Exploring Interrelationships among Swallowing, Cognition, and Quality of Life in Older Adults: A Narrative Review

Abstract

The natural aging process exerts complex and often subtle effects on swallowing and cognitive mechanisms, frequently perceived as normative changes. In recent decades, the pace of demographic aging has accelerated, increasing the clinical relevance of age-related functional decline. Swallowing is regulated by an intricate network of cortical and brainstem structures, and with advancing age, progressive changes in this process are collectively referred to as presbyphagia. Cognitive decline is associated with increased vulnerability to swallowing impairments, compromising swallowing efficiency and safety, and potentially leading to adverse health outcomes. Evidence indicates that dysphagia affects approximately 30% of individuals with cognitive impairment, underscoring the clinical significance of this association. There is growing recognition of the interconnectedness among aging, presbyphagia, cognitive deterioration, and their combined effect on the well-being of older adults. Neurocognitive impairment may contribute to age-related senescent changes in swallowing, further reducing deglutition safety and efficacy. This narrative review examines age-related physiological changes in swallowing, the influence of cognitive decline on deglutition, and their cumulative impact on quality of life (QoL) in older adults. A systematic literature search was conducted using PubMed, Google Scholar, ScienceDirect, Web of Science, and Elicit, and relevant recent studies were manually selected. This review synthesizes current findings to highlight clinical implications and promote awareness of the interplay between presbyphagia, cognitive decline, and QoL among the older population. Potential strategies for improving the management of these conditions in geriatric populations are also discussed. The review aims to inform interdisciplinary healthcare practices and encourage integrated approaches to screening, assessment, and intervention for age-related swallowing and cognitive challenges.