Confronting Presbyphagia and Oropharyngeal Dysphagia

The ability to swallow efficiently and safely is essential to maintaining nutrition, hydration, health status, and quality of life. The process of swallowing requires coordination among a complex series of psychological, sensory, and motor behaviors that are both voluntary and involuntary (Balou, Herzberg, Kamelhar, & Molfenter, 2019). Presbyphagia refers to the changes associated with natural, healthy aging in the head and neck anatomy and in the physiologic and neural mechanisms that underpin the function of swallowing (Cichero, 2018). This progression of change contributes, in part, to a natural decline in the ability of the body to adapt to physiological stress. Chewing impairment and dysphagia are syndromes that are most-often associated with old age. The World Health Organization included oropharyngeal dysphagia in the International Statistical Classification of Diseases and Related Health Problems (ICD) under subordinate codes 787.2 ICD9 and R13.10 ICD10 (Centers for Disease Control and Prevention, 2015). The reported prevalence of oropharyngeal dysphagia among older adults has varied widely among studies, subjects, and locations (Ortega, Cabre, & Clave, 2014). For example, the reported prevalence of chewing and swallowing disorders among community-healthy elders ranges between 11%~60% (Di Pede, Mantovani, Del Felice, & Masiero, 2016). Oropharyngeal dysphagia is an important factor that causes malnutrition and aspiration pneumonia in the elderly (Imaizumi et al., 2020). In view of the increasing prevalence of chewing and swallowing difficulties, PEACE has been adopted as the theoretical framework for this column "Perspectives on Chewing and Swallowing Care". The ultimate goal is to enable people to live long and enjoy a satisfactory quality of life (Enjoyment). To achieve this goal, people must have the ability to preserve in good condition the muscle groups and mechanisms related to swallowing (Preservation). However, preservation depends on three strategies: (1) Enhancing the knowledge and care skills related to chewing and swallowing difficulties, such as addressed in the four articles in this column: "Chewing screen and interventions for the elders", "The triangular relationship among swallowing disorder, aspiration pneumonia, and poor oral hygiene", "International classification systems of texture-modified foods", and "Innovative development of texture-softened foods for older adults living in residential care". (2) Holding a positive attitude (Attitude), especially regarding the potential for thoroughly implementing oral hygiene to break the vicious cycle of dysphagia-related aspiration pneumonia. Trust that people have the ability to maintain the strength of chewing and swallowing muscle groups and to resolve the comorbidities associated with sarcopenia and presbyphagia. (3) Practicing consistency in knowledge and action. Chewing and swallowing-related knowledge and care skills and positive attitudes may still be insufficient if knowledge and action are not united. When knowledge and action are united, the body may maintain to a good state of function and patients may enjoy peace through their life journey.