A Multidisciplinary Approach to Managing Swallowing Dysfunction in Older People

Pere Clavé is a digestive surgeon, professor at the Universitat Autònoma de Barcelona (UAB) and Director of Research and Innovation at the Consorci Sanitari del Maresme. He has an extensive career in the world of research and more specifically in GI physiology. Dr. Clavé is also the Founding President of the European Society for Swallowing Disorders (ESSD) and founder of the Fundació de Recerca en Gastroenterologia (Gastroenterology Research Foundation (FUREGA)). He is also head of the Digestive Motility Department at Hospital de Mataró, a multidisciplinary unit that works in conjunction for the diagnosis, treatment and research of oropharyngeal dysphagia. His proactivity in spreading knowledge on dysphagia to professionals from all over the word is well known: he is the director of the Master’s Degree and Postgraduate Diploma on Swallowing Disorders, multidisciplinary courses offered by the UAB; and he is also the coordinator of an online practicum available for SLP students at UAB focused on dysphagia. Omar Ortega is a postdoctoral researcher at Hospital de Mataró (Fundació Salut del Consorci Sanitari del Maresme) and affiliate partner of the Center for Biomedical Research in Hepatic and Digestive Diseases Network (CIBERehd, Instituto de Salud Carlos III; https://www.ciberehd.org). Degree in Biology. Master’s Degree in Advanced Microbiology from the Universitat de Barcelona. Doctor in Medicine (2016) at Universitat Autònoma de Barcelona. His research line has been focused on the respiratory complications of oropharyngeal dysphagia (OD) in older patients, the study of the pathophysiology of OD in older and post-stroke patients with new neurophysiological approaches and the development of new neurorehabilition treatments for these patients.

1. Introduction
2. Oropharyngeal dysphagia as a geriatric syndrome
3. Physiology and pathophysiology
3.1 Physiology and pathophysiology of oropharyngeal dysphagia in older persons
3.2 Brain structure, neurotopography and function in dysphagia in older persons
4. Sarcopenic dysphagia
5. Diagnosis of dysphagia in the older person
5.1 Dysphagia diagnosis: Noninstrumental assessment
5.2 Instrumental assessment (VFS, FEES, and HRM)
5.3 Other techniques to assess the swallowing function (neurophusiology - pSEPS, pMEPS, EMP, accelerometry, ultrasonography, and spontaneous swallowing frequency)
6. Complications of oropharyngeal dysphagia
6.1 Dehydration
6.2 Malnutrition
6.3 Oral health
6.4 Respiratory infections and aspiration pneumonia
6.5 Frailty, functional capactity, institutionalization, and quality of life
7. Treatment
7.1 Thickening products and alimentary fluids for older patients with swallowing disorders
7.2 Texture-modified foods for patients with swallowing and/or mastication impairments
7.3 Multimodal interventions-the role of the multidisciplinary team
7.4 Classical rehabilitation strategies
7.5 Pharmacological treatment
7.6 Neurorehabilitation strategies
7.6.1 Neurorehabilitation for oropharyngeal dysphagia in older patients
7.6.2 Transcutaneous electrical stimulation: neuromuscular and sensory stimulation for poststroke older patients with oropharyngeal dysphagia
8. Health economics of oropharyngeal dysphagia and its complications: Malnutrition and respiratory infections in older people
9. The development of scientific societies, history of dysphagia management, and research in Europe, UK, North America, Australia, New Zealand, South America, Japan, Korea, and China
10. Summary and conclusions