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過去の講演会
第296回 川崎医学会講演会
| :: 日 時 | 平成26年9月10日（水） 17:30・18:30 |
| :: 場 所 | 図書館小講堂 |
| :: 座 長 | 花山 耕三 |
「OROPHARYNGEAL DYSPHAGIA: A MAJOR GERIATRIC SYNDROME」
Prof. Pere Clavé MD, PhD1,2,3
1Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
2Unitat de Proves Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
3President of the European Society for Swallowing Disorders.
Oropharyngeal dysphagia (OD) is a very prevalent condition among older people with a prevalence ranging from mild symptoms in 25% of the independently-living to severe symptoms in more than 50% living in nursing homes. Clinical methods for screening (Eating Assessment Tool, EAT-10) and assessment (Volume-Viscosity Swallow Test, VVST) of OD offer excellent psychometric proprieties that allow adequate management of OD. Videofluoroscopy (VFS) is the gold standard for the study of the mechanisms of OD in the elderly. Oropharyngeal residue is mainly caused by weak bolus propulsion forces due to tongue sarcopenia. The neural elements of swallow response are also impaired in older persons, with prolonged and delayed laryngeal vestibule closure and slow hyoid movement causing oropharyngeal aspirations. Older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing aspiration pneumonia. (AP). OD causes malnutrition, dehydration, impaired quality of life, lower respiratory tract infections, AP, and poor prognosis including prolonged hospital stay and enhanced morbidity and mortality in several phenotypes of older patients ranging from independently-living older people, hospitalized older patients and nursing-home residents. Prevalence of dysphagia was higher than malnutrition in our older patients. Dysphagia was an independent risk factor for malnutrition, and both conditions were related to poor outcome. Enhancing bolus viscosity strongly improves safety of swallow in elderly patients. At nectar viscosity, the effect is due to intrinsic texture properties, spoon-thick viscosity adding changes in swallow physiology. There are new therapeutic strategies of afferent stimulation using TRPV1 agonists or electrical stimulus that can improve safety and efficacy of swallow by promoting strong changes in swallow physiology. We believe OD should be recognized as a major geriatric syndrome and we recommend a policy of systematic and universal screening and assessment of OD among older people to prevent its severe complications.