References
Dysphagia in the older person: an update
Abstract
Dysphagia is a common condition in the older person. Linda Nazarko provides an update on its identification and management
Dysphagia is thought to affect around 4 million people in the UK. It becomes more common as people age and is associated with frailty and poor outcomes. This article aims to update practice nurses on the clinical features of dysphagia, how to identify it, when to refer and how it is managed.
Dysphagia literally means difficulty eating, drinking or swallowing (Royal College of Speech and Language Therapists (RCSLT), 2022). Intact motor and nervous systems are essential to enable normal swallowing. The prevalence of conditions that affect swallowing rises with age (Patel et al, 2018; Cohen et al, 2021). The number of older people in the UK population is rising, so increasing numbers of people are at risk of dysphagia. The number of people aged 90 years and over in the UK has increased by more than 250% in the last 30 years, and was 609 503 in mid-2020 (Office for National Statistics, 2021).
There are four phases in a normal swallow (Table 1). Oropharyngeal dysphagia is described as difficulty initiating a swallow or passing food through the region of the mouth or throat. Oesophageal dysphagia refers to difficulty in transferring material down the oesophagus in the retrosternal region (Malagelada et al, 2015). Although oropharyngeal dysphagia can occur in up to 50% of older people and 50% of people with neurological conditions, and is associated with aspiration, severe nutritional and respiratory complications and even death, it is under-diagnosed and under-treated. Oesophageal dysphagia is less common and less severe, but with better recognised symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. There is a growing awareness among health professionals of oropharyngeal dysphagia (Clavé and Shaker, 2015).
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