Nutritional Issues and Swallowing in the Geriatric Population

Nutritional issues are not a part of normal aging but are present in 5%–30% of community-dwelling independent older adults, and up to 77% of older adults in long-term-care settings. The consequences of nutritional issues in older adults include disability, morbidity, mortality, reduced quality of life, and increased healthcare costs. Body mass index, weight loss, and questionnaires such as the Mini-Nutritional Assessment are useful for identifying older adults with malnutrition. A stepwise, interdisciplinary approach to malnutrition ensures that the contributing dietary, functional, dental, medication, mood, cognitive, and swallowing factors are appropriately treated. Medication reduction is frequently safer and more effective than the addition of an appetite stimulant when anorexia is contributing to malnutrition. Swallowing issues including dysphagia are more common in older adults with a history of stroke, traumatic brain injury, pneumonia, Parkinson's disease, and dementia. Dysphagia can result in a diminished quality of life, aspiration pneumonia, chronic lung disease, malnutrition, dehydration, hospitalization, and death. In older adults swallowing may be slower in all phases and result in pooling in the pharynx but is not considered a disorder. Evaluation and management of dysphagia is optimized with interprofessional collaborative practice including speech-language pathologists, physicians, nurses, dieticians, and others. Screening swallowing helps to identify individuals who require a comprehensive swallow assessment including a clinical swallow evaluation and instrumental swallow examinations, such as a videofluoroscopic swallow study (also known as modified barium swallow study) or a fiberoptic endoscopic evaluation of swallow. Treatment of swallowing problems includes education, compensatory strategies, and rehabilitative approaches, harnessing the principles of neuroplasticity to exercise swallow functions and improve swallow physiology. Healthcare professionals need to work as a team to systematically identify and treat factors contributing to malnutrition, weight loss, and dysphagia, to improve the quality of life of older adults. In this chapter, we will present a systematic approach to nutritional issues in older adults to help the interdisciplinary team care for these fragile patients.