Older adults are at a very high risk of dysphagia, compared to other populations. Estimates suggest that 40-60% of older adults in assisted living facilities, and 15-22% of older adults in the general population , are affected by dysphagia. The likely cause for the high risk in older adults is the impact ageing has on the swallowing process.
What causes dysphagia?
Dysphagia is a condition where an individual has difficulty swallowing, or moving the food and liquid from the back of the mouth to the stomach . It is generally an issue with either the throat or the oesophagus.
There are many factors that can lead to the development of dysphagia. Many dysphagia patients are older adults, babies, or people with nervous system disorders.
The most common causes are:
- Conditions that affect the brain, spinal cord and nerves: stroke, multiple sclerosis, Parkinson’s disease and brain tumours
- Issues that develop prior to birth or during early development: cleft palate, cerebral palsy and learning disabilities.
- These are commonly diagnosed in infancy or young childhood
- Obstructions which narrow the oesophagus: benign and malignant growths in and around the mouth, throat and oesophagus, reflux disorders and infections around the mouth and throat
- Conditions which affect the muscles of the mouth and oesophagus: scleroderma and achalasia
- Other causes: chronic obstructive pulmonary disease and complications post head or neck surgery
Dysphagia in older adults
A healthy person’s nerves and muscles act together during the swallowing process. The person will voluntarily move the food/liquid towards the back of the mouth. Then the body will reflexively close the airway, move the food/liquid into the oesophagus, and then move it down to the stomach using the muscles of the oesophagus.
However, ageing affects nerve conduction, muscle strength and mass, which can then increase the risk of dysphagia.
Dysphagia may occur in elderly people due to structural or motor issues such as:
- Alzheimer’s disease and dementia
- Reflux disorders such as gastro-oesophageal reflux disorder
- Weakened muscles and sarcopenia
Older adults are at a higher risk of suffering from malnutrition due to dysphagia .
Nutrition management of dysphagia in older adults
Dysphagia leads to an altered or decreased intake of food. This potentially reduces the amount of nutrition consumed, and increases the risk of malnutrition .
Malnutrition is the state of insufficient nutrients in the diet. It can be insufficient calories, macro-nutrients such as protein, or micro-nutrients such as vitamins and minerals.
To manage malnutrition in older adults with dysphagia, the food and liquid consumption needs to be optimised for their needs. This may include adding nutritional supplements; providing fortified or nutrient-dense options; and, ensuring foods and liquids are at the individual’s required level of texture-modification . By utilising one or more of these options, the risk of malnutrition can be significantly lowered and improve one’s quality of life.
It is essential to manage the condition in any patient, but older populations are of particular concern. This is where nutrition management is a key strategy to ensure the well-being of older adults.
- WebMD. (2017). Difficulty Swallowing (Dysphagia) – Overview. [online] Available at: 1. http://www.webmd.com/digestive-disorders/tc/difficulty-swallowing-dysphagia-overview#1 [Accessed 12 Sep. 2017].
- NHS.UK. (2017). Dysphagia (swallowing problems) – Causes – NHS Choices. [online] Available at: http://www.nhs.uk/Conditions/Dysphagia/Pages/Causes.aspx [Accessed 12 Sep. 2017].
- Sura, Livia, Aarthi Madhavan, Giselle Carnaby, and Michael A. Crary. “Dysphagia in the elderly: management and nutritional considerations.” Clinical interventions in aging 7 (2012): 287.