pp 1–24 | Cite as

A Systematic Review of Physiological Changes in Swallowing in the Oldest Old

  • Marie JardineEmail author
  • Anna Miles
  • Jacqueline Allen
Original Article


Age-related swallowing changes are well-researched in deglutology, usually distinguishing those over 60 years as older aged. World-wide, older adults are healthier and forecast to live longer: many over 85 years. It is necessary for clinicians to understand healthy swallowing changes in this ‘oldest old’ in order to appropriately manage swallowing complaints in older patients. This systematic review collated and critically appraised studies investigating swallowing changes in adults over 85 years using instrumental assessment. Criteria for inclusion were healthy subjects over 85 years. Exclusion criteria included studies focused on anatomy and oral processing. Studies published until December 2018 were retrieved from BIOSIS, CINAHL, Embase, Medline, and Scopus, totaling 2125 articles. During data screening, 64% of studies investigating age-related swallowing changes were excluded, as the oldest old were not recruited. After PRISMA screening, 44 articles met criteria. These were further reviewed for data extraction, bias and quality. Main quantitative age-related changes in swallowing included increases in delay in swallow onset, bolus transit times, duration of UES opening, pressure above the UES and UES relaxation pressure, and reduction in pressure at the UES. Few studies detected increased residue or airway compromise in the form of aspiration. Results were not easily comparable due to differences in age ranges, methods for deeming participants ‘healthy’, measures used to define swallowing physiology, and swallowing tasks. Age-related swallowing changes are identified that do not compromise safety. The oldest old are underrepresented in normative deglutition research. It is essential future studies plan accordingly to recruit those over 85 years.


Deglutition Deglutition disorders Systematic review Aged, 80 and over Healthy volunteers 



This study was funded by the Health Research Council of New Zealand and the HOPE Foundation.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Jaul E, Barron J. Age-related diseases and clinical and public health implications for the 85 years old and over population. Front Public Heal. 2017;5(December):1–7.Google Scholar
  2. 2.
    Madhavan A, Lagorio A, Crary M, Dahl W, Carnaby G. Prevalence of and risk factors for dysphagia in the community dwelling elderly: a systematic review. J Nutr Heal Aging. 2016;20(8):806–15.CrossRefGoogle Scholar
  3. 3.
    Leder SB, Suiter DM, Agogo GO, Cooney LM. An epidemiologic study on ageing and dysphagia in the acute care geriatric-hospitalized population: a replication and continuation study. Dysphagia. 2016;31(5):619–25.CrossRefGoogle Scholar
  4. 4.
    Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–36.CrossRefGoogle Scholar
  5. 5.
    Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.Google Scholar
  6. 6.
    Chen P, Golub J, Hapner E, Johns M. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. 2009;24:1–6.Google Scholar
  7. 7.
    Namasivayam-MacDonald A, Shune S. The burden of dysphagia on family caregivers of the elderly: a systematic review. Geriatrics. 2018;3(2):30.CrossRefGoogle Scholar
  8. 8.
    Plowman EK, Humbert IA. Elucidating inconsistencies in dysphagia diagnostics: redefining normal. Int J Speech Lang Pathol. 2018;20(3):310–7.CrossRefGoogle Scholar
  9. 9.
    Forster A, Samaras N, Gold G, Samaras D. Oropharyngeal dysphagia in older adults: a review. Eur Geriatr Med. 2011;2(6):356–62.CrossRefGoogle Scholar
  10. 10.
    Gleeson DCL. Oropharyngeal swallowing and aging. A review. J Commun Disord. 1999;32(6):373–96.CrossRefGoogle Scholar
  11. 11.
    Logemann JA, Curro FA, Pauloski B, Gensler G. Aging effects on oropharyngeal swallow and the role of dental care in oropharyngeal dysphagia. Oral Dis. 2013;19(8):733–7.CrossRefGoogle Scholar
  12. 12.
    Robbins JA. Old swallowing and dysphagia: thoughts on intervention and prevention. Nutr Clin Pract. 1999;14(5):S21–6.CrossRefGoogle Scholar
  13. 13.
    Sonies BC, Parent LJ, Morrish K, Baum BJ. Durational aspects of the oral-pharyngeal phase of swallow in normal adults. Dysphagia. 1988;3(1):1–10.CrossRefGoogle Scholar
  14. 14.
    Tracy JF, Logemann JA, Kahrilas PJ, Jacob P, Kobara M, Krugler C. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia. 1989;4:90–4.CrossRefGoogle Scholar
  15. 15.
    Ward SA, Parikh S, Workman B. Health perspectives: international epidemiology of ageing. Best Pract Res Clin Anaesthesiol. 2011;25(3):305–17.CrossRefGoogle Scholar
  16. 16.
    da Costa Santos CM, de Mattos Pimenta CA, Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007;15(3):508–11.CrossRefGoogle Scholar
  17. 17.
    Higgins J, Green S. Cochrane handbook for systematic reviews of interventions (Internet). The Cochrane Collaboration; 2011.
  18. 18.
    Balshem H, Helfand M, Schünemann HJ, Oxman A, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.CrossRefGoogle Scholar
  19. 19.
    Rademaker A, Pauloski B, Colangelo L, Logemann JA. Age and volume effects on liquid swallowing function in normal women. J Speech Lang Hear Res. 1998;41(2):275–84.CrossRefGoogle Scholar
  20. 20.
    Logemann J, Pauloski B, Rademaker A, Colangelo L, Kahrilas P, Smith C. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000;43(5):1264–74.CrossRefGoogle Scholar
  21. 21.
    Logemann J, Pauloski BR, Rademaker AW, Kahrilas PJ. Oropharyngeal swallow in younger and older women: videofluoroscopic analysis. J Speech Lang Hear Res. 2002;45(3):434–45.CrossRefGoogle Scholar
  22. 22.
    Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20(4):290–6.CrossRefGoogle Scholar
  23. 23.
    Yoshikawa M, Yoshida M, Nagasaki T, Tanimoto K, Tsuga K, Akagawa Y, et al. Aspects of swallowing in healthy dentate elderly persons older than 80 years. J Gerontol A Biol Sci Med Sci. 2005;60(4):506–9.CrossRefGoogle Scholar
  24. 24.
    Martin-Harris B, Brodsky MB, Michel Y, Lee F-S, Walters B. Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res. 2007;50(3):585.CrossRefGoogle Scholar
  25. 25.
    McCullough GH, Rosenbek JC, Wertz RT, Suiter D, McCoy SC. Defining swallowing function by age: promises and pitfalls of pigeonholing. Top Geriatr Rehabil. 2007;23(4):290–307.CrossRefGoogle Scholar
  26. 26.
    Ayala KJ, Logemann JA. Effects of altered sensory bolus characteristics and repeated swallows in healthy young and elderly subjects. J Med Speech Lang Pathol. 2010;18(3):34–58.Google Scholar
  27. 27.
    Butler SG, Maslan J, Stuart A, Leng X, Wilhelm E, Lintzenich CR, et al. Factors influencing bolus dwell times in healthy older adults assessed endoscopically. Laryngoscope. 2011;121(12):2526–34.CrossRefGoogle Scholar
  28. 28.
    Omari TI, Kritas S, Cock C, Besanko L, Burgstad C, Thompson A, et al. Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis. Neurogastroenterol Motil. 2014;26(1):59–68.CrossRefGoogle Scholar
  29. 29.
    Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, et al. Maximum upper esophageal sphincter (UES) admittance: a non-specific marker of UES dysfunction. Neurogastroenterol Motil. 2016;28(2):225–33.CrossRefGoogle Scholar
  30. 30.
    Omari TI, Dejaeger E, Van Beckevoort D, Goeleven A, Davidson GP, Dent J, et al. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology. 2011;140(5):1454–63.CrossRefGoogle Scholar
  31. 31.
    Dejaeger E, Pelemans W, Bibau G, Ponette E. Manofluorographic analysis of swallowing in the elderly. Dysphagia. 1994;9(3):156–61.CrossRefGoogle Scholar
  32. 32.
    Yokoyama M, Mitomi N, Tetsuka K, Tayama N. Role of laryngeal movement and effect of aging on swallowing pressure in the pharynx and upper esophageal sphincter. Laryngoscope. 2000;110(3):434–9.CrossRefGoogle Scholar
  33. 33.
    Leonard R, Kendall K, McKenzie S. UES opening and cricopharyngeal bar in nondysphagic elderly and nonelderly adults. Dysphagia. 2004;19(3):182–91.CrossRefGoogle Scholar
  34. 34.
    Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005;131:762–70.CrossRefGoogle Scholar
  35. 35.
    Martin-Harris B, Michel Y, Castell DO. Physiologic model of oropharyngeal swallowing revisited. Otolaryngol Head Neck Surg. 2005;133(2):234–40.CrossRefGoogle Scholar
  36. 36.
    Im I, Kim Y, Oommen E, Kim H, Ko MH. The effects of bolus consistency in pharyngeal transit duration during normal swallowing. Ann Rehabil Med. 2012;36(2):220–5.CrossRefGoogle Scholar
  37. 37.
    Veiga HP, Fonseca HV, Bianchini EMG. Sequential swallowing of liquid in elderly adults: cup or straw? Dysphagia. 2014;29(2):249–55.CrossRefGoogle Scholar
  38. 38.
    Miles A, Clark S, Jardine M, Allen J. Esophageal swallowing timing measures in healthy adults during videofluoroscopy. Ann Otol Rhinol Laryngol. 2016;125(9):764–9.CrossRefGoogle Scholar
  39. 39.
    Jardine M, Miles A, Allen J. Dysphagia onset in older adults during unrelated hospital admission: quantitative videofluoroscopic measures. Geriatrics. 2018;3(4):66.CrossRefGoogle Scholar
  40. 40.
    Kern M, Bardan E, Arndorfer R, Hofmann C, Ren J, Shaker R. Comparison of upper esophageal sphincter opening in healtly asymptomatic young and elderly volunteers. Ann Otol Rhinol Laryngol. May 1994;1999:982–9.Google Scholar
  41. 41.
    Kim Y, McCullough GH. Maximum hyoid displacement in normal swallowing. Dysphagia. 2008;23(3):274–9.CrossRefGoogle Scholar
  42. 42.
    Kurosu A, Logemann JA. Gender effects on airway closure in normal subjects. Dysphagia. 2010;25(4):284–90.CrossRefGoogle Scholar
  43. 43.
    Leonard R, Belafsky PC, Rees CJ. Relationship between fluoroscopic and manometric measures of pharyngeal constriction: the pharyngeal constriction ratio. Ann Otol Rhinol Laryngol. 2006;115(12):897–901.CrossRefGoogle Scholar
  44. 44.
    Van Herwaarden MA, Katz PO, Gideon RM, Barrett J, Castell JA, Achem S, et al. Are manometric parameters of the upper esophageal sphincter and pharynx affected by age and gender? Dysphagia. 2003;18(3):211–7.CrossRefGoogle Scholar
  45. 45.
    Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, et al. Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry. Neurogastroenterol Motil. 2016;28(12):1890–901.CrossRefGoogle Scholar
  46. 46.
    Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in postdeglutition retention in the elderly. Dysphagia. 1997;12(2):63–7.CrossRefGoogle Scholar
  47. 47.
    Khan TA, Shragge BW, Crispin JS, Lind JF. Esophageal motility in the elderly. Am J Dig Dis. 1977;22(12):1049–54.CrossRefGoogle Scholar
  48. 48.
    Nishimura N, Hongo M, Yamada M, Kawakami H, Ueno M, Okuno Y, et al. Effect of aging on the esophageal motor functions. J Smooth Muscle Res. 1996;32(2):43–50.CrossRefGoogle Scholar
  49. 49.
    Cock C, Besanko LK, Burgstad CM, Thompson A, Kritas S, Heddle R, et al. Age-related impairment of esophagogastric junction relaxation and bolus flow time. World J Gastroenterol. 2017;23(15):2785–94.CrossRefGoogle Scholar
  50. 50.
    Daggett A, Logemann J, Rademaker A, Pauloski B. Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia. 2006;21(4):270–4.CrossRefGoogle Scholar
  51. 51.
    Kelly AM, Macfarlane K, Ghufoor K, Drinnan MJ, Lew-Gor S. Pharyngeal residue across the lifespan: a first look at what’s normal. Clin Otolaryngol. 2008;33(4):348–51.CrossRefGoogle Scholar
  52. 52.
    Butler SG, Stuart A, Markley L, Rees C. Penetration and aspiration in healthy older adults as assessed during endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2009;118(3):190–8.CrossRefGoogle Scholar
  53. 53.
    Butler SG, Stuart A, Leng X, Rees C, Williamson J, Kritchevsky SB. Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope. 2010;120(11):2147–52.CrossRefGoogle Scholar
  54. 54.
    Butler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia. 2011;26(3):225–31.CrossRefGoogle Scholar
  55. 55.
    Butler SG, Stuart A, Markley L, Feng X, Kritchevsky SB. Aspiration as a function of age, sex, liquid type, bolus volume, and bolus delivery across the healthy adult life span. Ann Otol Rhinol Laryngol. 2018;127(1):21–32.CrossRefGoogle Scholar
  56. 56.
    Molfenter SM, Lenell C, Lazarus CL. Volumetric changes to the pharynx in healthy aging: consequence for pharyngeal swallow mechanics and function. Dysphagia. 2019;34(1):129–37.CrossRefGoogle Scholar
  57. 57.
    Kendall KA, Leonard RJ, McKenzie S. Airway protection: evaluation with videofluoroscopy. Dysphagia. 2004;19(2):65–70.Google Scholar
  58. 58.
    Kendall KA, Leonard RJ, McKenzie S. Common medical conditions in the elderly: impact on pharyngeal bolus transit. Dysphagia. 2004;19(2):71–7.Google Scholar
  59. 59.
    Dozier TS, Brodsky MB, Michel Y, Walters BC, Martin-Harris B. Coordination of swallowing and respiration in normal sequential cup swallows. Laryngoscope. 2006;116(8):1489–93.CrossRefGoogle Scholar
  60. 60.
    Leonard R, McKenzie S. Hyoid-bolus transit latencies in normal swallow. Dysphagia. 2006;21(3):183–90.CrossRefGoogle Scholar
  61. 61.
    Mendell DA, Logemann JA. temporal sequence of swallow events during the oropharyngeal swallow. J Speech Lang Hear Res. 2007;50(5):1256.CrossRefGoogle Scholar
  62. 62.
    Brodsky M, McFarland D, Michel Y, Orr S, Martin-Harris B. Significance of nonrespiratory airflow during swallowing. Dysphagia. 2012;27(2):178–84.CrossRefGoogle Scholar
  63. 63.
    Kagaya H, Yokoyama M, Saitoh E, Kanamori D, Susa C, German RZ, et al. Isolated pharyngeal swallow exists during normal human feeding. Tohoku J Exp Med. 2015;236(1):39–43.CrossRefGoogle Scholar
  64. 64.
    Herzberg EG, Lazarus CL, Steele CM, Molfenter SM. Swallow event sequencing: comparing healthy older and younger adults. Dysphagia. 2018;33(6):759–67.CrossRefGoogle Scholar
  65. 65.
    Humbert IA, Fitzgerald ME, McLaren DG, Johnson S, Porcaro E, Kosmatka K, et al. Neurophysiology of swallowing: effects of age and bolus type. Neuroimage. 2009;44(3):982–91.CrossRefGoogle Scholar
  66. 66.
    Moon HI, Jung Y, Eng M, Choi S. Effect of age on cortical activation during swallowing: an fMRI study. J Korean Dysphagia Soc. 2016;6:26–33.CrossRefGoogle Scholar
  67. 67.
    Malandraki GA, Perlman AL, Karampinos DC, Sutton BP. Reduced somatosensory activations in swallowing with age. Hum Brain Mapp. 2011;32(5):730–43.CrossRefGoogle Scholar
  68. 68.
    Dodds RM, Granic A, Davies K, Kirkwood TBL, Jagger C, Sayer AA. Prevalence and incidence of sarcopenia in the very old: findings from the Newcastle 85+ study. J Cachexia Sarcopenia Muscle. 2016;8(2):229–37.CrossRefGoogle Scholar
  69. 69.
    Zhao W-T, Yang M, Wu H-M, Yang L, Zhang X, Huang Y. Systematic review and meta-analysis of the association between sarcopenia and dysphagia. J Nutr Heal Aging. 2018;22(8):1003–9.CrossRefGoogle Scholar
  70. 70.
    Molfenter SM, Amin MR, Branski RC, Brumm JD, Hagiwara M, Roof SA, et al. Age-related changes in pharyngeal lumen size: a retrospective MRI analysis. Dysphagia. 2015;30(3):321–7.CrossRefGoogle Scholar
  71. 71.
    Yin T, Jardine M, Miles A, Allen J. What is a normal pharynx? A videofluoroscopic study of anatomy in older adults. Eur Arch Otorhinolaryngol. 2018;275(9):2317–23.CrossRefGoogle Scholar
  72. 72.
    Sergi G, De Rui M, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. 2011;28(7):509–18.CrossRefGoogle Scholar
  73. 73.
    Gallagher L, Naidoo P. Prescription drugs and their effects on swallowing. Dysphagia. 2009;24(2):159–66.CrossRefGoogle Scholar
  74. 74.
    Kendall KA, Ellerston J, Heller A, Houtz DR, Zhang C, Presson AP. Objective measures of swallowing function applied to the dysphagia population: a one year experience. Dysphagia. 2016;31(4):538–46.CrossRefGoogle Scholar
  75. 75.
    Nagy A, Leigh C, Hori SF, Molfenter SM, Shariff T, Steele CM. Timing differences between cued and noncued swallows in healthy young adults. Dysphagia. 2013;28(3):428–34.CrossRefGoogle Scholar
  76. 76.
    Cock C, Omari T. Systematic review of pharyngeal and esophageal manometry in healthy or dysphagic older persons (> 60 years). Geriatrics. 2018;3(4):67.CrossRefGoogle Scholar
  77. 77.
    Namasivayam-MacDonald AM, Barbon CEA, Steele CM. A review of swallow timing in the elderly. Physiol Behav. 2018;184:12–26.CrossRefGoogle Scholar
  78. 78.
    Winiker K, Gillman A, Guiu Hernandez E, Huckabee ML, Gozdzikowska K. A systematic review of current methodology of high resolution pharyngeal manometry with and without impedance. Eur Arch otorhinolaryngol. 2019;276(3):631–45.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Speech ScienceUniversity of AucklandAucklandNew Zealand
  2. 2.Department of SurgeryUniversity of AucklandAucklandNew Zealand

Personalised recommendations