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Objectives/Hypothesis In previous studies, we consistently found that approximately 30% of asymptomatic healthy older adults silently aspirated liquids during a flexible endoscopic evaluation of swallowing (FEES) and that their aspiration status was stable for the following year. However, no studies have systematically evaluated effects of silent aspiration on lung parenchyma and airways. We used computed tomography (CT) to compare lungs of healthy older adult aspirators versus nonaspirators. We hypothesized that CT images would show pulmonary differences in healthy older adult aspirators versus nonaspirators. Study Design Prospective study. Methods Fifty healthy older adults (25 aspirators and 25 nonaspirators) who participated in a previous FEES were randomly selected. CT scans were performed; on inspiration, lung views were taken at 1.25 mm and 2.5 mm windows, and on expiration, lung views were taken at 2.5 mm. CT scans were reviewed by radiologists blinded to group assignment. Outcomes included bronchiectasis, bronchiolectasis, bronchial wall thickening, parenchymal band, fibrosis, air trapping, intraluminal airway debris, and tree-in-bud pattern. Results χ2 analyses between aspirators and nonaspirators found no statistically significant differences between aspirators and nonaspirators for any outcomes ( P > .05). Logistic regression analyses adjusted for smoking did not change the results. Conclusions There were no differences in pulmonary CT findings between healthy older adult aspirators and nonaspirators. This study adds to the evidence that some aspiration may be within the range of normal for older adults, or at least does not contribute to a change in pulmonary appearance on CT images. Level of Evidence 3b Laryngoscope, 124:494-497, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To identify treatable risk factors for aspiration in older adults, particularly those associated with sarcopenia, we examined tongue composition. We hypothesized that isometric and swallowing posterior tongue strength would positively correlate with posterior tongue adiposity, and healthy older adults who aspirate would have greater tongue adiposity than healthy older adults who did not aspirate. Study Design: Prospective. Methods: Participants were 40 healthy adults, comprised of 20 aspirators (mean age, 78 years) and 20 nonaspirators (mean age, 81 years), as identified via flexible endoscopic evaluation of swallowing. Measures of maximal isometric posterior tongue strength and posterior swallowing tongue strength were acquired via tongue manometry. An index of posterior tongue adiposity was acquired via computed tomography for a 1-cm region of interest. Results: Posterior tongue adiposity was correlated with posterior tongue isometric ( r = 0.32, P = .05) but not swallowing pressures ( P > .05) as examined with separate partial correlation analyses. Tongue adiposity did not significantly differ as a function of age, gender, or aspiration status ( P > .05). Conclusions: Lower posterior isometric tongue strength was associated with greater posterior tongue adiposity. However, aspiration in healthy older adults was not affected by posterior tongue adiposity. This finding offers insight into the roles of tongue composition and strength in healthy older adults. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Scant data exist on normal bolus dwell time assessed during flexible endoscopic evaluation of swallowing (FEES). The purpose of this study was to examine bolus dwell time in healthy older adults. Because it has been previously reported that some healthy older adults aspirate, we also sought to determine if bolus dwell time varied as a function of aspiration status. Study Design: Prospective. Methods: Seventy-six healthy volunteers from the seventh, eighth, and ninth decades of life participated. Dwell times were analyzed via FEES as a function of pharyngeal location, liquid type, delivery method, purée type, viscosity, age, and gender. Results: Longer dwell times were evidenced with the eldest participants, straw delivery, and the smallest volume. Adults in the ninth decade were 4.8 ( P = .01) and 3.8 ( P = .02) times more likely to have longer dwell times at the vallecula and 7.1 ( P = .002) and 3.8 ( P = 0.02) at the pyriform sinus than those in the seventh and eighth decades, respectively. Longer dwell times at the vallecula and pyriform sinuses were 2 and 2.38 times ( P < .0001) more likely for straw than cup delivery, respectively. Boluses of 5 mL were 1.5 times ( P < .05) more likely to result in longer dwell times than larger volumes. Bolus dwell times did not significantly differ as a function of aspiration status. Conclusions: Advanced age, straw delivery, and small volumes yielded longer dwell times. These variables should be considered before diagnosing an abnormal bolus dwell time in elder patients. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Although flexible endoscopic evaluation of swallowing (FEES) is an established diagnostic tool, little data exist on the effects of varying liquid types on the swallowing outcomes in healthy older adults., Study Design: Prospective., Methods: Seventy-six healthy older adult volunteers participated (i.e., 18, 28, and 30 volunteers in the 7th, 8th, and 9th decades of life, respectively). The effects of age, sex, liquid type (i.e., water, skim, 2% milk, or whole milk), delivery method (i.e., cup or straw), and volume (i.e., 5, 10, 15, or 20 mL) on Penetration Aspiration Scale (PAS) scores were assessed during FEES., Results: Penetration and silent aspiration were observed in 83% and 28% of the participants, respectively. This represented 19% and 3% of participants' 2,432 swallows, respectively. Liquid type (P = .0001), bolus volume (P = .02), and delivery method (P = .04) significantly affected PAS scores. PAS scores were significantly (P < .05) greater for milk versus water swallows, whole- versus skim-milk swallows, 10- and 20-mL versus 5-mL volumes, and straw versus cup delivery. The risk for aspiration increased by approximately two-, three-, and seven-fold with maximal increases in bolus volume, fat content of liquids, and age, respectively., Conclusions: Occasional aspiration may be an underappreciated phenomenon during FEES in healthy older adults. In addition, milk yielded a higher likelihood of aspiration than water. Accordingly, different liquid types, bolus volumes, and delivery methods should be used to ensure an accurate assessment of aspiration status in healthy older adults.