Presented at the 18th Annual Meeting of the Dysphagia Research Society, San Diego, California, U.S.A., March 5–7, 2010.
Article first published online: 22 OCT 2010
Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 120, Issue 11, pages 2147–2152, November 2010
How to Cite
Butler, S. G., Stuart, A., Leng, X., Rees, C., Williamson, J. and Kritchevsky, S. B. (2010), Factors influencing aspiration during swallowing in healthy older adults. The Laryngoscope, 120: 2147–2152. doi: 10.1002/lary.21116
This work was supported by NIDCD R03 DC009875, Wake Forest School of Medicine Claude D. Pepper Older Americans Independence Center (P30 AG21332), and the GCRC grant of Wake Forest University Baptist Medical Center (M01-RR07122). The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 22 OCT 2010
- Article first published online: 22 OCT 2010
- Manuscript Accepted: 4 JUN 2010
- Manuscript Revised: 2 JUN 2010
- Manuscript Received: 24 FEB 2010
- flexible endoscopic evaluation of swallowing;
- older adults;
- delivery method;
- bolus volume;
- Level of Evidence: 2c
Although flexible endoscopic evaluation of swallowing (FEES) is an established diagnostic tool, little data exist on the effects of varying liquid types on the swallowing outcomes in healthy older adults.
Seventy-six healthy older adult volunteers participated (i.e., 18, 28, and 30 volunteers in the 7th, 8th, and 9th decades of life, respectively). The effects of age, sex, liquid type (i.e., water, skim, 2% milk, or whole milk), delivery method (i.e., cup or straw), and volume (i.e., 5, 10, 15, or 20 mL) on Penetration Aspiration Scale (PAS) scores were assessed during FEES.
Penetration and silent aspiration were observed in 83% and 28% of the participants, respectively. This represented 19% and 3% of participants' 2,432 swallows, respectively. Liquid type (P = .0001), bolus volume (P = .02), and delivery method (P = .04) significantly affected PAS scores. PAS scores were significantly (P < .05) greater for milk versus water swallows, whole- versus skim-milk swallows, 10- and 20-mL versus 5-mL volumes, and straw versus cup delivery. The risk for aspiration increased by approximately two-, three-, and seven-fold with maximal increases in bolus volume, fat content of liquids, and age, respectively.
Occasional aspiration may be an underappreciated phenomenon during FEES in healthy older adults. In addition, milk yielded a higher likelihood of aspiration than water. Accordingly, different liquid types, bolus volumes, and delivery methods should be used to ensure an accurate assessment of aspiration status in healthy older adults. Laryngoscope, 2010