Age-related Changes Affecting the Normal Swallow

There are several common physiologic changes that occur as part of the normal ageing process “that weaken the integrity of deglutition” (Schindler & Kelly, 2002, p. 589; Horner, Alberts, Dawson & Cook, 1994). Normal healthy ageing adults typically develop adequate compensatory strategies to accommodate these changes such that they do not experience or report complications (Horner et al.). (See

Pre-oral stage: with normal ageing, changes to olfactory and visual senses result in reduced sensation of smell and sight (Crary & Groher, 2003). Reduced olfactory sensory discrimination negatively effects salivation such that older adults will experience reduced or delayed salivatory response when presented with food (Easterling & Robbins, 2008).

Oral preparatory stage: age-related changes to skeletal muscle strength are normal and result in reduced strength of the face and tongue muscles (Fucile et al., 1998) and the muscles of mastication (Jaradeh, 1994). Reduced tongue control often results in food particles entering the valleculae prematurely. Loss of dentition or poorly fitting dentures diminishes the ability to chew food properly (Easterling & Robbins, 2008; Griffin et al., 2009). Food residue in the buccal and oral cavities may go unnoticed.

Oral stage: Diminished pharyngeal sensory discrimination coupled with insufficient lingual pressure reserve necessary to propel the bolus back towards the fauces result in delayed initiation of the pharyngeal stage (Schindler & Kelly, 2002). In other words, age related physiological changes result in the pharyngeal reflex initiating when the bolus is farther back in the oral cavity (Logemann, 1998 in Seikel, King & Drumright, 2010). The ability to produce saliva also decreases with age (Easterling & Robbins, 2008).

Pharyngeal stage: with age, pharyngeal sensory discrimination diminishes and the pharyngeal musculature weakens (Schindler & Kelly, 2002). This results in older adults needing multiple swallows in order to sufficiently clear the bolus from the pharynx and pharyngeal transport of the bolus taking longer (Easterling & Robbin, 2008). Or reduced sensation may result in residue lining the pharynx (Griffin et al., 2009).

Oesophageal stage: common age-related changes to the UES are decreased resting tone and decreased area of the oesophageal inlet (Schindler & Kelly, 2002; Easterling & Robbins, 2008).

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