Factors influencing aspiration during swallowing in healthy older adults

Susan G. Butler, Andrew Stuart, Xiaoyan Leng, Catherine Rees, Jeff Williamson, Stephen B. Kritchevsky
2010 The Laryngoscope  
Objectives/Hypothesis-While 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. Study Design-Prospective. Methods-Seventy-six healthy older adult volunteers participated (i.e., 18, 28, and 30 in the 7th, 8th, and 9th decades of life, respectively). The effects of age, gender, liquid type (i.e., water, skim, 2%, and whole milk), delivery method (i.e.,
more » ... and straw), and volume (i.e., 5, 10, 15, and 20 ml) on Penetration Aspiration Scale (PAS) scores were assessed during FEES. Results-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 = 0.0001), bolus volume (p = 0.02) and delivery method (p = 0.04) significantly affected PAS scores. PAS scores were significantly (p < 0.05) 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 2, 3 and 7 fold with maximal increases in bolus volume, fat content of liquids, and age, respectively. Conclusions-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 utilized to assure an accurate assessment of aspiration status in healthy older adults. Level of Evidence = 2c Send Proofs and
doi:10.1002/lary.21116 pmid:20938951 pmcid:PMC3780773 fatcat:ypypczgeibdl3pvqopiwx7x6vq