Nestle Supplement 2

NUTRITION AND THE OLDER PERSON Figure 4. Algorithm for screening, diagnosis, and treatment of oropharyngeal functional dysphagia at the Hospital de Mataró, Barcelona, Spain. Note the involvement of several professional domains of the dysphagia multidisciplinary team and the vertical and horizontal flows of information. The continuous black lines indicate the diagnostic screening strategy of patients at risk; the broken lines indicate flow of information on patient status; and broken dotted lines indicate therapeutic interventions. COMPLICATIONS The severity of oropharyngeal dysphagia varies from moderate difficulty to complete inability to swallow. Oropharyngeal dysphagia may give rise to two groups of clinically relevant complications in older people: 1) 25%–75% of patients with dysphagia present a decrease in the efficacy of deglutition leading to malnutrition and/or dehydration; 2) when a decrease in deglutition safety occurs, choking and tracheobronchial aspiration may result in pneumonia1,2 in 50% of cases with an associated mortality of up to 50%. A recent 10-year review found a 93.5% increase in the number of hospitalized elderly patients with a diagnosis of aspiration pneumonia, while other types of pneumonia in the elderly decreased.25 The risk of aspiration pneumonia is higher in older patients because incidence of dysphagia is 12 • DECEMBER 2007 high.26 In elderly nursing home occupants with oropharyngeal dysphagia, aspiration pneumonia occurrence is 43%–50% during the first year and has a mortality23 of up to 45%. Figure 5 summarizes the pathophysiology of complications related to dysphagia in the elderly. The incidence and the prevalence of aspiration pneumonia (AP) in the community are poorly defined. Aspiration pneumonia increases in direct relation with age and underlying diseases. The pathogenesis of AP has been recently revised14,15 and presumes the contribution of risk factors that alter swallowing function, cause aspiration, and predispose the oropharynx to bacterial colonization. Aspiration observed at VFS is associated with a 5.6–7 fold increase in pneumonia risk.27 Up to 45% of elderly patients with dysphagia present with penetration into

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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