Page 87 - Portuguese Journal - SPORL - Vol 61. Nº2
P. 87
in the head and neck anatomy, as well as in Screening and Clinical Assessment
several neural and muscular mechanisms, Screening should be performed by a
causing a loss of the functional reserve that healthcare professional to identify patients
can affect swallowing. However, swallowing in at risk of dysphagia, along with referral to
healthy older adults is not necessarily hindered; a multidisciplinary team that can conduct
when these changes do not compromise a clinical/functional and instrumental
safe swallowing, the phenomenon is called assessment. Notably, screening only
presbyphagia . Nevertheless, it is difficult identifies the disease and does not provide
18
to establish the difference between what is information on the severity of dysphagia or
deemed physiological swallowing in older its best treatment. All patients with probable
people and the state in which these changes or previously confirmed dysphagia (positive
represent a disorder or dysfunction. screening results) should be considered
for clinical evaluation of swallowing by a
Consequences of Dysphagia for Health speech therapist, which entails a thorough
Aspiration with subsequent aspiration clinical history, an evaluation of oral and
pneumonia, malnutrition, and dehydration motor function, and an assessment of the
caused by a decrease in the ingestion of foods ability to ingest food. A clinical evaluation of
and liquids can result in reduced quality of life these patients can help confirm dysphagia,
and increased risk of mortality. determine its severity, and select the best
a. Aspiration pneumonia management approach, be it an instrumental
Aspiration pneumonia occurs predominant- and/or individualized/personalized treatment.
ly in older patients with a history of swal- Thus, the assessment of swallowing requires
lowing disorder. It accounts for 6–53% of all a three-step process: screening (to identify
pneumonias, depending on the definition of the presence of dysphagia); clinical evaluation
aspiration pneumonia and the study. Several (to validate the presence of dysphagia and
studies indicate that 5–15% of all community- determine the best intervention); instrumental
acquired pneumonias are aspiration pneu- evaluation. Unlike clinical evaluation,
monias . Many authors have reported that instrumental evaluation is not necessary in all
17
patients with aspiration pneumonia were cases and can be restricted to patients with
mostly older adults and had more severe OPD or esophageal dysphagia .
19
disease and comorbidities than those with
non-aspiration pneumonia. Instrumental evaluation
b. Malnutrition and dehydration Study of Swallowing by Videofluoroscopy
In older adults, the ingestion of foods and Videofluoroscopy (VFC) is the traditional
liquids is often reduced as a consequence of gold standard for the diagnosis of OPD.
age-related changes such as anorexia of ag- VFC is a dynamic study that assesses the
ing, chewing problems, or cognitive decline. safety and efficacy of swallowing. It precisely
Moreover, the loss of autonomy associated measures the phases of swallowing and
with the presence of neurological diseases allows the selection and assessment of
in older adults increases the risk of malnutri- specific therapeutic strategies. The main
8
tion and dehydration . videofluoroscopic signs of dysphagia are
bolus penetration and aspiration, delayed or
Nutritional and/or therapeutic interventions lack of coordination during the swallowing
are necessary to avoid or reduce these serious reflex, deficient preparation and propulsion,
outcomes, the main objective being the ineffective swallowing or presence of residues,
provision of adequate amounts of energy and and dysfunctional opening of the UES .
20
nutrients to minimize the risk of malnutrition Additionally, VFC contributes significantly to
and dehydration. the treatment of OPD by allowing the triage
Volume 61 . Nº2 . June 2023 229
