Lecture 3

Age Related Changes: Geriatric

Aging: Physiologic Impact Vertebral column thinning Lung ossification Cervical osteophytes Larngoptosis TMJ ossification Delayed oral stimulation identification Xerostomia Dentition loss Decreased swallow rates Increased relaxation time of the cricopharyngeus Longer airway closure time Posterior positioning of the bolus Delayed initiation Delayed transit through the phrynx

Respiration during the Swallow

Normal respiratory sequence• Inspiration

• Velum lowers so that breathing can continue during mastication

• Exhalation begins

• Apnea during the swallow

• Exhalation is completed

Triad of Symptoms

Respiratory compromise Dysphagia Protein-calorie malnutrition

• Anyone of these symptoms can contribute to the triad

• The physiology of aging contributes to the probability that anyone of these symptoms could occur.

Saliva

Important functions of saliva• Increase taste perception

• Decreased bacteria

• Maintains acid levels in the stomach

• Facilitates food breakdown Xerostomia

• Dryness of the mouth, pharynx

• Can significantly contribute to dysphagia symptoms

Esophageal Symptoms

Gastroesophageal reflux disease (GERD)• Can exacerbate

• Asthma

• COPD

• Apnea

• Bradycardia

• Hypotension

• Globus sensation (feels like lump in throat)

• Can cause pharyngeal, even oral phase problems.

Differential Diagnosis

Dementia• Cognitive

• Anorexia• Immobility

Neurologic• Sudden onset

• Liquids more difficult than solids Progressive obstructive

• Mechanical problem

• Solids more difficult than liquids

Onset of Symptoms

Sudden Slow-progressive Decompensation

• Short-term

• UTI

• URI

• Dehydration

• Changes in medication

Oral Candidiasis Fungal infection-Thrush Systemic

• Antibiotics• Xerostomia• Immunosuppressed• Chronic disease• Malnourished

Local• Dentures

• Ill fitting• Poor hygiene• overwear

Treatment

Dependent on etiology• Dementia

• Neurologic

• Progressive obstructive Dietary management Surgical Enteral feedings Time-frame Follow-up Mealtime observation