Puisieux F, D'Andrea C, Baconnier P, Bui-Dinh D, Castaings-Pelet S, Crestani B, Desrues B, Ferron C, Franco A, Gaillat J, Guenard H, Housset B, Jeandel C, Jebrak G, Leymarie-Saddles A, Orvoen-Frija E, Piette F, Pinganaud G, Salle J-Y, Strubel D, Vernejoux J-M, de Wazières B, Weil-Engerer S
Service de Gériatrie, Hôpital des Bateliers, CHRU de Lille, 23, rue des Bateliers, 59037 Lille cedex, France.
Rev Mal Respir. 2011 Oct;28(8):e76-93. doi: 10.1016/j.rmr.2011.09.007. Epub 2011 Oct 22.
Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).
吞咽障碍（或吞咽困难）在老年人中很常见，其患病率常常被低估。它们可能导致严重并发症，包括脱水、营养不良、气道阻塞、吸入性肺炎（感染过程）或肺炎（由吸入无菌胃内容物引起的化学损伤）。此外，吞咽困难的影响不仅是身体上的，也是情感和社会方面的，会导致抑郁、生活质量改变和社会隔离。虽然吞咽方面的一些变化可能是衰老的自然结果，但老年人的吞咽困难主要是由中枢神经系统疾病引起的，如中风、帕金森病、痴呆、药物、局部口腔和食管因素。为了有效治疗，管理需要多学科团队的方法，并仔细评估患者的口咽解剖结构和生理功能、医学和营养状况、认知、语言和行为。临床评估可以通过电视荧光透视检查来完成，该检查能够观察吞咽过程中食团的运动以及口腔、咽部和喉部的运动。治疗取决于潜在病因、吞咽困难的程度和预后。有多种治疗方法可供选择，包括代偿策略（姿势改变和饮食调整）、直接或间接治疗技术（吞咽动作、药物和外科手术）。
