During the ageing process there are some normal changes that occur to the swallow, Shindler and Kelly (2002) state that over time self-learned compensatory strategies cover up the changes in physiology that weaken deglutition. These normal changes combined with bilateral hemispheric stroke intensify dysphagia in this population. The following information on the normal changes in deglutition that occur during ageing is sourced from Groher & Crary (2010) and Shindler & Kelly (2002);

  • Changes with sensory perception change smell and taste causing a reduced and delayed salvation response.
  • Reduced strength and motivation to prepare food.
  • Reduction in appetite.

Oral Preparatory Stage
  • Tongue hypertrophy and increased connective tissue cause reduced tongue mobility needed to hold bolus.
  • Reduced skeletal and facial muscle strength causing reduced masticatory strength.
  • Alterations in dentition causing problems with oral preparation of bolus and reduced sensory receptors of the hard palate.

Oral Stage
  • Tongue hypertrophy and increased connective tissue cause reduced tongue mobility needed to propel the pharyngeal swallow. This increases the chance of premature bolus entry into the vallecula.
  • Time to reach maximum swallow pressure is slower.
  • Slower oral stage transit times.

Pharyngeal Stage
  • Elderly patients usually require multiple swallows to successfully clear bolus from the pharynx.
  • Decrease in connective tissue of suprahyoid musculature resulting in reduced opening of PES.
  • Reduced hyoid bone movement causing less distention of PES.
  • Duration of airway closure is longer.
  • Slower Pharyngeal transit times.
  • Increased connective tissue in the UES and decreased cross-sectional area of the oesophageal inlet cause delayed movement of bolus from the pharynx.

Oesophageal Stage
  • Oesophageal motor activity decreases as a result of smooth muscle thickening.
  • Delayed oesophageal emptying.
  • Increased dilation of the oesophagus.

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