European Society for Swallowing Disorders FEES Accreditation Program for Neurogenic and Geriatric Oropharyngeal Dysphagia

Excerpt

The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. The central coordination of this complex sensorimotor task uses a widespread network of cortical, subcortical, and brainstem structures. Many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles, and structures may result in an impaired oropharyngeal swallow, i.e., neurogenic oropharyngeal dysphagia (OD). In addition, aging is also associated with multifactorial changes of swallowing physiology for which the term presbyphagia has been coined [1]. OD has been reported in about 10–27% of older community dwelling residents [2‐4]. In the nursing home, setting numbers are significantly higher and cross the 50% margin, which is similar to figures reported for older individuals admitted to hospital with a diagnosis of pneumonia [5]. Disease-specific prevalence data for OD are also substantial. Thus, disordered swallowing is reported in more than half of acute stroke patients and patients with traumatic brain injury, at least one-third of patients with Parkinson’s disease and dementia and a significant number of patients with neuromuscular disorders, such as amyotrophic lateral sclerosis and myasthenia gravis [6‐11]. In view of the demographic shift, especially with increasing numbers of very old people, i.e., those aged over 85 years, these already alarming figures will further increase in the coming years since many underlying pathologies, particularly stroke, dementia and Parkinson’s disease, are age related [12]. It has been estimated up to 16 million US, 40 million EU and 8 million Japanese citizens require care for dysphagia. The clinical consequences of dysphagia are directly linked to the patient’s overall prognosis, and may include aspiration pneumonia, malnutrition, and dehydration. In the presence of disordered swallowing, mortality is increased and elevated rates of infectious complications have been reported for several medical conditions, such as stroke or Parkinson’s disease, but are also present in other patient populations [13]. In addition, older patients discharged from general hospitals with both dysphagia and malnutrition presented a mortality rate of 65.8% at 1 year follow-up [14]. …