General Medical Information

Presbyphagia

Byron J. Bailey

Swallowing disorders and aspiration are serious problems in a limited segment of the elderly population. Among the ambulatory elderly, dysphagia is an uncommon diagnosis, but about 12% of hospitalized patients have swallowing disorders, with an incidence of about 33% on neurology-neurosurgery services. Almost 50% of residents in some nursing homes need physical assistance with feeding. The incidence and severity of dysphagia have not been precisely determined at the present time.

Aspiration is swallowing spillover into the tracheobronchial tree and may produce cough, intermittent fever, tracheobronchitis, pneumonia, atelectasis, or empyema. Neurologic disorders are common predisposing factors; these include stroke, epilepsy, drugs, tumors, and infection. Many forms of neurologic disorders may contribute to dysphagia and aspiration.

It has been shown that sensory discrimination declines in the oral cavity with aging, and recently Aviv reported that there is a progressive decrease in pharyngeal sensation with increased age as well. They propose that sensory loss in the hypopharynx and larynx is a significant factor in some elderly patients who have problems with aspiration.

Some elderly patients suffer from dysphagia secondary to cricopharyngeal muscle dysfunction, sometimes termed cricopharyngeal achalasia. These patients have an unexplained failure of the upper esophageal sphincter to relax completely in a coordinated manner. Recent reports suggest that most of these patients can be helped by a surgical procedure (cricopharyngeal myotomy).

Details of evaluating and managing these patients are presented in other relevant chapters. Many therapeutic options are available to enhance laryngeal function and swallowing and to prevent the potentially fatal consequences of chronic aspiration.