高齢者の嚥下障害：presbyphagia

高齢者の嚥下障害に関するレビュー論文を紹介します。ここでもpresbyphagia（老人性嚥下機能低下、老嚥）が出てきます。

Humbert IA, Robbins J. Dysphagia in the elderly. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):853-66, ix-x.

下記のHPで全文見ることができます。

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182519/pdf/nihms79128.pdf

論文の中にPresbyphagia versus Dysphagiaという項目があります。やや長いですがこの部分を以下、引用します。

Although the anatomical, physiological, psychological and functional changes that occur in the dynamic process we refer to as “aging” place older adults at risk for dysphagia; a healthy older adult’s swallow is not inherently impaired. Presbyphagia refers to characteristic changes in the swallowing mechanism of otherwise healthy older adults. Clinicians are becoming more aware of the need to distinguish among dysphagia, presbyphagia (an old, yet healthy, swallow) and other related diagnoses in order to avoid over diagnosing and over treating dysphagia. With the increased threat of acute illness, multiple medications, and any number of age-related conditions, older adults are more vulnerable and can cross the line from a healthy older swallow to a person with dysphagia in association with certain perturbations including acute illness, surgery, chemo radiation and other factors. Previous work has focused primarily on the anatomy and physiology of the oropharyngeal swallowing mechanism. Age effects on the temporal evolution of isometric and swallowing pressure indicate a progression of change that, when combined with naturally diminished functional reserve (the resilient ability of the body to adapt to physiological stress make the older population more susceptible to dysphagia. We review age-related changes in peripheral and central nervous system control of head and neck structures for swallowing in this paper. In addition, we briefly discuss promising strategies for neurorehabilitation of
dysphagia that are based upon the recognition that swallowing disruption may, in part, be a manifestation of “sarcopenia”, the age-related loss of skeletal muscle mass, organization and strength as well as age-related changes in sensorimotor acuity and efficiency.

以上、引用です。Presbyphagiaは健常高齢者における加齢による嚥下機能変化とあります。そして、DysphagiaかPresbyphagiaかその他かを区別する必要性を、臨床家はより認識するようになったとあります。

急性疾患、手術、化学療法、放射線療法、複数の薬物療法、加齢に関連した状況などが生じることで、健常高齢者（原発性Presbyphagia）はより脆弱になり、嚥下障害（Dysphagia）に移行することがあります。

サルコペニアは主に四肢で研究されていますが、頭部や頚部の筋肉にも生じます。口腔、咀嚼、舌、嚥下の筋肉にも生じます。原発性Presbyphagia＝原発性サルコペニアによる嚥下障害ではありませんが、強い関連があります。

サルコペニアによる嚥下障害やPresbyphagiaは、今までその重要性をあまり指摘されてきませんでした。確かにエビデンスは少ないですが、まったくないということはありません。どちらも研究は主に原発性で進んでいますが、臨床では二次性が多いです。

二次性Presbyphagiaは広義のサルコペニアによる嚥下障害と同様に、疾患の治療だけでなく、廃用予防（早期経口摂取）、栄養改善、舌や舌骨上筋群などレジスタンストレーニングの併用、つまりリハ栄養管理が機能改善に重要だと考えます。

Abstract
The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.