[Dysphagia] Management of the ageing swallow

[chris_claire at bigpond.com (Chris and Claire Langdon)]

Hi Tamsin

Maybe start with some of the references on xerostomia? eg.
Astor, F.C., K.L. Hanft, and J.O. Ciocon, Xerostomia: a prevalent condition in the elderly. Ear Nose Throat J, 1999. 78(7): p. 476-9.

Although xerostomia is associated with aging, studies have determined that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably not a condition of aging, but most likely one of systemic or extrinsic origin. Saliva seems to undergo chemical changes with aging. As the amount of ptyalin decreases and mucin increases, saliva can become thick and viscous and present problems for the elderly. One of the most prevalent causes of xerostomia is medication. Anticholinergics, such as psychotropic agents and antihistamines, and diuretics can dry the oral mucosa. Chronic mouth breathing, radiation therapy, dehydration, and autoimmune diseases, such as Sjogren's, can also diminish salivation, as can systemic illness such as diabetes mellitus, nephritis, and thyroid dysfunction. Xerostomia can lead to dysgeusia, glossodynia, sialadenitis, cracking and fissuring of the oral mucosa, and halitosis. Oral dryness can affect denture retention, mastication, and swallowing. Dry mouth symptom can be treated with hydration and sialagogues or with artificial saliva substitutes. Because patients are at risk for dental caries, they should be referred to a dentist for preventive care. In patients with Sjogren's syndrome and in those who have undergone radiation therapy, pilocarpine has been used recently with good results.

Ettinger, R.L., Review: xerostomia: a symptom which acts like a disease. Age Ageing, 1996. 25(5): p. 409-12.

This review considers the changes in salivary glands associated with ageing and concludes that there is no evidence to show that xerostomia is likely to result from the ageing process alone. The four main factors causing xerostomia are presented and it can be seen that the condition is a side-effect of diseases and the drugs used to treat these diseases. As xerostomia has a significant effect on a person's quality of life, a multifaceted approach to treating xerostomia is presented. All health care workers should be sensitive to those complaining of dry mouth and help them to seek care.

Porter, S.R., C. Scully, and A.M. Hegarty, An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004. 97(1): p. 28-46.

Salivary gland disease gives rise to salivary gland enlargement, pain, and prolonged xerostomia (dry mouth). Xerostomia is the most common long-standing problem for the majority of affected patients. There are many causes of dry mouth, with long-standing xerostomia being a particular problem in Sjogren's syndrome and after radiation to the head and neck region. Xerostomia is usually managed with saliva substitutes, but a large number of potential systemic therapies of long-standing xerostomia now exist. Some-particularly immunosuppressants-are of fundamental interest for the potential reduction of gland damage in Sjogren's syndrome but as yet are of limited clinical usefulness. Others, particularly pilocarpine and cevimeline, are, or have the potential to be, clinically useful in stimulating salivation by virtue of their action on cholinergic receptors.

Cheers,,

Claire

----- Original Message ----- 
From: "WEST Tamsin (SVHM)" <Tamsin.WEST@svhm.org.au>
To: <dysphagia@b9.com>
Sent: Monday, October 10, 2005 12:59 PM
Subject: [Dysphagia] Management of the ageing swallow


> 
> Hello,
> 
> I was wondering (hoping!) the listserve might be able to offer some assistance. A colleague of mine is completing a presentation on management of the ageing swallow/deconditioning. She was looking for references/articles/evidence to support the idea that poor oral health can affect the swallow process.  (not that it is an indicator for dysphagia). Does anyone have any good references? Possibly along the lines of changes in taste/sensation/oral awareness/bolus formation etc??  I know this is very general but any help would be appreciated. Thankyou,
> Tamsin.
> 
> Tamsin West
> Speech Pathologist
> St. Vincent's Health
> Melbourne, Australia
> 
> 
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