oday we are going to talk about the aging swallow. I thought I would start out with a quote by George Carlin: “Death is caused by swallowing small amounts of saliva over a long period of time." I think that quote sets the tone for today, because the overriding theme of today's discussion is going to be about differentiating between what is normal aging and what is truly a disorder.
Here are the specific learning objectives for today. We are going to describe how to distinguish normal aging from a truly disordered dysphagic swallow. We are going to define three strategies to improve nutrition and hydration in our elderly clients. We are going to describe how to identify those clients who could potentially benefit from some of our interventions, particularly from exercise to improve endurance for feeding and swallowing. As we will see, for some of our clients, eating really is an endurance activity.
As speech pathologists working in this field of dysphagia, we have a lot of challenges around staying up to date. We are bombarded with information. There is a lot of information about normal swallowing and disordered swallowing and treatment strategies. Unfortunately, a lot of it conflicts with a lot of other information. We are getting information from a wide variety of sources, including our fellow clinicians, and it can be really difficult sometimes to sort out what information is truly evidence-based, what information is anecdotal, and what is just speech pathology urban legend.
Practice Patterns of SLPs
A case review–type study was conducted in 2013 (Carneby & Harenberg). It was an internet survey in which SLPs were given a case with a lot of specific information and then were asked, “What would you do if this were your client?”
The results indicated that there were as many as 47 different interventions that were recommended. The problematic part was that only a very small percentage of people reported that they were choosing their recommendations based specifically on the physiological abnormalities. We are often in a situation where we are just throwing the kitchen sink at people and putting all kinds of interventions into place, including dietary interventions, compensatory strategies, maybe some sensory interventions and exercises. We are just throwing the kitchen sink at people without really trying to match specific dysphagia symptoms to the specific interventions.