A Letter to the Editor on Presbyphagia: A Conceptual Analysis of Contemporary Proposals and their Influences on Clinical Diagnosis.

Abstract

The author identified three main operational definitions of presbyphagia in the specialized literature: (1) changes in healthy older people's swallowing, (2) a swallowing disorder compensated by physiological reserves, and (3) a synonym of dysphagia. As the author stated in the conclusion, presbyphagia should be considered an etiology of oropharyngeal dysphagia (OD). However, significant methodological flaws were found, including selecting only one person to screen and analyze articles in the systematic review, not using any keywords or MeSH terms in the search, not presenting a search strategy, limiting the search term to "presbyphagia", and omitting details about screening, inclusion, and exclusion criteria. The operational definitions describe that aging inherently causes swallowing impairment. However, they disregard age-related changes without significant functional impact, as found by a previous study, reviewed in the current research, but analyzed inconsistently by the author. This recent study showed that presbyphagia is the opposite of OD, framing both the "negative" aspects of swallowing and the "compensatory positives" as natural consequences of aging, consistent with the World Health Organization's concept of intrinsic capacity. This perspective positions aging as an adaptive process-not a disease or cause of disease-, although it may increase vulnerability due to cumulative factors. Since OD is a symptom, attributing it to aging frames aging itself as a disease, contradicting current geriatrics and gerontology paradigms.