This article covers dysphagia in older patients, which is an important topic due to an ageing population, and a relatively common symptom that we see in clinic. Dysphagia could be due to presbyphagia secondary to changes in head and neck anatomy, reduced muscle mass and movement. However, it could also be secondary to xerostomia from medications such as anticholinergics, antihypertensives and diuretics, stroke, dementia and Parkinsons’s disease. The authors found that about 50% of elderly patients with dysphagia would have positive endoscopic findings such as pooling of saliva in pyriform fossae, incomplete glottic closure or vocal cord paralysis. Further investigation would be symptom-based. Video fluoroscopy remains the main investigation for patients presenting with dysphagia. Fibreoptic endoscopic evaluation of swallowing (FEES) has an important role as well, as it could be performed at the bedside and could assess effectiveness of the patient’s swallow and for any airway penetration. For patients with suspected pharyngeal pouch, barium swallow is the investigation of choice. Management of pharyngeal pouch is determined by patients’ symptoms, such as weight loss and history of chest infections. The authors also discuss management of cricopharyngeal spasm, with patients undergoing myotomy having better results than botox injection. They found that endoscopic myotomy had better results and fewer complications when compared with the open approach. The mainstay in treatment of dysphagia in the elderly is nutrition, hydration and aspiration avoidance. If swallowing therapy fails, gastrostomy feeding is potentially an option. However, the authors advocate an individualised decision-making process, as gastrostomy feeding does not improve survival or function. They also found that gastrostomy feeding in patients with dementia has a worse prognosis. 

Dysphagia in the older patient.
Nawaz S, Tulunay-Ugur O.
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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