Frailty, Swallowing and Dysphagia

Purpose of Review This paper is a brief overview of the relationship between frailty, swallowing and dysphagia. Its goal is to explore the interplay between age and sarcopenia in the development of dysphagia, which is known to be linked to aspiration pneumonia. It is postulated that there is growing justification for routine screening for dysphagia in older frail people, to enable rehabilitation of swallowing through exercise and nutritional intervention, after a hospital stay. Recent Findings The global population is ageing, with a particular increase in the very old and frail. Frail people have a limited functional and physiological reserve and often have sarcopenia. Any subsequent insult (trauma, illness, medication change) frequently results in decompensation and the need for a hospital stay. Often, in these patients, there are changes in the biomechanics of swallowing that can cause impairment and dysphagia. But, many patients adapt the way they eat with subtle compensatory techniques, to bypass this difficulty. It is possible that many more people, than is currently evident, have undiagnosed dysphagia. Pneumonia and respiratory disease are common reasons for hospital admission in the frail elderly population. Dysphagia with aspiration is an important aetiological factor in pneumonia, which is a serious health concern with increasing age. Dysphagia may simply be a consequence of physiological decompensation, related to age, frailty and sarcopenia. Dysphagia is not systematically screened for and may not be identified in many older frail people who have adapted their swallowing, to accommodate their dysphagia. This may be a significant factor in pneumonia-related hospital admissions. Swallow rehabilitation, after such admission to hospital, is also rarely offered in the acute medical setting. This needs to change to reduce recurrent admission, morbidity and mortality. Summary The population is ageing. Sarcopenia, frailty and dysphagia are common with increasing age. Pneumonia is a common admission to hospital and often, aspiration secondary to dysphagia is a common cause. Proactive identification and intervention has the potential to reduce morbidity, hospital admission, length of hospital stay and mortality.