What is dysphagia and why it affects seniors
Dysphagia is the medical term for a swallowing disorder that makes it difficult to move food or liquid from the mouth to the stomach. In older adults, dysphagia is common and often related to underlying medical conditions or the natural aging process. Muscle weakness, neurological disorders like Parkinson's or dementia, and reduced coordination can all contribute to swallowing problems. If not addressed, this can lead to malnutrition, dehydration, and a higher risk of aspiration pneumonia, which occurs when food or liquid enters the lungs.
Types of swallow tests for older adults
There are two primary types of instrumental swallowing tests used for the elderly, which are typically performed after an initial clinical bedside evaluation by a speech-language pathologist (SLP).
Modified Barium Swallow (MBS) / Videofluoroscopic Swallowing Study (VFSS)
This is a moving X-ray study that evaluates the entire swallowing process, from the mouth to the esophagus.
- How it's done: The patient is seated upright and asked to swallow small amounts of different substances (thin liquid, thickened liquid, puree) mixed with barium, a contrast material. The barium makes the path of the food and liquid visible on the X-ray, allowing the healthcare team to observe any issues.
- What it reveals: The MBS can identify biomechanical problems, such as a delayed swallowing reflex, poor tongue control, or if material is entering the airway (aspiration).
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Unlike an MBS, a FEES test does not use X-rays. Instead, it uses a flexible camera to view the swallowing anatomy directly.
- How it's done: A thin, flexible endoscope with a tiny camera is passed through the patient's nose to the back of their throat. The patient is then given different foods and liquids, sometimes colored to be more visible, to swallow.
- What it reveals: The FEES procedure allows the SLP to directly observe the pharyngeal (throat) and laryngeal (voice box) structures in real-time. It can detect issues like residue left in the throat after a swallow, aspiration, or problems with airway closure.
Comparison of swallow tests for seniors
| Feature | Modified Barium Swallow (MBS) | Fiberoptic Endoscopic Evaluation of Swallowing (FEES) |
|---|---|---|
| Equipment | Moving X-ray machine (fluoroscopy) | Small, flexible camera (endoscope) |
| Location | X-ray department or clinic | Can be performed bedside, in a clinic, or nursing home |
| Visualization | Views the entire swallow process from the mouth to the esophagus | Provides a direct, close-up view of the pharynx and larynx during swallowing |
| Radiation Exposure | Involves a small amount of radiation exposure | No radiation exposure |
| Invasiveness | Non-invasive externally, but requires drinking barium | Minimally invasive, involving a camera through the nose |
| Best for | Identifying problems across all phases of swallowing, including the esophagus | Assessing secretion management, residue, and airway protection in the throat |
What to expect during a swallow test
For most instrumental swallow tests, the patient will be seated in an upright position. The procedure is non-painful, although some patients might find the barium solution's chalky taste unpleasant. Throughout the test, a speech-language pathologist will guide the patient, asking them to swallow different food and liquid consistencies. After the imaging is complete, the SLP and a radiologist review the video to make a diagnosis and create a treatment plan. Results can help determine if the patient requires dietary modifications, swallowing therapy, or postural changes while eating.
Conclusion
For older adults, a swallow test, or dysphagia evaluation, is a critical diagnostic tool for identifying swallowing difficulties caused by age-related changes or underlying medical conditions. Tests like the Modified Barium Swallow and Fiberoptic Endoscopic Evaluation provide detailed information that is essential for preventing serious complications like aspiration pneumonia. The assessment helps healthcare providers develop personalized management plans, ensuring the safety and nutritional well-being of the patient. If you or a loved one notice signs of swallowing problems, consulting a healthcare provider for a swallowing assessment is a crucial step toward better health outcomes, based on information from the National Institutes of Health.
