Like postural techniques, effectiveness of sensory stimuli can be assessed during instrumental evaluation. dysphagia, which comes from the Greek wordsdys(difficulty) andphagia(to eat), refers to the sensation of food being delayed or hindered in its passage from the mouth to the stomach. Dysphagia may be classified anatomically as either oropharyngeal or esophageal. Oropharyngeal, or transfer, dysphagia is related to the initiation of the swallow (ie, the movement of a food bolus from the hypopharynx to the esophagus). Esophageal dysphagia arises in the body of the esophagus and relates to difficulty in passing food to the stomach. Dysphagia may result either from mechanical obstruction or altered motor function along the area of food passage. The elderly are at an increased risk for development of dysphagia due to illnesses that affect the swallowing mechanism. To better serve this vulnerable group of patients, healthcare providers must inquire about the presence of dysphagia and have a working knowledge of its pathophysiology. This review addresses several commonly encountered questions about caring for elderly persons with dysphagia, including a discussion on the mechanisms crucial to normal swallowing and how they may be affected by the aging process. == How Common Is usually Dysphagia in the Elderly Population? == The true prevalence of dysphagia is usually higher in the elderly population than the general population. Although the prevalence of dysphagia in the Midwestern US population was reported to be 6% to 9%,1its prevalence in community-dwelling persons over age 50 years is usually estimated to be between 15% and BQCA 22%.2-4The prevalence of dysphagia BQCA is even higher in those residing in assisted living facilities and nursing homes, where up to 40% to 60% of residents are reported to have feeding difficulties.4,5Irrespective of age, dysphagia is commonly associated with certain diseases such as cerebrovascular accidents, amyotrophic lateral sclerosis, Parkinson disease (PD), myasthenia gravis, and tardive dyskinesia, all of which increase in prevalence with aging. The prevalence of dysphagia is usually expected to increase rapidly in the near future, given the demographic trends in the United States. According to data released by the US Census Bureau, between January 2000 and July 2009, the total US population increased by 9%, the number of persons age 65 years and older increased by 13%, and the number of persons age 85 years and older increased by 32%. For the next 18 years, 10,000 more Americans will become seniors each day because of the aging Baby Boomer population. It is expected that by 2030, 1 in 5 US residents will be age 65 years or older.6With the rapid growth of the aging population, it is not surprising that dysphagia is increasingly recognized as an important national healthcare issue that is associated with enormous cost. == What Is the Physiology of Normal Swallowing? == Swallowing represents a function that involves more than 30 nerves and muscles.7Bolus preparation and passage from the BQCA oral cavity into the esophagus are volitional, while further passage across the aerodigestive tract to the stomach is reflexive. After initiation of a swallow, it takes less than 1 second for a bolus to reach the esophagus2and an additional 10 to 15 seconds to complete Rabbit Polyclonal to ADA2L the swallow. On average, a person performs approximately 600 swallows each day effortlessly. The swallowing centers are bilaterally represented within the central nervous system, and the degree of each hemispheric representation seems to be critical in determining recovery of the swallowing function after a dysphagic stroke.8 Swallowing is conventionally described as 3 anatomic phases: oral, pharyngeal, and esophageal (Determine 1). The oral phase is the volitional component of swallowing activity, which prepares and propels food into the pharynx and involves use of the cranial nerves V (trigeminal), VII (facial), and XII (hypoglossal). The pharyngeal phase of swallowing involves sealing of the airway and projection of the bolus into the esophagus. This mechanism is usually mediated reflexively and involves cranial nerves V (trigeminal), X (vagus), XI (accessory), and XII (hypoglossal). The esophageal phase further propels the bolus into the stomach by coordinated esophageal peristalsis and relaxation of the lower esophageal sphincter. Salient features of the normal swallowing mechanism are depicted inFigure 1. == Physique 1. == Salient features of the normal swallowing.