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.
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This study was funded by the Health Research Council of New Zealand and the HOPE Foundation.
Conflict of interest
The authors declare that they have no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Marie Jardine has received scholarships for her PhD from the Health Research Council of New Zealand and the HOPE Foundation.
Appendix 1: Details of Included Studies
|Study (in chronological order)||Age range||Participant groups (n)||Oldest group (mean, SD)||How deemed ‘healthy’?||Medications?||Instrumental assessment||Swallow tasks (bolus size, texture)||Study aim|
|Khan et al. ||20–89 years||
20–39 years (43)|
60–89 years (49)
|Not stated||Interview: ‘carefully questioned’||Not stated||LRM||5 ml boluses of water, total unclear||Effect of age on esophageal motility|
|Dejaeger et al. ||Not stated||
Healthy volunteers (20)|
|80 years, 5 years||No relevant history||Not stated||
|At least 3 × 10 ml liquid barium||Effect of age on quantitative and qualitative swallowing measures|
|Nishimura et al. ||23–89 years||
< 49 years (11)|
50–59 years (15)
60–69 years (11)
> 70 years (10)
|Not stated||No relevant history||Screened||LRM||10 × 3–5 ml tap water||Effect of age on esophageal motility|
|Dejaeger et al. ||Not stated||
|80 years, 7 years||No relevant history||Screened||
|3 × 10 ml liquid barium||Quantitative differences in swallowing between swallows with and without pharyngeal residue|
|Rademaker et al. ||20–89 years||
20–39 years (61)|
40–59 years (45)
60–79 years (38)
80–89 years (23)
|Not stated||No relevant history||Screened||VFS||2 × 1, 3, 5 and 10 ml liquid barium||Effect of age and bolus size on healthy swallowing function|
|Kern et al. ||24–90 years||
|75 years, 2.8 years||Not stated: ‘without any swallowing difficulties’||Not stated||
|3 × 5 and 10 ml liquid barium||Effect of age on timing, width and pressure of UES opening, and associated biomechanical events|
|Logemann et al. ||21–94 years||
21–29 years (8)|
80–94 years (8)
|Not stated||No relevant history||Screened||VFS||2 × 1 and 10 ml liquid barium||Effect of age on swallowing timing and biomechanics|
|Yokoyama et al. ||21–89 years||
21–31 years (32)|
61–74 years (12)
75–89 years (12)
|Not stated||Not stated: ‘nondysphagic’||Not stated||
|10 ml liquid barium||Effect of age on swallowing pressure and function|
|Logemann et al. ||21–93 years||
21–29 years (8)|
80–93 years (8)
|Not stated||No relevant history||Screened||VFS||2 × 1 and 10 ml liquid barium||Effect of age on swallowing function|
|Van Herwaarden et al. ||18–91 years||
< 60 years (61)|
> 60 years (23)
|71.3 years||No relevant history||Screened||LRM||3 × at least 4 swallows of 5 ml water, 5 ml pudding and ¼ cookie||Effect of age and gender on UES and pharyngeal manometric parameters|
|Kendall et al. ||18–88 years||
|Not stated||Self–reported, no relevant history||Not stated||VFS||1 and 20 ml liquid barium||Coordination between structural movements relative to bolus movements before UES opening|
|Kendall et al. ||65–88 years||
No medical problems (23)|
Medical conditions (63)
|Not stated||No relevant history, head and neck exam||Screened: taken for chronic older conditions||VFS||1 and 20 ml liquid barium||Effect of medical conditions on swallowing in older adults|
|Leonard et al. ||18–88 years||
|Median 70 years||Interview, HEENT exam, dietary questionnaire||Screened: taken for chronic older conditions||VFS||Lateral: 1 and 3 ml paste, 20 ml liquid bolus. Anterior–posterior: 20 ml liquid bolus||Effect of age on UES opening. Relationship between UES opening and swallowing events|
|Kim et al. ||21–87 years||
|Not stated||Questionnaire, cranial nerve exam||Not stated||VFS||2 × 5 and 10 ml thin liquid. Puree and solid not analyzed||Effect of age and gender on swallowing timing|
|Martin-Harris et al. ||Not stated||All healthy (76)||Not stated ≥ 81 years||Interview, questionnaire||Screened||VFS||2 × 5 ml liquid barium||Normative respiratory patterns and temporal coordination of breathing and swallowing|
|Martin-Harris et al. ||21–97 years||
21–40 years (21)|
41–59 years (21)
61–80 years (19)
81–97 years (21)
|86 years||Interview, questionnaire||Screened||VFS||2 × 5 ml liquid barium||Effect of age on swallowing and interdependence of temporal onsets of swallowing events|
|Yoshikawa et al. ||24–87 years||
|81.2 years||Questionnaire, interview, repetitive saliva swallowing test||Not stated||VFS||3 ml barium solution, 3 × 10 ml barium solution||Effect of age on swallowing|
|Daggett et al. ||20–94 years||
< 30 years (13)|
30–39 years (14)
40–49 years (13)
60–69 years (15)
70–79 years (13)
80–89 years (13)
90+ years (4)
|Not stated||No relevant history||Screened||VFS||2 × thin liquid (1, 3, 5, 10 ml, own sip from cup), 3 ml pudding, ¼ cookie, bite of apple||Effect of age, bolus type and volume on severity of penetration|
|Dozier et al. ||23–91 years||All healthy (70)||Not stated||Interview, questionnaire||Screened||VFS||50 ml of liquid barium||Comparison of respiratory patterns during sequential swallowing to single liquid swallows|
|Leonard and McKenzie ||18–88 years||
|Median 70 years||No relevant history||Screened: taken for chronic older conditions||VFS||Lateral: 1 and 3 ml paste, 20 ml liquid bolus. Anterior–posterior: 20 ml liquid bolus||Relationship between bolus transit and hyoid displacement|
|Martin–Harris et al. ||21–97 years||All healthy (76)||Not stated||Interview, questionnaire||Screened||VFS||2 × 5 ml liquid barium||Effect of age on bolus head location and temporal measures|
|McCullough et al. ||21–103 years||
21–39 years (20)|
40–59 years (20)
60–79 years (20)
80+ years (20)
|Not stated||Questionnaire, cranial nerve, oral motor and structural exam||Not stated||VFS||3 × 5 and 10 ml thin, 2 × 20 ml thin, 2 × 5 ml puree, 2 × cookie, 3 oz thin liquid sequential||Effect of age, gender and bolus on swallowing function, residue, penetration and aspiration|
|Mendell and Logemann ||22–92 years||
20–29 years (20)|
40–49 years (20)
60–69 years (20)
70–79 years (20)
80+ years (20)
|Not stated||No relevant history from database||Screened||VFS||2 × 3 and 10 ml liquid barium, 1x 3 ml paste barium||Description of swallowing event sequencing|
|Kelly et al. ||23–88 years||
|75 years||No relevant history||Screened||FEES||5, 10 ml and large mouthful liquid, 10 ml yogurt, 10 ml chopped banana, 3x3 cm sandwich||Effect of age on amount and location of pharyngeal residue from unmodified boluses|
|Kim and McCullough ||21–87 years||
|77.2 years, 6.85 years||Questionnaire, cranial nerve exam, oral motor/structural exam||Not stated||VFS||2 × 5 and 10 ml thin liquid barium||Effect of age on hyoid movement|
|Butler et al. ||69–87 years||Healthy older adults (20)||78.9 years||Questionnaire||Screened||
|Catheter in vs out (5 ml water and 10 ml milk); 10 ml water vs milk vs barium; cup vs syringe (5 and 10 ml milk); 5 ml milk vs pudding vs 2 g cracker||Effect of catheter, bolus (type, volume, viscosity), delivery method or gender on penetration and aspiration in healthy older adults|
|Ayala and Logemann ||20–90 years||
20–30 years (10)|
60–70 years (10)
80–90 years (10)
|83.7 years||Self–reported||Not stated||VFS||45 total swallows, including cold, thin, paste, sour, sweet, cold and sour, water||Effect of sensory bolus characteristics (temperature, taste, viscosity) and continuous use on swallowing|
|Butler et al. ||61–90 years||
61–70 years (18) 71–80 years (28)|
81–90 years (30)
|83.8 years, 2.3 years||Self-reported||Not stated||FEES||5, 10, 15 and 20 ml × water, skim milk, 2% milk, whole milk via straw and cup||Effect of age, sex, liquid type, delivery method and volume on penetration and aspiration|
|Kurosu and Logemann ||22–94 years||
|84.5 years||Questionnaire||Screened||VFS||2 × 1, 3, 5, 10 ml and self-selected sip liquid barium, 2 × 3 ml barium paste, ¼ cookie with paste||Effect of age and gender on airway closure and UES opening|
|Butler et al. ||61–90 years||
61–70 years (18)|
71–80 years (26)
81–90 years (33)
|83.6 years, 2.4 years||Self-reported||Not stated||FEES||5, 10, 15 and 20 ml × water, skim milk, 2% milk, whole milk via straw and cup; soy milk (5, 10, 15 and 20 ml straw); puree (5, 10 ml applesauce and pudding); 2 g cracker||Effect of age, sex, liquid type, delivery method and viscosity on bolus dwell times|
|Butler et al. ||69–87 years||Healthy older adults (19)||79.2 years||Questionnaire||Screened||
Catheter in: 5 and 10 ml water and milk|
Catheter out: 5 and 10 ml water and milk via syringe; 5, 10, 15 ml water and milk via cup
|Effect of aspiration status, sensor location, liquid type and volume on pharyngeal and UES pressures|
|Brodsky et al. ||21–97 years||
21–40 years (21)|
41–60 years (21)
61–80 years (19)
> 81 years (21)
|Not stated||Interview, questionnaire||Screened||VFS||2 × 5-ml liquid barium||Relationship between swallow non-inspiratory flow and swallowing events, and effect of age|
|Im et al. ||21–89 years||
|77.25 years, 8.4 years||Cranial nerve exam, questionnaire||Not stated||VFS||2 × 5 ml thin liquid, thick liquid, puree||Effects of age, gender and bolus consistency on swallowing|
|Omari et al. ||20–91 years||
20–39 years (15)|
40–59 years (15)
60–79 years (18)
80+ years (20)
|84 years||Self-reported, questionnaire||Screened||HRIM||5 × 5 ml and 10 ml saline, 5 ml and 10 ml viscous bolus||Effect of age on automated impedance manometry (AIM) analysis and the swallow risk index|
|Veiga et al. ||62–87 years||Elderly (30)||72.8 years, 7 years||No relevant history||Not stated||FEES||100 ml water via cup and via straw||Effect of cup or straw during sequential swallowing by healthy elderly|
|Kagaya et al. ||25–89 years||
Younger < 60 years (28)|
≥ 60 years (25)
|Median 70 years||No relevant history||Not stated||VFS||10 ml liquid barium, 8 g corned beef, 5 ml liquid barium with 4 g corned beef||Effect of age and bolus type on occurrence of isolated pharyngeal swallow|
|Cock et al. ||20–93 years||
|85 years, 4 years||No relevant history, questionnaire||Screened||HRIM||5 × 5 and 10 ml liquid and viscous bolus||Effect of age on bolus clearance and esophageal propulsive physiology|
|Cock et al. ||20–91 years||
Older healthy (16)
|85 years, 4 years||Interview, questionnaire||Screened||HRIM||5 × 5 ml liquid and viscous boluses||Comparison of UES function in patients (with restricted UES opening) to healthy controls across ages|
|Miles et al. ||20–98 years||
< 40 years (36)|
40–59 years (27)
60–79 years (32)
80+ years (13)
|Not stated||Questionnaire||Not stated||VFS||20 ml fluid bolus, barium tablet, 5 ml paste||Esophageal bolus transit times in healthy adults for a normative database|
|Cock et al. ||20–93 years||
|85 years, 4 years||No relevant history, questionnaire||Screened||HRIM||5 × 5 and 10 ml liquid and viscous bolus||Evaluation of esophagogastric junction function and effect of age|
|Butler et al. ||20–90 years||
20–30 years (27)|
31–40 years (29)
41–50 years (30)
51–60 years (27)
61–70 years (28)
71–80 years (31)
81–90 years (31)
|84 years, 2.2 years||Self-reported||Not stated||FEES||4 liquid types (water, skim milk, 2% milk and whole milk) with 4 bolus volumes (5, 10, 15, and 20 ml) using 2 delivery methods (straw vs cup)||Effect of age, sex, liquid type, bolus volume and bolus delivery on penetration and aspiration|
|Herzberg et al. ||22–90 years||
|74.7 years||No relevant history||Not stated||VFS||3 × 5 and 20 ml thin liquid barium, 5 ml nectar thick barium||Effect of age on swallowing event sequencing|
|Jardine et al. ||20–99 years||
Older > 70 years (59)
|81.2 years, 8.18 years||Questionnaire||Not stated||VFS||Lateral view: 1, 3, 20, 100 ml liquid barium, 3 ml barium paste. A-P view: 20 ml liquid barium, 3 ml paste, pill||Comparison of quantitative swallowing measures in healthy adults vs older patients with new onset dysphagia|
|Molfenter et al. a||> 65 years||Healthy seniors (44)||76.9 years, 7.1 years||Interview, oral motor sensory exam, questionnaire||Not stated||VFS||12 self-administered, uncued barium boluses. 9 for this study: 3 × 5 ml and 20 ml thin liquid, nectar thick liquid||Effect of pharyngeal volume on pharyngeal swallowing biomechanics and residue in healthy aging|
Appendix 2: Adapted checklist from the Critical Appraisal Skills Programme
Was the cohort recruited in an acceptable way?
Was the outcome accurately measured to minimize bias?
Have the authors identified all important confounding factors, and included these in the design and/or analysis?
Do the results include quantitative measures of swallowing or swallowing parameters?
Are the results plausible?
Does the study include participants over 85 years old?
Do the results develop our understanding of swallowing in advanced age?
Does the study report clinical implications?
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Cite this article
Jardine, M., Miles, A. & Allen, J. A Systematic Review of Physiological Changes in Swallowing in the Oldest Old. Dysphagia 35, 509–532 (2020). https://doi.org/10.1007/s00455-019-10056-3
- Deglutition disorders
- Systematic review
- Aged, 80 and over
- Healthy volunteers