Elsevier

Archives of Gerontology and Geriatrics

Volume 78, September–October 2018, Pages 64-70
Archives of Gerontology and Geriatrics

Age-related declines in the swallowing muscle strength of men and women aged 20–89 years: A cross-sectional study on tongue pressure and jaw-opening force in 980 subjects

https://doi.org/10.1016/j.archger.2018.05.015Get rights and content

Highlights

  • Tongue pressure (TP) and jaw-opening force (JOF) decline with age.

  • The decrease in TP and JOF is more significant in men than women.

  • TP declined more steeply than did the JOF.

  • Different patterns exist in the age-related decline in swallowing muscle strength.

  • Maintained JOF in healthy elderly people might contribute to safe swallowing.

Abstract

Swallowing muscle strength weakens with aging. Although numerous studies have investigated tongue pressure (TP) changes with age, studies on jaw-opening force (JOF), an indicator of suprahyoid muscle strength, are lacking. We investigated differences between age-related declines in TP and JOF in a cross-sectional study of 980 healthy and independent participants (379 men, 601 women) without dysphagia. Hand grip strength (HGS), TP, and JOF were compared among decade-based age groups in multiple comparison analyses with post-hoc tests and effect size calculated. Participants were divided into adult (20 s–50 s) and elderly groups (60 s–80 s); within each group, Pearson correlations between age and muscle strength indices were evaluated. TP started to significantly decline in the 60 s and 50 s for men and women (p < .01, medium effect size and p < .05, small effect size, respectively); HGS also declined at these ages (men: p < .01, women: p < .01, medium effect size). JOF started to significantly decline in men in their 80 s (p < .01, large effect size), but remained unchanged in women. In the elderly group, all measurements declined with age more sharply in men (HGS: r = −0.56, TP: r = −0.63, JOF: r = −0.13) than in women (HGS: r = −0.38, TP: r = −0.49, JOF: r = −0.003). TP declined more steeply than did JOF. Thus, the age related-decline in TP was similar to that of the HGS, but not the JOF. The results reveal that different patterns exist in the age-related decline in swallowing muscle strength, and suggest that maintenance of JOF might contribute to safe swallowing in healthy elderly individuals.

Introduction

Sarcopenia is defined as a progressive and systemic decrease in skeletal muscle mass and strength, accompanied by physical impairment, deterioration in patients’ quality of life, and death (Cruz-Jentoft et al., 2010). The reduction in muscle mass and strength causes frailty and disability in elderly individuals (Xue, Bandeen-Roche, Varadhan, Zhou, & Fried, 2008). In general, muscle strength peaks in the fourth decade, then declines steadily with age (Lindle et al., 1997). In a study of 2468 Japanese individuals aged over 40 years, hand grip strength (HGS) began to decline in men in their sixties and in women in their fifties (Yoshimura et al., 2011). Thus, muscle strength deterioration and weakness already occur in middle age; however, it declines at a faster rate in old age.

In addition, sarcopenia reduces the strength of the muscles involved in swallowing, causing dysphagia in elderly individuals (Butler, Stuart, Leng et al., 2011; Butler, Stuart, Wilhelm et al., 2011; Iinuma et al., 2012; Machida et al., 2017). A relationship between tongue strength and aging has been reported (Butler, Stuart, Leng et al., 2011; Machida et al., 2017; Nicosia et al., 2000), as the tongue plays an important role not only in speech, but also in propelling the bolus into the pharynx and pushing it into the esophagus by contacting the pharyngeal muscles (Felton, Gaige, Reese, Wedeen, & Gilbert, 2007). Although maximal tongue strength decreases gradually with aging, tongue strength during swallowing does not (Nicosia et al., 2000). Furthermore, a study comparing maximum tongue pressure (TP) among age groups concluded that TP was greater in men than in women in the second to fourth decades of life (Utanohara et al., 2008). In addition, TP started to decline sooner in men than in women.

Suprahyoid muscle contraction plays an important role in elevating the hyoid bone, contributing to upper esophageal sphincter opening with cricopharyngeal muscle relaxation (Cook et al., 1989). Decreased suprahyoid muscle contraction results in decreased hyoid elevation, which can cause pharyngeal residue, leading to aspiration after swallowing (Eisenhuber et al., 2002). Recently, we developed a jaw-opening sthenometer to measure suprahyoid strength, as the suprahyoid muscle is a jaw-opening muscle, and showed that the jaw-opening force (JOF) is a useful screening measure for dysphagia (Hara et al., 2014). The JOF is associated with the cross-sectional area of the geniohyoid muscle, which is the one of the suprahyoid muscles (Kajisa et al., 2018). Therefore, the JOF can be used as an indicator of suprahyoid muscle strength. Furthermore, a previous study demonstrated that a low JOF leads to a lower position of the hyoid bone in the neck during resting, resulting in a compensatory larger displacement of the hyoid bone during swallowing (Shinozaki et al., 2017). In addition, we previously demonstrated that the JOF is significantly lower in men with sarcopenia than in men without sarcopenia (Machida et al., 2017). However, data regarding the deterioration of JOF among sex and age groups are lacking. Therefore, in the present study, we investigated the age at which different indices of muscle strength (HGS, TP, and JOF) decline and whether sex effects exist, comparing declines in TP and JOF to those of HGS, as a standard of skeletal muscle strength.

Section snippets

Participants

Data from 980 healthy participants (379 men, 601 women) who agreed to undergo the measurements listed below were collected from a database system in a Kobayashi dental clinic between April 2015 and March 2017. All participants were Japanese and citizens of Tokyo metropolis. Most of them live in Edogawa-ku, which is located in Tokyo metropolis, that has an estimated population of 682,418. The participants were able to consume regular food and did not complain of dysphagia. The participants

HGS, TP, and JOF among age groups

In both men and women, ANOVAs were performed to evaluate age-group effects on the HGS and TP, while the Kruskal-Wallis test was performed to evaluate the effect of age-group on the JOF (Table 1). Significant age-group differences in the HGS and TP were observed in both men and women, with a large effect size, and in the JOF in men, with a small effect size. Post-hoc analyses demonstrated that the HGS in men in their 60 s was significantly lower than that in men in their 20 s (r = 0.39, medium

Decline in TP with aging

Numerous reports have shown that TP declines with age (Butler, Stuart, Leng et al., 2011; Nicosia et al., 2000; Utanohara et al., 2008). However, only one study on age-related TP deterioration has reported that TP becomes significantly weaker in men in their 60 s and women in their 70 s (Utanohara et al., 2008). In the present study, TP declines significantly in women in their 50 s with a small effect and in men in their 60 s with a medium effect. Reasons for this sex-specific age difference at

Funding

This work was supported by a grant from the Japanese Dental Science Federation (JDSF-DSP1-2017-116-2).

Declaration of interest

None.

References (36)

  • I.J. Cook et al.

    Opening mechanism of the human upper esophageal sphincter

    American Journal of Physiology

    (1989)
  • A.J. Cruz-Jentoft et al.

    Sarcopenia: European consensus on definition and diagnosis. Report of the European working group on sarcopenia in older people

    Age and Ageing

    (2010)
  • T.J. Doherty et al.

    Effects of ageing on the motor unit: A brief review

    Canadian Journal of Applied Physiology

    (1993)
  • D.R. Earles et al.

    Velocity training induces power-specific adaptations in highly functioning older adults

    Archives of Physical Medicine Rehabilitation

    (2000)
  • E. Eisenhuber et al.

    Videofluoroscopic assessment of patient with dysphagia: Pharyngeal retention is a predictive factor for aspiration

    American Journal of Roentgenology

    (2002)
  • S.M. Felton et al.

    Mechanical basis for lingual deformation during the propulsive phase of swallowing as determined by phase-contrast magnetic resonance imaging

    Journal of Applied Physiology

    (2007)
  • X. Feng et al.

    Age-related changes of hyoid bone position in healthy older adults with aspiration

    Laryngoscope

    (2014)
  • K.Y. Forrest et al.

    Patterns and determinants of muscle strength change with aging in older men

    The Aging Male

    (2005)
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