Sarcopenia Structurally, sarcopenia is associated with age-related reductions in muscle mass and crosssectional area, a reduction in the number or size of muscle fibers, and a transformation or selective loss of specific muscle fiber types (18). Sarcopenia is inherently associated with diminished strength. There are reports in the literature of sarcopenia-like changes in muscles of the upper aerodigestive tract (19–21) and the observed age-related changes in strength and function (5,6) suggest pervasive changes in lingual muscle composition (22–24). Ongoing work is generating novel interventions effective for diminishing sarcopenia and increasing strength. Although most of the initial work in this area has been performed in the limb musculature, emerging work in cranial-innervated muscles is quite relevant to swallowing in older individuals and will be discussed later in more detail.
Abstract The risk for disordered oropharyngeal swallowing (dysphagia) increases with age. Loss of swallowing function can have devastating health implications including dehydration, malnutrition, and pneumonia, as well as reduced quality of life. Age-related changes place older adults at risk for dysphagia for two major reasons: One is that natural, healthy aging takes its toll on head and neck anatomy and physiologic and neural mechanisms underpinning swallowing function. This progression of change contributes to alterations in the swallowing in healthy older adults and is termed presbyphagia, naturally diminishing functional reserve. Second, disease prevalence increases with age and dysphagia is a co-morbidity of many age-related diseases and/or their treatments. Sensory changes, medication, sarcopenia and age-related diseases are discussed herein. Relatively recent findings that health complications are associated with dysphagia are presented. Nutrient requirements, fluid intake and nutritional assessment for older adults are reviewed relative to their relations to dysphagia. Dysphagia screening and the pros and cons of tube feeding as a solution are discussed. Optimal intervention strategies for elders with dysphagia ranging from compensatory interventions to more rigorous exercise approaches are presented. Compelling evidence of improved functional swallowing and eating outcomes resulting from active rehabilitation focusing on increasing strength of head and neck musculature is provided. In summary, while oropharyngeal dysphagia may be life-threatening, so are some of the traditional alternatives, particularly for frail, elderly patients. While the state of the evidence calls for more research, this review indicates the behavioral, dietary and environmental modifications emerging in this past decade are compassionate, promising and in many cases preferred alternatives to the always present option of tube feeding.