Published online by Cambridge University Press: 19 May 2010
The gastrointestinal (GI) tract is affected by physiological changes of aging as well as by comorbid disease processes such as atherosclerosis and diabetes mellitus (DM). Multiple medication use in the elderly often has direct effects on intestinal mucosa and motility. GI problems may be the cause of common problems seen in the elderly such as dysphagia, weight loss, and constipation. GI disease in the elderly may also present atypically, have higher complication rates, and more complex treatment issues.
Dysphagia is a common problem among older adults. In the nursing home the prevalence of dysphagia is as high as 50%–60%. Dysphagia is defined as the inability to initiate a swallow or a sensation that solids or liquids do not pass easily from the mouth into the stomach. In older patients, difficulty with eating may not only be associated with pharyngoesophageal disease or the GI tract, but also with cognitive and psychiatric problems, neurological deficits, and dental disease. In oropharyngeal dysphagia, the main complaint is food getting stuck in the throat, nasal regurgitation, and coughing. Swallowrelated coughing occurs because of the misdirection of the food bolus into the airway. Oropharyngeal dysphagia is usually caused by local, neurological, or muscular disease such as esophageal cancer, cerebrovascular accident, and muscular dystrophy. Patients with esophageal dysphagia complain of food getting stuck in the sternum region. Dysphagia for both solids and liquids from the onset usually implies a motility disorder of the esophagus such as achalasia, whereas mechanical obstructing lesions such as Zenker diverticulum initially cause dysphagia for solids only, but may progress to involve liquids.