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.
Abstract: Fujii 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.
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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.
32 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.
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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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TL;DR: Although preserved, a significantly larger volume of water is required to stimulate this reflex by rapid pulse injection in the elderly, suggesting some deterioration in this age group of patients with compromised airway safety during swallowing.
Abstract: Background: Mechanism(s) of aspiration, a common complication of oropharyngeal dysphagia, is not completely elucidated. Since the pharyngoglottal closure reflex induces vocal cord a
107 citations
TL;DR: Electron-microscopic morphometric techniques were used to examine age-related changes in postmortem human superior laryngeal nerves obtained at autopsy and showed an extensive and statistically significant decrease in myelinated fibers with small axonal diameters in the old age group compared with the young adult age group.
Abstract: • Electron-microscopic morphometric techniques were used to examine age-related changes in postmortem human superior laryngeal nerves obtained at autopsy (young adult, aged 20 to 30 years; old, 60 years and over). A statistically significant age-related loss of myelinated nerve fibers was detected (old, 7032 ± 1572; young, 10179 ± 1969), representing a 31% decrease. Much of this loss occurred selectively in small myelinated fibers (1 to 2 μm) where there was an extensive (67%) and significant age-related fiber loss. A corresponding analysis of axonal diameter of myelinated nerve fibers similarly showed an extensive (67%) and statistically significant decrease in myelinated fibers with small axonal diameters (0 to 0.5 μm) in the old age group compared with the young adult age group. These findings may represent a significant histomorphologic correlate to the observed age-related sensorimotor dysfunction of the upper aerodigestive tract common in the elderly. ( Arch Otolaryngol Head Neck Surg . 1990;116:1062-1069)
77 citations
TL;DR: Sucking in normal adults is described and the videofluoroscopic measurements of bolus position at the onset of swallow suggest that there may be diverse sites for elicitation of the swallowing response/reflex rather than a single site (i.e., the anterior faucial arch).
Abstract: A "delayed swallowing reflex/response" (i.e., when the swallow reflex is not triggered when the bolus passes the back of the tongue at the anterior facial arch) Logemann has been widely accepted as an abnormality. Careful review of the literature supports the premise that a "delayed swallowing reflex/response" may in fact be a variation of normal. This paper describes swallowing in normal adults. We report the videofluoroscopic measurements of bolus position at the onset of swallow. A radiopaque marker was affixed to the anterior facial arch and the distance between the head of the bolus and the anterior facial arch was measured at the onset of swallow. A statistically significant proportion of swallows (22 of 30) occurred after the head of the bolus passed the anterior facial arch. This finding suggests that there may be diverse sites for elicitation of the swallowing response/reflex rather than a single site (i.e., the anterior facial arch). The relevance of this finding to treatment using thermal stimulation is discussed, as is the versatility of the normal pharynx.
59 citations