Pharyngeal wall differences between normal younger and older adults.
TL;DR: The data suggest that the posterior pharyngeal wall is thinner and does not constrict to the same extent in older subjects compared with younger individuals, which contribute to the understanding of differences in pharygeal strength, swallowing efficiency, and safety associated with aging.
Abstract: Previous research has demonstrated differences in pharyngeal size and constriction between normal younger and older adults The distance between the larynx and the hyoid bone at rest is greater in older persons, as is the anteroposterior width of the pharynx when it is maximally expanded during swallow In addition, pharyngeal clearing during swallow is reduced with aging These observations suggest that the aging pharynx undergoes structural changes consistent with atrophy The purpose of this investigation was to compare pharyngeal wall thickness at rest and when maximally constricted during swallow in younger and older adults Videofluoroscopic swallow studies were performed on 178 normal adults Measures of posterior pharyngeal wall thickness were determined at rest and during maximum constriction of the pharynx during a 20-ml bolus swallow Data were subjected to analysis of variance and Student t test procedures to determine sex and age differences We found no statistically significant differences between the men and women in either age group, and so we then pooled our data across sex Mean pharyngeal wall thickness at rest was 039 cm (±009) in the younger group and 030 cm (±008) in the older group (p < 001) Pharyngeal wall thickness measured at the same point during maximum constriction was 108 cm (±034) in the younger group and 092 cm (±036) in the older adults (p<001) Our data suggest that the posterior pharyngeal wall is thinner and does not constrict to the same extent in older subjects compared with younger individuals These findings contribute to our understanding of differences in pharyngeal strength, swallowing efficiency, and safety associated with aging
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TL;DR: Consistent with existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, the size of the pharygeal lumen increases.
Abstract: Age-related loss of muscle bulk and strength (sarcopenia) is often cited as a potential mechanism underlying age-related changes in swallowing. Our goal was to explore this phenomenon in the pharynx, specifically, by measuring pharyngeal wall thickness and pharyngeal lumen area in a sample of young versus older women. MRI scans of the neck were retrospectively reviewed from 60 women equally stratified into three age groups (20s, 60s, 70+). Four de-identified slices were extracted per scan for randomized, blinded analysis: one mid-sagittal and three axial slices were selected at the anterior inferior border of C2 and C3, and at the pit of the vallecula. Pixel-based measures of pharyngeal wall thickness and pharyngeal lumen area were completed using ImageJ and then converted to metric units. Measures of pharyngeal wall thickness and pharyngeal lumen area were compared between age groups with one-way ANOVAs using Sidak adjustments for post-hoc pairwise comparisons. A significant main effect for age was observed across all variables whereby pharyngeal wall thickness decreased and pharyngeal lumen area increased with advancing age. Pairwise comparisons revealed significant differences between 20s versus 70+ for all variables and 20s versus 60s for all variables except those measured at C2. Effect sizes ranged from 0.54 to 1.34. Consistent with existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, the size of the pharyngeal lumen increases.
67 citations
Cites background from "Pharyngeal wall differences between..."
...The pharyngeal wall thickness data from the sagittal MRI slices replicate previous work [18] from (lateral) view videofluoroscopy with comparable data despite different imaging modalities....
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...However, it is worth pointing out that in their large sample of 178 normal adults, Aminpour and colleagues [18] found no significant difference in pharyngeal wall thickness from lateral videofluoroscopy between men and women in either the young or old age categories....
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...[18] found reduced pharyngeal wall thickness both at rest and during swallowing in older subjects as measured on lateral view videofluoroscopy....
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TL;DR: The utility of acoustic pharyngometry to monitor pharyngeal lumen volume is established and appears to impact both pharynGEal swallowing mechanics and function in a sample of healthy, functional seniors.
Abstract: Pharyngeal lumen volume is prone to increase as a consequence of pharyngeal muscle atrophy in aging. Yet, the impact of this on swallowing mechanics and function is poorly understood. We examined the relationship between pharyngeal volume and pharyngeal swallowing mechanics and function in a sample of healthy community-dwelling seniors. Data were collected from 44 healthy seniors (21 male, mean age = 76.9, SD = 7.1). Each participant swallowed 9 boluses of barium (3 × 5 ml thin, 3 × 20 ml thin, 3 × 5 ml nectar). Pharyngeal shortening, pharyngeal constriction, pyriform sinus and vallecular residue were quantified from lateral view videofluorosopic swallowing studies. Pharyngeal lumen volume was captured during an oral breathing task with acoustic pharyngometry. In addition, within-participant measures of strength and anthropometrics were collected. Four linear mixed effects regression models were run to study the relationship between pharyngeal volume and pharyngeal constriction, pharyngeal shortening, pyriform sinus residue, and vallecular residue while controlling for bolus condition, age, sex, and posterior tongue strength. Increasing pharyngeal lumen volume was significantly related to worse constriction and vallecular residue. In general, larger and thicker boluses resulted in worse pharyngeal constriction and residue. Pharyngeal shortening was only significantly related to posterior tongue strength. Our work establishes the utility of acoustic pharyngometry to monitor pharyngeal lumen volume. Increasing pharyngeal lumen volume appears to impact both pharyngeal swallowing mechanics and function in a sample of healthy, functional seniors.
54 citations
TL;DR: Swallowing physiology can be improved using this standardized high-intensity exercise protocol in healthy adults with evidence of dysphagia following completion of an exercise-based swallowing intervention.
Abstract: Purpose
The aim of this study was to investigate improvements in swallowing function and physiology in a series of healthy older adults with radiographically confirmed dysphagia, following completion of an exercise-based swallowing intervention.
36 citations
Cites background from "Pharyngeal wall differences between..."
...Sarcopenia has been established in the tongue, geniohyoid muscle(15) and the pharyngeal constrictors.(16,17) It follows then, that exercises that target the swallowing muscles are desirable for reversing sarcopenia and age-related dysphagia....
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TL;DR: The notion that larger pharyngeal volumes are associated with worse swallowing efficiency is supported, a finding the authors attribute to atrophy of the pharynGEal musculature in healthy aging.
Abstract: Purpose It has been widely reported that a proportion of healthy, community-dwelling seniors will develop dysphagia in the absence of a known neurological, neuromuscular, or structural cause. Our o...
24 citations
TL;DR: The findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging.
Abstract: Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85–91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young ( 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration–aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ2 = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.
20 citations
References
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TL;DR: Elderly patients with clinical signs suggestive of dysphagia and/or who have CAP should be referred for a swallow evaluation and consideration for treatment with an angiotensin-converting enzyme inhibitor.
813 citations
TL;DR: Bedside assessment of swallowing is of use in identifying patients at risk of developing complications after acute stroke and the value of routine screening with videofluoroscopy to detect aspiration is questioned.
Abstract: Background and PurposeThe published data on the relationship between dysphagia and both outcome and complications after acute stroke have been inconclusive. We examined the relationship between these, using bedside assessment and videofluoroscopic examination. MethodsWe prospectively studied 121 consecutive patients admitted with acute stroke. A standardized bedside assessment was performed by a physician. We performed videofluoroscopy blinded to this assessment within 3 days of stroke onset and within a median time of 24 hours of the bedside evaluations. The presence of aspiration was recorded. Mortality, functional outcome, length of stay, place of discharge, occurrence of chest infection, nutritional status, and hydration were the main outcome measures. ResultsPatients with an abnormal swallow (dysphagia) on bedside assessment had a higher risk of chest infection (P=.05) and a poor nutritional state (P<.001). The presence of dysphagia was associated with an increased risk of death (P=.001), disability ...
687 citations
TL;DR: Swallowing difficulty and lack of influenza vaccination are important, modifiable risks for pneumonia and other LRTIs in elderly residents of long-term care facilities and challenge the commonly held belief that pneumonia leads to long- term decline in functional status in this population.
Abstract: Background: Little is known about the risk factors, outcome, and impact of pneumonia and other lower respiratory tract infections (LRTIs) in residents of long-term care facilities. Objective: To determine the risk factors and the effect of these infections on functional status and clinical course. Methods: Active surveillance for these infections was conducted for 475 residents in 5 nursing homes from July 1, 1993, through June 30, 1996. Information regarding potential risk factors for these infections, functional status, transfers to hospital, and death was also obtained. Results: Two hundred seventy-two episodes of pneumoniaandotherLRTIsoccurredin170residentsduring228 757 days of surveillance for an incidence of 1.2 episodes per 1000 resident-days. Multivariable analysis revealed that older age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.12.6 per 10-year interval; P = .01), male sex (OR, 1.9; 95% CI, 1.1-3.5; P = .03), swallowing difficulty (OR, 2.0; 95% CI, 1.2-3.3; P = .01), and the inability to take oral medications (OR, 8.3; 95% CI, 1.4-50.3; P = .02) were significant risk factors for pneumonia; receipt of influenza vaccine (OR, 0.4; 95% CI, 0.3-0.5; P = .01) was protective. Age (OR, 1.6 [95% CI, 1.0-2.5] per 10-year interval; P = .05) and immobility (OR, 2.6; 95% CI, 1.8-3.8; P = .01) were significant risk factors for other LRTIs, and influenza vaccination was protective (OR, 0.3; 95% CI, 0.2-0.4; P = .01). Residents with pneumonia (OR, 0.7; 95% CI, 0.3-1.4; P = .31) or with other LRTIs(OR,0.5;95%CI,0.2-1.1; P = .43)werenomorelikely to have a deterioration in functional status than individuals in whom infection did not develop. Conclusions: Swallowing difficulty and lack of influenza vaccination are important, modifiable risks for pneumonia and other LRTIs in elderly residents of long-term care facilities. Our findings challenge the commonly held belief that pneumonia leads to long-term decline in functional status in this population. Arch Intern Med. 1999;159:2058-2064
336 citations
TL;DR: It is concluded that the propagated pharyngeal contraction facilitates pharygeal clearance but has a minimal role in the process of bolus propulsion during swallowing.
258 citations
TL;DR: Although there were only a small number of patients who met the criteria for this pilot study, a strong association was found between swallowing dysfunction and aspiration pneumonia.
Abstract: The medical literature has emphasized that aspiration of gastric contents or oral bacteria is a common cause of aspiration pneumonia. Swallowing disorders have been implicated in this disease but not studied at the time that aspiration pneumonia was diagnosed. A significant difference was found in the incidence of videofluoroscopically confirmed oropharyngeal swallowing problems in a group of patients diagnosed with aspiration pneumonia (AP) when compared with patients with nonaspiration pneumonia (NAP). Six of the 9 patients in the AP group aspirated during the videofluoroscopic evaluation and 2 others were considered to be at risk for aspiration. None of the 7 NAP patients demonstrated swallowing problems or aspiration. A significant difference in oral transit time also occurred between the two groups. Liquid was found to have a significantly faster oral transit time than paste or a cookie. Pharyngeal transit times were not found to be significantly different. Although there were only a small number of patients who met the criteria for this pilot study, a strong association was found between swallowing dysfunction and aspiration pneumonia.
169 citations