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Journal ArticleDOI

Examination of chew swallow in healthy elderly persons: Does the position of the leading edge of the bolus in the pharynx change with increasing age?

01 Jan 2011-Japanese Journal of Comprehensive Rehabilitation Science (Kaifukuki Rehabilitation Ward Association)-Vol. 2, pp 48-53

TL;DR: For solid foods, the position of the leading edge of the bolus during chewing in the pharynx changed with increasing age; this may affect the number of chew cycles and increasing age.

AbstractFujii W, Kondo I, Baba M, Saitoh E, Shibata S, Okada S, Onogi K, Mizutani H: Examination of chew swallow in healthy elderly persons: Does the position of the leading edge of the bolus in the pharynx change with increasing age? Jpn J Compr Rehabil Sci 2011; 2: 48-53 Objective: To determine whether aging infl uences the position of the leading edge of the bolus during chew swallow as identifi ed using videofl uorography (VF). Methods: Subjects comprising 53 healthy individuals (35 men and 18 women; mean age of 54.5 ± 19.3 years and range of 25-89 years), were subdivided into 4 groups: young adults, middle age, sixties, and seventy and over. Subjects underwent lateral VF to evaluate the position of the leading edge of the bolus just prior to the onset of swallowing, with normal chew swallow for solid foods and swallowing on command for liquids. Results: For solid foods, the position of the leading edge of the bolus during chewing changed with increasing age. Mastication time and the number of chew cycles increased with increasing age and were much higher in women than in men for the seventy and over group. Conclusion: For solid foods, the position of the leading edge of the bolus during chewing in the pharynx changed with increasing age; this may affect the number of chew cycles and increasing age. Gender may also affect both of these factors, with women tending to show a deeper transition of the bolus into the pharynx.

Topics: Bolus (digestion) (52%)

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Citations
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Journal ArticleDOI
TL;DR: Removing dentures in elderly edentulous individuals influences bolus transport during feeding, resulting in the exacerbation of the reduced swallowing reserve capacity that accompanies ageing, and may increase the risk of dysphagia.
Abstract: Summary Prosthetic treatment with dentures is often required for the elderly who have reduced swallowing function. Therefore, it is important to understand the relationship between denture-wearing and feeding function from the perspective of swallowing. To clarify changes in bolus transport during feeding in elderly edentulous patients with or without complete dentures. Subjects were 15 elderly edentulous volunteers who were treated with maxillary and mandibular complete dentures. The test food was 10 g of minced agar jelly containing barium sulphate with a particle diameter of 4·0–5·6 mm. Lateral videofluoroscopy was performed to assess the position of the leading edge of the bolus, the bolus volume in each area at swallow onset, bolus transit time and the mandibular position during pharyngeal swallowing. There were significant changes between the bolus transport with and without dentures. Without dentures, the leading edge of the bolus at swallow onset fell from the valleculae area to the hypopharynx, and the bolus volume in the hypopharynx increased. Bolus transit time increased in the oral cavity, valleculae and hypopharynx. The mandibular position shifted anterosuperior direction. The results arose owing to anatomical changes in the oral and pharyngeal structure and the following functional changes: poor food manipulation, poor bolus formation and delayed swallowing reflex. Removing dentures in elderly edentulous individuals influences bolus transport during feeding, resulting in the exacerbation of the reduced swallowing reserve capacity that accompanies ageing, and may increase the risk of dysphagia.

25 citations


01 Jan 2020
TL;DR: Oral diadochokinesis deterioration is significantly associated with oral phase prolongation for initial swallowing of solid food in older adults.
Abstract: Background: Prolongation of bolus forming complicates ingestion, in particular in older adults. Objectives: The purpose of this study is to examine which oral functions are associated with prolongation of the oral phase of forming a bolus until swallowing in older adults. Design: Cross-sectional study. Setting: three nursing homes in Kitakyushu, Japan from August 2017 to October 2018. Participants: 39 adults >60-years. Measurements: Number of functional teeth, chewing ability, swallowing ability, tongue and cheek pressure, saliva flow rate, oral diadochokinesis, global cognitive function, and body mass index, were examined. Time of oral phase until the first swallowing of solid food was measured as the outcome of the study using video, and audio recording of the swallowing sound by a throat microphone, with the cutoff point designated at 30 s. Based on the oral phase, participants were divided in two groups: normal and prolonged. Results: The 39 enrolled participants had a median age of 87 years, 17.3% were men, and 48.7% had prolonged oral phase. In the prolonged group, the swallowing ability, saliva flow rate, tongue and cheek pressure, and oral diadochokinesis were significantly lower than in the normal group. Binomial logistic regression analysis revealed that oral phase prolongation was associated with oral diadochokinesis (odds ratio 0.81, 95% confidence interval 0.67–0.98) after adjusting for potential covariates. Conclusion: Oral diadochokinesis deterioration is significantly associated with oral phase prolongation for initial swallowing of solid food in older adults.

1 citations


Cites background from "Examination of chew swallow in heal..."

  • ...5 demonstrated that the average oral phase is about 25 s in individuals >70-years-old (4)....

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  • ...It is frequently observed that the time from mouthing food to the initial swallowing tends to be prolonged in older adults (4)....

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References
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Journal ArticleDOI
TL;DR: Several parameters, including total duration of oropharyngeal swallowing, were significantly longer in the oldest age group than in any other age group, and females had a longer duration of upper esophageal sphincter (UES) opening.
Abstract: In an effort to evaluate the effect of normal aging on oropharyngeal events of swallowing, 80 normal volunteers, stratified by gender into four age groups, were studied. Liquid and semisolid swallows were performed and recorded simultaneously using videofluoroscopy and manometry. Several parameters, including total duration of oropharyngeal swallowing, were significantly longer in the oldest age group than in any other age group. A delay in initiation of maximal hyolaryngeal excursion primarily accounted for the longer durations with increased age. Significant durational changes also were found as a function of bolus consistency and presence or absence of the manometry tube. Females had a longer duration of upper esophageal sphincter (UES) opening. The amplitude of pharyngeal pressures, duration of peak pharyngeal pressures, and rate of propagation of the contractions were not significantly different for age, gender, or consistency of bolus. No significant differences were found between age groups or between genders in UES pressure. Normal aging affects some parameters of swallowing, while others are preserved.

581 citations


Journal ArticleDOI
TL;DR: A new model for bolus formation and deglutition is proposed because there was no predictable tongue–palate contact at any time in the sequence of complete feeding sequences on soft and hard foods.
Abstract: Food movements during complete feeding sequences on soft and hard foods (8 g of chicken spread, banana, and hard cookie) were investigated in 10 normal subjects; 6 of these subjects also ate 8 g peanuts. Foods were coated with barium sulfate. Lateral projection videofluorographic tapes were analyzed, and jaw and hyoid movements were established after digitization of records for 6 subjects. Sequences were divided into phases, each involving different food management behaviors. After ingestion, the bite was moved to the postcanines by a pull-back tongue movement (Stage I transport) and processed for different times depending on initial consistency. Stage II transport of chewed food through the fauces to the oropharyngeal surface of the tongue occurred intermittently during jaw motion cycles. This movement, squeeze-back, depended on tongue–palate contact. The bolus accumulated on the oropharyngeal surface of the tongue distal to the fauces, below the soft palate, but was cycled upward and forward on the tongue surface, returning through the fauces into the oral cavity. The accumulating bolus spread into the valleculae. The total oropharyngeal accumulation time differed with initial food consistency but could be as long as 8–10 sec for the hard foods. There was no predictable tongue–palate contact at any time in the sequence. A new model for bolus formation and deglutition is proposed.

366 citations


Journal ArticleDOI
TL;DR: Alternation of jaw adductor and abductor activity during mastication provided a framework for integration of chewing, transport, and swallowing.
Abstract: The coordination of mastication, oral transport, and swallowing was examined during intake of solids and liquids in four normal subjects. Videofluorography (VFG) and electromyography (EMG) were recorded simultaneously while subjects consumed barium-impregnated foods. Intramuscular electrodes were inserted in the masseter, suprahyoid, and infrahyoid muscles. Ninety-four swallows were analyzed frame-by-frame for timing of bolus transport, swallowing, and phases of the masticatory gape cycle. Barium entered the pharynx a mean of 1.1 s (range −0.3 to 6.4 s) before swallow onset. This interval varied significantly among foods and was shortest for liquids. A bolus of food reached the valleculae prior to swallow onset in 37% of sequences, but most of the food was in the oral cavity at the onset of swallowing. Nearly all swallows started during the intercuspal (minimum gape) phase of the masticatory cycle. Selected sequences were analyzed further by computer, using an analog-to-digital convertor (for EMG) and frame grabber (for VFG). When subjects chewed solid food, there were loosely linked cycles of jaw and hyoid motion. A preswallow bolus of chewed food was transported from the oral cavity to the oropharynx by protraction (movement forward and upward) of the tongue and hyoid bone. The tongue compressed the food against the palate and squeezed a portion into the pharynx one or more cycles prior to swallowing. This protraction was produced by contraction of the geniohyoid and anterior digastric muscles, and occurred during the intercuspal (minimum gape) and opening phases of the masticatory cycle. The mechanism of preswallow transport was highly similar to the oral phase of swallowing. Alternation of jaw adductor and abductor activity during mastication provided a framework for integration of chewing, transport, and swallowing.

363 citations


Journal ArticleDOI
TL;DR: Scanning of the thorax demonstrated that 71% of patients aspirated, whereas aspiration was observed in only 10% of control subjects, which may indicate an important role of silent aspiration in the development of community-acquired pneumonia in the elderly.
Abstract: Pneumonia is a major cause of death in the elderly. To investigate the role of silent aspiration in community-acquired pneumonia, we examined the occurrence of silent aspiration during sleep in 14 elderly patients with acute episode of pneumonia and 10 age-matched control subjects by a new technique using indium111 chloride. Scanning of the thorax demonstrated that 71% of patients aspirated, whereas aspiration was observed in only 10% of control subjects. The percentage of positive scans was significantly higher in patients with acute episode of pneumonia than in control subjects (p < 0.02). The results may indicate an important role of silent aspiration in the development of community-acquired pneumonia in the elderly.

312 citations


Journal ArticleDOI
Abstract: Swallows of 4 bolus volumes (1, 5, 10, 20 ml) were examined in three groups of subjects: 6 subjects 20-29 years of age, 12 subjects 30-59 years of age, and 6 subjects 60-79 years of age. A simultaneous manometric and videofluoroscopic data collection protocol permitted measurement of bolus transit, temporal aspects of the oropharyngeal swallow, and pharyngeal peristalsis. Statistically significant effects of increasing bolus volume were oral transit of the bolus head (decreased) and duration of cricopharyngeal opening (increased). Five measures were significantly changed with increasing age: duration of pharyngeal swallow delay (increased), duration of pharyngeal swallow response (decreased), duration of cricopharyngeal opening (decreased), peristaltic amplitude (decreased), and peristaltic velocity (decreased).

303 citations