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


Swallowing is a complex process, and dysphagia is incredibly common with advancing age. Dysphagia can be asymptomatic, but often contributes to significant reductions in quality of life for patients and caregivers, discomfort with eating, higher risks of pneumonia and dehydration, and weight loss and debility. For patients with stroke and dementia, dysphagia is highly associated with reduced survival, and can serve as a prompt to explore goals of care and values near the end of life. These discussions are often highly stressful for patients and families and healthcare providers as well, so considerable effort invested in building trust and understanding and valuing preferences can reduce the burden involved in creating and navigating treatment plans.

Evidence to support early evaluation and treatment of dysphagia in older adults is limited, and more research with larger cohorts and improved study design is needed. Fortunately, exciting research should shed new evidence regarding the underlying mechanisms of dysphagia in older adults and the optimal treatments for these impairments in the years ahead.

There are many areas where this research is critically needed. Underlying mechanisms and the results of interventions targeting these mechanisms are still at nascent stages of investigation. Also, it has been shown that swallowing dysfunction begins early in Alzheimer-type dementia.[47] Direct interventions to strengthen and improve swallowing function in early-stage dementia, at a time when the patient is cognitively able to participate in such therapies and before they have a negative impact on swallowing, have a lot of face validity and are currently an area of active research. The impact of swallowing evaluation and treatment on broader health outcomes, such as pneumonia and nutritional status, in older adults requires elucidation. As eating and swallowing are so intimately linked to quality of life, it is critical that future studies include standard measures of the impact of evaluations and interventions on quality of life in those populations who are able to participate in such an assessment.