Presbyphagia: A Closer Look
The term “presbyphagia” refers to natural changes within the swallowing mechanism for aging adults. As the prevalence of swallow disorders increases with age, the characteristics of presbyphagia may put the patient at risk for aspiration. A contributing factor to these common changes as we age is sarcopenia (the loss of muscle mass associated with the natural aging process). Studies have determined that the natural deterioration of buccal (cheek), labial (lip), and lingual (tongue) strength, range of motion, and coordination may result in reduced intake, prolonged mastication, reduced ability to control food or liquids in the mouth (bolus cohesion and control) and slowed swallowing (A-P transit). These changes may result in decreased PO intake, malnutrition, and increasing risk for aspiration pneumonia.
These changes may result in decreased PO intake, malnutrition, and increasing risk for aspiration pneumonia.
Declines in lung function (pulmonary elasticity) and respiratory muscle strength have been associated with the normal aging process which contributes to a productive cough response, which serves as a defense mechanism for the respiratory system. Therefore, possibility of decreased lung function can be viewed as an attributing cause of aspiration.
When presbyphagia is compounded by an onset of a new disorder (such as a stroke), gradual decline due to a progressive disease (such as Parkinson’s disease), or a new health condition (i.e., surgery requiring intubation) the level of dysphagia can increase. This should be confirmed by an instrumental assessment such as a Modified Barium Swallow Study (MBSS). A speech-language pathologist may then create an intervention plan consisting of swallow strategies, oropharyngeal/respiratory exercises, and diet modifications to reduce residues and incidence of penetration and aspiration. When working with patients with cognitive impairments, implementation of swallow strategies and exercises may not be an option. With these individuals, a modified diet may be the safest option but of course, should be a last resort.