Elsevier

Geriatric Nursing

Volume 29, Issue 4, July–August 2008, Pages 275-285
Geriatric Nursing

Feature article
Dementia and Dysphagia

https://doi.org/10.1016/j.gerinurse.2007.10.015Get rights and content

In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.

Section snippets

Dysphagia

Dysphagia is the term used to describe disordered swallowing regardless of etiology. Logemann18 explained dysphagia as difficulty moving food from the mouth to the stomach and includes problems with “behavioral, sensory, and preliminary motor acts in preparation for the swallow, as well as cognitive awareness of the upcoming eating situation, visual recognition of food, and all of the physiologic responses to the smell and presence of food (pg 1).” For example, sensory damage can produce

Dysphagia and Dementia

When present, dysphagia predisposes individuals with dementia to dehydration, malnutrition, weight loss, and aspiration pneumonia.48, 49, 50 Aspiration of food and or secretions may predispose individuals to respiratory complications, aspiration pneumonia, and possibly death.51 With loss of vitality, dementia patients may become more dependent on others for care and more susceptible to depression. Because depression is frequently associated with loss of appetite, a vicious cycle may develop

Summary

See Table 1 for a summary of important points discussed in this article.

Swallowing is the safe and efficient movement of a bolus from the mouth to the stomach without aspiration. Like many physiologic functions, swallowing is subserved by a neural network that involved cortex, subcortical areas, brainstem, and cranial nerves. Age-related changes in sensation, dentition, and muscle strength make swallowing less efficient and problematic in many older neurologically adults. Dysphagia is the term

CARYN EASTERLING, PhD, CCC, BRS-S is an assistant professor with the Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI.

References (95)

  • M.S. Claggett

    Nutritional factors relevant to Alzheimer's disease

    J Am Diet Assoc

    (1989)
  • J.L. Fuh et al.

    Swallowing difficulty in Parkinson's disease

    Clin Neurol Neurosurg

    (1997)
  • G.H. McCullough et al.

    Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke

    J Commun Disord

    (2001)
  • T. Durnbaugh et al.

    Assessing problem feeding behaviors in mid-stage Alzheimer's disease

    Geriatr Nurs

    (1996)
  • T.E. Finucane et al.

    Use of tube feeding to prevent aspiration pneumonia

    Lancet

    (1996)
  • S.L. Mitchell et al.

    Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison

    J Am Med Dir Assoc

    (2004)
  • W.J. Dodds et al.

    Radiologic assessment of abnormal oral and pharyngeal phasese of swallowing

    AJR Am J Roentgenol

    (1990)
  • W.J. Dodds et al.

    Physiology and radiology of the normal oral and pharyngeal phases of swallowing

    AJR Am J Roentgenol

    (1990)
  • K.M. Hiiemae et al.

    Food transport and bolus formation during complete feeding sequences on foods of different initial consistency

    Dysphagia

    (1999)
  • J.B. Palmer et al.

    Coordination of mastication and swallowing

    Dysphagia

    (1992)
  • M.J. Alberts et al.

    Aspiration after stroke: lesion analysis by brain MRI

    Dysphagia

    (1992)
  • J. Robbins et al.

    Swallowing after unilateral stroke of the cerebral cortex: preliminary experience

    Dysphagia

    (1988)
  • S.K. Daniels et al.

    The role of the insular cortex in dysphagia

    Dysphagia

    (1997)
  • S.K. Daniels et al.

    Lesion localization in acute stroke patients with risk of aspiration

    J Neuroimaging

    (1999)
  • M.K. Kern et al.

    Cerebral cortical representation of reflexive and volitional swallowing in humans

    Am J Physiol Gastrointest Liver Physiol

    (2001)
  • R.E. Martin et al.

    Cerebral cortical representation of automatic and volitional swallowing in humans

    J Neurophysiol

    (2001)
  • K. Mosier et al.

    Parallel cortical networks for volitional control of swallowing in humans

    Exp Brain Res

    (2001)
  • S. Hamdy et al.

    Cortical activation during human volitional swallowing: an event-related fMRI study

    Am J Physiol Gastrointest Liver Physiol

    (1999)
  • S. Hamdy et al.

    Identification of the cerebral loci processing human swallowing with H2 15 O PET activation

    J Neurophysiol

    (1999)
  • M.K. Kern et al.

    Swallow related cerebral cortical activity maps are not specific to deglutition

    Am J Physiol Gastrointest Liver Physiol

    (2001)
  • R.E. Martin et al.

    Cerebral areas processing swallowing and tongue movement are overlapping but distinct: a functional magnetic resonance imaging study

    J Neurophysiol

    (2004)
  • J.A. Logemann

    Evaluation and treatment of swallowing disorders

  • J. Horner et al.

    Swallowing in Alzheimer's disease

    Alzheimer Dis Assoc Disord

    (1994)
  • B.R. Bloem et al.

    Prevalence of subjective dysphagia in community residents aged over 87

    BMJ

    (1990)
  • M.J. Feinberg et al.

    Prandial aspiration and pneumonia in an elderly population followed over 3 years

    Dysphagia

    (1996)
  • M.E. Groher et al.

    The prevalence of swallowing disorders in two teaching hospitals

    Dysphagia

    (1986)
  • J. Horner et al.

    Silent aspiration following stroke

    Neurology

    (1988)
  • S. Lindgren et al.

    Prevalence of swallowing complaints and clinical findings among 50-70 year old men and women in an urban population

    Dysphagia

    (1991)
  • G.R. Locke et al.

    Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota

    Gastroenterology

    (1997)
  • B.C. Sonies

    Oropharyngeal dysphagia in the elderly

    Clin Geriat Med

    (1992)
  • C.M. Steele et al.

    Mealtime difficulties in a home for the aged: not just dysphagia

    Dysphagia

    (1997)
  • P.K. Lieu et al.

    The impact of swallowing disorders in the elderly

    Ann Acad Med Singapore

    (2001)
  • H. Nilsson et al.

    Quantitative aspects of swallowing in an elderly nondysphagic population

    Dysphagia

    (1996)
  • J.A. Robbins et al.

    Age effects on lingual pressure generation as a risk factor for dysphagia

    J Gerontol

    (1996)
  • J.E. Aviv et al.

    Age-related changes in pharyngeal and supraglottic sensation

    Ann Otol Rhinol Laryngol

    (1994)
  • J.V. Sitzmann

    Nutritional support of the dysphagic patient: methods, risks and complications of therapy

    J Parenter Enteral Nutr

    (1988)
  • H.H. Chauncey et al.

    The effect of the loss of teeth on diet and nutrition

    Int Dent J

    (1984)

    • Cited by (141)

    • Thirstiness, body hydration and thickened water: A study about their relationship

      2023, Food Quality and Preference

    • A novel multi-target strategy for Alzheimer's disease treatment via sublingual route: Donepezil/memantine/curcumin-loaded nanofibers

      2022, Biomaterials Advances

    • Sarcopenic dysphagia in institutionalised older adults

      2021, Endocrinologia, Diabetes y Nutricion

    • Eating problems in people with dementia with Lewy bodies: Associations with various symptoms and the physician's understanding

      2024, International Psychogeriatrics

    • Prevalence of swallowing disorder in different dementia subtypes among older adults: a meta-analysis

      2024, Age and Ageing

    • Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study

      2023, BMC Geriatrics
    View all citing articles on Scopus

    CARYN EASTERLING, PhD, CCC, BRS-S is an assistant professor with the Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI.

    ELIZABETH ROBBINS, MA is a research assistant, Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI.

    View full text
    Copyright © 2008 Mosby, Inc. All rights reserved.