1. Lecture 3 Age Related Changes: Geriatric

2. Aging: Physiologic Impact Vertebral column thinning Lung ossification Cervical osteophytes Larngoptosis TMJ ossification Delayed oral stimulation identification Xerostomia Dentition loss Decreased swallow rates Increased relaxation time of the cricopharyngeus Longer airway closure time Posterior positioning of the bolus Delayed initiation Delayed transit through the phrynx

3. Respiration during the Swallow Normal respiratory sequence Inspiration Velum lowers so that breathing can continue during mastication Exhalation begins Apnea during the swallow Exhalation is completed

4. Triad of Symptoms Respiratory compromise Dysphagia Protein-calorie malnutrition Anyone of these symptoms can contribute to the triad The physiology of aging contributes to the probability that anyone of these symptoms could occur.

5. Saliva Important functions of saliva Increase taste perception Decreased bacteria Maintains acid levels in the stomach Facilitates food breakdown Xerostomia Dryness of the mouth, pharynx Can significantly contribute to dysphagia symptoms

6. Esophageal Symptoms Gastroesophageal reflux disease (GERD) Can exacerbate Asthma COPD Apnea Bradycardia Hypotension Globus sensation (feels like lump in throat) Can cause pharyngeal, even oral phase problems.

7. Differential Diagnosis Dementia Cognitive Anorexia Immobility Neurologic Sudden onset Liquids more difficult than solids Progressive obstructive Mechanical problem Solids more difficult than liquids

8. Onset of Symptoms Sudden Slow-progressive Decompensation Short-term UTI URI Dehydration Changes in medication

9. Oral Candidiasis Fungal infection-Thrush Systemic Antibiotics Xerostomia Immunosuppressed Chronic disease Malnourished Local Dentures Ill fitting Poor hygiene overwear

10. Treatment Dependent on etiology Dementia Neurologic Progressive obstructive Dietary management Surgical Enteral feedings Time-frame Follow-up Mealtime observation