[Deglutition disorders in the elderly. Evaluation methods].
FROM DISCOVERY TO CLINICAL DIAGNOSIS: Dysphagia is easy to diagnose in its acute stage and when complicating a known neurological disease. However diagnosis may be greatly delayed when expressed by respiratory or nutritional symptoms, or when the patient presents cognitive disorders, as is frequent in the elderly. In such instances, simple tests such as the water test are clearly indicated. However, although they are reliable for diagnosing dysphagia, they are not precise in diagnosis of inhalation. Clinical examination is essential for diagnosing the etiology of the disorder. In the absence of clinical orientation, a nasofibroscopy is mandatory and digestive endoscopy debatable. SPECIALIZED EXAMINATIONS: The first-line supplementary examination is a videoradiography. It consists in the patient swallowing a liquid or solid barium sulfate bolus. This detects any anatomical or functional abnormalities. It is the examination of choice for the diagnosis of inhalation and its mechanism. Videoendoscopy is complementary to videoradiography. It can be conducted in first intention in patients who cannot be transported to the radiology unit. It provides precise information on glottal closing and pharyngeal contraction. IMPACT ON MANAGEMENT: In a restricted number of patients, the precise knowledge of the mechanism of dysphagia can help to orientate specific treatment. In others, such examinations will orient re-education, postural adaptation and the modification of food texture. In many patients, precise diagnosis of the mechanism at the origin of dysphagia has no impact on the management of dysphagia.
Pouderoux
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Service d'Hépato-Gastroentérologie, Unité de Réadaptation Gériatrique, Hôpital Caremeau, CHU de Nimes, Avenue du Professeur Robert Debré, 30900 Nimes. philippe.pouderoux@chu-nimes.fr
Jacquot
J M
JM
Royer
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E
Finiels
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H
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004576:Electromyography; D004724:Endoscopy; D006801:Humans; D008365:Manometry; D015203:Reproducibility of Results; D013997:Time Factors; D014741:Video Recording
Les troubles de la déglutition du sujet âgé. Procédés d'évaluation.