150

Part II Nutrition Assessment, Consequences, and Implications

Figure 10.1 Risk Factors for Oropharyngeal Colonization by Respiratory Pathogens and Aspiration Pneumonia in Older Adult

Stroke

Neurological disorders

Esophageal disorders

Current smoking

Malnutrition

Poor oral hygiene

Older age Altered consciousness

Oropharyngeal dysphagia

Medication Silent aspiration Pneumonitis

Pneumonia not identified as aspiration pneumonia

Other

Colonization oropharyngeal

Dry mouth Antibiotics

↓ Immunity

Aspiration pneumonia

Source: Reprinted with permission from Rofes L, Arreola V, Almirall J, Cabré M, Campins L, García-Peris P, Speyer R, Clavé P. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract. 2011;2011:1-13.

BOX 10.5 Aspiration

There are three instances when aspiration can occur: before, during, or after the actual swallow. ●

Aspiration before swallowing is either the result of insufficient closure of the oral cavity during the preparatory phase or the inability to start the swallow reflex when contrast enters the pharynx.

● ●

Aspiration during swallowing is due to insufficient closure of the larynx.

Aspiration after swallowing is the result of stasis of contrast in the pharynx—when the larynx opens, the contrast leaks into the trachea.

Source: Smithuis R. Swallowing disorders—interpretation of radiographic studies. Radiology Assistant. www.radiologyas- sistant.nl/en/p440bca82f1b77/swallowing-disorders -interpretation-of-radiographic-studies.html. Published January 3, 2007.

after an ischemic stroke (40). Considering that as many as 6 million older adults may be at risk for dys- phagia (33), it is imperative that effective screening tools be utilized to identify and successfully treat this condition.

DYSPHAGIA SCREENING A multidisciplinary approach must be taken to mini- mize the rate of mis- or underdiagnosed dysphagia. The team should consist of the health care profession- als involved in the individual’s care: the registered dietitian nutritionist (RDN); nurse; speech therapist; gastroenterologist; ear, nose, and throat (ENT) special- ist; neurologist; surgeon; rehabilitation physician; radiologist; and geriatrician (20). Interviews with the older adult and caregiver also play a critical role in cor- rectly diagnosing the problem. Videofluoroscopy (VFS) is the gold standard in diagnosing dysphagia (27), followed by fiberoptic endo- scopic evaluation of swallowing (FEES) (40). However, while these tests will confirm the presence of dysphagia, it is possible to detect it by close observation of the