Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people.

Oropharyngeal dysphagia (OD) is a very frequent condition among older people with a prevalence ranging from mild symptoms in 25% of the independently living to severe symptoms in more than 50% living in nursing homes. There are several validated methods of screening, and clinical assessment and videofluoroscopy are the gold standard for the study of the mechanisms of OD in the elderly. Oropharyngeal residue is mainly caused by weak bolus propulsion forces due to tongue sarcopenia. The neural elements of swallow response are also impaired in older persons, with prolonged and delayed laryngeal vestibule closure and slow hyoid movement causing oropharyngeal aspirations. OD causes malnutrition, dehydration, impaired quality of life, lower respiratory tract infections, aspiration pneumonia, and poor prognosis including prolonged hospital stay and enhanced morbidity and mortality in several phenotypes of older patients ranging from independently living older people, hospitalized older patients and nursing home residents. Enhancing bolus viscosity of fluids greatly improves safety of swallow in all these patients. We believe OD should be recognized as a major geriatric syndrome, and we recommend a policy of systematic and universal screening and assessment of OD among older people to prevent its severe complications.