Dysphagia Basics
Patient report of difficulty initiating a swallow or coughing or choking while eating would indicate this broad category of dysphagia.
Oropharyngeal Dysphagia
This phase of swallowing is most often disrupted in geriatric patients.
pharyngeal phase
All instrumental swallowing evaluations require these three things of patients.
alertness, cooperation, and ability to follow simple commands
These two items should be discussed and established before placement of a feeding tube in older adults.
clear goals and timeline for re-evaluation to determine if goals are being met
This is a medication class that can worsen dysphagia (include its effect).
anticholinergics, CNS depressants, etc
Patient report of a sensation of food getting "stuck" in their chest or regurgitation of undigested food would indicate this broad category of dysphagia.
Esophageal Dysphagia
Name one disorder/complication seen in geriatric patients that can disrupt the oral preparatory phase of swallowing and why this occurs.
poor dentition decrease in salivation, CVA, dementia, Parkinson's disease, disruption of the oral mucosa from mucositis, thrush, etc.
This type of swallow study involves an in-depth feeding/swallowing history, oral peripheral examination, and trial of swallows of various food consistencies.
bedside swallow evaluation
These are predictors of early mortality after feeding tube placement (name two).
advanced age, CNS pathology (stroke, dementia), cancer (except early stage head/neck cancer), disorientation, low serum albumin
This is the estimated prevalence of dysphagia in community-dwelling geriatric patients.
~15-20%
Understanding this about the character of the oral intake that leads to dysphagia symptoms can help in determining the etiology of a patient's dysphagia
consistency (liquid vs solid vs both)
Name one disorder/complication seen in geriatric patients that can disrupt the pharyngeal phase of swallowing and why this occurs.
neurologic disorders (stroke, dementia, motor neuron disease, etc), Parkinson's disease, malignancy, etc
This type of swallow study allows functional evaluation of swallowing by radiographic visualization and can detect the degree of oropharyngeal dysfunction as well as severity of aspiration, including silent aspiration.
modified barium swallow/video fluoroscopy (MBS)
These are potential adverse quality of life effects of tube feeding for patients with advanced dementia (name three).
denial of pleasure of eating, increasing risk for physical and chemical restraints, distress from presence of tube, increasing risk of pressure ulcers, decreased social interaction
This is the estimated prevalence of dysphagia in geriatric patients residing in nursing homes.
~40-60%
These are structural/physiologic changes that can occur with aging and affect the swallowing process (name two).
loss of teeth/use of dentures, reduced muscle strength (atrophy), decreased taste and olfaction, altered salivary secretion, impaired cough and swallow reflexes, decreased tongue root retraction, reduced pharyngeal constriction and sensation, reduced breathing and swallowing coordination, decreased cognitive function, etc.
Name one disorder/complication seen in geriatric patients that can disrupt the esophageal phase of swallowing and why this occurs.
esophageal stricture, malignancy, severe atherosclerosis or large thoracic aortic aneurysm causing impingement of the esophagus, etc
This type of swallow study involves direct anatomic visualization, making it the optimal method for identifying structural abnormalities in the oropharynx.
fiber-endoscopic evaluation of swallowing (FEES)
While prevention of this clinical condition is often used as a reason for placing a feeding tube in patients with dysphagia, it is not supported by the literature.
aspiration pneumonia
These are the primary cranial nerves involves in swallowing.
V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), XII (hypoglossal)