Byline: Rebecca Leonard, Ph.D., Professor, Department of Otolaryngology, UC Davis
Aging & Swallowing
Swallowing difficulty, or dysphagia, is often associated with medical conditions such as stroke, neurological diseases, or surgeries involving the head and neck. However, aging alone can significantly impact swallowing. Research estimates that 20% of individuals over the age of 50, and most individuals by the age of 80, experience some level of swallowing difficulty. With the senior population in the U.S. expected to reach 19% by 2030, understanding how aging affects swallowing is critical to prevention and treatment efforts.
Video Comparing Young vs Elderly Swallowing
[Editors note: Click on the image below to view a 16 second video fluoroscopy clip of a swallow by a 20-something year old (on the left) versus a 70-something year old (on the right). Notice how smoothly liquids glide down the throat of the younger subject versus the effort and time required by the older subject to clear his throat. Video provided courtesy of Rebecca Leonard.]
Changes in Swallowing Mechanics with Age
While some age-related changes are apparent, like missing or shifting teeth, others are less obvious but can greatly affect swallowing safety and efficiency. Here are some key changes:
Reduced Vocal Cord Bulk and Sensitivity
The vocal cords, which help protect the airway during swallowing, may lose bulk and sensitivity with age. If they don’t close quickly or completely, food or liquid can enter the lungs— which is called aspiration. Symptoms of aspiration may include coughing while eating/drinking or a wet sounding voice. In some cases, aspiration can lead to aspiration pneumonia, a serious lung infection.
Weakened Tongue and Throat Muscles
The tongue and throat muscles work to propel food and liquids into the esophagus. With age, these muscles may lose strength, leaving food in the throat after swallowing, which increases the risk of aspiration.
Decreased Esophageal Opening Size
The esophageal sphincter, located at the top of the esophagus, must relax to allow food to pass through. Aging can reduce the size of this opening, making it harder to swallow solid foods, pills, or large sips of liquids.
Longer and More Dilated Throat
An aging throat becomes longer and more dilated, slowing down the swallowing process. What takes about 1 second in younger individuals can take 20% longer in older adults. This delay requires the airway to remain protected for an extended time, increasing the risk of swallowing difficulties.
Additional Contributing Factors
Age-related swallowing challenges can also be compounded by:
Decreased Smell and Taste: Reducing appetite and altering food enjoyment.
Changes in Brain Function: Affecting swallowing coordination.
Medication Side Effects: Many prescriptions cause dryness, making swallowing more difficult.
Chronic Conditions: Diseases like diabetes or COPD can exacerbate swallowing difficulties.
Recognizing and Managing Swallowing Changes
For many older adults, these changes occur gradually, and compensations are made unconsciously. However, persistent symptoms should not be ignored.
Some symptoms, for example, coughing or choking during or after eating or drinking, or a feeling that food or a pill gets “stuck” somewhere, may be an indication of a more serious problem, and need to be brought to your physician’s attention right away.
Seek professional evaluation from a physician or speech-language pathologist who specializes in treating dysphagia if you experience changes or difficulty with swallowing. For some individuals, a swallowing test may be needed to identify specific issues and guide treatment.