Page 84 - Portuguese Journal - SPORL - Vol 61. Nº2
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adult population aged 65 years and over and is present in the mouth, the prevention of
approximately 50% of institutionalized adults premature pharyngeal entry with maintained
2.
The prevalence of many diseases that cause nasal breathing results from the concerted
dysphagia increases with age, and changes action of the orbicularis muscle of the lips and
related to aging per se can contribute to the palatoglossus muscle that seal the oral
dysphagia . For both reasons, the global cavity anteriorly and posteriorly, respectively .
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prevalence of dysphagia is increasing in aging The onset of the oral propulsive phase occurs
societies. after chewing and bolus formation, with
The advances in the instrumental evaluation posterior mobilization of food through the
of swallowing help determine the specific movement of the tongue pressing against the
anatomical and physiological changes. hard palate and subsequent initiation of the
Nevertheless, the dysfunction and etiology pharyngeal phase .
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of the condition may remain unknown if the
basic understanding of the physiology of Pharyngeal Phase
swallowing and the changes that occur with The pharyngeal phase starts when the bolus
aging is lacking . comes in contact with the isthmus of the
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Common disease states such as depression, fauces and, unlike the previous phase, is totally
cognitive impairment, dementia, and a reflex phenomenon. This phase lasts for one
behavioral changes can delay the recognition second, and the speed of bolus transport is
of dysphagia in older people. 30–40 cm/s. In this phase, there is a sequence
Thus, the difficulty in diagnosing dysphagia of events in which the aerodigestive route
in this population is multifactorial, and its becomes an exclusively digestive one: trigger
management includes numerous medical point, closure of the soft palate, elevation
and technical specialties. Notably, although and laryngeal anterior propulsion, laryngeal
this is an eminent problem in healthcare, OPD closure, propulsion, and opening of the upper
is only marginally integrated into the graduate esophageal sphincter (UES). Finally, all the
training of the Portuguese healthcare previous events are sequentially inverted to
professionals who work with these patients. reconfigure the aerodigestive tract .
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Anatomy and Physiology of Swallowing Esophageal Phase
Safe and effective swallowing involves This phase starts when the bolus passes
the coordinated participation of multiple the UES and enters the stomach. This reflex
structures that transfer food from the mouth process includes the following phases: entry
to the stomach. This mechanism encompasses into the esophagus, UES closure, onset of
three stages: the oral, pharyngeal, and esophageal peristalsis, opening of the lower
esophageal phases . esophageal sphincter (LES), and passage to
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the stomach .
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Oral Phase
The oral phase begins with the entry of Swallowing in Older Adults
food into the mouth and is divided into two Aging causes a progressive deterioration of the
sequential moments—the oral preparatory sensorimotor functions, including swallowing.
and propulsive phases—both voluntary. Although numerous studies have shown
The oral preparatory phase mainly involves physiological changes in swallowing with
the preparation of the bolus and reduction advanced age, there is strong disagreement
in the size of the food particles through the regarding the definitions of normal and
production of saliva and adequate coordination pathological swallowing.
between the lips, mouth, mandible, and Changes in the swallowing function are
tongue movements for chewing. When food associated with normal aging, but older people
226 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
