The effect of tongue strength on meal consumption in long term care

Purpose: As many as 74% of residents in long-term care (LTC) are anticipated to have swallowing difficulties (dysphagia). Low food intake is commonly reported in persons with swallowing problems, but food intake may also be affected by fatigue in the swallowing muscles. As fatigue sets in during mealtimes, the strength of the tongue may decline. Tongue strength is also known to decline with age but it is unclear how this functional change may influence food intake. In this pilot study, we explored the relationship between tongue strength and meal consumption in persons not previously diagnosed with dysphagia. Methods: The Iowa Oral Performance Instrument was used to collect maximum anterior isometric tongue-palate pressures from 12 LTC residents (5 male; mean age: 85, range 65-99). Residents were also screened for dysphagia with applesauce and a water swallow test. Each resident was observed at three different meals to record the length of time taken to eat the meal, amount of food consumed, and any indication of overt signs of swallowing difficulty (e.g. coughing). Results: Residents who displayed observable swallowing difficulties at mealtimes had significantly lower tongue strength than those without swallowing difficulties (p < 0.01). Those with lower tongue strength took significantly longer to complete meals (p < 0.05) and consumed less food. Tongue strength was not predictive of performance on the water screen and the water swallow test was not a good predictor of which participants were observed to display mealtime difficulties. Conclusion: Among seniors in long term care, reduced tongue strength is associated with longer meal times, reduced food consumption, and the presence of observable signs of swallowing difficulty. Further exploration of these relationships is warranted. (C) 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.