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      Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

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          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.

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          Most cited references150

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          A penetration-aspiration scale.

          The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.
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            Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis.

            This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.
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              Dysphagia: current reality and scope of the problem.

              Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.
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                Author and article information

                Journal
                Clin Interv Aging
                Clin Interv Aging
                Clinical Interventions in Aging
                Clinical Interventions in Aging
                Dove Medical Press
                1176-9092
                1178-1998
                2016
                23 February 2016
                : 11
                : 189-208
                Affiliations
                [1 ]Department for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany
                [2 ]Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
                [3 ]Department of Neurology, University Hospital Münster, Münster, Germany
                [4 ]Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
                [5 ]Centro de Investigación Biomédica en Red de enfermadades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
                [6 ]Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Salford Royal Hospital, Salford, UK
                [7 ]Department of Geriatrics, Witten- Herdecke University, Schwelm, Germany
                [8 ]Helios Clinic Schwelm, Schwelm, Germany
                [9 ]Department of Speech, Language and Hearing Sciences, Boston University School of Medicine, Boston, MA, USA
                [10 ]Department of Geriatrics, Alexianer Hospital Krefeld, Krefeld, Germany
                [11 ]Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
                [12 ]Department of Phoniatrics and Pediatric Audiology, University of Marburg, Marburg, Germany
                [13 ]Department of Geriatrics, Marien Hospital Hamburg, Hamburg, Germany
                [14 ]Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
                [15 ]Department of General Internal Medicine and Geriatrics, St John of God Hospital Regensburg, Regensburg, Germany
                Author notes
                Correspondence: Rainer Wirth, Department of Internal Medicine and Geriatrics, St Marien-Hospital Borken, Am Boltenhof 7, D-46325 Borken, Germany, Tel +49 2861 973410, Fax +49 2861 9753410, Email rainer.wirth@ 123456hospital-borken.de
                Article
                cia-11-189
                10.2147/CIA.S97481
                4770066
                26966356
                ede3eb0c-2189-4ca7-b934-7ac1d2ef5f61
                © 2016 Wirth et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Review

                Health & Social care
                aspiration,dehydration,dysphagia,geriatric,malnutrition,older
                Health & Social care
                aspiration, dehydration, dysphagia, geriatric, malnutrition, older

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