AGE –RELATED CHANGES IN EATING AND SWALLOWING FINAL 2.pptx

ppt on swallowing

1. AGE –RELATED CHANGES IN EATING AND SWALLOWING Submitted by –Sonali Gupta Submitted to – Appas Saha

2. INTRODUCTION The word presbyphagia refers to all changes in swallowing physiology that occur as people grow older. Primary presbyphagia refers to changes in deglutition patterns that occur naturally as individuals mature. Primary presbyphagia is not a disease in and of itself, but it does lead to a more generalized, naturally decreased functional reserve, making older adults more vulnerable to dysphagia. Secondary presbyphagia occurs when swallowing problems emerge in the elderly as a comorbidity of a specific condition, such as stroke or neurological disorders. Each step of deglutition is affected by increasing age.

3. The most essential influencing variables in the oral preparatory phase are decreased input for smell and taste, as well as a frequently multifactorial cause of dry mouth. Sarcopenia, or the  agingrelated  decrease of skeletal muscle mass, strength, and quality, has a negative impact on the oropharyngeal phase. The swallowing reflex is delayed due to diminished sensory feedback from the oropharyngeal mucosa. Finally, as individuals become older, connective tissue flexibility declines and the axial skeleton alters, resulting in a variety of swallowing patterns.

4. Dysphagia is more common as people get older, with 10–20 percent of people over 65 years old having swallowing problems. There are a number of anatomical and physiological changes that affect the way we eat and  swallow as we become older.  Aging is associated with ossification of the hyoid bone, thyroid, and cricoid cartilages, atrophy of intrinsic laryngeal muscles, dehydration of the laryngeal mucosa, loss of suppleness of laryngeal ligaments, and flaccidity and bowing of the vocal folds. The degree and length of hyolaryngeal excursion and laryngeal vestibule closure are  affected by these alterations.  While chewing function is preserved, muscle weakness and tooth loss have an impact on  meal choices, chewing efficiency, and post-swallow oral residue.

5. Reduced tongue pushing force and slight delays in activating the swallow reflex  increase pharyngeal residue, resulting in a faster rate of swallow clearing but no increase in penetration or aspiration. The duration of laryngeal excursion and closure is maintained until around the age of 60, after which it starts to deteriorate. There are also sensory changes, such as a loss of taste and a reduction in olfaction  appreciation (smell). Daily drug use, which is frequent in old age, has been shown to have a deleterious  impact on taste and olfaction.

6. The anorexia of ageing is characterized by a decrease in food intake as a result of normal ageing. The stomach fundus is less flexible, allowing for a higher filling of the stomach antrum,  which signals the central nervous system to stop eating. A reduction in food consumption may put you at risk for muscle wasting.  Sarcopenia is defined as a severe decrease of muscle mass and function, which is a  hallmark feature of frailty. While sarcopenia is most typically connected with the appendicular skeletal muscles used for  walking and hand grip, it can also affect the muscles used for eating and swallowing.  With ageing and changes in muscle fiber composition, there is a cross-sectional reduction in jaw muscles.

7. Muscle fiber alterations can also be seen in the aged diaphragm, where Type II muscles are atrophying. These alterations diminish the efficiency of expulsive airway behaviors like coughing and sneezing, creating a mechanism that raises the chance of pneumonia developing. In muscles involved in eating and swallowing, age-related fatty infiltration has been discovered.  The geniohyoid muscle, for example, has been found to have fatty infiltration and plays a function in the anterior and superior movement of the hyoid during swallowing.  Despite the fact that the authors hypothesized that fat infiltration of the geniohyoid would be linked to an increased risk of aspiration. Reduced tongue strength is linked to high levels of sarcopenia . Reduced tongue strength has been linked to a higher risk of aspiration by increasing the possibility of bolus retention in the pharynx .

8. Aspiration Risk: Healthy and Frail Elders More than  twothirds  of frail elderly patients experienced oropharyngeal residue, more than half experienced laryngeal penetration of the bolus, and 17 percent had tracheobronchial aspiration, according to a research.  Oropharyngeal residue was connected to impaired tongue propulsion and delayed hyolaryngeal excursion across all liquid thickness levels. Where as healthy controls lacked these characteristics.

9. Choking Risk: Healthy and Frail Elders Choking is seven times more common in people over 65 than it is in children aged 1–4 years, with men having a larger risk than women.  A diagnosis of pneumonitis is connected with an increased risk of choking on food, which is particularly important.  Food choking is made more likely in adults by poor dentition and the use of sedatives and psychiatric drugs. The physical texture, size, and form of foods are all factors that enhance the danger of choking.  Choking can be caused by fibrous, hard, solid, stringy, chewy, sticky, dry, crumbly, brittle foods, or foods formed in such a way that they can occlude the airway (round or long).

10. Feature That Increases Risk of Eating or Swallowing Problems in Elders Impact And Evidence of Increased Risk Associated With Individual Features Increased age: Aged more than 65 years Increased Risk of Choking on Food Increased Likelihood of Dysphagia Diagnosis Increased Diagnosis of Frailty Poor dental status: Dental disease, missing teeth, poorly fitting dentures Increased risk of choking on food Postural instability during meals Difficulty maintaining postural stability during meals more likely in frail than robust elders . Difficulty maintaining head position during meals more likely in frail than robust elders Poor mobility Bedfast, increased likelihood to develop aspiration pneumonia

11. Feature That Increases Risk of Eating or Swallowing Problems in Elders Impact And Evidence of Increased Risk Associated With Individual Features Fatigue during meals Reduced ability to tolerate the physical effort of a meal more likely in frail elders than robust elders Sedative, opioid or antipsychotic medication Sedative, opioid or antipsychotic types of medication affect the effectiveness of cough and swallowing reflexes and have been associated with increased choking risk Individuals older than 85 years take a larger proportion of medications that affect level of consciousness or swallowing response Chronic vs. Acute lung infection Fever one day per week for several months associated with lung infection increases likelihood of developing aspiration pneumonia Reduced hand grip strength Weak hand grip strength more than x2 likely to develop dysphagia, although further research required

12. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. Aging can be simply defined as growing older regardless of chronologic age. It is a universal and expected process that results in physiologic decline. In contrast, senescence is the state of old age reached in the later years of life. Primary aging  is the whole of the degenerative and involutional changes that happen with age. Secondary aging is the entirety of changes that happen with age as a result of outward or natural variables, specifically, disease.

13. Due to changes in eating and swallowing function as gets older, there is a natural inclination for elders to self-select ‘soft' foods due to tooth loss and chewing fatigue.  However, tooth loss and poor dental health are linked to an increased risk of choking, especially as people get older. Aging is just the process of becoming older, regardless of chronological age.  It is an inevitable and universal process that leads to physiologic deterioration. Senescence, on the other hand, is the state of old age that occurs in the final years of life. The term "primary ageing" refers to all of the degenerative and involutional changes that occur as people get older. Secondary ageing refers to all of the changes that occur with age as a result of external or natural factors, such as disease.

14. Old age is a time when diseases become more severe and numerous, making it increasingly difficult to distinguish between primary and secondary ageing. Although this degree is difficult for people to gain, it has little practical value in clinical geriatrics. The concept of a person maturing, or the fascinating expression of both essential and ageing as controlled by hereditary factors, is far more valuable. The effects of ageing on a person's organ systems vary in terms of frequency and severity. The rate of deterioration and the level of execution needed of a system determine functional decay.

15. Minor alterations will be detected using advanced diagnostic or physiologic tests, as previously stated. When  agerelated  degeneration reaches a critical point, the physiology of the organ framework is permanently altered. Still, when the framework is forced to function in reaction to stress, modifications ranging from inefficiency to ineffectiveness may be detected. At the point of weakening, brokenness cannot be likened to impairment on the off chance that the system's execution prerequisites are kept up at baseline or resting levels. 

16. As a result, maturation can be viewed as a dynamic loss of energy range in physiologic work, reducing the ability to efficiently respond to inner or external pressure and maintain homeostasis. The holistic approach is embraced and fostered by geriatric medicine because of the variety and interrelationships of the difficulties affecting the elderly. The old are thought to have devised effective psychologic, behavioural , and physiologic compensations to deal with the numerous restrictions that come with ageing. These standards reflect a belief that ageing is a foundation of modified alteration that is altered by disease. It's possible that the rate of organ system breakdown will increase.

17. Medical and psychosocial disorders that can be fixed are sought out and managed. For chronic illnesses, care and alleviation are prioritized over cure, and every effort is made to maximize residual function. Risk vs. benefit, individual autonomy, and self-image are all important considerations in the decision-making process. It may be difficult to change the rate of organ system degeneration. Execution prerequisites, on the other hand, are frequently not fixed and can be modified to avoid or limit malfunction. Before a disease is classified, care should be exercised unless an age-related malfunction results in disability that contributes considerably to ill-health.

18. The association between oropharyngeal deglutition and ageing is a bit of a paradox.  On the one hand, because nourishment and hydration are essential for survival, it would appear that the swallowing process is one of the physiologic systems that ages well. The ROSS test appears to be a simple and safe investigative technique that can offer quantitative measures of particular swallowing indices with a high degree of accuracy. Multiple swallows to clear the oral cavity are more common in the elderly, which represents an age related shift in swallowing pattern rather than  morphodynamic  changes.  This pattern was seen in 38% of controls, showing that it is not an abnormal finding. T he oropharyngeal pump may fire numerous times before all of the bolus is moved from the oral cavity, independent of age or kind of preswallowing activity.

19. Aging-related changes in swallowing, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques Authors: Chin-Man Wang, Ji- Yih Chen, Chiung -Cheng Chuang, Wen-Chun Tseng, Alice MK Wong and Yu-Cheng Pei Geriatr Gerontol Int 2015; 15: 736–744 AIM: To identify aging-related changes in swallowing and the synchronization of swallowing and respiration in a population of healthy adults by using integrated non-invasive techniques. METHODS- Hardware and software A noninvasive electrophysiological monitoring device based on the BIOPAC MP100 system was utilized to assess swallowing. Piezoelectric sensors were used to quantify laryngeal movement, and two Medi-Trace 100 ECG 3-cm conductive electrodes were used to measure submental  sEMG  activity.

20. Study participants

21. RESULTS:

22. Oral and pharyngeal transit time as a factor of age, gender, and consistency of liquid bolus   Authors: J Nikhil, Rahul K Naidu, Gayathri Krishnan, R Manjula J Laryngol Voice 2014;4:45-52

23. Methods:

24. Results and Discussion :