Garand Kendrea L Focht, Hill Elizabeth G, Amella Elaine, Armeson Kent, Brown Alonna, Martin-Harris Bonnie
1 Department of Speech Pathology and Audiology, University of South Alabama, Mobile, Alabama, USA.
2 Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Ann Otol Rhinol Laryngol. 2019 May;128(5):426-432. doi: 10.1177/0003489419826141. Epub 2019 Jan 30.
Typical aging may result in subclinical swallowing alterations (presbyphagia), which can place an individual at risk for dysphagia-related conditions, such as aspiration pneumonia, secondary to loss of functional reserve and rising incidence of age-related diseases associated with dysphagia. The purpose of this study was to investigate occurrence of airway invasion among healthy, nondysphagic community-dwelling adults. Further, we tested for differences of airway invasion across age categories and between sexes.
Each eligible participant underwent a videofluoroscopic swallow study using a standardized approach of various volumes and viscosities. Ten swallows observed in the lateral viewing plane was assessed for observation of bolus airway invasion using the Penetration-Aspiration Scale (PAS) scoring system. Eligible participants (N = 195) were categorized according to 1 of 3 age categories (21-39 years, 40-59 years, 60 years and older) and sex (male, female) for analyses.
Out of 1936 swallows analyzed, we observed penetration in 113 swallows (5.8%) and aspiration in 6 swallows (0.3%). Majority (98%) of bolus airway invasion events occurred during the swallow. Mean or worst PAS scores did not significantly differ across age categories or between sexes. The odds ratios of PAS impairment between age categories did not reveal any significant differences. Males were more likely to have impaired PAS scores relative to females (odds ratio [OR] = 3.5; P = .01).
Entrance of ingested material into the airway observed during videofluoroscopy is uncommon in healthy adults, which helps support the notion that aging may not directly correlate with increased risk of aspiration. Rather, the increased risk of aspiration observed in the aging population may result from the increased incidence of neurological and other diseases with dysphagia as common sequelae with advancing age. Future investigations should compare age-matched healthy controls with a diseased population (eg, cerebral vascular accident) to further explore the relationship between aspiration risk as a function of age compared to consequence of disease/injury.
典型的衰老可能导致亚临床吞咽改变（老年吞咽困难），由于功能储备丧失以及与吞咽困难相关的年龄相关性疾病发病率上升，这可能使个体面临吞咽困难相关疾病的风险，如吸入性肺炎。本研究的目的是调查健康、无吞咽困难的社区居住成年人中气道侵犯的发生率。此外，我们还测试了不同年龄组和性别之间气道侵犯的差异。
每位符合条件的参与者采用标准化的不同体积和粘度方法进行视频荧光吞咽造影研究。使用渗透 - 误吸量表（PAS）评分系统，在侧位观察平面观察10次吞咽，评估食团气道侵犯情况。符合条件的参与者（N = 195）根据3个年龄组（21 - 39岁、40 - 59岁、60岁及以上）和性别（男性、女性）中的1个进行分类分析。
在分析的1936次吞咽中，我们观察到113次吞咽出现渗透（5.8%），6次吞咽出现误吸（0.3%）。大多数（98%）食团气道侵犯事件发生在吞咽过程中。不同年龄组或性别之间的平均或最差PAS评分没有显著差异。年龄组之间PAS受损的比值比没有显示出任何显著差异。相对于女性，男性更有可能出现PAS评分受损（比值比[OR] = 3.5；P = 0.01）。
在视频荧光吞咽造影中观察到摄入物质进入气道在健康成年人中并不常见，这有助于支持衰老可能与误吸风险增加没有直接关联的观点。相反，在老年人群中观察到的误吸风险增加可能是由于随着年龄增长，神经系统和其他疾病的发病率增加，吞咽困难是常见的后遗症。未来的研究应将年龄匹配的健康对照与患病群体（如脑血管意外）进行比较，以进一步探讨误吸风险作为年龄函数与疾病/损伤后果之间的关系。
