Swallow respiratory patterns and aging: presbyphagia or dysphagia?
BACKGROUND
Assessment referrals are increasing for unexpected dysphagia, particularly for older people. It is unclear if this is due to more impaired swallows or healthy age-related changes. Swallow respiration coordination prevents aspiration, and may deteriorate with age. Nonpathological features of the swallow in healthy aging and the factors that influence an individual's ability to eat and drink safely need greater understanding. Some changes might predispose an older person to dysphagic complications in the event of an insult such as a stroke. We investigated the effects of healthy aging on resting and swallow respiratory patterns.


METHODS
Fifty healthy volunteers (aged 20-78 years) were recruited to have swallow respiration patterns recorded on a computer. Bolus volume and consistency variations were studied: 5 and 20 ml of water and 5 ml of yogurt.


RESULTS
Measurable swallows significantly decreased with age for water boluses. Swallow apnea increased with age (5 ml of water r = 0.433, p = .002; 5 ml of yogurt r = 0.367, p = .023). Independent of age were: breathing out (occurred after 98% of boluses); multiple swallowing (occurred with all bolus types); post-swallow respiration reset pattern (more irregular after yogurt, Wilcoxon signed rank Z = -2.236, p = .025); and resting respiration.


CONCLUSIONS
Subtle changes occur in swallow respiration coordination with age. These changes may be compensatory protective mechanisms rather than the result of decreased muscle mobility or reaction times, and not indicative of impairment. Misattributing healthy age-related changes to impairment affects patient care and the use of healthcare resources.
Leslie
Paula
P
School of Surgical and Reproductive Sciences, Faculty of Medical Sciences, University of Newcastle, Newcastle-upon-Tyne, NE2 4HH, United Kingdom. paula.leslie@ncl.ac.uk
Drinnan
Michael J
MJ
Ford
Gary A
GA
Wilson
Janet A
JA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology; D001049:Apnea / Q000175:diagnosis*; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012119:Respiration; D015656:Respiratory Mechanics; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric