title: Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis.
abstract: BACKGROUND
  Age-related loss of swallowing efficiency may occur for multiple reasons. Objective assessment of individual dysfunctions is difficult and may not clearly differentiate these from normal. Pharyngeal pressure-flow analysis is a novel technique that allows quantification of swallow dysfunction predisposing to aspiration risk based on a swallow risk index (SRI). In this study, we examined the effect of ageing on swallow function.
  
  
  METHODS
  Studies were performed in 68 healthy subjects aged 20-91 years (mean 59 years; 29 male), asymptomatic for oropharyngeal disease. Swallowing of liquid and viscous boluses was recorded with a pressure-impedance catheter. Indices of swallow function including the SRI, postswallow residues, upper esophageal sphincter opening and bolus transit time were derived using purpose designed software.
  
  
  RESULTS
  Swallow function worsened with increasing age with a significant decline after 80 years. Higher SRI correlated with increasing age (r = 0.257, p < 0.05 for liquids and r = 0.361, p < 0.005 viscous bolus). Subjects over 80 years were overrepresented amongst those with an SRI considered diagnostically relevant (SRI > 15). In addition, upper esophageal sphincter opening was reduced and postswallow residues increased in older subjects.
  
  
  CONCLUSIONS
  Pharyngeal pressure-flow analysis reveals multiple functional abnormalities in older individuals. The higher SRI levels seen in asymptomatic elders possibly reflect a loss of functional reserve with ageing. Automated impedance manometry analysis of swallow function may allow the risk of developing disordered swallowing to be quantified numerically.
authors.affiliation: Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia; School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia; Department of Gastroenterology and Hepatology, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: T I
authors.initials: TI
authors.lastname: Omari
authors.forename: S
authors.initials: S
authors.lastname: Kritas
authors.forename: C
authors.initials: C
authors.lastname: Cock
authors.forename: L
authors.initials: L
authors.lastname: Besanko
authors.forename: C
authors.initials: C
authors.lastname: Burgstad
authors.forename: A
authors.initials: A
authors.lastname: Thompson
authors.forename: N
authors.initials: N
authors.lastname: Rommel
authors.forename: R
authors.initials: R
authors.lastname: Heddle
authors.forename: R J L
authors.initials: RJ
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010614:Pharynx / Q000502:physiology*; D011312:Pressure; D055815:Young Adult
keywords: ageing; aspiration; bolus residue; deglutition; electric impedance; manometry