Dysphagia (difficulty swallowing)

Dysphagia is a swallowing disorder in which the swallowing process is impaired. The difficulties in dysphagia can occur in multiple stages of swallowing. Swallowing disorders are common among the elderly population.

Globally, it affects 10 to 33 percent of older adults, especially those who have experienced a heart attack or neurological diseases such as Parkinson’s and Alzheimer’s.

In general, dysphagia can be divided into three major categories: oral, pharyngeal and esophageal; respectively affecting the mouth cavity, the pharynx or upper part of the digestive tract and the esophagus. In surgerical contexts, oral and pharyngeal dysphagia are often grouped together as oropharyngeal dysphagia.

Oropharyngeal dysphagia is often seen in chronic neurological disorders, particularly in cases of Parkinson’s disease, stroke and Alzheimer’s disease. It is not a result of the normal aging process, but can be an early sign of neuromuscular disorder. Symptoms of oropharyngeal dysphagia include choking, coughing, nasal regurgitation, difficulty swallowing, having to swallow multiple times to clear food from the mouth, and drooling. These symptoms occur in the throat and area.

Gastroesophageal reflux disease (GERD), functional esophageal disorders and esophagitis are the most common causes of esophageal dysphagia. Less common causes include medication, obstructive lesions and esophageal motility disorders. With esophageal dysphagia, the main symptom is the sensation that food gets stuck after swallowing, while there are no issues with the act of swallowing itself.

Older people are often unaware that they have swallowing difficulties, even though they may suffer from some degree of dysphagia and silent aspiration. This is especially comming in individuals with Parkinson’s disease, dementia and sarcopenia.

Dysphagia can lead to malnutrition, reduced quality of life, dehydration, weight loss and aspiration pneumonia.

According to Ueshima et al. (2021), approximately 40% of people with dysphagia are at risk of malnutrition and around 13.6% of those at risk of malnutrition have dysphagia. Furthermore, the co-occurrence of dysphagia and malnutrition is estimated to range between 3% and 29%. The fear of choking, anorexia and a reduced preference for food due to the modified textures can make patients with oropharyngeal dysphagia more susceptible to malnutrition and inadequate food intake. Additionally, texture-modified food is generally lower in nutrients and more likely to cause malnutrition and sarcopenia compared to a standard diet.

Malnutrition leads to general muscle loss and atrophy of the muscles involved in the swallowing process, which promotes the development of dysphagia. It is therefore important to assess the nutritional status of all patients with dysphagia.

People with dysphagia live with reduced physical swallowing function and a heavy psychological burden, which can lead to decreased quality of life.

According to studies, general dehydration, reduced fluid in body cells and decreased saliva production are observed in elderly individuals with oropharyngeal dysphagia. This may be related to a loss of thirst sensation, reduced water intake and the loss of body fluids with lower osmolarity than plasma. Patients with dysphagia are at higher risk of dehydration, which result in morbidity and hospital readmission.

According to Yoshimatsu et al. (2022), aspiration pneumonia is a type of pneumonia associatied with dysphagia. It is also defined as the risk of pneumonia. Although neither dysphagia nor aspiration necessarily involve infection, the impaired swallowing mechanism allows liquids or food to enter the airway, potentially leading to aspiration. In aspiration, food particles reach the lungs. It is one of the most significant health risks in the elderly with dysphagia.

One of the primary therapeutic goals in improving the effectiveness and safety of food consumption in dysphagia is the modification of food texture. The consistency of solid and liquid foods is adjusted according to the patient’s characteristics. These adjustments can be made in accordance with the IDDSI framework.

IDDSI is the abbreviation for International Dysphagia Diet Standardization Initiative. This framework was developed with the aim of creating an internationally standardized terminology for texture-modified foods. Thee lack of such standardized terminology has been a major barrier, not only to the treatment of dysphagia, but also to research on its condition, making this framework highly important. Modifying food consistency is a key element in the treatment of dysphagia.