The Swallowing Profile of Healthy Aging Adults: Comparing Noninvasive Swallow Tests to Videofluoroscopic Measures of Safety and Efficiency Purpose It has been widely reported that a proportion of healthy, community-dwelling seniors will develop dysphagia in the absence of a known neurological, neuromuscular, or structural cause. Our objective was to test whether various feasible, noninvasive measures of swallowing could differentiate safe versus unsafe and efficient versus inefficient swallowing on ... Research Article
Research Article  |   July 13, 2018
The Swallowing Profile of Healthy Aging Adults: Comparing Noninvasive Swallow Tests to Videofluoroscopic Measures of Safety and Efficiency
 
Author Affiliations & Notes
  • Sonja M. Molfenter
    Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
  • Danielle Brates
    Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
  • Erica Herzberg
    Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
  • Mehak Noorani
    Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
  • Cathy Lazarus
    Mount Sinai Beth Israel, New York, NY
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Sonja M. Molfenter: smm16@nyu.edu
  • Editor-in-Chief: Julie Liss
    Editor-in-Chief: Julie Liss×
  • Editor: Michelle Ciucci
    Editor: Michelle Ciucci×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Special Populations / Older Adults & Aging / Speech / Research Articles
Research Article   |   July 13, 2018
The Swallowing Profile of Healthy Aging Adults: Comparing Noninvasive Swallow Tests to Videofluoroscopic Measures of Safety and Efficiency
Journal of Speech, Language, and Hearing Research, July 2018, Vol. 61, 1603-1612. doi:10.1044/2018_JSLHR-S-17-0471
History: Received December 20, 2017 , Revised February 5, 2018 , Accepted March 12, 2018
 
Journal of Speech, Language, and Hearing Research, July 2018, Vol. 61, 1603-1612. doi:10.1044/2018_JSLHR-S-17-0471
History: Received December 20, 2017; Revised February 5, 2018; Accepted March 12, 2018

Purpose It has been widely reported that a proportion of healthy, community-dwelling seniors will develop dysphagia in the absence of a known neurological, neuromuscular, or structural cause. Our objective was to test whether various feasible, noninvasive measures of swallowing could differentiate safe versus unsafe and efficient versus inefficient swallowing on videofluoroscopy (VF) in a sample of healthy seniors.

Method VFs from 44 (21 male, 23 female) healthy community-dwelling seniors (> 65 years old) were compared with a series of feasible, noninvasive swallowing metrics: maximal tongue strength (anterior and posterior), hand grip strength, pharyngeal volume, age, body mass index, 3-oz water swallow challenge, the 10-item Eating Assessment Tool questionnaire, and the Frailty Index. The VF protocol included 9 liquid barium boluses (3 × 5 ml thin, 3 × 20 ml thin, and 3 × 5 ml nectar). Each swallow was rated (randomized and blind) for safety using the Penetration–Aspiration Scale score and for efficiency using the Normalized Residue Ratio Scale (NRRS). Participants were deemed “unsafe” if they had any single Penetration–Aspiration Scale scores ≥ 3 and “inefficient” if they had any NRRS valleculae score > 0.082 or NRRS pyriform sinus score > 0.067. Univariate analyses of variance were run for each continuous swallowing measure by swallowing safety and swallowing efficiency status. Pearson's chi-square analyses were used to compare binary outcomes by swallow safety and efficiency status. Bonferroni corrections were applied to control for multiple comparisons.

Results None of the swallowing measures significantly differentiated safe from unsafe swallows. Although several variables trended to distinguishing efficient from inefficient swallows (age, 10-item Eating Assessment Tool, 3-oz water swallow challenge), only one variable, pharyngeal volume, was significantly different between efficient and inefficient swallows (p = .002).

Conclusion Our findings support the notion that larger pharyngeal volumes (measured using acoustic pharyngometry) are associated with worse swallowing efficiency, a finding we attribute to atrophy of the pharyngeal musculature in healthy aging.

Acknowledgments
This study was funded by NIH National Institute on Deafness and Other Communication Disorders 1R21DC015067. The authors would like to thank Charles Lenell, Emily Ottinger, Shelby Norman, Il Young Jung, Julie Bancroft, Wendy Liang, Chelsea Sandler, Marina Casale, and Katrin Gabriel for their assistance during data collection and data analysis. Portions of this work were presented at the 2017 ASHA Convention in Los Angeles, CA.
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