Purpose: Traditionally, etiology of dysphagia is thought to be related to multiple medical diagnoses including stroke, head and neck cancer, degenerative neurological conditions, and so forth. However, community dwelling older adults (CDOA) can present with dysphagia in the absence of any specific etiology. The purpose of this research was to develop a multidimensional framework to help identify those CDOA at risk for dysphagia of nonspecific etiology. Method: Pertinent literature was examined to identify support for the proposed framework and to explain how the various elements support the model. Results: Several factors that are not traditionally thought to be associated with dysphagia can both initiate and exacerbate symptoms of swallowing difficulties. Swallowing difficulties may be subtle and underreported. Monitoring for symptoms related to preclinical dysphagia may be helpful for early identification. Conclusions: Dysphagia in CDOA is complex and multidimensional. Clinicians working with older adults will benefit from considering elements described in this multidimensional framework to better understand the etiology of swallowing deficits and improve management. Supplemental Material: https://doi.org/10.23641/asha.14150078

Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed ‘pre-clinical dysphagia’. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach’s α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.

Purpose: Both the enjoyment of foods and safe swallowing revolve around incorporating multiple streams of sensory feedback to form a positive sensory experience; these include information about the taste, smell, texture, temperature, and even the sight of food. Traditional swallowing assessment and treatment paradigms have primarily focused on the motor aspects of swallowing. However, sensory information is vital for not only enjoying foods while eating but also coordinating safe and efficient swallow behaviors. The purpose of this clinical focus article is to discuss the clinical importance of sensation in swallowing evaluation and intervention. Conclusions: During their clinical assessments of swallowing, speech-language pathologists are already documenting the functional results of oropharyngeal sensorimotor impairments (e.g., residue). A combination of sensory and motor aspects is already integrated within current behavioral treatment strategies for dysphagia. Focused attention to the salient sensory features of swallowing has the potential to improve swallowing evaluation and intervention efforts. A discussion of potential future research in improved measurement and documentation of altered sensation is provided.

Purpose Patient-reported outcomes (PROs) are an important feature in clinical evaluation of swallowing. The Eating Assessment Tool (EAT-10) and the Sydney Swallow Questionnaire (SSQ) are two valida...

Purpose: This article describes practical strategies for enhancing swallow assessments for individuals with intellectual or cognitive disabilities through the inclusion of visual communication supports (known as augmentative and alternative communication [AAC]). These strategies were developed to support understanding and self-expression during the swallow assessments for individuals with Down syndrome, as part of a large research study. Over the last 2 years, these supports have been integrated into swallow assessments with 14 adults with Down syndrome. Method: Clinicians and researchers with expertise in swallowing and AAC collaboratively designed and refined visual communication aids to enhance understanding and task completion of swallowing-related assessments, including the Mann Assessment of Swallowing Ability, Iowa Oral Performance Instrument, spontaneous swallowing frequency, food avoidance inquiries, and lingual somatosensation testing. A summary table of assessments and suggested strategies is provided. All study procedures were approved by the Institutional Review Board (IRB #00022372) at The Pennsylvania State University. Results: Our observations suggest the integration of AAC enhances the accessibility of swallow assessments for individuals with intellectual disabilities, supporting their participation in these assessments. Many participants referenced the visual aids, such as videos, as key to their understanding of what to expect and what to do during assessments. These observations are consistent with research showing that multisensory modalities and adaptations can improve functional outcomes for people with Down syndrome. Conclusions: Incorporation of visual supports may be useful for clinicians and researchers seeking to improve accessibility in swallow assessments for diverse populations. Clearly, dedicated research is necessary to examine these observations systematically.

Individuals with acute stroke on nonoral feeding regimens frequently develop pneumonia, questioning the long-held belief that pneumonia in stroke patients is a caused by food and liquid aspiration alone. Refluxate and colonized oral secretions are thought to contribute to an acidic oropharyngeal environment. If aspirated, these colonized oral secretions with increased acidity, can result in increased risk to the respiratory system. This study aimed to investigate the relationship between pharyngeal acidity, dysphagia, and pneumonia in acute stroke patients. Twenty-one patients (mean age 67 years) admitted to a stroke unit were recruited into this study. We evaluated their stroke and dysphagia severity via clinical measures. Pharyngeal acidity was measured using a Restech Dx-pH measurement probe placed transnasally for 24 hours. Sixty two (62%) patients presented with moderate to severe stroke and 38% with dysphagia. Seven patients (33%) were positive for pharyngeal acidity. Two patients with pharyngeal acidity were diagnosed with chest infection. Pharyngeal acidity was significantly correlated with stroke severity (r = 0.487, P = 0.03) and significantly and inversely correlated to clinical swallow performance (rho = -0.626, p = 0.02). Additionally, pharyngeal acidity was significantly associated with categorical dysphagia scores (χ2(3,21) = 10.5, p<0.01), functional oral intake (χ2(3,21) = 15.7, p<0.001), presence of modified diets (χ2(1,21) = 14.0, p=0.0001), and tube feeding (χ2 (1,21) = 9.992, p = 0.002). Preliminary results suggest that acute stroke patients with dysphagia may present with increased risk for increased pharyngeal acidity. Pharyngeal acidity can result in negative sequelea, including respiratory complications. A better understanding of these potential relationships may lead to enhanced assessment and treatment approaches that limit pharyngeal acidity and resulting respiratory complications in acute stroke patients.