Dysphagia in old-old women: Prevalence as determined according to self-report and the 3-ounce water swallowing test

Objectives To determine whether symptoms and clinical signs of swallowing dysfunction could be easily identified in community-dwelling elderly adults and to examine the association between self-report and direct observation of symptoms and signs of swallowing dysfunction. Design Physiological substudy conducted as a home visit within an observational cohort study. Setting Baltimore City and County, Maryland. Participants Community-dwelling elderly women without history of dysphagia or neurological disease aged 85 to 94 enrolled in the Women's Health and Aging Study II (N = 47). Measurements Three trials of the 3-ounce water swallowing test, swallowing function questionnaire, and frailty status. Results Thirty-four (72%) subjects demonstrated swallowing dysfunction in at least one swallowing trial and 16 (34%) in all three trials. The most common signs of dysfunction were throat clear and wet voice. Conversely, participants reported few symptoms of dysphagia on a swallowing function questionnaire. The most common symptom, reported by approximately 15% of participants, was the sensation of the food going "down the wrong way," 8.5% or fewer participants reported other symptoms. Conclusion Signs of swallowing dysfunction were present in a large majority of community-dwelling old-old women, but they were largely unrecognized and reported. Formal evaluation of swallowing function in community-dwelling elderly adults is necessary to determine the clinical consequences of these findings.