Nestle Supplement 2

NUTRITION AND THE OLDER PERSON Figure 1. Configuration of the oropharynx during swallow response. Each phase of the response (reconfiguration, duration, and conclusion) is defined by opening (O) or closing (C) events occurring at the glossopalatal junction (GPJ), velopharyngeal junction (VPJ), laryngeal vestibule (LV), and upper esophageal sphincter (UES). assess alterations in the biomechanical events of oropharyngeal swallow response, to attempt to prevent and treat the potential complications of dysphagia, such as aspiration pneumonia and malnutrition, and to recognize oropharyngeal dysphagia as a major geriatric syndrome. Identification of functional oropharyngeal dysphagia as a major neurological and geriatric syndrome will induce many changes in the provision of medical and social services in the near future. Education of health professionals on diagnosis and treatment of dysphagia and its complications, early diagnosis, development of specific complementary explorations in the clinical setting, improvement in therapeutic strategies to avoid aspirations and malnutrition, and research into its pathophysiology are the cornerstones to allow maximal recovery potential for older patients with functional oropharyngeal dysphagia. and laryngeal tumors, neck osteophytes, postsurgical esophageal stenosis, and Zenker’s diverticulum.2 Dysphagia may also result as a side effect in patients with head and neck cancers undergoing radiotherapy. Most hospitals are fully equipped to diagnose and treat structural causes of dysphagia. However, oropharyngeal dysphagia in the elderly is more frequently a functional disorder of deglutition affecting oropharyngeal swallow response caused by aging or associated to systemic or neurological diseases. In biomechanical terms, the oropharyngeal swallow response (OSR) consists of the temporal arrangement of oropharyngeal structures from a respiratory to a digestive pathway, the transfer of the bolus from the mouth to the esophagus, and the recuperation of the respiratory configuration.6 Configuration of the oropharynx during swallow response is defined by opening (O) or closing (C) events occurring at the glossopalatal junction (GPJ), velopharyngeal junction (VPJ), laryngeal vestibule (LV), and upper esophageal sphincter (UES) that can be measured during videofluoroscopic studies (Figure 1).The OSR is a stereotyped sequence of excitatory and inhibitory events involv- PATHOPHYSIOLOGY Oropharyngeal dysphagia may result from a wide range of structural alterations that may impair bolus progression. Most common structural abnormalities include esophageal 8 • DECEMBER 2007

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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