It is obvious that deglutition is critical to sustaining life because it is the means for satisfying our nutrition and hydration needs. In addition, eating is generally a pleasurable social activity that is enjoyed by most people. It is clear from this discussion that normal swallowing is a complex process that has been discussed in terms of stages beginning when food is placed in the mouth and ends in the stomach. There is a body of research that indicates swallow physiology changes with age due to a number of different factors. These changes are observed in sensory, motor, and structural body systems that support swallowing. These changes can leave some elderly vulnerable to swallowing problems. For instance, Barczi et al. [34
] indicated that diminished oropharyngeal functional reserve is part of the aging process. It can often put the elderly at greater risk for dysphagia, since there is a higher likelihood that environmental stressors such as chronic illness or other medical conditions stress their functional capacity, thus giving rise to a swallowing problem. Healthcare professionals should be alert to symptoms that were discussed herein. Training sessions such as informational presentations by an SLP can also assist professionals who provide services to community dwellers in forming an awareness of potential swallowing problems.
For example, Daniels and her associates [35
] developed a screening protocol that they used to identify patients who may need instrumental testing such as video fluorography. Patients were required to drink calibrated volumes of water and were evaluated for dysphonia, dysarthria, abnormal volitional cough, abnormal gag reflex, cough following a swallow, and voice change following a swallow. If a patient demonstrated at least two of the six behavioral predictors, she/he was referred for an instrumental study. An SLP could use the list of predictors and develop an instructional module that could be used to educate various professional groups and the elderly. If such symptoms were noted in an actual situation, the healthcare professional could discuss the problem with the individual and seek their permission for referral.
Elderly patients who develop swallowing disorders due to some medical condition such as stroke or head/neck cancer are generally managed by a healthcare team that includes an SLP [4
]. Team composition may vary but often consists of a dietician, nurse, occupational therapist, physical therapist, physicians which may include an otolaryngologist, gastroenterologist, neurologist and/or radiologist, respiratory therapist and social worker. Each professional provides a unique perspective in the development of a rehabilitation program for the patient. Collectively, they formulate an interdisciplinary rehabilitation plan to minimize the impact of the swallowing disorder and any additional problems that manifest. For instance, the SLP may work with the dietician to create an appropriate diet for the patient. The dietician determines the patient’s nutritional and hydration needs, while the SLP determines the safest way to provide the nutrition and hydration. This would be in supplement to treatment for the swallowing disorder. In addition, the SLP may work with the occupational and physical therapists if corrective patient positioning is needed to improve feeding performance or transfer of food from hand to mouth is a problem. Such interdisciplinary cooperation ensures that the patient receives sufficient nutrition and hydration and treatment directed to maximum recovery of all physiological functions [36
Finally, it is evident that the SLP has a number of different therapeutic interventions available for use. The selection of a specific intervention will depend on the patient’s swallowing disorder and the severity of the disorder; however, an important issue that must be considered is the evidence that is available to support the different treatments that [36
]. What scientific evidence is available to either support or refute the different treatments? In most cases, there is some evidence from case studies or small cohort studies to support the efficacy of most treatments; however, definitive randomized controlled trials are lacking. An additional caveat is that research findings for some of the treatments are equivocal. For example, thermal stimulation is used quite frequently to stimulate initiation of the pharyngeal swallow, but there are studies that both support and refute the treatment [17
]. Similarly, NMES is a treatment that is used very frequently, but it is very controversial, because current research findings are equivocal [5
]. Readers are referred to Practice Portal of the American Speech-Language-Hearing Association (http://ncepmaps.org/adultdysp/
) for current evidence reviews regarding the different treatments that have been discussed [37