In an On Medicine blog post about improving the safety of swallowing in older people, David G Smithard discusses CTAR-SwiFt, a study of a swallowing exercise rehabilitation intervention.
Chest infections and pneumonia are common causes of admission to the hospital for older people. 90% of cases may be due to the inhalation of infected saliva or food/liquid. Many older adults do not recognise that they have a problem with their swallowing.The pharynx is a crucial part of human anatomy performing both swallowing and breathing. When we swallow the airway is protected by the larynx lifting and rotating forwards so that it comes into contact with the back of the tongue.
Lifting of the larynx requires good functioning muscles strength. The quality and function of these muscles may deteriorate with age, as a consequence the larynx does not lift as high or rotate as far forward as in younger adults. Similarly, the valve at the top of the esophagus does not relax and food gets stuck in the pharynx. Following a swallow breathing commences and food could be inhaled from the pharynx. Food can enter the airway during or after swallowing.
Participants will be requested to perform an isometric squeeze for one minute, three times, with a rest between each squeeze. The intervention lasts for 12 weeks and will be undertaken once or twice per day. At the start and at monthly intervals, an assessment of the swallow, the amount being eaten and walking speed will be done. At the end of the study, participants will be interviewed to enable the research team to identify areas of the study that need improvement before a larger study. We also plan to look at recruitment rate, and the numbers completing the study.
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