The vicious cycle of dysphagia-sarcopenia-dysphagia
Dysphagia is a key cause of malnutrition leading to sarcopenia. But sarcopenia itself may weaken the muscles involved in swallowing, and lead to more severe dysphagia and the related risks of aspiration and pneumonia6. The importance of dysphagia management in the rehabilitation of frail elderly was addressed by Dr Hidetaka Wakabayashi of Yokohama City University Medical Center, Department of Rehabilitation Medicine, Japan. In a study of Japanese older adults with swallowing difficulty, sarcopenic dysphagia was suggested by an association between thin mid-upper arm circumference and poor swallowing function7. “A general reduction in lean body mass including those muscles involved in swallowing is responsible for this association” explained Dr Wakabayashi. These results suggest the novel concept of sarcopenic dysphagia; “however, a definition and diagnostic criteria are yet to be established”.
Screen for malnutrition and dysphagia to help those under threat of adverse events
An estimated 75% of dysphagia sufferers are undiagnosed, so Dr Wakabayashi emphasized the importance of identifying those elderly people at risk of, or already suffering from, dysphagia and malnutrition. The gold standard for screening elderly for malnutrition is the Mini Nutritional Assessment (MNA®), a simple 6-item questionnaire on appetite, weight loss, mobility, acute disease, depression/dementia and body mass index or calf circumference8. Dr Wakabayashi described a new dysphagia screening tool that has recently been developed: the 10-item Eating Assessment Tool (EAT-10). EAT-10 is a questionnaire comprising 10 questions measuring a person’s perceptions of swallowing difficulty. It is designed to rapidly identify dysphagia symptom severity. A score of three or higher indicates dysphagia risk.
An EAT-10 validation study has been conducted in a Japanese population of 393 frail elderly people (130 men, 263 women), with a mean age of 83 years. The results, publication in press, were described. Only 21% (n=82) of respondents had normal swallowing; 44% (n=172) had dysphagia with aspiration (material in the airway) and 35% (n=139) had dysphagia without aspiration. “Although more testing is required, I am confident that the high sensitivity and specificity of EAT-10 will make it an effective tool for future routine screening for dysphagia” said Dr Wakabayashi. Rehabilitation is the next step for those people identified to suffer dysphagia, and multidomain intervention with oral hygiene, resistance exercise, and modified foods and liquids is important to combat sarcopenic dysphagia, prevent pneumonia, and avoid the spiral of decline into severe frailty.
6. Wakabayashi H, Fujimoto A. Dysphagia due to sarcopenia: potential and practice of rehabilitation nutrition. 2012. Ishiyaku, Tokyo [Japanese]
7. Kuroda Y, Kuroda R. Relationship between thinness and swallowing function in Japanese older adults: implications for sarcopenic dysphagia. J Am Geriatr Soc. 2012;60(9):1785-6.