EpistemisPresbyophagy
Specialty: Geriatrics.
Why it occurs
- Decreased elasticity of pharyngeal tissues and loss of muscle mass (sarcopenia) in the constrictor muscles of the pharynx
- Delay in the onset of the swallowing reflex due to decreased tactile and thermal sensitivity of the oropharynx
- Reduction in saliva production (xerostomia) that makes it difficult to form a cohesive bolus
- Decreased lifting movement of the hyoid bone and larynx during swallowing
- Loss of teeth or poorly fitted prostheses that prevent effective chewing
Initial workup
Clinical evaluation of swallowing at the bedside using the volume-viscosity clinical examination method (MECV-V); videofluoroscopy of swallowing or endoscopic evaluation of swallowing (FEES) by otolaryngology or rehabilitation; complete dental assessment of occlusal stability and functionality; complete analysis to rule out anemia, hypoalbuminemia and micronutrient deficiency.
red flags
Immediate cough or systematic throat clearing after swallowing water or solids, repetitive respiratory infections (recurrent lobar or segmental pneumonia), involuntary progressive weight loss associated with a manifest fear of eating or drinking, persistent "wet voice" after swallowing food, or episodes of choking with cyanosis that require unobstruction maneuvers.
Standard management
- Pilocarpine — 5 mg orally two to three times a day, only if there is documented severe xerostomia due to salivary gland atrophy, controlling cholinergic side effects such as sweating, lacrimation or bradycardia
- Xanthan gum-based food thickener — systematically added to all liquids to achieve safe viscosities: nectar, honey or pudding, as determined by the MECV-V test
- Optimize systemic analgesia if there is cervical or pharyngeal pain that aggravates presbyophagia.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Geriatrics
- Listed causes
- 5
- Treatment options
- 3