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Tsuji T, Yamasaki K, Kondo K, Hongu N, Matsumoto Y, Fukuo K, Habu D. Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study. J Hum Nutr Diet 2024; 37:574-582. [PMID: 38229274 DOI: 10.1111/jhn.13281] [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: 08/18/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS At-risk of malnutrition was associated with discontinuation of home medical care among older patients.
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Affiliation(s)
- Taeko Tsuji
- Department of Health and Nutrition, Faculty of Human Science, Osaka Aoyama University, Minoh, Japan
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Nishinomiya, Japan
| | - Kyoko Kondo
- Research Support Platform, Osaka Metropolitan University Graduate School of Medicine, Osaka-shi, Japan
| | - Nobuko Hongu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Daiki Habu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
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Liu M, Chen X, Ma P, Deng M. Summary of the best evidence for the management of dysphagia in elderly patients. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08530-2. [PMID: 38459985 DOI: 10.1007/s00405-024-08530-2] [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: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To search for and summarize the best evidence for themanagement of elderly patients with dysphagia. METHODS Clinical decisions, recommended practices, evidence summaries, clinical practice guidelines, expert consensus, and systematic reviews on the management of dysphagia among elderly patients were systematically reviewed from domestic and foreign guideline websites, association websites, and Chinese and English databases according to the 6S model of evidence-based resources. The search period was between January 1, 2010 and November 1, 2023. Two researchers evaluated the quality of the included literature respectively and extracted evidence. RESULTS A total of 14 literatures were identified, including 2 guidelines, 2 clinical decisions, 5 evidence summaries, 3 expert consensus statements, and 2 systematic reviews. Twenty-four pieces of evidence from 7 aspects were summarized, including assessment, treatment and rehabilitation, medication care, nutrition management, oral care, complication management, and psychological care. CONCLUSION The best evidence-based recommendations for the management of dysphagia in elderly patients is summarized, it is suggested that the best evidence should be selected according to the actual situation of patients, and a personalized management plan should be formulated to improve the quality of life of patients and achieve high-quality nursing.
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Affiliation(s)
- Mengdan Liu
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Xushu Chen
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Peng Ma
- Intensive Care Unit, Longquanyi District Hospital of Chengdu University of Traditional Chinese Medicine, 783, Xindu Dadao, Xindu District, Chengdu, 610000, Sichuan, China
| | - Min Deng
- The Publicity Division, Neijiang First People's Hospital, Neijiang, 641000, Sichuan, China.
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Tamura A, Yamaguchi K, Yanagida R, Miyata R, Tohara H. Physical, oral, and swallowing functions of three patients with type a xeroderma pigmentosum: a report of three cases. BMC Oral Health 2024; 24:163. [PMID: 38302989 PMCID: PMC10832268 DOI: 10.1186/s12903-024-03933-3] [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: 04/18/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Xeroderma pigmentosum (XP) is an extremely rare and severe form of photosensitivity. It is classified into types A-G or V according to the gene responsible for the disease. The progression and severity of symptoms vary depending on the type. Although dysphagia caused by decreased swallowing function and dental malposition due to stenosis of the dentition in the facial and oral regions is common, it has not been reported in detail. We report three cases of type A XP, in which central and peripheral neurological symptoms appeared early on and progressed rapidly. We describe the oral function of these patients, focusing on the swallowing function and dentition malposition. CASE PRESENTATION Two males (27 and 25 years old) and one female (28 years old) presented with diverse neurological symptoms. We focused on the relationship between the changes in swallowing and oral functions and conditions due to decline in physical function. Some effects were observed by addressing the decline in swallowing and oral functions. In particular, a dental approach to manage the narrowing of the dentition, which was observed in all three patients, improved the swallowing and oral functions and maintained the current status of these functions. CONCLUSIONS In type A XP, early decline in oral and swallowing functions is caused by the early decline in physical function, and it is necessary to monitor the condition at an early stage.
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Affiliation(s)
- Atsuko Tamura
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Rie Miyata
- Department of Pediatrics, Tokyo Kita-Medical Center, 4-17-56 Akabanedai, Tokyo, 115-0053, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Suseki K, Yamashita M, Kojima Y, Minegishi Y, Komiya K, Takaso M. Lower SMI is a risk factor for dysphagia in Japanese hospitalized patients with osteoporotic vertebral and hip fracture: A retrospective study. Osteoporos Sarcopenia 2022; 8:152-157. [PMID: 36605170 PMCID: PMC9805941 DOI: 10.1016/j.afos.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/21/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Many patients with osteoporotic fragile fracture often suffer from dysphagia that results in malnutrition, further deterioration of physical strength, and rehabilitation difficulties. This study aims to investigate the risk factors for dysphagia in hospitalized patients with osteoporotic vertebral and/or hip fractures. Methods Between January 2020 and December 2021, 569 inpatients were managed for osteoporotic vertebral or hip fractures. Of these, 503 patients were analyzed and 66 were excluded as the required data could not be obtained or dysphagia with causative diseases such as cerebrovascular disease. The patients were divided into 2 groups: patients with dysphagia (P-group) and patients without dysphagia (N-group). We investigated gender, fracture site, age, systemic skeletal muscle mass index (SMI), bone mineral density (BMD), and body mass index (BMI) in early stage of hospitalization and studied their relationship with dysphagia. Results There were no significant differences in gender and fracture site between the 2 groups. A significant difference was observed in age, SMI, BMD, and BMI (P < 0.01). We performed a logistic regression analysis with the P-group as the objective variable and age, SMI, BMD, and BMI as explanatory variables. We divided objective groups into all patients, patients with vertebral fracture, patients with hip fracture, men, and women. SMI was an independent risk factor in all groups. Conclusions Lower SMI was a risk factor for dysphagia in hospitalized patients with osteoporotic vertebral and hip fractures. We carefully observed swallowing function of patients with decreased SMI to maintain the nutritional status and prevent rehabilitation difficulties.
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Affiliation(s)
- Kaoru Suseki
- Department of Spine Surgery, Yokohama General Hospital, 2201-5, Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, 225-0025, Japan,Department of Orthopaedic Surgery, Yokohama General Hospital, 2201-5, Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, 225-0025, Japan,Corresponding author. Department of Spine Surgery, Yokohama General Hospital, 2201-5, Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, 225-0025, Japan.
| | - Masaomi Yamashita
- Department of Orthopaedic Surgery, Funabashi Central Hospital, 6-13-10, Kaijin, Funabashi, Chiba, 273-8556, Japan
| | - Yoshiaki Kojima
- Department of Orthopaedic Surgery, Yokohama General Hospital, 2201-5, Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, 225-0025, Japan
| | - Yojiro Minegishi
- Department of Orthopaedic Surgery, Yokohama General Hospital, 2201-5, Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, 225-0025, Japan
| | - Koichiro Komiya
- Department of Orthopaedic Surgery, Yokohama General Hospital, 2201-5, Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, 225-0025, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 228-8555, Japan
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Nanto T, Ono T, Hori K, Murakami K, Uchiyama Y, Maeda Y, Domen K. The Effects of Tongue Elevation using a Weighted Plastic Bottle on the Tongue Pressure and Activity of Suprahyoid Muscles. J Oral Rehabil 2022; 49:1041-1048. [PMID: 36029125 DOI: 10.1111/joor.13365] [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: 10/04/2021] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A rise in tongue pressure coincides with an increase in the suprahyoid muscles activity. OBJECTIVES The aim was to investigate the effects of holding a weighted plastic bottle on tongue pressure and the suprahyoid muscles activity. METHODS Eighteen participants (8 men and 10 women; mean age 42 ± 16 years) participated in this study. All participants had no history of speech, language, hearing, or swallowing disorders and no tooth loss, and they did not require dentures. Healthy participants held gauzes connected with a plastic bottle with increasing resistive loads of 0 g, 250 g, 500 g, and 750 g, between their palate and tongue. The maximum tongue pressure and average tongue pressure were measured during a 5-second hold. The average tongue pressure was defined as the mean tongue-pressure data in each task. The suprahyoid muscles activity was measured using the electromyogram (EMG). The root mean square of the EMG signals measured while lifting different loads and while performing the head lifting exercises were compared. All variables were examined using the Friedman's test and Wilcoxon signed-rank test. RESULTS The maximum tongue pressure (p < .05) and average tongue pressure values (p < .05) increased gradually in the anterior-median region with increasing resistive loads, and the root mean square amplitudes for 250 g, 500 g, and 750 g were not significant compared to head lifting exercises. CONCLUSION These results indicated that Plastic bottle holding could be a potential strength-training tool for the tongue and the suprahyoid muscles.
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Affiliation(s)
- Tomoki Nanto
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.,Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Murakami
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshinobu Maeda
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Swallowing disorders and associated factors in older adults living in nursing homes. Eur Arch Otorhinolaryngol 2022; 279:3733-3740. [PMID: 35357579 DOI: 10.1007/s00405-022-07355-1] [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: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to identify the frequency of swallowing disorders and the associated factors in older adults living in nursing homes. METHODS This is a cross-sectional study with a sample of 73 older adults (≥ 60 years; mean age = 80 ± 7.49 years; female = 82.2%) living in five non-profit Brazilian nursing homes. Demographic and clinical data were collected. The frequency of swallowing disorders was determined by the Volume-Viscosity Swallow Test (VVS-T). Covariables with a p-value less than 0.20 according to Pearson's chi-square test or Fisher's exact test were included in the multiple logistic regression analysis model. The level of significance was 5%. RESULTS The frequency of swallowing disorders was 63%. The multiple logistic regression model revealed that the chance of an older adult living in a nursing home presenting with swallowing disorders increased by 8% with each 1-year increase in age. Decreases in oral intake level improved the chance of a negative result in the VVS-T by approximately four times, and an individual with a FOIS level below seven was almost 11 times more likely to have a swallowing disorder. CONCLUSION The frequency of swallowing disorders in older adults living in nursing homes is high and is associated with age and oral intake. The management care team should be aware of the early detection of these conditions to prevent complications of oropharyngeal dysphagia.
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Xie L, Jiang J, Fu H, Zhang W, Yang L, Yang M. Malnutrition in Relation to Muscle Mass, Muscle Quality, and Muscle Strength in Hospitalized Older Adults. J Am Med Dir Assoc 2021; 23:722-728. [PMID: 34953766 DOI: 10.1016/j.jamda.2021.11.025] [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: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Muscle quality is an essential muscle metric, which can be assessed by measuring intermuscular adipose tissue (IMAT) and skeletal muscle radiodensity (SMD) via computed tomography (CT) images. We aimed to explore the associations of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition with muscle mass, muscle quality, and muscle strength in hospitalized older adults. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS Hospitalized older patients. METHODS Malnutrition was defined by the GLIM criteria after screening by the Mini Nutrition Assessment-Short Form (MNA-SF). Chest CT images were used to segment skeletal muscle area (SMA) and IMAT, and to measure SMD. Skeletal muscle index (SMI) was calculated by SMA (cm2)/body height squared (m2). Handgrip strength (HGS) was measured using a digital dynameter. Univariate and multivariate logistic regression models were performed to calculate odds ratios (ORs) and 95% CIs. RESULTS We included 1135 patients. The MNA-SF score is positively associated with SMI, SMD, and HGS, but negatively associated with IMAT. Compared to patients with normal nutrition, patients with malnutrition had significantly lower SMD and HGS in both men and women. Women with malnutrition had significantly higher IMAT than women with normal nutrition, whereas men with malnutrition had significantly lower SMI than men with normal nutrition. After adjustment for confounders, SMI (adjusted OR 0.95, 95% CI 0.93, 0.98), SMD (adjusted OR 0.94, 95% CI 0.93, 0.98), and HGS (adjusted OR 0.91, 95% CI 0.89, 0.94) were significantly and negatively associated with malnutrition. IMAT appeared to be positively associated with malnutrition, but the result was not statistically significant (adjusted OR 1.03, 95% CI 1.00, 1.07). CONCLUSIONS AND IMPLICATIONS Our study provides new evidence regarding the association between handgrip strength and malnutrition in older inpatients. Moreover, a small association of chest CT--derived muscle quality and mass with malnutrition is identified.
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Affiliation(s)
- Lingling Xie
- West China School of Nursing/Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaojiao Jiang
- Rehabilitation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongbo Fu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenyi Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Yang
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Moloney L, Jarrett B. Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2108-2140.e6. [PMID: 34581276 DOI: 10.1016/j.jand.2020.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.
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Affiliation(s)
- Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
| | - Brittany Jarrett
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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Ikenaga Y, Kusunoki T, Yamaguchi H. Percutaneous Endoscopic Gastrostomy Reduces Aspiration Pneumonia Rate in Stroke Patients with Enteral Feeding in Convalescent Rehabilitation Wards. Prog Rehabil Med 2021; 6:20210031. [PMID: 34514181 PMCID: PMC8387208 DOI: 10.2490/prm.20210031] [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: 04/24/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The effect of percutaneous endoscopic gastrostomy (PEG) on the prevention of aspiration pneumonia and improvements in activities of daily living (ADL) for enteral feeding-dependent stroke patients is unclear. We sought to clarify differences in the rates of aspiration pneumonia and ADL improvement between stroke patients receiving PEG and those receiving nasogastric tube feeding (NGT) in convalescent rehabilitation wards. METHODS We assessed 10 years of data from the Kaga Regional Cooperation Clinical Pathway for Stroke, which covers patients in the southern district of Ishikawa Prefecture of Japan. Logistic regression analysis with propensity score adjustment was used to examine how the enteral feeding method affected aspiration pneumonia rates. Linear regression analysis, adjusted by propensity scores, was also performed to ascertain the effect of the enteral feeding method on ADL improvement. RESULTS Overall, 47 patients with PEG and 49 patients with NGT were analyzed. The incidence of aspiration pneumonia was 4.67 times higher in the NGT group than in the PEG group in the propensity score-adjusted logistic regression analysis (odds ratio 4.67, 95% confidence interval 1.30-16.67, P=0.02). The enteral feeding method had no significant effect on ADL improvement in the propensity score-adjusted linear regression analysis. CONCLUSIONS In convalescent rehabilitation wards, aspiration pneumonia was more likely to occur in stroke patients with NGT than in those with PEG; however, the enteral feeding method did not affect ADL improvement. These results provide a basis for determining the appropriate enteral feeding method for stroke patients who cannot take adequate nutrition orally during convalescence/rehabilitation.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan
- Council of Kaga Local Stroke Network, South Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan
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Nutritional Assessment in Adult Patients with Dysphagia: A Scoping Review. Nutrients 2021; 13:nu13030778. [PMID: 33673581 PMCID: PMC7997289 DOI: 10.3390/nu13030778] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023] Open
Abstract
Malnutrition negatively affects the quality of life of patients with dysphagia. Despite the need for nutritional status assessment in patients with dysphagia, standard, effective nutritional assessments are not yet available, and the identification of optimal nutritional assessment items for patients with dysphagia is inadequate. We conducted a scoping review of the use of nutritional assessment items in adult patients with oropharyngeal and esophageal dysphagia. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify articles published in English within the last 30 years. Twenty-two studies met the inclusion criteria. Seven nutritional assessment categories were identified: body mass index (BMI), nutritional screening tool, anthropometric measurements, body composition, dietary assessment, blood biomarkers, and other. BMI and albumin were more commonly assessed in adults. The Global Leadership Initiative on Malnutrition (GLIM), defining new diagnostic criteria for malnutrition, includes the categories of BMI, nutritional screening tool, anthropometric measurements, body composition, and dietary assessment as its required components, but not the blood biomarkers and the “other” categories. We recommend assessing nutritional status, including GLIM criteria, in adult patients with dysphagia. This would standardize nutritional assessments in patients with dysphagia and allow future global comparisons of the prevalence and outcomes of malnutrition, as well as of appropriate interventions.
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Miura K, Koda M, Funayama T, Takahashi H, Yamazaki M. Sarcopenic Dysphagia After Occipito-Cervical Fusion Surgery in an Elderly Patient With High-Cervical Myelopathy Caused by Retro-Odontoid Pseudotumor: A Case Report. Cureus 2020; 12:e11881. [PMID: 33415034 PMCID: PMC7781783 DOI: 10.7759/cureus.11881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Occipito-cervical fusion surgery may cause dysphagia due to inadequate occipito-cervical alignment. However, little is known about any other mechanisms behind postoperative dysphagia. We present a rare case of severe sarcopenic dysphagia despite appropriate occipito-cervical alignment after occipito-cervical fusion surgery. An 85-year-old man who presented with high-cervical myelopathy due to a retro-odontoid pseudotumor underwent occipito-cervical fusion surgery and developed severe dysphagia immediately after the surgery. Swallowing videoendoscopy revealed stagnation of thick fluid at the larynx. Oral intake was prohibited and swallowing rehabilitation was performed. Subsequently, he showed a gradual improvement in swallowing function. He was allowed to start oral intake in the fourth week after surgery and was able to swallow solid foods in the sixth week after surgery. In this case, several parameters of occipito-cervical alignment such as the occipito-C2 angle (O-C2 angle), swallowing line (S-line), C2-C7 angle, and pharyngeal inlet angle, which are recognized as predictors of postoperative dysphagia after occipito-cervical fusion surgery, were adequate to prevent postoperative dysphagia. However, the patient had sarcopenia and cervical hyperlordosis to compensate for thoracic hyperkyphosis, which induces the hypertonicity of hyoid muscles. These findings led to a diagnosis of sarcopenic dysphagia after surgical invasion. Sarcopenic dysphagia is considered to be associated with skeletal and swallowing muscle weakness, apart from thinness, malnutrition, and surgical invasion. Elderly patients with sarcopenia may present with sarcopenic dysphagia because of surgical invasion after occipito-cervical fusion surgery. In such cases, it is important not only to control intraoperative occipito-cervical alignment but also to evaluate preoperative swallowing function.
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Affiliation(s)
- Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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Savas S, Yilmaz M. Self Reported Dysphagia is not Associated with Sarcopenia Defined by the Revised EWGSOP2 Criteria and Regional Thresholds at the Hospital Among Ambulatory Older Patients. Mater Sociomed 2020; 31:253-257. [PMID: 32082088 PMCID: PMC7007625 DOI: 10.5455/msm.2019.31.253-257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Dysphagia and sarcopenia are geriatric syndromes, and they are shown to be related. There is no study on dysphagia and sarcopenia with the revised European Working Group on Sarcopenia in Older People (EWGSOP)2 criteria. Aim: We aimed to evaluate dysphagia and sarcopenia with the revised criteria implementing regional thresholds for skeletal muscle mass (SMM) in hospitalized older patients. Methods: Ambulatory patients ≥60 years of age from the Internal Medicine Department of our hospital were taken into the study. Grip strength, SMM via bioelectrical impedance analysis, nutritional status, dysphagia screening with Eating Assessment Tool-10, prior hospitalizations and diet were evaluated. Sarcopenia was defined by EWGSOP2 criteria using regional SMM thresholds adjusted to body mass index (BMI) (SMMI (BMI)). Results: Out of 112, 61 patients were enrolled. Sarcopenia, nutritional risk, and dysphagia were shown in 36.1%, 88.5%, and 14.8% of the patients. The risk of dysphagia was not associated with sarcopenia (p=0.263). Hospitalizations (≥1) in one year with pneumonia, modified diet, malnutrition, and low SMMI (BMI) were more common in patients with dysphagia risk than in the patients without (p=0.001, p<0.01, p=0.011, p=0.008, respectively). The median age and BMI were higher where SMMI (BMI) was lower in the group with dysphagia risk than in the group without (p=0.016, p=0.034, p=0.032), respectively. Conclusion: We found that self-reported dysphagia was not associated with sarcopenia defined by the EWGSOP2 criteria in ambulatory hospitalized patients over 60 years of age. Further studies using revised criteria, different adjustments and thresholds are needed to reveal possible differences.
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Affiliation(s)
- Sumru Savas
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University. Bornova, Izmir, Turkey
| | - Merve Yilmaz
- Department of Internal Medicine, School of Medicine, Ege University. Bornova, Izmir, Turkey
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Håglin L, Edström M, Bäckman L, Forsgren L. Low level of phosphate in male patients reporting swallowing disturbances in early Parkinson's disease. CLINICAL NUTRITION EXPERIMENTAL 2020. [DOI: 10.1016/j.yclnex.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA,
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Hoyano K, Tsujihashi E, Nishio K, Tsuji T. Relationship between the nutritional state of elderly people in need of support or nursing care and jaw-opening force and tongue pressure. J Phys Ther Sci 2019; 31:747-750. [PMID: 31645799 PMCID: PMC6801332 DOI: 10.1589/jpts.31.747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We hypothesized that an association exists between the nutritional state of elderly people and the deterioration in the swallowing function associated with sarcopenia, which is reflected by the strength of the tongue and suprahyoid muscles. Therefore, we conducted a comparative study of the nutritional state and swallowing muscle strength. [Participants and Methods] The participants in this study were 25 elderly people in need of support or nursing care, situated at a geriatric health service facility, who were able to understand instructions and ate three meals per day orally. We evaluated the strength of the tongue muscles using a tongue pressure measurement device and the strength of the suprahyoid muscles by measuring the jaw-opening force. The nutritional state was evaluated using the Mini Nutritional Assessment. [Results] There was a significant correlation between the Mini Nutritional Assessment score and the jaw-opening force. Conversely, no correlation was found between the Mini Nutritional Assessment score and the tongue pressure. [Conclusion] The significant correlation between the Mini Nutritional Assessment score and the jaw-opening force suggests that the strength of the suprahyoid muscles, which reflects the swallowing function and jaw-opening force, deteriorates with age and is affected by the nutritional state. This suggests that the nutritional state could be an important indicator for the evaluation of the swallowing function.
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Affiliation(s)
- Kengo Hoyano
- Faculty of Health Science, Department of Rehabilitation, Division of Speech-Language-Hearing Therapy, Fukui Health Science University: 55 Egami-cho 13-1, Fukui 910-3190, Japan
| | - Eiko Tsujihashi
- Faculty of Health Science, Department of Rehabilitation, Division of Speech-Language-Hearing Therapy, Fukui Health Science University: 55 Egami-cho 13-1, Fukui 910-3190, Japan
| | - Keiko Nishio
- Faculty of Health Science, Department of Rehabilitation, Division of Speech-Language-Hearing Therapy, Fukui Health Science University: 55 Egami-cho 13-1, Fukui 910-3190, Japan
| | - Tetsuro Tsuji
- Faculty of Health Science, Department of Rehabilitation, Division of Speech-Language-Hearing Therapy, Fukui Health Science University: 55 Egami-cho 13-1, Fukui 910-3190, Japan
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16
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de Oliveira Branco AA, de Castro Corrêa C, de Souza Neves D, Huehara T, Theresa Weber SA. Swallowing patterns after adenotonsillectomy in children. Pediatr Investig 2019; 3:153-158. [PMID: 32851310 PMCID: PMC7331379 DOI: 10.1002/ped4.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/01/2019] [Indexed: 11/12/2022] Open
Abstract
IMPORTANCE Hypertrophy of the pharyngeal and palatine tonsils can interfere with breathing, physical and cognitive development, and quality of life, including sleep quality. There are important relationships between the muscles of the airways, the anatomy, and the pattern of breathing and swallowing. OBJECTIVE The aims of the present study were to evaluate the swallowing process in children after adenotonsillectomy undertaken to treat obstructive breathing disorders. METHODS Subjects were 85 children or adolescents who underwent adenotonsillectomy in a reference hospital between 2003 and 2007. For the clinical evaluation of swallowing, the protocol of orofacial myofunctional evaluation with scores (OMES) was used, videofluoroscopy of deglutition was performed, and the Dysphagia Outcome and Severity Scale (DOSS) and Classification for Severity of Dysphagia to Videofluoroscopy Scale were applied for analysis. RESULTS Out of the 85 evaluated children, 43 were male (50.59%), the average age at evaluation was 12.11 years, the average age at the time of surgery was 6.73 years, and post-surgery time was 3.00-8.00 years. In the clinical evaluation of swallowing, half the sample (50.59%) recorded the poorest score for lip and tongue behavior. A score of 1 was observed in 67.06% of subjects for other behaviors, and in 15.30% of subjects for efficiency of swallowing. Videofluoroscopic analysis demonstrated that the most frequent swallowing alterations were labial sealing (50.59%), residue in vallecula (51.76%), and use of compensatory maneuvers (61.18%). Analysis of DOSS showed that normal swallowing was attributed to 48.31% of subjects at level 7, 44.95% at level 6, and 6.74% at level 5. For the Classification for Severity of Dysphagia to Videofluoroscopy, 75.28% were classified as having mild dysphagia. INTERPRETATION Alterations in the dynamics of swallowing are common in children who have undergone surgery of the tonsils, even at late follow-up.
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Affiliation(s)
- Anete Antunes de Oliveira Branco
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery DepartmentBotucatu Medical SchoolState University São PauloUNESPBrazil
| | - Camila de Castro Corrêa
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery DepartmentBotucatu Medical SchoolState University São PauloUNESPBrazil
| | - Daniela de Souza Neves
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery DepartmentBotucatu Medical SchoolState University São PauloUNESPBrazil
| | - Tais Huehara
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery DepartmentBotucatu Medical SchoolState University São PauloUNESPBrazil
| | - Silke Anna Theresa Weber
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery DepartmentBotucatu Medical SchoolState University São PauloUNESPBrazil
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Watanabe K, Umegaki H, Huang CH, Arakawa Martins B, Asai A, Kanda S, Nomura H, Kuzuya M. Association between dysphagia risk and unplanned hospitalization in older patients receiving home medical care. Geriatr Gerontol Int 2019; 19:977-981. [PMID: 31415130 DOI: 10.1111/ggi.13753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 01/02/2023]
Abstract
AIM Home medical care for older adults with chronic conditions is becoming an increasing important issue in Japan. We need to support long-term medical care at home and avoid unplanned hospitalizations, which can adversely affect activities of daily living and quality of life. In this study, we investigated whether swallowing function is a risk for unplanned hospitalization in older patients with functional decline who are receiving home medical care. METHODS In the current study, we examined data obtained in the Observational study of Nagoya Elderly with HOme MEdical study (ONEHOME) that investigated the medical health of older adults receiving home medical care services in Nagoya City, Japan. The data analyzed were patients' age, sex, number of medications, Dysphagia Severity Scale, Charlson Comorbidity Index, Barthel Index, Mini Nutritional Assessment - Short Form, Frailty Index and dementia independent scale. The Dysphagia Severity Scale was categorized into the presence or absence of dysphagia risk. The association between dysphagia risk and days until first hospitalization was investigated by Cox regression analysis. RESULTS In total, 86 out of 178 patients had a hospitalization during the study period of 4 years. Cox regression analysis with adjustment for age, sex, Charlson Comorbidity Index, Barthel Index and Mini Nutritional Assessment - Short Form scores showed that a lower Dysphagia Severity Scale score was significantly associated with unexpected hospitalization. CONCLUSIONS Dysphagia risk predicts the first unexpected hospitalization in older individuals receiving home medical care. Patients' swallowing function is an important factor for estimating prognosis. Geriatr Gerontol Int 2019; 19: 977-981.
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Affiliation(s)
- Kazuhisa Watanabe
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chi-Hsien Huang
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Beatriz Arakawa Martins
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Center), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Paradise, South Australia, Australia.,National Health and Medical Research Council Centre of Research, Excellence Frailty and Healthy Aging, University of Adelaide, Paradise, South Australia, Australia
| | | | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital, Nagoya, Japan
| | | | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Tsuji T, Yamamoto K, Yamasaki K, Hayashi F, Momoki C, Yasui Y, Ohfuji S, Fukushima W, Habu D. Lower dietary variety is a relevant factor for malnutrition in older Japanese home-care recipients: a cross-sectional study. BMC Geriatr 2019; 19:197. [PMID: 31349800 PMCID: PMC6659217 DOI: 10.1186/s12877-019-1206-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 07/09/2019] [Indexed: 01/10/2023] Open
Abstract
Background Nutritional status of the older people is affected by various life-style factors. Although dietary habit is one of the life-style factors, it is unknown which of older home-care recipients’ dietary habits are associated with malnutrition. The purpose of this study was to examine the association of dietary variety, as an evaluation index for dietary habits, with malnutrition in Japanese older home-care recipients. Methods This cross-sectional study was conducted in a single city, Hyogo Prefecture, Japan between July and October 2016. Three hundred thirty-three community-dwelling older care recipients (aged 65 years or older who were receiving home-visit nursing care services) were enrolled. Their nutritional status (Mini Nutritional Assessment®-short form: MNA®-SF), dietary variety (Food frequency score [FFS]), socio-demographic characteristics (age, sex, marital status, etc.), health indicators (comorbidity [Charlson Comorbidity Index] and dysphagia status [Dysphagia Severity Scale]) were assessed. The participants were classified into two groups: malnourished (0–7 points) and non-malnourished (8–14 points), according to their MNA®-SF scores. Multivariate logistic regression analysis was used to examine the factors associated with malnutrition. Results A total of 317 participants were analyzed (118 men, 199 women, median age: 84 years). Compared to the fourth (highest) quartile of FFS, odds ratios (OR) (95% confidence intervals [CI]) of the third, second, and first (lowest) quartiles of FFS were 1.08 (0.42–2.80), 1.29 (0.56–2.98), and 2.30 (1.02–5.19), respectively (p for trend = 0.049). Higher Charlson Comorbidity Index score and the presence of dysphagia were also significantly associated with malnutrition (OR: 2.08, 95% CI: 1.08–4.00 and OR: 3.86, 95% CI: 2.08–7.17, respectively). Conclusion Lower dietary variety was significantly associated with malnutrition in Japanese older home-care recipients.
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Affiliation(s)
- Taeko Tsuji
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Kaoru Yamamoto
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Hyogo, Japan
| | - Fumikazu Hayashi
- Office of Epidemiology, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Chika Momoki
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, Nara, Japan
| | - Yoko Yasui
- Department of Clinical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daiki Habu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan.
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Wada M, Hanamoto A, Kawashima A. Elderly patients with lower-jaw mobility require careful food texture modification: A cohort study. J Gen Fam Med 2019; 20:93-100. [PMID: 31065473 PMCID: PMC6498125 DOI: 10.1002/jgf2.240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the relationship between lower-jaw mobility and oral ingestible food texture choices in elderly patients. This study aimed to evaluate whether lower-jaw mobility affects levels of food texture modification. METHODS This prospective cohort study targeted inpatients aged ≥65 years with pneumonia or urinary tract infection from August 2014 through July 2015. We defined "lower-jaw mobility" as movement of the lower jaw (more than about 1 cm) when gently supported from both sides of the mandibular angle with index fingers. The primary outcome was food texture at discharge, which was evaluated using "Japanese Dysphagia Diet 2013": non per os, codes 0-4 (in the order of increasing swallowing difficulty), and normal meal. RESULTS We evaluated 38 patients in the mobility group (mean age: 86.5 years) and 251 patients in the nonmobility group (mean age: 83.2 years). Percentages of patients capable of ingesting each food texture were as follows (mobility vs nonmobility): normal meal, 5.3% vs 50.1%; code 4, 39.5% vs 31.9%; code 3, 5.3% vs 8.8%; code 2, 10.5% vs 4.4%; code 1, 2.6% vs 0.8%; code 0, 0.0% vs 0.4%; and non per os, 36.8% vs 2.8%. Food texture codes were lower in the mobility group (P < 0.001). These relationships remained significant even after adjusting for potential confounding factors in multivariate analysis (P < 0.001). CONCLUSION Elderly patients with lower-jaw mobility were restricted to texture-modified foods. Lower-jaw mobility can be assessed easily even by nonmedical personnel, and regular assessment could help identify elderly patients requiring dietary adjustment.
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Affiliation(s)
- Mikio Wada
- Fukuchiyama City Hospital Ooe BranchFukuchiyamaKyotoJapan
| | - Akiko Hanamoto
- Department of General Internal MedicineFukuchiyama City HospitalFukuchiyamaKyotoJapan
| | - Atsushi Kawashima
- Department of General Internal MedicineFukuchiyama City HospitalFukuchiyamaKyotoJapan
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Hara K, Tohara H, Minakuchi S. Treatment and evaluation of dysphagia rehabilitation especially on suprahyoid muscles as jaw-opening muscles. JAPANESE DENTAL SCIENCE REVIEW 2018; 54:151-159. [PMID: 30302133 PMCID: PMC6175969 DOI: 10.1016/j.jdsr.2018.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
In our aging society, the number of patients with dysphagia, which is associated with disease and aging, is rapidly increasing. The swallowing reflex is a complex process that involves coordinated contractions of swallowing muscles. Many researchers have reported that age-related changes, such as frailty and sarcopenia, affect swallowing muscles and contribute to the decline in the swallowing function. Thus, simple, non-invasive evaluation methods and exercises for swallowing muscles in elderly patients with dysphagia are important. Anterior–superior hyolaryngeal elevation during swallowing results from contractions of the suprahyoid muscle, which plays a primary role in opening the upper esophageal sphincter, along with relaxation of the cricopharyngeal muscle and laryngeal closure. Thus, many researchers have studied methods for evaluating and augmenting suprahyoid muscles. On the other hand, some researchers have reported on dysphagia rehabilitation focused on jaw-opening actions, because hyolaryngeal elevation muscles correspond with jaw-opening muscles. In this study, we describe a new dysphagia evaluation method and an exercise that focuses on suprahyoid muscles with application of jaw-opening actions.
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Affiliation(s)
- M Payne
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Sun J, Li Z. Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function. Clinics (Sao Paulo) 2018; 73:e182. [PMID: 29924183 PMCID: PMC5996437 DOI: 10.6061/clinics/2018/e182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/15/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia. METHODS Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission. RESULTS After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration. CONCLUSIONS During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.
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Affiliation(s)
- Jie Sun
- Department of Clinical Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China, 221009
| | - Zeheng Li
- Department of Clinical Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China, 221009
- *Corresponding author. E-mail:
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Atrophy of Swallowing Muscles Is Associated With Severity of Dysphagia and Age in Patients With Acute Stroke. J Am Med Dir Assoc 2017; 18:635.e1-635.e7. [PMID: 28363443 DOI: 10.1016/j.jamda.2017.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/21/2022]
Abstract
IMPORTANCE Sarcopenia has been identified as an independent risk factor for dysphagia. Dysphagia is one of the most important and prognostically relevant complications of acute stroke. The role of muscle atrophy as a contributing factor for the occurrence of poststroke dysphagia is yet unclear. OBJECTIVE To assess whether there is a correlation between age and muscle volume and whether muscle volume is related to dysphagia in acute stroke patients. DESIGN, SETTING, AND PARTICIPANTS This retrospective, single-center study included 73 patients with acute ischemic or hemorrhagic stroke who underwent computed tomography angiography on admission and an objective dysphagia assessment by Fiberoptic Endoscopic Evaluation of Swallowing within 72 hours from admission. With the help of semiautomated muscle segmentation and 3-dimensional reconstruction volumetry of the digastric, temporal, and geniohyoid muscles was performed. For further analysis, participants were first divided into 4 groups according to their age (<61 years, n = 12; 61-75 years, n = 16; 76-85 years, n = 28; ≥86 years, n = 17), secondly into 3 different groups according to their dysphagia severity using the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) (FEDSS 1 and 2, n = 25; FEDSS 3 and 4, n = 32; FEDSS 5 and 6, n = 16). MAIN OUTCOME AND MEASURE Correlation of muscle volumes with age and dysphagia severity. RESULTS Muscle volumes of single muscles (except for geniohyoid and the right digastric muscles) as well as the sum muscle volume were significantly and inversely related to dysphagia severity. We found a significant decline of muscle volume with advancing age for most muscle groups and, in particular, for the total muscle volume. CONCLUSIONS Apart from features being determined by the acute stroke itself (eg, site and size of stroke), also premorbid conditions, in particular age-related muscle atrophy, have an impact on the complex pathophysiology of swallowing disorders poststroke.
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Suzuki M, Maeda K, Shamoto H, Wakabayashi H. Effects of aging and sarcopenia on strength of swallowing muscles in older adults. Geriatr Gerontol Int 2017; 17:360-361. [DOI: 10.1111/ggi.12802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Mizue Suzuki
- Yokohama Brain and Spine Center; Yokohama City Kanagawa Japan
| | - Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation; Tamana Regional Health Medical Center; Tamana City Kumamoto Japan
| | - Hiroshi Shamoto
- Department of Neurosurgery; Minamisoma Municipal General Hospital; Minamisoma City Fukushima Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama City Kanagawa Japan
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Yoshimura Y, Wakabayashi H, Maeda K, Nishioka S. Relationship between sarcopenia and household status in community-dwelling older women. Geriatr Gerontol Int 2017; 17:179-180. [PMID: 28112494 DOI: 10.1111/ggi.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan
| | - Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Tamana City, Kumamoto, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital 4-11, Nagasaki City, Nagasaki Prefecture, Japan
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Ikenaga Y, Nakayama S, Taniguchi H, Ohori I, Komatsu N, Nishimura H, Katsuki Y. Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward. J Stroke Cerebrovasc Dis 2017; 26:1013-1019. [PMID: 28108097 DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. METHOD Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. RESULTS Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. CONCLUSIONS Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan.
| | - Sayaka Nakayama
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Hiroki Taniguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Isao Ohori
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Nahoko Komatsu
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Hitoshi Nishimura
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Yasuo Katsuki
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
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Enoki H, Sugiyama M, Izawa S, Hirose T, Hasegawa J, Iguchi A, Kuzuya M. [Factors associated with malnutrition in community-dwelling disabled elderly--the KANAGAWA-AICHI Disabled Elderly Cohort (KAIDEC) Study]. Nihon Ronen Igakkai Zasshi 2016; 51:547-53. [PMID: 25749326 DOI: 10.3143/geriatrics.51.547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM This study aimed to identify factors associated with malnutrition in community-dwelling disabled elderly. METHODS A cross-sectional study of baseline data for 1,142 community-dwelling elderly (81.2±8.7 years) from of the KANAGAWA-AICHI Disabled Elderly Cohort (KAIDEC) study was conducted. The data included the participants' demographic characteristics, nutritional status (Mini Nutritional Assessment short-form: MNA-SF), dysphagia status (Dysphagia Severity scale: DSS), comorbidity, basic activities of daily living (bADL), hospitalization with in the past three months and care level according to the Long-Term Care Insurance program. The participants were considered to be in malnutrition or at risk of malnutrition if their MNA-SF score was 0-7 or 8-11, respectively. The chi square test, analysis of variance, Jonckheere-Terpstra trend test and logistic regression analysis were used for the statistical analysis. RESULTS A total of 16.7% of the participants were classified as having malnutrition. In addition, a higher prevalence of malnutrition was associated with a higher care level in the long-term care insurance program, and malnutrition was associated with a lower bADL score, the presence of dysphagia and dementia and hospitalization with in the past three months. CONCLUSIONS The present study demonstrated that malnutrition in community-dwelling disabled elderly is associated with a lower bADL score, the presence of dysphagia and dementia and hospitalization with in the past three months.
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Affiliation(s)
- Hiromi Enoki
- Department of Health and Medical Science, Aichi Shukutoku University
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Rehabilitation Nutrition for Possible Sarcopenic Dysphagia After Lung Cancer Surgery. Am J Phys Med Rehabil 2016; 95:e84-9. [DOI: 10.1097/phm.0000000000000458] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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NAKAMICHI M, WAKABAYASHI H. Effect of Long-Term Proton Pump Inhibitor Therapy on Nutritional Status in Elderly Hospitalized Patients. J Nutr Sci Vitaminol (Tokyo) 2016; 62:330-334. [DOI: 10.3177/jnsv.62.330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wakabayashi H, Matsushima M, Uwano R, Watanabe N, Oritsu H, Shimizu Y. Skeletal muscle mass is associated with severe dysphagia in cancer patients. J Cachexia Sarcopenia Muscle 2015; 6:351-7. [PMID: 26673551 PMCID: PMC4670744 DOI: 10.1002/jcsm.12052] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the association between skeletal muscle mass, activities of daily living (ADLs) and severe dysphagia in cancer patients. METHODS A nested case-control study was performed in 111 consecutive cancer patients with dysphagia who were prescribed speech therapy. Skeletal muscle mass comprising the cross-sectional area of the left and right psoas muscles was assessed via abdominal computed tomography at the third lumbar vertebral level. ADLs were evaluated by the Barthel Index. The severity of dysphagia was assessed by the Food Intake Level Scale and was characterized by non-oral feeding or oral food intake at discharge. Univariate and logistic regression analyses were applied to examine the associations between dysphagia, skeletal muscle index (SMI) and ADLs. RESULTS There were 86 men and 25 women (mean age, 70 years). The mean SMI was 5.68 ± 1.74 cm(2)/m(2) in men and 4.43 ± 1.21 cm(2)/m(2) in women. The median Barthel Index score was 20. Thirty-three patients were on non-oral feeding at discharge. The mean SMI did not differ significantly between non-oral feeding and oral food intake groups in t-test. The median Barthel Index score was lower in the non-oral feeding group in Mann-Whitney U test. Logistic regression analysis of the severity of dysphagia adjusted for age, sex, SMI, Barthel Index score, serum albumin, cancer type and stage, and vocal cord paralysis showed that SMI was associated independently with oral food intake at discharge. Barthel Index score showed a tendency to be associated with oral food intake. CONCLUSIONS Skeletal muscle mass is associated with severe dysphagia in cancer patients. ADLs show a tendency to be associated with severe dysphagia in cancer patients.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan ; Division of Clinical Epidemiology, Jikei University School of Medicine 3-25-8 Nishi-shinbashi, Minato ward, Tokyo, 105-0003, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Jikei University School of Medicine 3-25-8 Nishi-shinbashi, Minato ward, Tokyo, 105-0003, Japan
| | - Rimiko Uwano
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
| | - Naoko Watanabe
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
| | - Hideyuki Oritsu
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
| | - Yoshitaka Shimizu
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
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Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014; 5:269-77. [PMID: 25223471 PMCID: PMC4248414 DOI: 10.1007/s13539-014-0162-x] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022] Open
Abstract
Malnutrition and sarcopenia often occur in rehabilitation settings. The prevalence of malnutrition and sarcopenia in older patients undergoing rehabilitation is 49-67 % and 40-46.5 %, respectively. Malnutrition and sarcopenia are associated with poorer rehabilitation outcome and physical function. Therefore, a combination of both rehabilitation and nutrition care management may improve outcome in disabled elderly with malnutrition and sarcopenia. The concept of rehabilitation nutrition as a combination of both rehabilitation and nutrition care management and the International Classification of Functioning, Disability and Health guidelines are used to evaluate nutrition status and to maximize functionality in the elderly and other people with disability. Assessment of the multifactorial causes of primary and secondary sarcopenia is important because rehabilitation nutrition for sarcopenia differs depending on its etiology. Treatment of age-related sarcopenia should include resistance training and dietary supplements of amino acids. Therapy for activity-related sarcopenia includes reduced bed rest time and early mobilization and physical activity. Treatment for disease-related sarcopenia requires therapies for advanced organ failure, inflammatory disease, malignancy, or endocrine disease, while therapy for nutrition-related sarcopenia involves appropriate nutrition management to increase muscle mass. Because primary and secondary sarcopenia often coexist in people with disability, the concept of rehabilitation nutrition is useful for their treatment. Stroke, hip fracture, and hospital-associated deconditioning are major causes of disability, and inpatients of rehabilitation facilities often have malnutrition and sarcopenia. We review the concept of rehabilitation nutrition, the rehabilitation nutrition options for stroke, hip fracture, hospital-associated deconditioning, sarcopenic dysphagia, and then evaluate the amount of research interest in rehabilitation nutrition.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama city, Japan, 232-0024,
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