For Speech-Language Pathologists (SLPs) who work with the aging population, it is essential to understand normal swallowing physiology changes that occur with age. This is important because we don’t want to label someone who has “normal” age-related swallowing changes as having dysphagia.
Functional Vs. Normal Swallowing
Aging aside, we know that there is a range of what is considered “normal” for swallowing. In fact, at CSP we prefer to use the term “functional” versus “normal” when describing swallowing. As we age, there are changes in swallow onset, as it has been found that material tends to fall deeper into the pharynx prior to swallow onset and there may be a longer bolus dwell time. Laryngeal penetration and aspiration are observed more frequently with each decade of life. There is often more pharyngeal residue with age as the pharyngeal lumen tends to widen over time due to sarcopenia.
Other changes that may be noted are dentition changes, such as loss of teeth or the use of dentures. Consequently, wearing dentures can impact the proprioception of determining hardness to signal how hard to bite. There is also a reduction in salivary flow and mucus tends to be thicker. There is a decrease in fast-twitch muscle fibers. Therefore, we may see decreased lingual and pharyngeal pressures. Some experience reduced tactile sensation and taste sensation with age.
Age-Related Swallowing Changes
Collectively these age-related changes may impact our patient’s overall swallow function or oral intake. These swallowing changes may not be optimal, but they don’t necessarily mean the swallow is impaired. Our skilled and knowledgeable clinicians can look at the big picture and help assist with a plan of care to improve swallow safety and efficiency. Also, in CSP’s FEES training courses, we discuss the impact of aging on overall swallow function.
Butler, S. G., Stuart, A., Markley, L. & Rees, C. (2009). Penetration and aspiration in healthy older adults as assessed during endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol., 118(3), 190-198.
Butler, S. G., Stuart, A., & Kemp, S. (2009). Flexible endoscopic evaluation of swallowing in healthy young and older adults. Ann Otol Rhinol Laryngol, 118(2), 99-106.
Butler, S. G., Stuart, A., Feng, X., Rees, C., Williamson, J. & Kritchevsky, S. (2010). Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope, 120, 2147-2152.
Butler, S. G., Stuart, A., Markley, L., Feng, X, Kritchevsky, S. B. (2017). Aspiration as a function of age, sex, liquid type, bolus volume, and bolus delivery across the healthy adult life span. Annals of Otology, Rhinology & Laryngology 1-12.
Dua, K. S., Ren, J. Bardan, E., Xie, P., & Shaker, R. (1997). Coordination of the deglutitive glottal function and pharyngeal bolus transit during normal eating. Gastroenterology, 112(1), 73-83.
Humbert IA, Robbins J. Dysphagia in the elderly. Phys Med Rehabil Clin N Am. 2008;19(4):853-x. doi:10.1016/j.pmr.2008.06.002
Langmore, SE, Skarupski, KA, Park, PS, &Fries, BE. (2002) Predictors of aspiration in nursing home residents. Dysphagia, Fall; 17(4) 298-307.
Langmore, SE, Terpenning, MS, Schork AS, Yinmiuao, C, Murray, J, Lopatin, D, Loesche, WJ. (1998). Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia 13 69-81.
Matsuo, Koichiro and Palmer, Jeffery B. (2008) Anatomy and physiology of feeding and swallowing – normal and abnormal. Phys Med Rehabil Clin N Am, November: 19(4) 691-701.Robbins, J., Hamilton, J. W., Lof, G. L, & Kempster, G.B. (1992). Oropharygneal swallowing in normal adults of different ages. Gastroenterology, 103(3). 823-829.