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Validation of Questionnaire for Chewing and Swallowing Function of the Elderly.

Hyoung Su PARK ; Don kyu KIM ; Sang Yi LEE ; Hee Sang KIM ; Hoon Chang SUH

Journal of the Korean Dysphagia Society.2017;7(1):25-34.

OBJECTIVE: This study aims to develop a new screening dysphagia questionnaire for elderly people. METHOD: Initial questionnaire for mastication and swallowing function of elderly people were composed of 20 questions. Total of 30 experts were invited to participate in the Delphi survey, including physiatrists, occupational therapists and dietitians. Modified Delphi method was performed into two rounds. Twenty young adults and twenty elderly volunteers were tested with these items and were compared with other pre-existing tests. Also, validity of selected evaluating items was tested using VFSS. RESULT: For the first round of surveys, a consensus was reached on 72.5% of the questionnaire. Final agreement was reached on 98% of the questionnaire. The results of the first round survey with the 20 evaluation items and second round showed that the content validity ratio (CVR) and stability were high enough and met the criteria of consistent agreement from a group of specialists. The final round survey following the 1st and 2nd round survey was implemented, which finally reduced to 14 items from initial 20 items. The researcher allocated the items into the 3 categories. The score of the developed item were highly correlated with that of the pre-existing screening questionnaire and time parameters of the VFSS showing a significant difference according to the score. CONCLUSION: We developed a screening tool for evaluation of chewing nad swallowing function for the elderly people. Though it is necessary to be verified through large scale clinical studies, it may be simply applicable to the elderly people with mastication and swallowing dysfunction or could be evaluated by caregivers.
Aged* ; Caregivers ; Consensus ; Deglutition Disorders ; Deglutition* ; Humans ; Mass Screening ; Mastication* ; Methods ; NAD ; Nutritionists ; Specialization ; Volunteers ; Young Adult

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Effect of Chin Tuck Maneuver on Aspiration and Pharyngeal Residues Evaluated Using Simultaneous Videofluoroscopic Swallowing Study and Fiberoptic Endoscopic Evaluation of Swallowing.

Sung Eun HYUN ; Hyun BANG ; Se Hee JUNG

Journal of the Korean Dysphagia Society.2016;6(2):70-75.

OBJECTIVE: To evaluate the effect of chin tuck maneuver on aspiration and pharyngeal residue using both videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). METHOD: Subjects with dysphagia were trained by occupational therapists for chin tuck maneuver at least for a week. After training, all participants underwent VFSS and FEES simultaneously with each neutral and chin tuck posture with various tests diets. The modified penetration-aspiration scale (mPAS) and a new scale for pharyngeal residue were used for evaluation of aspiration and pharyngeal residue. RESULT: A total of 35 patients (mean age, 64.2±12.1 years) were included. A significant change in the mPAS was caused by chin tuck posture in thin liquid (P=0.02) only in the VFSS evaluation. The vallecular residues were decreased by chin tuck posture in rice porridge (right, P=0.01; left, P=0.009), and thin liquid (right, P=0.007; left, P=0.01). The pyriform sinus residues were also decreased by chin tuck posture in rice porridge (right: P=0.02; left: P=0.03), curd-type yogurt (right, P=0.02; left, P=0.005), and thin liquid (right, P=0.001; left, P=0.003). CONCLUSION: Chin tuck maneuver is effective in preventing penetration or aspiration and in decreasing pharyngeal residues when evaluated by simultaneous VFSS and FEES.
Chin* ; Deglutition Disorders ; Deglutition* ; Diet ; Endoscopy ; Fees and Charges ; Fluoroscopy ; Humans ; Methods ; Posture ; Pyriform Sinus ; Yogurt

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Dysphagia in Patients with Dementia.

Ju Kang LEE

Journal of the Korean Dysphagia Society.2016;6(2):66-69.

Dysphagia is a frequent problem in dementia as Alzheimer's disease. Changes of swallowing function can be started even in the early stages of dementia. Structural and physiologic changes of oral/dental functions in the elderly underlies in persons with dementia. Cognitive based dysphagia is caused by impairment of consciousness and attention, memory, perception, and goal management related with feeding activities. Behavioral and psycholocal symptoms of dementia (BDSD) often results in dysphagia and eating disorders. Dysphagia in dementia should be approached individually. The goals of the program are the maintenance of the optimal nutrition and the prevention of complication such as aspiration pneumonia. Close observation by medical staffs and caregivers is the key to detect early signs of eating disorders in dementia patients. Assessment includes medical history, oral/dental function, swallowing function, and nutritional status. Sensory stimulation methods, adaptive equipment and utensil, diet modification, behavioral and environmental modification are the strategies for managing the problem. Enteral tube feeding is not proven to improve survival of end state dementia patients.
Aged ; Alzheimer Disease ; Caregivers ; Consciousness ; Deglutition ; Deglutition Disorders* ; Dementia* ; Eating ; Enteral Nutrition ; Food Habits ; Humans ; Malnutrition ; Medical Staff ; Memory ; Nutritional Status ; Pneumonia, Aspiration

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Home Care of Elderly with Dysphagia.

MiKyoung LEE

Journal of the Korean Dysphagia Society.2016;6(2):60-65.

Due to the increase in elderly population, there has been an increase in number of patients with dysphagia in the community. Dysphagia results in aspiration pneumonia and complications such as malnutrition, dehydration in the elderly. These complications increase the hospital admission rates and are often the cause of death. For this reason, the goal of healthcare for elderly with dysphagia living in the community is to select elderly with dysphagia by early screening, maintain adequate nutritious status and prevent future complications. The families of dysphagia elders should be educated and supported in order to successfully care for these patients at home. Severe cases of elderly with dysphagia are to receive health professional service in conjunction with the services from hospital based home care medical center. It also requires governance support so that health professionals such as speech language pathologists will care for dysphagia patients in home.
Aged* ; Cause of Death ; Deglutition Disorders* ; Dehydration ; Delivery of Health Care ; Health Occupations ; Home Care Services* ; Home Care Services, Hospital-Based ; Humans ; Malnutrition ; Mass Screening ; Pneumonia, Aspiration

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Yong Sung KIM

Journal of the Korean Dysphagia Society.2016;6(2):54-59.

The goal of this short review is to summarize physiologic changes in gastrointestinal (GI) tract with aging and common GI disorders in the elderly. Normal aging is associated with various changes in GI tract, such as alteration of enteric nervous system, decreased smooth muscle excitability, and decreased GI motility. Elderly individuals frequently have GI disorders (e.g. dysphagia, gastroesophageal reflux disease and functional constipation), however, physiologic change in GI tract with aging seems to have a minor effect on these disorders. Various aging-related chronic diseases such as diabetes mellitus or Parkinson's disease and frequently used drugs such as anticholinergics or opioid analgesics in the elderly are more important in pathogenesis of GI disorders in the elderly. Therefore, clinicians should be aware of the aging-related physiologic GI change as well as an effect of comorbid chronic diseases and drugs on elderly patients with GI disorders.
Aged* ; Aging ; Analgesics, Opioid ; Cholinergic Antagonists ; Chronic Disease ; Deglutition Disorders ; Diabetes Mellitus ; Enteric Nervous System ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Gastrointestinal Motility ; Gastrointestinal Tract* ; Humans ; Muscle, Smooth ; Parkinson Disease

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Oropharyngeal Dysphagia in the Elderly.

Bo Hae KIM ; Eun Jae CHUNG

Journal of the Korean Dysphagia Society.2016;6(2):49-53.

Dysphagia is difficulty of effect movement of the bolus from the mouth to the stomach. From and anatomical standpoints, dysphagia is typically classified as oropharyngeal dysphagia (OPD) and esophageal dysphagia (ED). In general, OPD is more highly prevalent condition compared with ED, and associated with severe complications such as malnutrition, dehydration and aspiration pneumonia. These complications are fatal especially in the elderly. Therefore, for preventing severe complications, appropriate and prompt management should be provided to dysphagia patients. However, the decrease of swallowing function is considered as a part of natural aging process. This condition is called as presbyphagia. Although Presbyphagia refers to characteristic changes in the process of swallowing of healthy elderly, it can be a risk factor of dysphagia. With this in mind, for avoiding overdiagnosis or underdiagnosis of dysphagia, we should distinguish among presbyphagia, dysphagia and other related diagnoses. For this reason, understanding about physiology of normal swallowing and natural changes of swallows by aging are essential for physicians. Hence, this review discusses the normal swallow, senile changes of swallow, and dysphagia especially in OPD.
Aged* ; Aging ; Deglutition ; Deglutition Disorders* ; Dehydration ; Diagnosis ; Humans ; Malnutrition ; Medical Overuse ; Mouth ; Physiology ; Pneumonia, Aspiration ; Risk Factors ; Stomach ; Swallows

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Dysphagia in Gastrointestinal Cancer Patients.

Cheal Wung HUH ; Young Hoon YOUN

Journal of the Korean Dysphagia Society.2017;7(1):1-7.

Dysphagia is one of the common symptoms that are encountered in clinical practice. However, dysphagia is still crucial and must be thoroughly investigated because it may be a key symptom of several malignancies. There are two types of dysphagia, oropharyngeal and esophageal dysphagia. Esophageal dysphagia can be caused by esophageal neuromuscular motility disorder, various inflammatory disorders, and also extrinsic or intrinsic structural lesions such as esophageal cancer. This article focuses on malignant esophageal dysphagia, including its causes, risk factors, clinical symptoms, and management.
Deglutition Disorders* ; Esophageal Neoplasms ; Gastrointestinal Neoplasms* ; Humans ; Risk Factors

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Nutrition Support and Transition to Oral Intake in Cancer Patients with Dysphagia.

Bo Eun KIM

Journal of the Korean Dysphagia Society.2017;7(1):19-24.

Dysphagia in cancer patients are mainly caused by brain tumor, head and neck cancer and esophageal cancer. Also both paralytic and mechanical dysphagia may occur with a high rate of malnutrition that has been reported. In cases when oral ingestion is impossible for a long time due to cancer treatments including surgery, decision should be made on if it may be an indication of nutrition support or not. In the case of nutrition support having to be initiated, the route and method of nutrition support must be determined. During enteral nutrition supply, we should predict and monitor probable complications according to the feeding rate depending on the change of patient's conditions, and if required, medication assistances may be needed. Through VFSE (Video fluoroscopic swallowing exam), when the transition to oral intake is carried out, nutritional supply should be monitored to plan the tapering and discontinuation of nutrition support. Since the effort of international standardization regarding dysphagia stage has been sustained, it is necessary to make the viscosity- and texture-based dysphagia diet standardization on the ground of clinical evidence in Korea, too.
Brain Neoplasms ; Deglutition ; Deglutition Disorders* ; Diet ; Eating ; Enteral Nutrition ; Esophageal Neoplasms ; Head and Neck Neoplasms ; Humans ; Korea ; Malnutrition ; Methods

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Prosthetic Treatment after Oral Cancer Ablation.

Myoung Sang YOU ; Dong Young KIM ; Kang Min AHN

Journal of the Korean Dysphagia Society.2017;7(1):8-12.

Ablative surgery for oral cancer treatment results in tissue defect. Large tissue defect requires free flap reconstruction that requires long operation time. Maxillectomy involves the teeth and maxilla that separates the maxillary sinus and nasal cavity from oral cavity. Resection of the maxilla causes oro-antral or oro-nasal fistula, which results in difficulty while chewing and swallowing. Regurgitation of the ingested food into the maxillary sinus or nasal cavity makes it difficult for a patient to digest. Obliteration of the fistula is the most important part of dental prosthesis in patients who underwent maxillectomy. Local flap is indicated when the fistula is less than 10mm, however, larger sized defects are closed with free flap or obturator. The decision of treatments should be based on patient's general condition, risk of recurrence, size of the defect and financial aspect.
Aphasia ; Deglutition ; Dental Prosthesis ; Fistula ; Free Tissue Flaps ; Humans ; Mastication ; Maxilla ; Maxillary Sinus ; Mouth ; Mouth Neoplasms* ; Nasal Cavity ; Recurrence ; Tooth

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Radiation Induced Dysphagia.

Yun Sung LIM

Journal of the Korean Dysphagia Society.2017;7(1):13-18.

Swallowing dysfunction following radiation therapy for head and neck cancer is a major cause of morbidity and reduced quality of life, which means that organ preservation is not equal to functional preservation. Radiation induces tissue damage followed by hypoxia, fibrosis, and functional deterioration. Intensity modulated radiation therapy can be a valid strategy to reduce long-term dysphagia. Recently, prophylactic swallowing exercise has been gaining attention for its role in better functional swallowing after radiation therapy. However, further longitudinal and objective studies are still needed.
Anoxia ; Deglutition ; Deglutition Disorders* ; Fibrosis ; Head and Neck Neoplasms ; Organ Preservation ; Quality of Life ; Rehabilitation

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