Swallowing Assessment in Geriatric Care

Importance of Swallowing Assessment

Dysphagia is highly associated with reduced survival in patients with stroke and dementia, and increases rates of aspiration pneumonia, affecting mortality in older adults 1, 2
Dysphagia causes malnutrition, dehydration, aspiration pneumonia, and increased hospitalizations, contributing to morbidity in older adults 1
Dysphagia significantly reduces quality of life for patients and caregivers, causing discomfort with eating, and leads to weight loss and debility, as recommended by the American Geriatrics Society 1, 3

Up to 55% of patients who aspirate have silent aspiration without protective cough reflex, making clinical detection difficult without formal assessment, according to the American Geriatrics Society 4
Older adults have higher rates of silent aspiration than younger adults, further necessitating proactive screening, as recommended by the American Geriatrics Society 5, 4
Screen for dysphagia when red flags are present, such as coughing or choking during swallowing, nasal regurgitation of food, wet vocal quality after swallowing, poor secretion management, weak cough, feeling of food getting stuck, history of stroke, dementia, Parkinson's disease, or other neurodegenerative conditions, and recurrent pneumonia or unexplained weight loss 4, 6, 1

Use the EAT-10 questionnaire as a validated screening tool (sensitivity 86%, specificity 76% for identifying aspiration) in the initial geriatric assessment, as recommended by the American Geriatrics Society 4
Refer to a speech-language pathologist for clinical evaluation including medical history review, patient/caregiver interview, and cranial nerve examination if screening is positive or clinical suspicion exists, according to the American Geriatrics Society 4, 5
Proceed to instrumental assessment (videofluoroscopic swallowing study or fiberoptic endoscopic evaluation) when signs of dysphagia are present, as bedside evaluations alone are insufficient to determine treatment interventions, as recommended by the American Geriatrics Society 4, 5