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


When trouble occurs with swallowing, it can be described by the phase during which it occurs: oral, pharyngeal, or esophageal dysphagia. However, often patients have physiologic impairments that occur within multiple phases of the swallow. Impairments may occur in planning the motor sequence of swallowing, coordination and timing, or anatomical structural displacement during swallowing. These various impairments can lead to airway invasion in the form of penetration or aspiration. Penetration occurs when the bolus enters the laryngeal vestibule but does not move below the true vocal folds and into the trachea. Aspiration occurs when the bolus enters the laryngeal vestibule and moves into the trachea and lungs. Healthy individuals with intact laryngeal sensation will cough or clear the throat in response to airway invasion, but many patients with dysphagia have impaired sensation and do not respond (eg, cough or throat clear) to aspiration, termed silent aspiration. During swallowing evaluations, the underlying causative biomechanical impairments are sought to best inform the creation of a treatment plan. Table 1 provides examples of levels of dysfunction, contributing diseases, and clinical presentation of dysphagia.