J. Gerontol. Geriatr., Volume 68, Issue 2 (June 2020) – 8 articles , Pages 61-121

Atrophy or hypofunction of the salivary gland because of aging, radiotherapy or disease causes hyposalivation and impairs the quality of life of patients by compromising mastication, swallowing and speech and by leading to a loss of taste. Moreover, hyposalivation exacerbates dental caries and induces periodontal disease, and oral candidiasis. Currently, no satisfactory therapies have been established to solve salivary hypofunction. Current treatment options for atrophy or hypofunction of the salivary glands in clinical practice are only symptomatic and include saliva substitutes and parasympathetic agonists, such as pilocarpine, to stimulate salivary flow. However, parasympathomimetics have systemic side effects, so different treatment options are necessary, and research has recently focused on this. The main strategies that have been proposed to restore salivary gland atrophy and hypofunction are gene therapy by gene activation/silencing during stem cell differentiation and by the use of viral vectors, such as adenoviruses; cell-based therapy with salivary gland cells, stem cells and non-salivary gland and/or non-epithelial cells to regenerate damaged salivary gland cells; replacement with tissue bioengineering in which organoids from pluripotent stem cells are used in the development of organ replacement regenerative therapy. Remarkable progression in this research field has been made in the last decade, but a definitive therapy for salivary gland hypofunction has not been developed due to intrinsic challenges that come with each approach. However, with research efforts in the future, a range of precision medicine therapies may become available individualized to each patient. Full article

The progressive aging of the population is a widely documented figure worldwide. Just as most individuals can lead longer lives, it is equally true that most of them experience a period of their life, specifically that of older age, characterized by the coexistence of multiple diseases. The growing number of elderly people with multimorbidity entails the need of treatment regimens that require the simultaneous administration of multiple drugs, in complex therapy regimens. This represents a real medical challenge, intended to an ever-increasing impact in the years to come. “Polypharmacy”, generally understood as the simultaneous use of multiple drugs in the same patient, is obviously the rational response to the treatment of complex pathological pictures in aged individuals. Conversely, this polypharmacy implies a growing concern regarding the inappropriate and not strictly necessary simultaneous intake of a large number of drugs. This situation can lead to an actual change in the benefits of each single drug towards adverse effects, when it is taken in combination with other drugs, in complex and prolonged therapeutic regimens. This is precisely the “heart” of the clinical problem of polypharmacy and the adverse effects it causes. These considerations are particularly felt in the Ear-Nose-Throat (ENT) field, in which the specialist, generally lacking an adequate doctrinal and clinical background in gerontology and geriatrics, is called to evaluate and treat complex pathological pictures that embrace and overlap in conditions of multimorbidity, in regime of polypharmacy. The following displayed order will be adopted to discuss this complex issue: current definitions of polypharmacy, current concepts of clinical pharmacology of the elderly, polypharmacy in ENT clinical practice and in the secretory senescence of head-neck structures. Full article

Xerostomia is a common occurrence in older people, impairing their quality of life. When salivary gland function goes below 50%, patients show oral mucosal dryness and consequent problems on speaking and eating. They present oral health impairment. Their quality of life is compromised too. The prevalence of xerostomia is reported to be approximately 30% in people over 65 years old. Drug-induced xerostomia is the most common cause of dry mouth in elderly, because many older adults are taking at least one medication that causes salivary dysfunction. Among the autoimmune disease that can cause xerostomia, Sjögren’s syndrome (SS) is the most representative one in elderly. Dryness of oral mucosa and eyes is the main symptom of the disease. The “Elderly onset primary Sjogren’s Syndrome” (EopSS) is a common disease in Caucasian population, with a global incidence of 3% but a geographic variability. Patients with SS are frequently misdiagnosed, and physicians treat each symptom individually, unaware of underlying systemic disease. The control of symptoms with substitution of saliva and tears is recommended; therapies with anti-CD20 and Interferon-α are useful in patients with residual glandular function and salivary flow. Among the endocrinopathies, diabetes mellitus (DM) is the most common cause of xerostomia in older patients. Hyposalivation increases in diabetic patients with low metabolic control, which can cause more severe side effects in relation to oral health. Xerostomia may be produced by changes in salivary composition (caused by diabetes complications such as neuropathy, angiopathy, and metabolic failure) instead of changes in salivary quantity. Treating diabetes itself, maintaining good glycaemic values, can allay xerostomia in those patients. Doctors and dentists have to be aware of the various oral manifestations of diabetes in order to make an early diagnosis and treatment, avoiding further complications. Full article

Aging is a progressive and multifaceted event, which involves all the cells and organs of the human body. In this chapter we will try to analyze how the senses of smell and taste change with age. Anatomical and physiological modifications of the nose and salivary glands will be described, as well as changes in structures of the Central Nervous System and neurochemical processes that underlie these two senses. Full article

The vestibular and cochlear senescence is a complex degenerative disease and one of the most prevalent chronic conditions of elderly, affecting tens of millions of people worldwide. In this review, we will try to summarize the most important sites and involved mechanism trying to figure out strategies to prevent its clinical consequences. Full article

Glandular senescence is a pathophysiological process that can alter the swallowing process in all its stages. The production of saliva in the elderly changes both qualitatively and quantitatively; qualitative alterations are more objective than quantitative alterations, whose measurement methods are still under discussion. In the elderly, xerostomia is not always related to hyposalivation, and hyposalivation is not strictly related to glandular senescence. In these patients, a reduced functional reserve can turn a physiological presbyphagia to a pathological dysphagia. The analysis and recognition of the signs and symptoms of this process require a multidisciplinary approach and the implementation of appropriate therapies. Full article

Saliva is an essential body fluid. It is important in maintaining oral health, taste acuity, mastication, deglutition, digestion, regulation of oral flora, oral cleansing, voice acuity, and speech articulation. In the elderly, the glandular parenchyma undergoes involution of the cellular component, and this leads to a reduction in the production of saliva. Qualitative and quantitative alterations of this biological fluid can cause patient discomfort and quality of life decline. This often translates into xerostomia, whose real meaning is mouth dryness. We will discuss here causes of xerostomia in the elderly, such as drugs, head and neck radiotherapy, and autoimmune diseases. Full article

Secretory senescence of the upper and lower airway represents the most important risk factor for respiratory complication in the elderly. In most cases, patients present with high health care costs due to the relevant number of hospitalizations and medical cares. A growing evidence is accumulating on the role of immunosenescence in the pathogenesis of chronic rhinosinusal disorders, and on defect in the lubrication of the corneal, conjunctival and scleral mucosa, delicate structures of the external eye, and of trachea-bronchial diseases, dependent on a failure of the gland system and reduction of mucociliary clearance (MCC). The presence of multiple comorbidities in the elderly may significantly contribute to a systemic pro-inflammatory state which negatively affects the airway. Secretory senescence promotes systemic inflammation and exacerbates the pre-existing pathologies. The role of cytokines is associated to a pro-inflammatory state of breathing apparatus. Several observations support the hypothesis that the secretory senescence can act in a paracrine and vasocrine manner to influence the structure and function of glands, mucus and lacrimal secretions, thus contributing to fraility and hospitalizations in the elderly. Given the recognized role of secretory senescence in the pathophysiology of airway disease, it should be desirable to identify specific therapies targeting the nasal, lacrimal and tracheo- bronchial secretory system able to modulate its pro-inflammatory profile and the negative effect of the inflammatory burden on the elderly. Full article