at Scopus
  44. J. A. Logemann, P. J. Kahrilas, M. Kobara, and N. B. Vakil, “The benefit of head rotation on pharyngoesophageal dysphagia,” Archives of Physical Medicine and Rehabilitation, vol. 70, no. 10, pp. 767–771, 1989. View at Google Scholar · View at Scopus
  45. J. S. Lewin, T. M. Hebert, J. B. Putnam Jr., and R. A. DuBrow, “Experience with the chin tuck maneuver in postesophagectomy aspirators,” Dysphagia, vol. 16, no. 3, pp. 216–219, 2001. View at Publisher · View at Google Scholar · View at Scopus
  46. A. Rasley, J. A. Logemann, P. J. Kahrilas, A. W. Rademaker, B. R. Pauloski, and W. J. Dodds, “Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture,” American Journal of Roentgenology, vol. 160, no. 5, pp. 1005–1009, 1993. View at Google Scholar · View at Scopus
  47. R. Shaker, C. Easterling, and C. Easterling, “Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening,” Gastroenterology, vol. 122, no. 5, pp. 1314–1321, 2002. View at Google Scholar · View at Scopus
  48. M. L. Freed, L. Freed, R. L. Chatburn, and M. Christian, “Electrical Stimulation for swallowing disorders caused by stroke,” Respiratory Care, vol. 46, no. 5, pp. 466–474, 2001. View at Google Scholar · View at Scopus
  49. V. Leelamanit, C. Limsakul, and A. Geater, “Synchronized electrical stimulation in treating pharyngeal dysphagia,” Laryngoscope, vol. 112, no. 12, pp. 2204–2210, 2002. View at Google Scholar · View at Scopus
  50. T. A. Burnett, E. A. Mann, S. A. Cornell, and C. L. Ludlow, “Laryngeal elevation achieved by neuromuscular stimulation at rest,” Journal of Applied Physiology, vol. 94, no. 1, pp. 128–134, 2003. View at Google Scholar · View at Scopus
  51. L. Blumenfeld, Y. Hahn, A. LePage, R. Leonard, and P. C. Belafsky, “Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study,” Otolaryngology-Head and Neck Surgery, vol. 135, no. 5, pp. 754–757, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  52. M. Kiger, C. S. Brown, and L. Watkins, “Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy,” Dysphagia, vol. 21, no. 4, pp. 243–253, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  53. H. Bogaardt, D. Van Dam, N. M. Wever, C. E. Bruggeman, J. Koops, and W. J. Fokkens, “Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis,” Annals of Otology, Rhinology and Laryngology, vol. 118, no. 4, pp. 241–246, 2009. View at Google Scholar · View at Scopus
  54. D. W. Shaw, I. J. Cook, G. G. Jamieson, M. Gabb, M. E. Simula, and J. Dent, “Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum,” Gut, vol. 38, no. 6, pp. 806–811, 1996. View at Google Scholar · View at Scopus
  55. W. J. Ravich, “Botulinum toxin for UES dysfunction: therapy or poison?” Dysphagia, vol. 16, no. 3, pp. 168–170, 2001. View at Publisher · View at Google Scholar · View at Scopus
  56. R. B. H. Williams, K. L. Wallace, G. N. Ali, and I. J. Cook, “Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia,” American Journal of Physiology, vol. 283, no. 1, pp. G16–G26, 2002. View at Google Scholar · View at Scopus
  57. P. Clavé, V. Arreola, and V. Arreola, “Diagnosis and treatment of functional oropharyngeal dysphagia. Features of interest to the digestive surgeon,” Cirugia Espanola, vol. 82, no. 2, pp. 62–76, 2007. View at Publisher · View at Google Scholar · View at Scopus
  58. S. Hamdy, S. Jilani, V. Price, C. Parker, N. Hall, and M. Power, “Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury,” Neurogastroenterology and Motility, vol. 15, no. 1, pp. 69–77, 2003. View at Publisher · View at Google Scholar · View at Scopus
  59. J. A. Logemann, B. R. Pauloski, L. Colangelo, C. Lazarus, M. Fujiu, and P. J. Kahrilas, “Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia,” Journal of Speech and Hearing Research, vol. 38, no. 3, pp. 556–563, 1995. View at Google Scholar · View at Scopus
  60. J. C. Rosenbek, J. A. Robbins, E. B. Roecker, J. L. Coyle, and J. L. Wood, “A penetration-aspiration scale,” Dysphagia, vol. 11, no. 2, pp. 93–98, 1996. View at Publisher · View at Google Scholar · View at Scopus
  61. Y. T. Wang and D. Bieger, “Role of solitarial GABAergic mechanisms in control of swallowing,” American Journal of Physiology, vol. 261, no. 3, pp. R639–R646, 1991. View at Google Scholar · View at Scopus
  62. C. H. Hockman, A. Weerasuriya, and D. Bieger, “GABA receptor-mediated inhibition of reflex deglutition in the cat,” Dysphagia, vol. 11, no. 3, pp. 209–215, 1996. View at Publisher · View at Google Scholar · View at Scopus
  63. R. O. Dantas and M. Â. N. Souza, “Dysphagia induced by chronic ingestion of benzodiazepine,” American Journal of Gastroenterology, vol. 92, no. 7, pp. 1194–1196, 1997. View at Google Scholar · View at Scopus
  64. K. S. Dua, S. N. Surapaneni, R. Santharam, D. Knuff, C. Hofmann, and R. Shaker, “Effect of systemic alcohol and nicotine on airway protective reflexes,” American Journal of Gastroenterology, vol. 104, no. 10, pp. 2431–2438, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  65. L. G. Sokoloff and R. Pavlakovic, “Neuroleptic-induced dysphagia,” Dysphagia, vol. 12, no. 4, pp. 177–179, 1997. View at Publisher · View at Google Scholar · View at Scopus
  66. R. Dziewas, T. Warnecke, and T. Warnecke, “Neuroleptic-induced dysphagia: case report and literature review,” Dysphagia, vol. 22, no. 1, pp. 63–67, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  67. W. Knol, R. J. Van Marum, P. A. F. Jansen, P. C. Souverein, A. F. A. M. Schobben, and A. C. G. Egberts, “Antipsychotic drug use and risk of pneumonia in elderly people,” Journal of the American Geriatrics Society, vol. 56, no. 4, pp. 661–666, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  68. T. Ebihara, H. Takahashi, and H. Takahashi, “Capsaicin troche for swallowing dysfunction in older people,” Journal of the American Geriatrics Society, vol. 53, no. 5, pp. 824–828, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  69. T. Ebihara, K. Sekizawa, H. Nakazawa, and H. Sasaki, “Capsaicin and swallowing reflex,” The Lancet, vol. 341, no. 8842, p. 432, 1993. View at Google Scholar · View at Scopus
  70. T. Ebihara, S. Ebihara, M. Maruyama, M. Kobayashi, A. Itou, H. Arai, and H. Sasaki, “A randomized trial of olfactory stimulation using black pepper oil in older people with swallowing dysfunction,” Journal of the American Geriatrics Society, vol. 54, no. 9, pp. 1401–1406, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  71. T. Hamamoto, M. Takumida, K. Hirakawa, T. Tatsukawa, and T. Ishibashi, “Localization of transient receptor potential vanilloid (TRPV) in the human larynx,” Acta Oto-Laryngologica, vol. 129, no. 5, pp. 560–568, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  72. A. Watando, S. Ebihara, T. Ebihara, T. Okazaki, H. Takahashi, M. Asada, and H. Sasaki, “Effect of temperature on swallowing reflex in elderly patients with aspiration pneumonia,” Journal of the American Geriatrics Society, vol. 52, no. 12, pp. 2143–2144, 2004. View at Google Scholar · View at Scopus
  73. K. Nakayama, K. Sekizawa, and H. Sasaki, “ACE inhibitor and swallowing reflex,” Chest, vol. 113, no. 5, p. 1425, 1998. View at Google Scholar · View at Scopus
  74. K. Sekizawa, T. Matsui, T. Nakagawa, K. Nakayama, and H. Sasaki, “ACE inhibitors and pneumonia,” The Lancet, vol. 352, no. 9133, p. 1069, 1998. View at Google Scholar · View at Scopus
  75. T. Nakagawa, H. Wada, K. Sekizawa, H. Arai, and H. Sasaki, “Amantadine and pneumonia,” The Lancet, vol. 353, no. 9159, p. 1157, 1999. View at Google Scholar · View at Scopus
  76. F. S. Monte, F. P. da Silva-Júnior, P. Braga-Neto, M. A. Nobre e Souza, and V. M. de Bruin, “Swallowing abnormalities and dyskinesia in Parkinson's disease,” Movement Disorders, vol. 20, no. 4, pp. 457–462, 2005. View at Google Scholar