Trouble Swallowing Over 50? Here’s Why

Trouble Swallowing Over 50? Here’s Why

Almost 40% of seniors are living with a swallowing disorder known as dysphagia. It’s a major health problem associated with aging, but it’s still not known if the condition is a natural part of healthy aging or if it is caused by an age-related disease that still has to be diagnosed, like Parkinson’s disease or amyotrophic lateral sclerosis (ALS).

Causes of Dysphagia in People Over 50

Dysphagia, or difficulty swallowing, can arise in individuals over 50 due to various factors. One common cause is age-related changes in the muscles and tissues involved in swallowing, known as presbyphagia. This natural decline can lead to weakened muscles and reduced coordination, making swallowing less efficient. Additionally, conditions such as gastroesophageal reflux disease (GERD), which becomes more prevalent with age, can irritate the esophagus and make swallowing uncomfortable.

Neurological disorders like stroke, Parkinson's disease, and Alzheimer's disease are also significant contributors to dysphagia in older adults, as they can impair the brain's ability to coordinate swallowing motions. Furthermore, structural issues such as esophageal strictures, tumors, or the presence of a hiatal hernia can obstruct the swallowing passage, causing difficulty or pain during swallowing. Overall, a combination of age-related changes, underlying health conditions, and anatomical abnormalities can contribute to dysphagia in individuals over 50.

Symptoms of Dysphagia

Dysphagia manifests through a variety of symptoms, which can vary in severity depending on the underlying cause and individual circumstances. Common symptoms include difficulty swallowing food or liquids, sensation of food getting stuck in the throat or chest, choking or coughing while eating or drinking, regurgitation, unintended weight loss due to avoidance of eating, or recurrent chest infections from aspiration of food or liquids into the lungs.
In some cases, individuals may also experience pain or discomfort during swallowing, known as odynophagia. Furthermore, dysphagia can lead to psychological impacts such as anxiety or avoidance of social eating situations. Recognizing these symptoms is crucial for prompt diagnosis and appropriate management of dysphagia, which can significantly improve an individual's quality of life.

What to Do if You Have Trouble Swallowing

If you find yourself experiencing difficulty swallowing, it's essential to seek medical advice promptly. Consulting a healthcare professional, such as a primary care physician or a specialist like an otolaryngologist or gastroenterologist, can help identify the underlying cause and determine the appropriate course of action. During the evaluation, your healthcare provider may recommend diagnostic tests such as a barium swallow, endoscopy, or imaging studies to assess the swallowing function and identify any structural abnormalities or disorders. Additionally, they may suggest dietary modifications, such as modifying food texture or consistency, or recommend swallowing exercises to improve muscle strength and coordination. 

In some cases, innovative tools like Nutri-Strips, which provide nutritional supplementation in a convenient strip, that you place on your tongue and swallow, may be recommended to ensure adequate nutrient intake while managing swallowing difficulties. Seeking timely medical attention and following your healthcare provider's recommendations are crucial steps in effectively managing dysphagia and maintaining overall health and well-being.

Possible Treatments for Dysphagia

Treatment options for dysphagia depend on the underlying cause and severity of the condition. One common approach is speech therapy, where a speech-language pathologist provides exercises to improve swallowing function and coordination. These exercises may focus on strengthening muscles involved in swallowing or practicing specific swallowing techniques to minimize discomfort or aspiration risk. Additionally, dietary modifications, such as altering food texture or consistency, can make swallowing easier and safer.

In some cases, feeding tubes may be necessary to ensure adequate nutrition and hydration, particularly if swallowing difficulties are severe or if there is a risk of aspiration pneumonia. Medications can also be prescribed to manage underlying conditions contributing to dysphagia, such as acid reflux or neurological disorders. Surgical interventions, such as dilation of strictures or tumor removal, may be necessary for structural abnormalities causing swallowing difficulties. Collaborating with a multidisciplinary team, including physicians, speech therapists, dietitians, and surgeons, can help tailor a comprehensive treatment plan to address the individual needs of patients with dysphagia.

After a recent study, University of Missouri researchers have established a model that identifies aging as a key factor in dysphagia development. This may lead to new therapeutic treatments.

"As people age, and especially once they’re 50 and older, their ability to swallow quickly and safely deteriorates with each advancing decade,” said assistant professor of otolaryngology at the School of Medicine and lead author of the study.

“For years, we haven’t known why. Through our research with mice, we now know this disorder can occur naturally and independent of another disease.

“Our next step is to study this model to determine why age-related dysphagia, also called presbyphagia, occurs and identify ways to prevent it.”

Other Dysphagia Considerations

Pneumonia Risk

People who have presbyphagia generally experience slow, delayed, and uncoordinated swallowing that gets in the way of airway function. This puts older people at risk for getting life-threatening malnutrition and aspiration pneumonia, which is caused when food or saliva is breathed into the lungs or airways.

These risks are increased when an individual has an existing health condition, such as a neurodegenerative disease, head and neck cancer, or a major surgery.

Videofluoroscopy has long been the gold standard for diagnosing swallowing disorders in humans. A video fluoroscopic swallow study is a radiologic examination of an individual’s swallowing function that uses a special X-Ray device called a fluoroscope.

The patient is observed swallowing various foods and liquids mixed with a contrast agent that can be seen by fluoroscopy in order to evaluate his or her ability to swallow safety and effectively.

Same Symptoms In Mice

However, because a long-term study of the swallowing ability of an individual as he or she ages is unfeasible, Lever and her research team studied the swallowing function of healthy mice across an approximate two-year lifespan.

"We have a miniaturized fluoroscope and swallow test protocol that are unique to our lab that we can use to determine if a mouse has dysphagia,” Lever says. “By studying the swallowing function of healthy mice over their lifespan, we found they exhibit many of the same symptoms of dysphagia as healthy aging adults.”

The researchers established 15 metrics that could be compared to human swallowing function. These metrics include functions such as swallow rate, pharyngeal transit time—the time it takes liquid to be swallowed through the pharynx, or throat, and into the esophagus, or food tube—and the number of ineffective swallows through the esophagus.

The researchers found that healthy aging mice develop symptoms of swallowing impairment that closely resemble the impairments seen in older adults: generally slowed swallowing function, impaired tongue function, larger size of the amount swallowed, and an increase in the time it takes liquid to travel through the throat to the stomach.

“We’re about to change the landscape of dysphagia intervention,” Lever says. “For years, we’ve only been able to treat the symptoms and have been unable to address the root causes of dysphagia. “Though more research is needed, this knowledge sets the stage for us to study ways to prevent, delay or potentially reverse swallowing disorders using new therapies.” The study was published online by the journal Dysphagia. Funding from the University of Missouri and the National Institutes of Health helped support the project. Source: University of Missouri

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