title: Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting.
abstract: Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.
authors.affiliation: Department for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany; Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Wirth
authors.affiliation: Department of Neurology, University Hospital Münster, Münster, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
authors.affiliation: Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Beck
authors.affiliation: Centro de Investigación Biomédica en Red de enfermadades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Clavé
authors.affiliation: Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Salford Royal Hospital, Salford, UK.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Hamdy
authors.affiliation: Department of Geriatrics, Witten- Herdecke University, Schwelm, Germany; Helios Clinic Schwelm, Schwelm, Germany.
authors.forename: Hans Juergen
authors.initials: HJ
authors.lastname: Heppner
authors.affiliation: Department of Speech, Language and Hearing Sciences, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Langmore
authors.affiliation: Department of Geriatrics, Alexianer Hospital Krefeld, Krefeld, Germany.
authors.forename: Andreas Herbert
authors.initials: AH
authors.lastname: Leischker
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, Toronto, Canada.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Martino
authors.affiliation: Department of Phoniatrics and Pediatric Audiology, University of Marburg, Marburg, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Pluschinski
authors.affiliation: Department of Geriatrics, Marien Hospital Hamburg, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rösler
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
authors.affiliation: Department of Neurology, University Hospital Münster, Münster, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Warnecke
authors.affiliation: Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany; Department of General Internal Medicine and Geriatrics, St John of God Hospital Regensburg, Regensburg, Germany.
authors.forename: Cornel Christian
authors.initials: CC
authors.lastname: Sieber
authors.affiliation: Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Volkert
mesh_terms: D000368:Aged; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology* / Q000534:rehabilitation*; D003681:Dehydration / Q000453:epidemiology; D003704:Dementia / Q000150:complications; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy / Q000453:epidemiology; D010300:Parkinson Disease / Q000150:complications; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D065908:Transcranial Direct Current Stimulation; D050781:Transcranial Magnetic Stimulation
keywords: aspiration; dehydration; dysphagia; geriatric; malnutrition; older