What is sarcopenia and how does it impact swallowing?
Sarcopenia is defined as age-related loss of muscle. It impacts tongue strength, the ability to lateralize the tongue, and the ability to protrude the tongue. Reduced tongue strength and problems with lateralization can actually create issues with residue that is found in the anterior and lateral sulci. If the tongue doesn’t have the strength to move the residue then that puts a patient at risk for pocketing and creates bacteria-laden saliva. This makes oral care very important.
The literatures suggests that 1 out of 5 adults ages 60 and older has sarcopenia. By age 60, there is a 10-50% loss of skeletal muscle which will most likely not come back. By age 85, a person loses at least 55% of skeletal muscle. Therefore, it is very important for our patients to understand that if they don’t use their muscles they will lose them. This is especially true for the tongue. With tongue movement, it is important to inform patients that if they only chew in the front of their mouth then those are the only taste buds that will be activated. If they have the ability to move food around the entire oral cavity, they will activate more taste buds and increase the sensation of taste. Again, it is very important to get the tongue moving and keep it mobile.
There are certain symptoms associated with sarcopenia. The patient can have unintended weight loss (10 or more pounds in a year). Patients complain of being generally exhausted at least three days a week. Patients with sarcopenia will also have muscle weakness, slow walking speed, and low levels of physical activity. As a result, this impacts the ability for patients to move their bowels. If they are sedentary and not walking they tend to have a harder time moving their bowels, they become impacted; and that creates a problem with a patient’s willingness to eat.
There is also a certain progression to sarcopenia. First, there is the age-related deconditioning or loss of muscle mass. With the diagnosis of sarcopenia, muscle fiber type II are affected. These are the muscle fibers that are recruited for swallowing. They are fast-moving and very strong. If they are affected by atrophy and deconditioning, that will impact how the muscles work and they become much slower. That, in turn, creates dysphagia and the inability to protect the airway which then leads to penetration/aspiration events.
Sarcopenia is very important to understand. If we can keep those muscles moving and involve the clients in a therapy program, especially dealing with the tongue, we should be able to minimize the impact of sarcopenia at least on the swallow.