PRESBYPHAGIA AND SARCOPENIC DYSPHAGIA: ASSOCIATION BETWEEN AGING, SARCOPENIA, AND DEGLUTITION DISORDERS

Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated witha frailty in swallowing. Presbyphagia is different from dysphagia. Sarcopenic dysphagia is difficulty swallowingdue to sarcopenia of generalized skeletal muscles and swallowing muscles. Age-related loss of swallowingmuscle mass becomes evident in the geniohyoid muscle and tongue. Elderly subjects with both sarcopenia anddysphagia may have not only disease-related dysphagia but also sarcopenic dysphagia. In cases of aspirationpneumonia, deterioration in activity-, disease-, and nutrition-related sarcopenia of generalized skeletal musclesand swallowing muscles may develop into sarcopenic dysphagia. Assessment of sarcopenic dysphagia includesevaluation of both dysphagia and sarcopenia. The 10-item Eating Assessment Tool (EAT-10) and a water testcombined with pulse oximetry are useful for dysphagia screening. Assessment of the multi-factorial causes ofsarcopenia including nutritional review is important, because rehabilitation of sarcopenic dysphagia differsdepending on its etiology. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19thAnnual Meeting of the Japanese Society of Dysphagia Rehabilitation. Rehabilitation for sarcopenic dysphagiaincludes treatment of both dysphagia and sarcopenia. The core components of dysphagia rehabilitation are oralhealth care, rehabilitative techniques, and food modification. The causes of adult malnutrition may alsocontribute to the etiology of secondary sarcopenia and sarcopenic dysphagia. Therefore, nutrition management isindispensable for sarcopenic dysphagia rehabilitation. In cases of sarcopenia with numerous complicating causes,treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases,resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking.