老年人吞咽困难作为老年综合征：从基于疾病的诊断到基于机制的评估

文献信息

中文摘要

老年人吞咽困难通常使用疾病特异性标签来描述，例如卒中后吞咽困难、帕金森相关吞咽困难或肌少症性吞咽困难。这些标签在临床上很有用，但它们并不总能解释决定吞咽表现或在个体患者中指导管理的机制。即使在相同的诊断类别内，一名患者可能主要表现为神经控制受损和吞咽启动延迟，而另一名患者可能表现为肌肉输出减少、清除效率低下和疲劳。在日常实践中，这些机制常常重叠，临床医生经常根据主要且可改变的贡献因素调整管理，而不是仅依赖疾病标签。这篇叙述性综述重新将老年人吞咽困难视为一种多因素临床状况，其具有老年综合征的关键特征。它将导致吞咽困难的机制组织为临床相关领域，包括神经控制、肌肉功能、活动水平、全身储备和外部调节因素。这一视角并不取代基于疾病的诊断。相反，它提供了一种结构化方式，使临床推理更加明确，整合生理损害、活动水平限制和情境因素。将老年人吞咽困难理解为一种老年综合征，可能有助于在老年医学和康复实践中实现更个体化、全面和多学科的评估与管理。

英文摘要

Dysphagia in older adults is commonly described using disease-specific labels, such as post-stroke dysphagia, Parkinson-related dysphagia, or sarcopenic dysphagia. These labels are clinically useful, but they do not always explain the mechanisms that determine swallowing presentation or guide management in individual patients. Even within the same diagnostic category, one patient may present primarily with impaired neural control and delayed swallow initiation, whereas another may present with reduced muscular output, inefficient clearance, and fatigue. In daily practice, these mechanisms often overlap, and clinicians frequently adjust management according to the dominant and modifiable contributors rather than relying on the disease label alone. This narrative review reconsiders dysphagia in older adults as a multifactorial clinical condition that shares key characteristics of geriatric syndromes. It organizes the mechanisms contributing to dysphagia into clinically relevant domains, including neural control, muscle function, activity level, systemic reserve, and external modifiers. This perspective does not replace disease-based diagnosis. Instead, it provides a structured way to make clinical reasoning more explicit, integrating physiological impairment, activity-level limitation, and contextual factors. Understanding dysphagia in older adults as a geriatric syndrome may support more individualized, comprehensive, and multidisciplinary assessment and management in geriatric and rehabilitation practice.