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Baqué J, Huret O, Rayneau P, Schleich M, Morinière S. Acoustic Analysis of Swallowing of an Experimental Meal of Three Food Textures: A Comparative Aging Study. Dysphagia 2024; 39:452-458. [PMID: 37979004 PMCID: PMC11127804 DOI: 10.1007/s00455-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
Swallowing disorders in the elderly represent a public health problem, their detections are a medico-economic issue. The acoustic analysis of swallowing has the advantages of being non-invasive with no radiation, compared to videofluoroscopy or fiberoptic swallowing assessments. Acoustic analysis of swallowing has been tested in many studies but only on small food boluses. The aim of this study was to compare the acoustic swallowing parameters of two groups of healthy subjects, before and after 70 years old, during the intake of a series of 3 food textures. A laryngophone was used to record the pharyngeal phase of swallowing. The experimental meal was composed of 100 ml of mashed potatoes, 100 ml of water, and 100 ml of yogurt. Group 1 (50-70 years old) comprised 21 subjects and group 2 (over 70 years old) 23 subjects. Acoustic parameters analyzed were the number of swallows, average duration of swallowing, average duration of inter-swallowing, meal duration, and the average frequency of swallowing per minute. These parameters for groups 1 and 2 were compared. The average duration of inter-swallowing and the meal duration were significantly higher in the older group (p < 0.001), with a mean duration of inter-swallowing that was 2.4 s longer than the younger group. The average swallowing frequency per minute was higher in the younger group (11.3 vs 7.9; p < 0.001). This study demonstrated that acoustic analysis of an experimental meal of three food textures generated usable data on swallowing. In the over 70 age group, there was a decrease in swallowing frequency, indicating a slowdown in food intake. A reduced swallowing frequency could become a criteria to assess presbyphagia.
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Affiliation(s)
- Jean Baqué
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France.
| | - Océane Huret
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Pierre Rayneau
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Marianne Schleich
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Sylvain Morinière
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
- Francois-Rabelais University of Tours, University Hospital of Tours, 10 Boulevard Tonnelé, 37032, Tours, France
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Krekeler BN, Schieve HJP, Khoury J, Ding L, Haverbusch M, Alwell K, Adeoye O, Ferioloi S, Mackey J, Woo D, Flaherty M, La Rosa FDLR, Demel S, Star M, Coleman E, Walsh K, Slavin S, Jasne A, Mistry E, Kleindorfer D, Kissela B. Health Factors Associated With Development and Severity of Poststroke Dysphagia: An Epidemiological Investigation. J Am Heart Assoc 2024; 13:e033922. [PMID: 38533959 PMCID: PMC11179757 DOI: 10.1161/jaha.123.033922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Dysphagia after stroke is common and can impact morbidity and death. The purpose of this population-based study was to determine specific epidemiological and health risk factors that impact development of dysphagia after acute stroke. METHODS AND RESULTS Ischemic and hemorrhagic stroke cases from 2010 and 2015 were identified via chart review from the GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study), a representative sample of ≈1.3 million adults from southwestern Ohio and northern Kentucky. Dysphagia status was determined on the basis of clinical assessments and necessity for alternative access to nutrition via nasogastric or percutaneous endoscopic gastrostomy tube placement. Comparisons between patients with and without dysphagia were made to determine differences in baseline characteristics and premorbid conditions. Multivariable logistic regression determined factors associated with increased risk of dysphagia. Dysphagia status was ascertained from 4139 cases (1709 with dysphagia). Logistic regression showed that increased age, Black race, higher National Institutes of Health Stroke Scale score at admission, having a hemorrhagic stroke (versus infarct), and right hemispheric stroke increased the risk of developing dysphagia after stroke. Factors associated with reduced risk included history of high cholesterol, lower prestroke modified Rankin Scale score, and white matter disease. CONCLUSIONS This study replicated previous findings of variables associated with dysphagia (older age, worse stroke, right-sided hemorrhagic lesions), whereas other variables identified were without clear biological rationale (eg, Black race, history of high cholesterol, and presence of white matter disease) and should be investigated in future studies to determine biological relevance and potential influence in stroke recovery.
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Affiliation(s)
- Brittany N. Krekeler
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | | | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Mary Haverbusch
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Kathleen Alwell
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Opeolu Adeoye
- Department of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Simona Ferioloi
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Jason Mackey
- Department of NeurologyIndiana University School of MedicineIndianapolisINUSA
| | - Daniel Woo
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Matthew Flaherty
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Felipe De Los Rios La Rosa
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Baptist Health South FloridaMiami Neuroscience InstituteMiamiFLUSA
| | - Stacie Demel
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | | | - Elisheva Coleman
- Department of NeurologyUniversity of Chicago MedicineChicagoILUSA
| | - Kyle Walsh
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Sabreena Slavin
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Adam Jasne
- Department of NeurologyYale School of MedicineNew HavenCTUSA
| | - Eva Mistry
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Dawn Kleindorfer
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Department of NeurologyUniversity of MichiganAnn ArborMIUSA
| | - Brett Kissela
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
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Mascarenhas A, Mendo R, O'Neill C, Franco AR, Mendes R, Simão I, Rodrigues JP. Current Approach to Dysphagia: A Review Focusing on Esophageal Motility Disorders and Their Treatment. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:403-413. [PMID: 38476159 PMCID: PMC10928869 DOI: 10.1159/000529428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 03/14/2024]
Abstract
Background Dysphagia is a prevalent condition which may severely impact the patient's quality of life. However, there are still lacking standardized therapeutic options for esophageal motility disorders. Summary Dysphagia is defined as a subjective sensation of difficulty swallowing which can result from oropharyngeal or esophageal etiologies. Regarding esophageal dysphagia, after excluding structural causes and esophageal mucosal lesions, high-resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM has not only improved the sensitivity for detecting achalasia but has also expanded our understanding of spastic and hypomotility disorders of the esophageal body. The Chicago Classification v4.0 uses a hierarchical approach and provides a standardized diagnosis of esophageal motility disorders, allowing a tailored therapeutic approach. Dysphagia is often a long-term health problem that broadly impacts health and well-being and leads to physical and psychosocial disability, namely, malnutrition and aspiration pneumonia, as well as social isolation, depression, and anxiety. Apart from achalasia, most esophageal motility disorders tend to have a benign long-term course with symptoms of dysphagia and noncardiac chest pain that can improve significantly over time. Patient-reported outcomes (PROs) are self-assessment tools that capture the patients' illness experience and help providers better understand symptoms from the patients' perspective. Therefore, PROs have a critical role in providing patient-centered care. Key Messages Motility disorders should be ruled out in the presence of nonobstructive esophageal dysphagia, and treatment options should be considered according to the severity of symptoms reported by the patient.
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Affiliation(s)
- André Mascarenhas
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rui Mendo
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Catarina O'Neill
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Ana Rita Franco
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Raquel Mendes
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Inês Simão
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - José Pedro Rodrigues
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Pathophysiology Autonomous Disciplinary Area, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Chen Y, Li C, Fan Y, Jiao L, Silverman M, Ishimaru M, Wang J, Van Pelt AJ, Wang R. Associations of oral health status and swallowing function with cognitive impairment in the aging population: a cross-sectional study. BMC Oral Health 2023; 23:912. [PMID: 37993856 PMCID: PMC10666324 DOI: 10.1186/s12903-023-03640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationships of oral health status and swallowing function with cognitive impairment in community-dwelling older adults from Changsha, Hunan Province, China. METHODS In this cross-sectional study, we analyzed the data of 215 participants aged ≥ 50 years which were retrieved from the Xiangya and Panasonic mild cognitive impairment (MCI) Study, a community-based study conducted among the residents of the urban areas of Hunan province in China. Demographic information of all participants was collected. We determined oral function by evaluating oral hygiene, oral dryness, occlusal force, tongue pressure, chewing function, swallowing function, remaining teeth number, and other indicators. The mini-mental state examination (MMSE) was used to screen for cognitive function. The relationship between each oral function evaluation item and cognitive function was investigated using correlation analysis. The associations between oral health status and swallowing function with cognitive impairment were inferred using multiple regression analysis. RESULTS The general characteristics of participants showed statistically significant correlation coefficients in number of teeth remaining (p = 0.003) and number of teeth lost (p < 0.0001). Almost half of the 25 participants (48%) were aged from 70-80 years. Only 25 older adults (11.6% of the participants) were determined to have cognitive impairment by MMSE sores less than 24. Tongue pressure in male participants was the only significant independent variable that was associated with cognitive impairment (p = 0.01971). The results indicate that male participants with lower MMSE scores had a relative deficiency in tongue pressure. CONCLUSIONS In this cross-sectional study, the oral health status and swallowing function of participants were in relatively good condition and showed low correlations with cognitive impairment. However, lower tongue pressures were associated with lower MMSE scores in males, indicating it could serve as a novel oral function index for evaluating cognitive impairment.
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Affiliation(s)
- Yong Chen
- Laboratory of Food Oral Processing, School of Food Science & Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Canyang Li
- Rehabilitation Medicine Department, Speech and Language Pathology Therapy Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yongmei Fan
- Rehabilitation Medicine Department, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lili Jiao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, of Central South University, Changsha, Hunan, China
| | - Matthew Silverman
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Jing Wang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Alice J Van Pelt
- Section of Gastroenterology, Jr. VA Hospital, Edward Hines, Hines, IL, USA
- Division of Gastroenterology and Nutrition, Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Rumi Wang
- Rehabilitation Medicine Department, Speech and Language Pathology Therapy Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Rodrigues JP, Mascarenhas A, Félix C, Nascimento D, Correia H, Dias Curto J, Chagas C, Tato Marinho R, Mascarenhas Saraiva M. Translation, Cultural Adaptation and Validation of "PROMIS GI - Disrupted Swallowing" Scale for the Portuguese Language. ACTA MEDICA PORT 2023; 36:706-713. [PMID: 36961414 DOI: 10.20344/amp.19161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/24/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient's personal and professional lives. Patient-reported outcomes allow patients to directly quantify their experience regarding dysphagia and evaluate its true impact on quality of life. Among the scales available, Patient-Reported Outcomes Measurement Information System Gastrointestinal (PROMIS GI) Disrupted Swallowing stands out because it is a robust instrument that can be applied regardless of the type and etiology of dysphagia. The aim of this study was to translate, culturally adapt and validate PROMIS GI Disrupted Swallowing scale for the Portuguese-speaking population. MATERIAL AND METHODS Firstly, the seven items of the scale were translated and transculturally reviewed following the systematic method proposed by the Functional Assessment of Chronic Illness Therapy (FACIT). Afterwards, the pre-test version of the questionnaire was administered to a convenience sample (n = 6) for semantic evaluation, with the aim of detection and subsequent correction of possible problems in the translation. The final translated and certified version of the scale was administered to 200 voluntary adult participants (n = 123 healthy; n = 77 dysphagia) in Portugal, for evaluation of reliability and validity. RESULTS The Portuguese version of PROMIS GI Disrupted Swallowing presented acceptable internal consistency (coefficient of Cronbach's α of 0.919) and adequate test-retest reliability (intraclass correlation coefficient of 0.941). The translated version of the scale revealed a strong correlation with both Eckardt score (p < 0.001; ρ = 0.782) and the quality-of-life questionnaire EuroQol-5D (p < 0.001; ρ = -0.551), demonstrating evidence of convergent validity. CONCLUSION The Portuguese version of PROMIS GI Disrupted Swallowing scale presented conceptual, semantic, cultural and measurement equivalence relatively to the original items. The results attained demonstrated that the translation of this scale to Portuguese is reliable and valid for use both in clinical practice and for research purposes.
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Affiliation(s)
- José Pedro Rodrigues
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon; Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - André Mascarenhas
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Catarina Félix
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - David Nascimento
- Swallowing Disorders Unit. Department of Otolaryngology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Helena Correia
- Department of Medical Social Sciences. Northwestern University. Chicago. Illinois. Portugal
| | - José Dias Curto
- Department of Quantitative Methods. ISCTE Business School. Lisbon. Portugal
| | - Cristina Chagas
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Rui Tato Marinho
- Faculdade de Medicina. Universidade de Lisboa. Lisbon; Department of Gastroenterology and Hepatology. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
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Korčok M, Calle J, Veverka M, Vietoris V. Understanding the health benefits and technological properties of β-glucan for the development of easy-to-swallow gels to guarantee food security among seniors. Crit Rev Food Sci Nutr 2023; 63:11504-11521. [PMID: 35766942 DOI: 10.1080/10408398.2022.2093325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The world's population is growing rapidly and the number of elderly people with undernutrition and malnutrition is increasing. Common health problems among seniors are cardiovascular, inflammatory, gastrointestinal, and cognitive disorders, cancer, diabetes, psychological and dental problems. The food industry is trying to meet the demands of an aging society, but these efforts are not sufficient. New strategies are needed, and they demand foods development with modified textures that are easy to swallow, such as gels suitable for seniors. Depending on the specific needs of the elderly, bioactive compounds with health benefits should be included in food systems. Novel foods may play an important role in the prevention, maintenance, and treatment of age-related diseases. One of the most studied bioactive compound is β-glucan, a polysaccharide with approved health claims confirmed by clinical trials, such as "β-glucan contributes to the maintenance of normal blood cholesterol levels" and "the consumption of β-glucan from oats or barley contributes to the reduction of postprandial glucose spikes." In this review, the health benefits, and technological properties of β-glucan for the development of senior-friendly ready-to-swallow gels were described. In addition, some patents and studies conducted in connection with the development of the gel systems were collected.
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Affiliation(s)
- Melina Korčok
- Institute of Food Sciences, Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture, Nitra, Slovakia
| | - Jehannara Calle
- Institute of Food Sciences, Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture, Nitra, Slovakia
- Food Research Institute for the Food Industry (IIIA), Havana, Cuba
| | | | - Vladimir Vietoris
- Institute of Food Sciences, Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture, Nitra, Slovakia
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Konoike Y, Tsukayama I, Oji M, Kawakami T, Ishii K, Suzuki-Yamamoto T. A Thickening Agent Using Dioscorea japonica Powder Exhibits Suitable Properties for People with Dysphagia. Foods 2023; 12:3943. [PMID: 37959062 PMCID: PMC10649915 DOI: 10.3390/foods12213943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
In an aging society, the novel concept of added food functionality in a dysphagia diet is necessary for preventing diseases and maintain nutrition intake. The present study evaluated the utilization of Dioscorea japonica as a thickened liquid for people with dysphagia due to its unique physical properties and beneficial effects on chronic inflammation. The viscosity of the prepared thickened liquid using freeze-dried Dioscorea japonica powder was compared with those of xanthan gum and commercially available thickened liquids in selected conditions resembling to cooking. Dioscorea japonica powder showed high versatility, because the viscosity of its thickened liquid could be easily adjusted by modifying its blending amount and temperature. The thickened liquid of Dioscorea japonica had the most stable viscosity among the thickened liquids when NaCl was added and exhibited excellent resistance to α-amylase, similar to that of the other thickened liquids. The viscosity of the thickened liquid of Dioscorea japonica was relatively stable on changing the pH, but it was slightly unstable when the temperature changed. Overall, the thickened liquid of Dioscorea japonica powder has excellent viscosity stability, comparable to or better than commercially available thickened liquids, and is expected to be used as a new thickened liquid with added food functionality.
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Affiliation(s)
- Yuka Konoike
- Department of Nutritional Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama 719-1197, Japan; (Y.K.); (I.T.); (M.O.); (T.K.)
- Department of Nutrition and Life Science, Fukuyama University, 985-1 Sanzo, Higashimura-cho, Fukuyama 729-0292, Japan;
| | - Izumi Tsukayama
- Department of Nutritional Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama 719-1197, Japan; (Y.K.); (I.T.); (M.O.); (T.K.)
| | - Mei Oji
- Department of Nutritional Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama 719-1197, Japan; (Y.K.); (I.T.); (M.O.); (T.K.)
- The Faculty of Food Culture, Kurashiki Sakuyo University, 3515 Tamashima Nagao, Kurashiki, Okayama 710-0292, Japan
| | - Takayo Kawakami
- Department of Nutritional Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama 719-1197, Japan; (Y.K.); (I.T.); (M.O.); (T.K.)
| | - Kayoko Ishii
- Department of Nutrition and Life Science, Fukuyama University, 985-1 Sanzo, Higashimura-cho, Fukuyama 729-0292, Japan;
| | - Toshiko Suzuki-Yamamoto
- Department of Nutritional Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama 719-1197, Japan; (Y.K.); (I.T.); (M.O.); (T.K.)
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Mori H, Nakane A, Tohara H, Nakayama T. Evaluation of preventive care for swallowing difficulty through policy changes in Japanese long-term care insurance: analysis of a nationwide claims dataset for long-term care insurance. BMC Health Serv Res 2023; 23:1053. [PMID: 37784114 PMCID: PMC10546654 DOI: 10.1186/s12913-023-09990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/30/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Swallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services. METHODS The nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined. RESULTS Between 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users' disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014. CONCLUSIONS Due to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.
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Affiliation(s)
- Hiroko Mori
- Section of Epidemiology, Shizuoka Graduate University of Public Health, 4-27-2 Aoi-ku, Kita-ando, Shizuoka-shi, Shizuoka, 420-0881, Japan.
- Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyou-ku, Kyoto, Kyoto, 606-8501, Japan.
| | - Ayako Nakane
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyou-ku, Tokyo, 113-8510, Japan
| | - Haruka Tohara
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyou-ku, Tokyo, 113-8510, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyou-ku, Kyoto, Kyoto, 606-8501, Japan
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Yokota J, Endo R, Takahashi R. Improving physical performance reduces dysphagia via improvement of tongue strength in patients with acute heart failure: a two-wave cross-lagged mediation model analysis. Aging Clin Exp Res 2023; 35:2237-2246. [PMID: 37462898 DOI: 10.1007/s40520-023-02485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/21/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Physical performance improvement through whole-body exercise may have a positive impact on dysphagia via improvement of maximum tongue pressure (MTP). AIMS The present study aimed to quantitatively analyze whether improvement in physical performance reduces dysphagia by improving MTP in patients with acute heart failure (AHF). METHODS A total of 146 patients with AHF and dysphagia were included. Dysphagia was defined as a functional oral intake scale (FOIS) score < 6. The short physical performance battery (SPPB) indexed physical performance. A two-wave cross-lagged mediation model was used to examine whether an improvement in SPPB results improves the FOIS score via an improvement in MTP. The SPPB, MTP, and FOIS scores (T1: baseline, T2: hospital discharge) were included in the model. RESULTS A total of 146 patients were included in the final analysis. The SPPB result at T1 positively affected MTP (β = 0.150, P = 0.030) and the FOIS score (β = 0.249, P = 0.002) at T2. MTP at T1 also positively affected the FOIS score at T2 (β = 0.189, P = 0.026). Furthermore, the SPPB result indirectly affected the FOIS score by affecting the MTP (indirect effect = 0.028; 95% CI = 0.010, 0.078). DISCUSSION This study contributes to the knowledge base regarding the potential of exercise therapy as a new treatment strategy for dysphagia in patients with AHF. CONCLUSION An improvement in SPPB results improved the FOIS score by improving the MTP in patients with AHF.
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Affiliation(s)
- Junichi Yokota
- Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-Cho, Hirosaki, Aomori, 036-8564, Japan.
- Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan.
| | - Ryunosuke Endo
- Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-Cho, Hirosaki, Aomori, 036-8564, Japan
| | - Ren Takahashi
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
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Lippi L, Turco A, Moalli S, Gallo M, Curci C, Maconi A, de Sire A, Invernizzi M. Role of Prehabilitation and Rehabilitation on Functional Recovery and Quality of Life in Thyroid Cancer Patients: A Comprehensive Review. Cancers (Basel) 2023; 15:4502. [PMID: 37760472 PMCID: PMC10526253 DOI: 10.3390/cancers15184502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This narrative review aims to provide a comprehensive overview of the current prehabilitation and rehabilitation strategies for thyroid cancer survivors to optimize functional outcomes and enhance their quality of life. METHODS The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. RESULTS The review emphasizes the role of a comprehensive rehabilitation approach in targeting the different domains that generate disability in thyroid cancer patients. In this context, physical activity, range of motion exercises, myofascial release, joint mobilization, and postural exercises are crucial for improving functional outcomes and reducing treatment-related discomfort and disability. Moreover, tailored rehabilitative management addressing dysphonia and dysphagia might have a positive impact on the quality of life of these patients. Despite these considerations, several barriers still affect the implementation of a multimodal rehabilitative approach in common clinical practice. Thus, sustainable and effective strategies like digital innovation and patient-centered approaches are strongly needed in order to implement the rehabilitative treatment framework of these subjects. CONCLUSIONS This narrative review provides valuable insights into the current prehabilitation and rehabilitation strategies to treat thyroid cancer survivors, addressing physical, psychological, and vocational needs to optimize functional outcomes and enhance their quality of life.
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Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.T.); (S.M.)
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Alessio Turco
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.T.); (S.M.)
| | - Stefano Moalli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.T.); (S.M.)
| | - Marco Gallo
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy;
| | - Antonio Maconi
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.T.); (S.M.)
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
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11
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Zugasti Murillo A, Gonzalo Montesinos I, Cancer Minchot E, Botella Romero F. Hospital management of the patient with dysphagia. Survey and recommendations of SEEN nutrition area. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:1-9. [PMID: 37468415 DOI: 10.1016/j.endien.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/03/2022] [Indexed: 07/21/2023]
Abstract
INTRODUCTION The prevalence of dysphagia in hospitalized patients is extraordinarily high and little known. The goal of care should be to assess the efficacy and safety of swallowing, to indicate personalized nutritional therapy. The development of Dysphagia Units, as a multidisciplinary team, facilitates comprehensive care for this type of patient. MATERIAL AND METHODS A observational, cross-sectional, web-based survey-type study, focused on Spanish Society of Endocrinology and Nutrition department heads, was conducted in September-October 2021. The following data were analyzed: size and type of center, existence of a dysphagia unit, dysphagia screening, dietary and nutritional therapy, education and training of professionals and patients, codification, and quality of life evaluation. RESULTS 65 responses (39% of the total Endocrinology and Nutrition departments). 37% of hospitals have a Dysphagia Unit and 25% are developing it. 75.4% perform screening, with MECV-V in 80.6%, and VED (61.4%) and VFS (54.4%) are performed as main complementary tests. The centers have different models of oral diet, thickeners and nutritional oral supplements adapted to dysphagia. In 40% of the centers, no information is offered on dysphagia, nor on the use of thickeners, dysphagia is coded in 81%, 52.3% have specific nursing protocols and only 8% have scales for quality-of-life evaluation. CONCLUSIONS The high prevalence and the risk of serious complications require early and multidisciplinary management at the hospital level. The information received by the patient and caregiver about the dietary adaptations they need, is essential to minimize risks and improve quality of life.
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Affiliation(s)
- Ana Zugasti Murillo
- Sección de Nutrición Clínica, Servicio Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete Área de Nutrición de la SEEN, Albacete, Spain
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Krekeler BN, Schieve HJP, Khoury J, Ding L, Haverbusch M, Alwell K, Adeoye O, Ferioloi S, Mackey J, Woo D, Flaherty M, De Los Rios La Rosa F, Demel S, Star M, Coleman E, Walsh K, Slavin S, Jasne A, Mistry E, Kleindorfer D, Kissela B. Health factors associated with development and severity of post-stroke dysphagia: an epidemiological investigation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.29.23294807. [PMID: 37693442 PMCID: PMC10491359 DOI: 10.1101/2023.08.29.23294807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background and Purpose Dysphagia is a common post-stroke occurrence and has been shown to impact patients' morbidity and mortality. The purpose of this study was to use a large population-based dataset to determine specific epidemiological and patient health risk factors that impact development and severity of dysphagia after acute stroke. Methods Using data from the Greater Cincinnati Northern Kentucky Stroke Study, GCNKSS, involving a representative sample of approximately 1.3 million people from Southwest Ohio and Northern Kentucky of adults (age ≥18), ischemic and hemorrhagic stroke cases from 2010 and 2015 were identified via chart review. Dysphagia status was determined based on bedside and clinical assessments, and severity by necessity for alternative access to nutrition via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube placement. Comparisons between patients with and without dysphagia were made to determine differences in baseline characteristics and pre-morbid conditions. Multivariable logistic regression was used to determine factors associated with increased risk of developing dysphagia. Results Dysphagia status was ascertained from 4139 cases (1709 with dysphagia). Logistic regression showed: increased age, Black race, higher NIHSS score at admission, having a hemorrhagic stroke (vs infarct), and right hemispheric stroke increased risk of developing dysphagia after stroke. Factors associated with reduced risk included history of high cholesterol, lower pre-stroke mRS score, and white matter disease. Conclusions This study replicated many previous findings of variables associated with dysphagia (older age, worse stroke, right sided hemorrhagic lesions), while other variables identified were without clear biological rationale (e.g. Black race, history of high cholesterol and presence of white matter disease). These factors should be investigated in future, prospective studies to determine biological relevance and potential influence in stroke recovery.
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13
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Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
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Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
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14
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Jiang W, Zou Y, Huang L, Zeng Y, Xiao LD, Chen Q, Zhang F. Gustatory stimulus interventions for older adults with dysphagia: a scoping review. Aging Clin Exp Res 2023:10.1007/s40520-023-02437-4. [PMID: 37209267 DOI: 10.1007/s40520-023-02437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear. AIMS To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults. METHODS Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022. RESULTS This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions. CONCLUSION AND DISCUSSIONS Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.
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Affiliation(s)
- Wenyi Jiang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zou
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Lei Huang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Yanli Zeng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lily Dongxia Xiao
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Qian Chen
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengying Zhang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
- Nursing Key Laboratory of Sichuan Province, Chengdu, China.
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China.
- West China Hospital, Sichuan University, Chengdu, China.
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15
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Hua N, Zhang Y, Tan X, Liu L, Mo Y, Yao X, Wang X, Wiley J, Wang X. Nutritional Status and Sarcopenia in Nursing Home Residents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17013. [PMID: 36554892 PMCID: PMC9779149 DOI: 10.3390/ijerph192417013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study aimed to assess the nutritional status and sarcopenia in older people living in nursing homes. METHODS This cross-sectional study enrolled 386 older adults in nursing homes in Hunan Province, China. Assessments included the Mini Nutritional Assessment Short Form for nutrition risk, Dietary Diversity Score for dietary diversity and Mini Mental State Examination for cognitive status. Sociodemographic (e.g., age, sex and educational level), health-related characteristics (e.g., food intake, self-care status and medication), body composition (e.g., body mass index [BMI], protein, body fat mass [BFM], percent body fat [PBF], skeletal muscle index [SMI] and total body water [TBW]) and anthropometric parameters data (e.g., calf circumference [CC], upper arm circumference [UAC], handgrip and gait speed) were also collected. Malnutrition and their associated risk were analyzed by multivariable Poisson regression analysis. RESULTS In total, 32.4% of participants (n = 125) were at risk of malnutrition and 49.7% (n = 192) suffered from sarcopenia. Nutritional status was positively associated with age (risk ratio [RR] = 1.03), sarcopenia (RR = 1.88), tooth loss affecting food intake (RR = 1.45), low self-care status (RR = 1.82) and moderate/inadequate dietary diversity (RR = 2.04) and negatively associated with one child (RR = 0.27), BMI (RR = 0.82), protein (RR = 0.76), BFM (RR = 0.91), PBF (RR = 0.94), SMI (RR = 0.65), TBW (RR = 0.94), CC (RR = 0.89) and UAC (RR = 0.86). CONCLUSIONS Age, number of children, sarcopenia, food intake, self-care status, dietary diversity and body composition were associated with malnutrition among nursing home residents. For vulnerable groups, researchers should focus on raising the body composition indicators, such as BMI, protein, BFM, SMI and TBW and measuring CC and UAC for initial screening.
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Affiliation(s)
- Nan Hua
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Yifan Zhang
- School of Life Sciences, Central South University, Changsha 410013, China
| | - Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Li Liu
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London SE5 9PJ, UK
| | - Xuemei Yao
- Tangdu Hospital, Air Force Military Medical University, Xi’an 710032, China
| | - Xiuhua Wang
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - James Wiley
- School of Nursing, University of California, San Francisco, CA 94118, USA
| | - Xiaoqing Wang
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road Furong District, Changsha 421142, China
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16
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Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MB. An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic. Dysphagia 2022; 37:1349-1374. [PMID: 34981255 PMCID: PMC8723823 DOI: 10.1007/s00455-021-10396-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers' health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Jackie McRae
- Centre for Allied Health, St George's, University of London/University College London Hospitals NHS Foundation Trust, London, UK
| | - Gemma Clunie
- Imperial College London & Clinical Specialist SLT (Airways/ENT), Imperial College Healthcare NHS Trust, London, UK
| | - Patricia Gillivan-Murphy
- Clinical Specialist SLT, Voice & Swallowing Clinic, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yoko Inamoto
- SLHT, Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hanneke Kalf
- Division of Speech Pathology, Department of Rehabilitation, Radboud University Medical Centre / Donders Centre for Neuroscience, Nijmegen, The Netherlands
| | - Mershen Pillay
- Speech-Language Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philippa Ratcliffe
- Consultant SLT Royal National ENT and EDH University College London Hospitals NHS Foundation Trust, London, UK
| | - Theresa Richard
- Mobile Dysphagia Diagnostics, Medical SLP Collective, Buffalo, USA
| | - Ursula Robinson
- SLT, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Sarah Wallace
- Consultant SLT, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
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Cacciatore S, Brandi V, Cocchi C, Elmi D, Gava G, Massaro C, Murace CA, Recupero C, Tosato M, Calvani R, Landi F. Atypical Presentation of Pill Aspiration in Older Adults with Dysphagia: A Picture Not To Be Forgotten. Ann Geriatr Med Res 2022; 26:275-278. [PMID: 35918298 PMCID: PMC9535377 DOI: 10.4235/agmr.22.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Nonconventional clinical presentations of diseases are common in older adults. Even dramatic events, such as foreign body (FB) inhalation, can occur in a subtle and non-specific manner. Pill aspiration is a rare yet overlooked cause of airway injury. It accounts for approximately 7% of all FB aspirations. In contrast, oral dysphagia and polypharmacology, mainly administrated in solid oral dosage forms (SDOF), like tablets and pills, are common conditions in older adults. Herein, we present a case of SDOF aspiration in a 78-year-old man. FB inhalation developed with general clinical deterioration and neurological impairment (delirium) rather than overt respiratory symptoms. Bronchoscopy provided remarkable images of this unexpected finding. Caregivers and healthcare workers must be aware of the risk of SDOF aspiration and adopt proper safety measures. Early recognition and bronchoscopy for diagnostic and therapeutic purposes can be lifesaving in such cases.
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Affiliation(s)
- Stefano Cacciatore
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Corresponding Author Stefano Cacciatore, MD Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go A. Gemelli 8, Rome 00168, Italy E-mail:
| | - Vincenzo Brandi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Camilla Cocchi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Elmi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giordana Gava
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudia Massaro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Carla Recupero
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Matteo Tosato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Calvani
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Labeit B, Muhle P, von Itter J, Slavik J, Wollbrink A, Sporns P, Rusche T, Ruck T, Hüsing-Kabar A, Gellner R, Gross J, Wirth R, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Front Aging Neurosci 2022; 14:912691. [PMID: 35966778 PMCID: PMC9366332 DOI: 10.3389/fnagi.2022.912691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background “Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
- *Correspondence: Bendix Labeit,
| | - Paul Muhle
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Janna Slavik
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Ruck
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Reinhold Gellner
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Herne, Germany
| | - Inga Claus
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
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19
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Manejo hospitalario del paciente con disfagia. Encuesta y recomendaciones del área de nutrición de la SEEN. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Cavallaro G, Pontrelli M, Sammali M, Nelson E, Quaranta N, Fiorella ML. Presbyphagia: the importance of an early diagnosis in the aging population. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Lynch GS. Identifying the challenges for successful pharmacotherapeutic management of sarcopenia. Expert Opin Pharmacother 2022; 23:1233-1237. [PMID: 35549577 DOI: 10.1080/14656566.2022.2076593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gordon S Lynch
- Centre for Muscle Research, Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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22
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Physical Frailty and Oral Frailty Associated with Late-Life Depression in Community-Dwelling Older Adults. J Pers Med 2022; 12:jpm12030459. [PMID: 35330459 PMCID: PMC8954826 DOI: 10.3390/jpm12030459] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022] Open
Abstract
Late-life depression is a major mental health problem and constitutes a heavy public health burden. Frailty, an aging-related syndrome, is reciprocally related to depressive symptoms. This study investigated the associations of physical frailty and oral frailty with depression in older adults. This large-scale cross-sectional study included 1100 community-dwelling older adults in Taiwan. The participants completed a dental examination and questionnaires answered during personal interviews. The 15-item Geriatric Depression Scale was used to assess depression, and information on physical conditions and oral conditions was collected. Multivariable logistical regression analysis was conducted to examine associations of interest. Significant factors associated with depression were pre-physical frailty (adjusted odds ratio (aOR) = 3.61), physical frailty (aOR = 53.74), sarcopenia (aOR = 4.25), insomnia (aOR = 2.56), pre-oral frailty (aOR = 2.56), oral frailty (aOR = 4.89), dysphagia (aOR = 2.85), and xerostomia (aOR = 1.10). Depression exerted a combined effect on physical frailty and oral frailty (aOR = 36.81). Physical frailty and oral frailty were significantly associated with late-life depression in community-dwelling older adults in a dose–response manner. Developing physical and oral function interventions to prevent depression among older adults is essential.
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de Sire A, Ferrillo M, Lippi L, Agostini F, de Sire R, Ferrara PE, Raguso G, Riso S, Roccuzzo A, Ronconi G, Invernizzi M, Migliario M. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients 2022; 14:nu14050982. [PMID: 35267957 PMCID: PMC8912303 DOI: 10.3390/nu14050982] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy;
| | - Paola Emilia Ferrara
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Giuseppe Raguso
- Department of Otolaryngology-Head and Neck Surgery, University of Verona, 37129 Verona, Italy;
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, 28100 Novara, Italy;
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland;
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark
| | - Gianpaolo Ronconi
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Migliario
- Dental Clinic, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
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Murakami T, Kamide N, Ando M, Hata W, Sakamoto M. Association between tongue pressure and skeletal muscle mass and muscle function in community-dwelling older people without sarcopenia. Eur Geriatr Med 2022; 13:649-653. [PMID: 35122216 DOI: 10.1007/s41999-022-00608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to cross-sectionally investigate relationships between maximum tongue pressure (MTP) and whole-body muscle mass and strength for non-sarcopenic older adults. METHODS Study participants comprised 341 adults (105 men, 236 women) ≥ 65 years old (mean age, 72.7 ± 4.8 years). Participants were measured for MTP, grip strength, five-time chair stand test (FCST), gait speed, and skeletal muscle mass index (SMI). Multiple regression analysis adjusted for confounding factors was used to analyze relationships between MTP and each other variable. RESULTS MTP was significantly related to SMI (r = 0.15, p < 0.001), grip strength (r = 0.12, p < 0.05), FCST (r = - 0.14, p < 0.05), and age (r = 0.25, p < 0.001). Multiple regression analysis showed a positive association between MTP and SMI, even after accounting for the influence of age, sex, physical performance, and other potential confounding factors. CONCLUSION Whole-body muscle mass was suggested to be decreasing with tongue pressure decline before sarcopenia diagnosis in community-dwelling older adults.
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Affiliation(s)
- Takeshi Murakami
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
| | - Naoto Kamide
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Masataka Ando
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Wakana Hata
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Miki Sakamoto
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
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25
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Nutritional status and quality of life are associated with risk of sarcopenia in nursing home residents: A cross-sectional study. Nutr Res 2022; 101:14-22. [DOI: 10.1016/j.nutres.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 02/06/2023]
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26
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Riso S, Para O, Collo A, Campanini M, Rotunno S, Giorgetti G, Zanetti M. CLINICAL NUTRITION IN INTERNAL MEDICINE: AN ITALIAN SURVEY BY THE SCIENTIFIC SOCIETIES FADOI AND SINPE. Nutrition 2022; 98:111623. [DOI: 10.1016/j.nut.2022.111623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
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Tanaka K, Watanabe K, Kashiwagi H. Association between postextubation dysphagia and physical function in survivors of critical illness: A retrospective study. Clin Nutr ESPEN 2022; 47:147-151. [DOI: 10.1016/j.clnesp.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/11/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
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Latent changes in the pharyngeal stage of swallowing in non-aspirating older adults. Eur Geriatr Med 2022; 13:655-661. [PMID: 35091892 DOI: 10.1007/s41999-021-00604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The characteristic changes in the swallowing mechanism with aging are collectively termed presbyphagia. Although several studies have investigated presbyphagia in older adults, few have assessed oldest-old adults. We aimed to characterize the latent changes of swallowing function in oldest-old adults and to consider risk ages for presbyphagia. METHODS We analyzed the records of 85 individuals (44 males and 41 females, aged 25-101 years) who underwent videofluoroscopic swallowing studies. The included participants had penetration and aspiration scores of ≤ 2 and no history of aspiration, pneumonia, or diseases that affect swallowing. They were divided into four age groups: 25-64 years (non-older), 65-74 years (young-old), 75-84 years (middle-old), and ≥ 85 years (oldest-old). We analyzed and compared the pharyngeal delay time (PDT), duration of tongue base and posterior pharyngeal wall contact, duration and dimension of upper esophageal sphincter opening (UES-O), and maximal hyoid bone displacement between the age groups. RESULTS Among the older groups, the oldest-old showed significantly longer PDT than younger-old adults, and the UES-O tended to be wider in the former. However, no other remarkable differences were found between the oldest-old and other old groups. Statistical comparisons between the < 75 and ≥ 75-year age groups revealed significant age-related changes in the PDT and duration and dimension of UES-O. CONCLUSION On videofluoroscopic evaluation, physiological changes with aging affected few parameters of swallowing in our cohort. These findings indicate that in non-aspirating oldest-old adults, any deterioration may be adjusted for by compensatory changes to maintain swallowing function.
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Yu L, Li Y, Zhang D, Huang W, Li R, Zhu J, Li R, Zhao J, Wang J. A risk prediction model for dysphagia in older patients: a single-center prospective study. Geriatr Nurs 2022; 44:24-29. [PMID: 35007867 DOI: 10.1016/j.gerinurse.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
Surveys based on western populations have identified many risk factors for dysphagia in older people, but the potential risk factors consistent with the demographic characteristics of older, hospitalized Chinese patients require further study. This single-center prospective study aimed to determine the incidence of dysphagia in western China, and to develop and validate a model to predict the risk of dysphagia among older patients. A total of 343 inpatients (aged ≥ 65 years without dysphagia and cognitive impairment) were included. A score ≥ 2 on the Eating Assessment Tool-10 was defined as dysphagia. After a six-month follow-up, 70 (20.4%) patients were found to have dysphagia. The final model included age, wearing dentures, activities of daily living, cerebral vascular disease, coronary heart disease, and malignancy. The developed model has high predictive accuracy and can be easily implemented in daily practice.
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Affiliation(s)
- Lili Yu
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China; School of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | | | - Dongyun Zhang
- School of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Wanyun Huang
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Runping Li
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Junxia Zhu
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Rongxiu Li
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Jun Zhao
- Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
| | - Jing Wang
- Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
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30
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Dibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, Daniele A, De Pergola G, Bortone I, Lampignano L, Giannelli G, Panza F. Oral frailty and its determinants in older age: a systematic review. THE LANCET HEALTHY LONGEVITY 2021; 2:e507-e520. [DOI: 10.1016/s2666-7568(21)00143-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
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31
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Mizutani S, Egashira R, Yamaguchi M, Tamai K, Yoshida M, Kato T, Umezaki Y, Aoki H, Naito T. Changes in oral and cognitive functions among older Japanese dental outpatients: A 2-year follow-up study. J Oral Rehabil 2021; 48:1150-1159. [PMID: 34242428 DOI: 10.1111/joor.13224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between oral and cognitive functions among older people is highly debated. OBJECTIVE To examine whether oral functions are related to changes in the levels of mild cognitive impairment (MCI) biomarkers in older Japanese outpatients. METHODS This observational study included 52 outpatients aged ≥65 years who underwent dental examinations at the Fukuoka Dental College Hospital. The Mini-Mental State Examination (MMSE) was performed, and MCI blood biomarker levels were assessed at baseline and after 2 years. The present dental and periodontal conditions and the oral functions (tongue pressure and masticatory performance) were evaluated. Changes in parameters from baseline to follow-up were compared using the Wilcoxon signed-rank test, McNemar test or chi-squared test. Associations among changes in the parameters were analysed using Spearman's rank correlation coefficient. RESULTS The follow-up rate in this study was 67%. The masticatory performance was improved (p < 0.001), whereas gingival inflammation was decreased (p < 0.001) over the 2-year period. A significant increase in the MMSE score (p < 0.001) and a decrease in MCI risk (p < 0.001) were noted. The decrease in MCI risk was correlated with the increase in both masticatory performance (ρ = -0.34; p < 0.05) and MMSE score (ρ = -0.56; p < 0.01). CONCLUSION A decrease in MCI risk, as demonstrated by the levels of the blood biomarkers, was correlated with an increase in the masticatory performance in Japanese outpatients.
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Affiliation(s)
- Shinsuke Mizutani
- Oral health/Brain health/Total health Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Rui Egashira
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Masahiro Yamaguchi
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Keiko Tamai
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Mizuki Yoshida
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Tomotaka Kato
- Division of General Dentistry, Nippon Dental University Hospital, Tokyo, Japan
| | - Yojiro Umezaki
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Hisae Aoki
- Department of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
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Relationship between Masticatory Function and Bone Mineral Density in Community-Dwelling Elderly: A Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9070845. [PMID: 34356223 PMCID: PMC8305999 DOI: 10.3390/healthcare9070845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 01/12/2023] Open
Abstract
The relationship between masticatory function and bone mineral density (BMD) is unclear. This cross-sectional study examined this relationship after adjusting for confounding factors. The subjects were 702 community-dwelling elderly adults (306 men, 396 women) who had been recruited for the Community-Based Healthcare Research and Education study in 2019. Objective masticatory function was assessed using the gummy jelly method. The median for each descriptive statistic was 69.0 years for age, 86.2% for the young adult mean, and 18.0 for masticatory function. Comparisons of the groups with good and poor masticatory function by sex revealed a significant difference in muscle mass and the tooth number for both sexes (p < 0.05). Men showed significant differences in age (p < 0.05) and salivary occult blood findings (p < 0.05). Multivariate analysis using propensity scores showed a significant association between masticatory function and BMD in both sexes (men: odds ratio 163.0, 95% confidence interval 1.36–19,610.55, p = 0.04; women: odds ratio 48.65, 95% confidence interval 1.52–1561.15, p = 0.03 in women). Masticatory function and BMD in the community-dwelling elderly may be related. However, other factors, including frailty and sarcopenia, may also be involved. Regular oral health care by dentists and dental hygienists may benefit this population.
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Izumi M, Sonoki K, Ohta Y, Fukuhara M, Nagata M, Akifusa S. Swallowing dysfunction and the onset of fever in older residents with special care needs: a thirteen-month longitudinal prospective study. Odontology 2021; 110:164-170. [PMID: 34117954 DOI: 10.1007/s10266-021-00626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
A decline in swallowing function is frequently observed among older residents in nursing homes. We investigated whether swallowing dysfunction was related to the onset of fever in such individuals. Older residents aged ≥ 65 years from three nursing homes were included in this prospective study conducted from July 2017 to May 2019. The follow-up period was 13 months. The outcome was fever incidence in relation to the swallowing dysfunction. Baseline data on the activities of daily living, cognitive function, swallowing function, respiratory function, tongue pressure, and comorbidity conditions were collected. Dates on which the axillary temperature measured ay of participants was > 37.5 °C during the follow-up period were also recorded. For the statistical analyses, swallowing function assessed by the modified water swallow test (MWST) score was used to divide the participants into three groups: scores ≤ 3, 4, and 5. A total of 52 participants [median age, 89.5 years (67-104)] were enrolled. Kaplan-Meier analysis showed that the average periods until onset of fever in participants with MWST scores of ≤ 3, 4, and 5 were 8.0 (6.0-11.0), 10.0 (7.0-12.0), and 12.0 (10.0-13.0) months, respectively. Cox's proportional hazards regression model revealed that participants with an MWST score ≤ 3 were at a higher risk of fever than those with an MWST score of 5 (hazard ratio 11.5, 95% confidence interval 1.5-63.4, adjusted for possible confounders. The swallowing dysfunction correlated with the risk of fever in older residents of nursing homes.
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Affiliation(s)
- Maya Izumi
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokurakita-ku, Kitakyushu , Fukuoka, 803-8580, Japan
| | - Kazuo Sonoki
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokurakita-ku, Kitakyushu , Fukuoka, 803-8580, Japan
| | - Yuko Ohta
- Division of General Internal Medicine, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | - Masayo Fukuhara
- Division of General Internal Medicine, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | | | - Sumio Akifusa
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokurakita-ku, Kitakyushu , Fukuoka, 803-8580, Japan.
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Takamatsu Y, Aiba I. Skeletal muscle loss and body composition in progressive supranuclear palsy: A retrospective cross-sectional study. PLoS One 2021; 16:e0253079. [PMID: 34111224 PMCID: PMC8192011 DOI: 10.1371/journal.pone.0253079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Skeletal muscle mass loss has been associated with decreased physical performance; however, the body composition characteristics in progressive supranuclear palsy (PSP) are not well understood. We investigated body composition parameters, focusing on skeletal muscle mass, in patients with PSP and compared them with those of healthy older adults. METHODS This retrospective cross-sectional study included 39 patients with PSP and 30 healthy older adults (control group). Using a multi-frequency bioelectrical impedance analysis, we measured the skeletal mass index (SMI), basal metabolism, extracellular water/total body water ratio (ECW/TBW), and body fat percentage and examined the relationship between SMI and age, body mass index (BMI) and other body composition parameters. RESULTS The PSP group had a higher rate of low muscle mass (56.4%) than the control group (10.0%), although the ages and BMIs were similar. The leg SMI was lower for the PSP group, while the ECW/TBW was higher for the PSP group. The basal metabolism was lower for the PSP group than for the controls but only in the women. The basal metabolism and BMI showed a significant correlation with SMI in the PSP group. There was a significant correlation between SMI and age, ECW/TBW, and body fat percentage in the PSP group but only in the women. CONCLUSION This study is the first to show that a high proportion of patients with PSP have low muscle mass. We showed differences in terms of sex in muscle mass loss in women with PSP, which was associated with inactivity and aging.
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Affiliation(s)
- Yasuyuki Takamatsu
- Faculty of Health Sciences, Department of Rehabilitation Science, Hokkaido University, Sapporo, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
- * E-mail:
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Suboptimal Tongue Pressure Is Associated with Risk of Malnutrition in Community-Dwelling Older Individuals. Nutrients 2021; 13:nu13061821. [PMID: 34071812 PMCID: PMC8229542 DOI: 10.3390/nu13061821] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022] Open
Abstract
The tongue plays an important role in swallowing, and its dysfunction theoretically leads to inadequate oral intake and subsequent malnutrition. This study aimed to explore how different levels of tongue pressure are related to malnutrition among community-dwelling older individuals. The target population was community-dwelling adults aged ≥ 65 years. Tongue pressure was measured using the Iowa Oral Performance Instrument, whereas the mini nutrition assessment (MNA) test was administered to determine the nutritional status. A full MNA score of less than 24 points was defined as risk of malnutrition. Multivariate logistic regression analyses were conducted to calculate the odds ratio (OR) of risk of malnutrition among different quartiles of tongue pressure. Among the 362 participants, 26 (7.1%) were classified as having risk of malnutrition. Body weight, body mass index, handgrip strength, skeletal muscle mass index, sum MNA score, and serum levels of albumin were lower in the malnutrition risk groups than in the normal nutrition status group. A positive correlation was identified between tongue pressure and the MNA score (r = 0.143, p < 0.01). Treating the subgroup of the highest quartile of tongue pressure as the reference, the crude odds ratio (OR) of having risk of malnutrition was 5.37 (95% CI, 1.14–25.28) in the subgroup at the third quartile, 3.10 (95% CI, 0.60–15.84) in the subgroup at the second quartile, and 3.95 (95% CI, 0.81–19.15) in the subgroup at the lowest quartile. After adjustment for age and sex, the subgroup in the third quartile still presented with a significantly higher risk (OR, 4.85; 95% CI, 1.02–22.99) of risk of malnutrition. Compared with the subgroup at the highest quartile of tongue pressure, the crude OR for all the subgroups in the lower three quartiles was 4.17 (95% CI, 0.96–18.04), showing borderline significance (p = 0.05). In conclusion, we found hints for an association between decreased tongue pressure and an increased risk of malnutrition in community-dwelling older individuals. Older people with suboptimal tongue pressure should undergo a thorough assessment of their nutritional status and swallowing function for the early identification of subclinical malnutrition and dysphagia.
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Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Shigematsu T, Kayashita J. Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia. Nutrition 2021; 90:111295. [PMID: 34107332 DOI: 10.1016/j.nut.2021.111295] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of low tongue pressure on the improvement of swallowing function in people with sarcopenic dysphagia and ongoing dysphagia or physical rehabilitation. In addition, we investigated whether sarcopenic dysphagia at admission was associated with severity of malnutrition. METHODS This was a prospective cohort study of 146 people with sarcopenic dysphagia (mean age 84.6 ± 7.4 y; 68.4% women, 31.6% men) in a postacute rehabilitation hospital. Sarcopenic dysphagia was defined as the presence of both sarcopenia and dysphagia but not neurogenic dysphagia, such as dysphagia due to stroke. Low tongue pressure was classified as "probable" and normal tongue pressure as "possible" sarcopenic dysphagia. Swallowing function was assessed using the Food Intake Level Scale. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria. Study outcomes included the amount of change in Food Intake Level Scale score during the rehabilitation period and the association between probable sarcopenic dysphagia and the severity of malnutrition on admission. Statistical significance was set at P < 0.05. RESULTS There were 83 participants (58.6%) with probable sarcopenic dysphagia. The severity of malnutrition (moderate malnutrition: adjusted odds ratio, 3.388; P = 0.042) and severe malnutrition (adjusted odds ratio, 3.663; P = 0.015) was a contributing factor to probable sarcopenic dysphagia. Probable sarcopenic dysphagia (regression coefficient, -0.384; P = 0.017) was negatively associated with the amount of change in Food Intake Level Scale score. CONCLUSIONS Probable sarcopenic dysphagia with low tongue pressure was associated with poorer improvement in swallowing function and severe malnutrition during postacute rehabilitation. Patients with probable sarcopenic dysphagia may require aggressive nutritional therapy.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
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Diaz JG, Lombardi I. Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil. J Oral Rehabil 2021; 48:614-620. [PMID: 33586260 DOI: 10.1111/joor.13157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
Several studies report that 40% to 60% of older people have some difficulty chewing and/or swallowing, which can lead to malnutrition, dehydration, weight loss, a lack of eating desire, etc. Identify older adults with swallowing difficulties in the city of Santos, Brazil, among users of the public healthcare system. A cross-sectional study was conducted with 100 individuals aged 60 to 90 years with no neurological disorders. Patient histories were taken, and stomatognathic evaluations were performed. The Mini Mental Health Examination (MMHE) and swallowing-related quality-of-life questionnaire (SWAL-QOL) were administered. The clinical swallowing assessment was performed with liquid, pasty and solid foods using two assessment protocols (Dysphagia Risk Evaluation Protocol and the Protocol for the Introduction and Transition of Foods)'. We found complaints of poorly adapted dentures among 49.3% of denture wearers and a high prevalence of hypofunction of oro-facial muscles. Sixty-five per cent of the respondents had facial muscle hypofunction, 51% exhibited lip hypofunction, and 49% exhibited tongue hypofunction. Moreover, 54% reported difficulty swallowing. On the SWAL-QOL questionnaire, 37% reported choking when eating food, 44% reported choking when drinking liquids, 29% reported coughing during meals, and 77% reported difficulty chewing. The present study revealed an important prevalence of complaints related to swallowing difficulties among older people in the city of Santos with structural and physiological changes characteristic of presbyphagia. The most prevalent conditions were poorly adapted dentures and hypofunction of oro-facial muscles, underscoring the importance of stomatognathic interventions in primary care.
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Affiliation(s)
- Juliana Gonzalez Diaz
- Intedisciplinary postgraduate program at the Federal University of São Paulo, Federal University of São Paulo, Santos, SP, Brazil
| | - Império Lombardi
- Human Movement Sciences, Department of Federal University of São Paul, Santos, SP, Brazil
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Diagnosis and Treatment of Sarcopenic Dysphagia: A Scoping Review. Dysphagia 2021; 36:523-531. [PMID: 33620563 DOI: 10.1007/s00455-021-10266-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sarcopenic dysphagia is a swallowing disorder due to sarcopenia involving the whole-body skeletal muscles and swallowing muscles. This scoping review aimed to explore the currently known information on the diagnosis and treatment of sarcopenic dysphagia and to clarify the types of research required to develop the field. METHODS We searched the PubMed, MEDLINE, CINAHL, and Cochrane databases from their inception to October 2020, using the search terms "(sarcopenia or sarcopenic or myopenia or dynapenia) and (dysphagia or swallowing or deglutition) and (diagnosis or treatment)". Articles reporting diagnosis method and treatment of sarcopenic dysphagia were included. RESULTS Twenty-one and eight articles reported on the diagnostic and treatment method, respectively. A diagnostic algorithm for sarcopenic dysphagia was most frequently used (n = 10). Other diagnostic methods included consensus diagnostic criteria for sarcopenic dysphagia (n = 4), sarcopenia and dysphagia without other causes of dysphagia (n = 4), and both sarcopenia and dysphagia (n = 3). The medical treatments for patients with sarcopenic dysphagia were described in single-patient case reports (n = 8) only. There were six articles reporting on a combination of rehabilitation and nutritional support. These reports showed the importance of interdisciplinary rehabilitation nutrition for improving patients' nutritional status and sarcopenia. CONCLUSIONS A reliable and validated diagnostic algorithm was the most widely used diagnostic method for sarcopenic dysphagia. Only case reports have been published for the medical treatment of patients with sarcopenic dysphagia. Interdisciplinary rehabilitation nutrition may be useful for treating patients with sarcopenic dysphagia.
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Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Kayashita J, Mori N. Nutritional Management Enhances the Recovery of Swallowing Ability in Older Patients with Sarcopenic Dysphagia. Nutrients 2021; 13:nu13020596. [PMID: 33670314 PMCID: PMC7917588 DOI: 10.3390/nu13020596] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 12/14/2022] Open
Abstract
This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group (p = 0.004 and p < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (K.M.); (N.M.)
- Correspondence: ; Tel.: +81-53-471-8331; Fax: +81-53-474-8819
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan;
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (K.M.); (N.M.)
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University, Shinjuku-ku 162-8666, Japan;
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan;
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan; (T.O.); (A.N.)
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan; (T.O.); (A.N.)
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima 734-8558, Japan;
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (K.M.); (N.M.)
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Sandoval-Munoz CP, Haidar ZS. Neuro-Muscular Dentistry: the "diamond" concept of electro-stimulation potential for stomato-gnathic and oro-dental conditions. Head Face Med 2021; 17:2. [PMID: 33499906 PMCID: PMC7836574 DOI: 10.1186/s13005-021-00257-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/19/2021] [Indexed: 01/17/2023] Open
Abstract
Oro-Pharyngeal Dysphagia - or simply dysphagia - is the difficulty (persistent) in swallowing/passing food and/or liquid from the mouth to the pharynx into the esophagus and finally the stomach; a deglutition disorder (a symptom, by definition, often due to neuro-degenerative/−muscular, drug-induced or localized structural pathologies such as head and neck tumors, lesions and associated surgical and/or radiation injuries) linked to severe consequences on Quality of Life (QoL), including malnutrition, dehydration, and even sudden death. Likewise, Temporo-Mandibular Jaw and Joint disorder(s) – or simply TMD – is a multifactorial etiological condition, regularly encountered in the dental office. Whether due to malocclusion, bruxism, stress and/or trauma, TMD destabilizes the whole cranio-mandibular system structurally and functionally, via affecting mastication, teeth, supporting structures, comfort and aesthetics, and thus, QoL, again. While several treatment regimens do exist for such conditions, some of which have been standardized for use over the years, most continue to lack proper evidence-based literature support. Hence, (1) caution is to be exercised; and (2) the need for alternative therapeutic strategies is amplified, subsequently, the door for innovation is wide open. Indeed, neuromuscular electrical stimulation or “NMES”, is perhaps a fine example. Herein, we present the interested oro-dental health care provider with an up-dated revision of this therapeutic modality, its potential benefits, risks and concerns, to best handle the dysphagic patient: an intra-disciplinary approach or strategy bridging contemporary dentistry with speech and language therapy; a rather obscure and un-discovered yet critical allied health profession. A pre-clinical and clinical prospectus on employing inventive NMES-based regimens and devices to manage TMD is also highlighted.
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Affiliation(s)
- Catalina P Sandoval-Munoz
- BioMAT'X (Laboratorio de Biomateriales, Farmacéuticos y Bioingeniería de Tejidos Cráneo Máxilo-Facial), Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile
| | - Ziyad S Haidar
- BioMAT'X (Laboratorio de Biomateriales, Farmacéuticos y Bioingeniería de Tejidos Cráneo Máxilo-Facial), Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile. .,Programa de Doctorado en BioMedicina, Facultad de Medicina, Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile. .,Centro de Investigación e Innovación Biomédica (CIIB), Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile. .,Facultad de Odontología, Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile.
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Hansen T, Thomassen JD, Jensen LE, Irgens MR, Kjaersgaard A. Development of an Intervention for Improving Ingestion in Elders with Oropharyngeal Dysphagia. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1800159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tina Hansen
- Division of Occupational Therapy, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, University Hospital Hvidovre-Amager, Hvidovre, Denmark
| | - Julie Damm Thomassen
- Division of Occupational Therapy, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Lea Elm Jensen
- Division of Occupational Therapy, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Maja Rosenkrands Irgens
- Division of Occupational Therapy, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Annette Kjaersgaard
- Department for Education, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
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Mizuno S, Wakabayashi H, Fujishima I, Kishima M, Itoda M, Yamakawa M, Wada F, Kato R, Furiya Y, Nishioka S, Momosaki R. Construction and Quality Evaluation of the Japanese Sarcopenic Dysphagia Database. J Nutr Health Aging 2021; 25:926-932. [PMID: 34409973 DOI: 10.1007/s12603-021-1646-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To describe the activity and evaluate the quality of the Japanese sarcopenic dysphagia database. DESIGN Cohort registry study. SETTING 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team. PARTICIPANTS 467 dysphagic patients, aged 20 years and older. MEASUREMENTS The following indices were assessed at baseline: age, sex, main disease, sarcopenic dysphagia, whole body sarcopenia, Food Intake Level Scale (FILS), malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria, oral status assessed by the Revised Oral Assessment Guide or the Oral Health Assessment Tool, activities of daily living assessed by the Functional Independence Measure (FIM) or the Barthel Index (BI), Charlson comorbidity index, C-reactive protein and serum albumin levels, dysarthria, hoarseness, aphasia, pressure ulcers, bladder, bowel, and kidney function, respiratory status, polypharmacy, number of drugs, and involvement of health care professionals and rehabilitation nutrition team. FILS, FIM or BI, and outcome including discharge destination were assessed at follow-up. A simple comparison of cases and evaluation of the quality of data were performed. RESULTS The mean age was 80.4 ± 11.4 yr. The variable input error was 0. The number of patients with missing data was high for estimated glomerular filtration rate, C-reactive protein, serum albumin, skeletal mass index, and tongue pressure. The prevalence of either probable, possible, or no sarcopenic dysphagia was 105 (23%), 182 (39%), or 179 (38%), respectively. Doctors including physiatrists, nurses, physical therapists, and registered dietitians were involved with most patients, while the rehabilitation nutrition team was involved in only 16% of patients. CONCLUSIONS The quality of the database was relatively high. Sarcopenic dysphagia is common in patients with dysphagia.
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Affiliation(s)
- S Mizuno
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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Fedele D, De Francesco A, Riso S, Collo A. Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview. Nutrition 2021; 81:111016. [PMID: 33059127 PMCID: PMC7832575 DOI: 10.1016/j.nut.2020.111016] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.
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Affiliation(s)
- Debora Fedele
- Dietetic and Clinical Nutrition Unit, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy.
| | - Antonella De Francesco
- Dietetic and Clinical Nutrition Unit, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Alessandro Collo
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, Novara, Italy
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Geraci A, Calvani R, Ferri E, Marzetti E, Arosio B, Cesari M. Sarcopenia and Menopause: The Role of Estradiol. Front Endocrinol (Lausanne) 2021; 12:682012. [PMID: 34093446 PMCID: PMC8170301 DOI: 10.3389/fendo.2021.682012] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
During aging and menopausal transition in women, a progressive muscle degeneration (i.e. decrease in quality and muscle function) occurs. This muscle dysfunction, caused by decreased proliferation of muscle satellite cells, increased levels of inflammatory markers, and altered levels of sex hormones, exposes women to a raised incidence of sarcopenia. In this regard, hormonal balance and, in particular, estradiol, seems to be essential in skeletal muscle function. The role of the estradiol on satellite cells and the release of inflammatory cytokines in menopausal women are reviewed. In particular, estradiol has a beneficial effect on the skeletal muscle by stimulating satellite cell proliferation. Skeletal muscle can respond to estrogenic hormonal control due to the presence of specific receptors for estradiol at the level of muscle fibers. Additionally, estradiol can limit inflammatory stress damage on skeletal muscle. In this review, we primarily focused on the role of estradiol in sarcopenia and on the possibility of using Estradiol Replacement Therapy, which combined with nutritional and physical activity programs, can counteract this condition representing a valid tool to treat sarcopenia in women.
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Affiliation(s)
- Annalisa Geraci
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Annalisa Geraci,
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Evelyn Ferri
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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Egashira R, Mizutani S, Yamaguchi M, Kato T, Umezaki Y, Oku S, Tamai K, Obata T, Naito T. Low Tongue Strength and the Number of Teeth Present Are Associated with Cognitive Decline in Older Japanese Dental Outpatients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8700. [PMID: 33238565 PMCID: PMC7700411 DOI: 10.3390/ijerph17228700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022]
Abstract
To mitigate the impact of dementia, initiating early intervention is important. This study aims to investigate the associations between deterioration in oral function and cognitive decline in older outpatients whose oral health was maintained in the dental clinic. This study included 50 outpatients aged ≥65 years. We used the Japanese version of the Montreal Cognitive Assessment (MoCA-J) to assess cognitive decline. Oral function was evaluated by tongue pressure, masticatory performance, and swallowing ability. A full-mouth periodontal examination was conducted, and the occlusal support and number of teeth were recorded. Odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline (MoCA-J score ≤ 25 points) were calculated using logistic regression models. The age, number of teeth, tongue pressure, and masticatory performance were significantly correlated with cognitive decline (p < 0.05). Logistic regression analyses revealed that cognitive decline was independently associated with age (OR: 1.25; 95% CI: 1.03-1.52; p = 0.024), number of teeth (OR = 0.83; 95% CI: 0.76-1.00; p = 0.047), and lower tongue pressure (OR: 0.87; 95% CI: 0.77-0.98; p = 0.022). Lower tongue pressure and a small number of remaining teeth may be associated with cognitive decline in Japanese outpatients.
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Affiliation(s)
- Rui Egashira
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | - Shinsuke Mizutani
- OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
| | - Masahiro Yamaguchi
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | - Tomotaka Kato
- Department of Oral Health Sciences, University of Washington, Seattle, WA 98195, USA;
| | - Yojiro Umezaki
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | - Saori Oku
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
| | - Keiko Tamai
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
| | | | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka 814-0193, Japan; (R.E.); (M.Y.); (Y.U.); (K.T.); (T.N.)
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Nagano A, Maeda K, Koike M, Murotani K, Ueshima J, Shimizu A, Inoue T, Sato K, Suenaga M, Ishida Y, Mori N. Effects of Physical Rehabilitation and Nutritional Intake Management on Improvement in Tongue Strength in Sarcopenic Patients. Nutrients 2020; 12:nu12103104. [PMID: 33053651 PMCID: PMC7601202 DOI: 10.3390/nu12103104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
The study aimed to investigate the impact of physical intervention and the amount of nutritional intake on the increase in tongue strength and swallowing function in older adults with sarcopenia. From November 2018 and May 2019, older patients with sarcopenia who were admitted for rehabilitation were analyzed. The intervention employed in the study was the usual physical and occupational therapy for two months. Tongue strength was measured before and after two months of treatment. Data on tongue strength, the amount of energy and protein intake, intervention time, and swallowing function were examined. A total of 95 sarcopenic older patients were included (mean age 83.4 ± 6.5 years). The mean tongue strength after the intervention was significantly increased from 25.4 ± 8.9 kPa to 30.5 ± 7.6 kPa as a result of the treatment (p < 0.001). After adjusting the confounding factors in the multivariable models, an energy intake of ≥30 kcal/kg/day and a protein intake of ≥1.2 g/kg/day based on the ideal body weight had a significant impact on the increase in tongue strength after the treatment (p = 0.011 and p = 0.020, respectively). Swallowing function assessed using the Mann Assessment of Swallowing Ability was significantly increased after the treatment (mean difference between pairs: 1.12 [0.53-1.70]; p < 0.001). Physical intervention and strict nutritional management for older inpatients with sarcopenia could be effective to improve tongue strength and swallowing function.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan;
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-78-6364
| | - Masaki Koike
- Division of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahimachi, Kurume 830-0011, Japan;
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan;
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wago-kita, Naka-ku, Hamamatsu, Shizuoka 433-8127, Japan;
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan;
| | - Keisuke Sato
- Okinawa Chuzan Hospital Clinical Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Masaki Suenaga
- Department of Rehabilitation Medicine, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
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Association between stroke lesions and videofluoroscopic findings in acute stroke patients. J Neurol 2020; 268:1025-1035. [PMID: 32979098 DOI: 10.1007/s00415-020-10244-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. METHODS We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. RESULTS Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. CONCLUSION Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.
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Ambagtsheer RC, Beilby J, Seiboth C, Dent E. Prevalence and associations of frailty in residents of Australian aged care facilities: findings from a retrospective cohort study. Aging Clin Exp Res 2020; 32:1849-1856. [PMID: 31686388 DOI: 10.1007/s40520-019-01379-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Studies conducted among older people have shown that frailty is a common condition associated with an array of adverse outcomes. The aims of this study were to identify the prevalence and associations of frailty in older people residing in several aged care facilities located in Queensland, Australia. METHODS The database used for this study was drawn from the Aged Care Funding Instrument (ACFI) database of an Australian aged care provider, and contained data from ten aged care facilities in Queensland, Australia. A modification of an eFI originally developed by Clegg and colleagues and based on Rockwood's Frailty Index (FI) of cumulative deficits was used to identify frailty. RESULTS In total, 592 participants aged 75 years and over were included in the study (66.6% female). Median (IQR) age was 88.0 (9.0) years. Frailty prevalence among the sample was 43.6%, with 46.3% pre-frail and 10.1% not frail. In a multivariate logistic regression analysis incorporating three different models, frailty was significantly associated with three ACFI domains (Nutrition, Depression and Complex Health Care), along with facility size, consistently across two models. In the third model, frailty was also significantly associated with arthritis, diabetes, hypertension, osteoporosis and vision problems, along with male gender. CONCLUSION There is a need to develop frailty identification and management programs as part of standard care pathways for older adults residing in aged care facilities. Aged care facilities should consider regular frailty screening in residential aged care residents, along with interventions addressing specific issues such as dysphagia and depression.
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Cui F, Yin Q, Wu C, Shen M, Zhang Y, Ma C, Zhang H, Shen F. Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: A randomised controlled trial. J Oral Rehabil 2020; 47:1297-1303. [PMID: 32757479 DOI: 10.1111/joor.13068] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Feifei Cui
- ICU The First Affiliated Hospital of Soochow University Suzhou China
| | - Qingmei Yin
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Chao Wu
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Meifen Shen
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Yijie Zhang
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Chen Ma
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Haiying Zhang
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Fang Shen
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
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de Sire A, Giachero A, DE Santi S, Inglese K, Solaro C. Screening dysphagia risk in 534 older patients undergoing rehabilitation after total joint replacement: a cross-sectional study. Eur J Phys Rehabil Med 2020; 57:131-136. [PMID: 32594668 DOI: 10.23736/s1973-9087.20.06321-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this postacute phase, they might suffer from other symptoms, including dysphagia, defined as a dysfunction of the digestive system, characterized by an objective difficulty or a sensation of difficulty in swallowing. It is considered as a very challenging problem in older people and early detection is fundamental for a prompt and effective management. However, up to date, there is a lack of data on dysphagia risk screening in orthopedic rehabilitation inpatients. AIM The aim of this study was to evaluate dysphagia risk through Eating Assessment Tool (EAT-10) in older people undergoing rehabilitation after total hip or knee arthroplasty. DESIGN Cross-sectional study. SETTING Rehabilitation Unit. POPULATION All consecutive patients undergone total hip or knee arthroplasty, aged ≥65 years, referring to Orthopedics Rehabilitation Unit "Mons. Luigi Novarese" Hospital, Moncrivello, Italy, for a 24-month period (from 1st January 2018 to 31st December 2019). We excluded patients with: 1) diagnosis of neurological diseases; 2) pharyngeal or esophageal cancer; 3) maxillofacial cancer; 4) tracheotomy. METHODS Dysphagia risk was assessed through EAT-10. The cohort was divided into two groups, according to water swallowing test (WST), in order to evaluate differences in terms of different EAT-10 scores. Furthermore, based on pathological WST, we have stratified study participants by the American Speech-Language-Hearing Association (ASHA)'s National Outcomes Measurement System (NOMS) swallowing scale in order to evaluate differences in terms of the different EAT-10 scores. RESULTS We included 534 participants (180 men, 357 women), mean aged 74.8±5.6 years. Thirty-one patients (5.8%) had pathological WST and 34 (6.4%) reported EAT-10 ≥3. There were significant differences (P<0.001) between groups (pathological WST vs. normal WST) in terms of all EAT-10 total scores. EAT-10 reported a high specificity (96.8% if ≥3 and 98.4% if ≥4), but a low sensitivity (58.1% if ≥3 and 54.8% if ≥4). CONCLUSIONS EAT-10 might be considered as useful screening tools for dysphagia in older people, considering the high specificity of EAT-10≥4. CLINICAL REHABILITATION IMPACT Screening dysphagia risk should be recommended also in patients undergoing rehabilitation in order to set up an early diagnosis and management.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy -
| | - Alice Giachero
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Shara DE Santi
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Katia Inglese
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Claudio Solaro
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
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