How should dysphagia care of older adults differ? Establishing optimal practice patterns

An unprecedented demographic transformation is occurring as our population ages. Those older than age 65 represent the fastest growing segment of the population. Within this older group, approximately 10% to 30% of adults are estimated to have dysphagia, but true incidence and prevalence are unknown. They make up a heterogeneous mix of both healthy and disabled individuals that reside across a spectrum of living settings. As clinicians approach older adults with dysphagia, general geriatric principles should be followed to optimize care for this diverse group. Likewise, practitioners need to appreciate the physiology that distinguishes a healthy old swallow from dysphagia and acknowledge the wide array of causes that contribute to dysphagia in older people. Clinicians need to recognize the heterogeneity in health, functional abilities, social supports, and resources among the elderly and understand how these factors may influence approaches to dysphagia in different care settings. Standard outcome measures of pneumonia, malnutrition, and mortality must be blended with other quality of life indices. Advanced directives are essential in caring for elderly patients with dysphagia irrespective of their health acuity or care setting. Ultimately, patient and family preferences should dictate the swallowing and feeding interventions offered.