[Deglutition disorders in the elderly. Management].
GENERAL PRINCIPLES: The management of dysphagia requires multi-disciplinary interventions, implying various procedures, the choice of which depends on the results of the global prior assessment of the patient. General measures for oral hygiene, dental care and the organization of conditions in which meals are taken are essential, particularly for dependent patients. A change in food texture or in viscosity of liquids is a strategy commonly used. However, such changes must depend on objective bases and not unnecessarily penalize patients or expose them to further risks of complications. COMPENSATION AND RE-EDUCATION TECHNIQUES: Various strategies can help to counteract deficient deglutition mechanisms. Among these, adopting a particular position while swallowing is helpful in many dysphagic patients, but may be limited by severe cervical stiffness. The swallow reflex can be enhanced by sensorial stimulation techniques, although they are only effective short-term. Execution of voluntary maneuvers improves efficacy and safety when swallowing, but learning these maneuvers can be difficult or even impossible, even when accepted by the patients and compliance is inconsistent. Re-education techniques are intended to lastingly improve swallowing, but it is difficult to obtain the active participation of many elderly patients. Furthermore, these commonly used techniques lack seriousness and require validation. MISCELLANEOUS PROCEDURES: The efficacy of pharmacological intervention is not clear, other than in certain particular etiological contexts and, as with procedures enhancing the stimulating properties of food and liquids, will obviously be developed in the future. Surgery, or related techniques, provides help in certain specific conditions, notably when an anatomical disorder is responsible for the disorder. Gastrostomy is still controversial, not only with regard to its optimal practical use and its capacity to decrease respiratory infection risks and improve nutritional prognosis, but also with regard to its impact on patients' survival and quality of life.
Jacquot
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Unité de Réadaptation, Gériatrique, Département de Médecine Physique et Réadaptation, Hôpital Carémeau, C.H.U. 5, rue Hoche, 30029 Nimes. jean.marc.jacquot@chu-nimes.fr
Pouderoux
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Strubel
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D000367:Age Factors; D000368:Aged; D001676:Biofeedback, Psychology; D002986:Clinical Trials as Topic; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D004576:Electromyography; D004750:Enteral Nutrition; D005774:Gastrostomy; D006801:Humans; D011187:Posture; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors
Les troubles de la déglutition du sujet âgé. Prise en charge.