Swallowing Disorders in the Older Population

Colleen Christmas, MD; Nicole Rogus-Pulia, PhD, CCC-SLP


J Am Geriatr Soc. 2019;67(12):2643-2649. 

In This Article

The Healthy Swallowing Process

The swallowing process is remarkably complex, involving six cranial nerves, multiple muscle groups, and cortical and subcortical brain signals that must be precisely coordinated within a few seconds. Swallowing has been described as consisting of three phases that may overlap with one another (Figure 1). Swallowing begins with the oral preparatory phase, during which the bolus is prepared to be swallowed. The bolus is masticated and mixed with saliva for moistening and salivary amylase to begin the digestive process. During the oral phase, the food and/or liquid is collected into a cohesive bolus and sequentially propelled toward the pharynx under the pressure of the muscular tongue contacting the hard palate. The oral phase is under voluntary skeletal muscle control, thus requiring the participation of an alert person. In the pharyngeal phase, the tongue propels the food bolus into the pharynx, which triggers a series of events that comprise the pharyngeal swallow response. These include velopharyngeal closure, base of tongue retraction to the posterior pharyngeal wall, movement of the hyoid bone and larynx, closure of the airway at three levels (true vocal fold closure, false vocal fold approximation, arytenoid cartilage contact at the base of the epiglottis), contraction of the pharyngeal muscles, and opening of the upper esophageal sphincter. The pharyngeal phase is partially under voluntary control and partly involuntary. Finally, the esophageal phase of swallowing consists of a peristaltic wave of contraction that moves the food bolus through the esophagus under involuntary control.

Figure 1.

Normal phases of swallowing.