Nestle Supplement 2

NUTRITION AND THE OLDER PERSON Figure 2. Videofluoroscopic pictures and oropharyngeal swallow response during the ingestion of a 5-mL nectar bolus in A) a healthy individual and B) an older patient with neurogenic dysphagia and aspiration associated with stroke. An increased total duration of the swallow response may be seen, as well as a delayed closure of the laryngeal vestibule and delayed aperture of the upper sphincter. The white dot indicates the time when contrast penetrates into the laryngeal vestibule, and the red dot indicates passage into the tracheobronchial tree (aspiration). GPJ = glossopalatal junction; VPJ = velopharyngeal junction; LV = laryngeal vestibule; UES = upper esophageal sphincter. diagnostic and therapeutic process is of capital importance. Once a diagnosis of functional oropharyngeal dysphagia has been established, the goal of the diagnostic program is to evaluate two deglutition-defining characteristics: 1) efficacy, the patient’s ability to ingest all the calories and water he or she needs to remain adequately nourished and hydrated, and 2) safety, the patient’s ability to ingest all needed calories and water with no respiratory complications.1,2,9,16 To assess both characteristics of deglutition, two groups of diagnostic methods are available: 1) clinical methods, such as deglutition-specific medical history and clinical examination, usually used as screening methods, and 2) the exploration of deglutition using specific complementary studies, such as VFS. Clinical screening for oropharyngeal dysphagia should be low risk, quick, and low cost and should aim at selecting the highest risk patients who require further assessment. Current methods for clinical screening of dysphagia are the water swallow test,17 the 3-oz water test developed in the 10 • DECEMBER 2007 Burke Rehabilitation Center,18 the timed swallow test,19 and the standardized bedside swallow assessment (SBSA).20,21 For these tests, patients are asked to drink 50 mL,22 3 oz,1 150 mL,19 or 60 mL20,21 of water, respectively, from a glass without interruption, and coughing during or after completion, the presence of a post-swallow wet-hoarse voice quality, or swallow speed of less than 10 mL/second are scored as abnormal. These clinical bedside methods can detect dysphagia, although with differing diagnostic accuracy. The Burke’s 3-oz water swallow test identified 80% of patients aspirating during subsequent VFS examination (sensitivity 76%, specificity 59%).18 The SBSA showed variable sensitivity (47% to 68%) and specificity (67% to 86%) for detection of aspiration when used by speech swallow therapists or doctors.20,21 Note these screening procedures involve continuous swallowing of quite large amounts of liquid and may place the patient at high risk for aspiration. The author’s team developed a safer clinical method (the volume-viscosity swallow test,V-VST) using series of 5 mL–20

Table of Contents Feed for the Digital Edition of Nestle Supplement 2

Nestle Supplement Table of Contents Introduction to Weight Loss in Older Persons Diagnosis and Management of Oropharyngeal Dysphagia in the Elderly The Danger of Weight Loss in the Elderly Nutrients and Frailty

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