Nestle Supplement 2

NUTRITION AND THE OLDER PERSON Figure 5. Pathophysiology of nutritional and respiratory complications associated with oropharyngeal dysphagia in elderly patients. ding (3900 mPa.s) viscosity boluses.9 Systematic videofluoroscopic studies found increasing viscosity of liquids to pudding viscosity exerts such a dramatic reduction on the prevalence of penetrations and aspirations that routine introduction of dietary modifications in patients considered at risk of aspiration pneumonia is logical.9,23 In addition, clinical studies also found dietary modifications can reduce the risk of aspiration pneumonia.23 Patients with decreased efficiency of deglutition need dietary adjustments to concentrate their caloric and protein requirements in the low volume of food they can swallow. Modifying the texture of liquids is particularly important to ensure that patients with neurogenic or aging-associated dysphagia remain adequately hydrated and aspiration-free.2 This may be easily achieved by using appropriate thickening agents, which are readily available.9 Sensorial enhancement strategies. Oral sensorial enhancement strategies are particularly useful in patients with apraxia or impaired oral sensitivity (very common in elderly patients).32 The aim of these strategies is the initiation or acceleration of the oropharyngeal swallow response. Most sensorial enhancement strategies include a mechanical stim14 • DECEMBER 2007 ulation of the tongue, bolus modifications (volume, temperature, and taste), or a mechanical stimulation of the pharyngeal pillars.Acid flavors, such as lemon or lime, and cold substances, such as ice cream or ice, trigger the mechanism of deglutition.35 Studies using pharmacological stimulant agents also show some positive effects.26 Oral capsaicin troche supplementation before meals resulted in a significant improvement in respiratory protective reflexes, such as the swallowing reflex, in older people with a high risk for aspiration.36 Use of angiotensin-converting enzyme (ACE) inhibitors and stimulation of the oral cavity by simple oral care, which are effective in increasing substance P, reduced the incidence of aspiration pneumonia.37 Moreover, use of a dopamine agonist, such as amantadine, and a folic acid supplement that are known to activate dopaminergic neurons also prevented AP.37 The development of physical or drugbased strategies to accelerate the pharyngeal motor pattern represents a relevant field of research for the management of neurogenic dysphagia and aging-associated dysphagia.1 Neuromuscular praxis. The goal is improving the physiology of deglutition (the tonicity, sensitivity, and

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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