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Hu X, Ma YN, Karako K, Tang W, Song P, Xia Y. Comprehensive assessment and treatment strategies for dysphagia in the elderly population: Current status and prospects. Biosci Trends 2024; 18:116-126. [PMID: 38658363 DOI: 10.5582/bst.2024.01100] [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: 04/26/2024]
Abstract
As the population ages, the prevalence of dysphagia among older adults is a growing concern. Age-related declines in physiological function, coupled with neurological disorders and structural changes in the pharynx associated with aging, can result in weakened tongue propulsion, a prolonged reaction time of the submental muscles, delayed closure of the laryngeal vestibule, and delayed opening of the upper esophageal sphincter (UES), increasing the risk of dysphagia. Dysphagia impacts the physical health of the elderly, leading to serious complications such as dehydration, aspiration pneumonia, malnutrition, and even life-threatening conditions, and it also detrimentally affects their psychological and social well-being. There is a significant correlation between frailty, sarcopenia, and dysphagia in the elderly population. Therefore, older adults should be screened for dysphagia to identify both frailty and sarcopenia. A reasonable diagnostic approach for dysphagia involves screening, clinical assessment, and instrumental diagnosis. In terms of treatment, multidisciplinary collaboration, rehabilitation training, and the utilization of new technologies are essential. Future research will continue to concentrate on these areas to enhance the diagnosis and treatment of dysphagia, with the ultimate aim of enhancing the quality of life of the elderly population.
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Affiliation(s)
- Xiqi Hu
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Ya-Nan Ma
- Department of Gastroenterology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Kenji Karako
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wei Tang
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Peipei Song
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Ying Xia
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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Xue W, He X, Su J, Li S, Zhang H. Association between dysphagia and activities of daily living in older adults: a systematic review and meta-analysis. Eur Geriatr Med 2024:10.1007/s41999-024-00999-8. [PMID: 38842653 DOI: 10.1007/s41999-024-00999-8] [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: 01/21/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Numerous epidemiological studies have suggested a possible association between dysphagia and the risk of decline in Activities of daily living (ADL) among older adults. This systematic review and meta-analysis aimed to elucidate the relationship between dysphagia and ADL in older adults. METHODS PubMed, Web of Science, Cochrane Library, Embase, Ebsco, MEDLINE, Wiley, CINAHL, and Ovid databases were comprehensively examined for relevant studies published up to October 31, 2022. Quantitative studies published in English were included to explore the relationship between dysphagia and ADL in people aged 65 years and older. The NIH Quality Assessment Tool was used to assess the study quality. R software was used to draw forest plots and I2 was employed to indicate study heterogeneity. Sensitivity analysis was performed using the one-by-one exclusion method. Publication bias was measured using funnel plots and Egger's test. RESULTS A total of 3,498 studies were retrieved from the database, 22 of which were eventually included in the systematic evaluation, and 14 of which were subjected to meta-analysis. Data from nine studies were categorical variables, and meta-analysis results showed that swallowing disorders in older adults were associated with a lower ability to perform ADL (OR = 3.39, 95% CI: 2.55-4.50, p < 0.001), with moderate heterogeneity (I2 = 62%, p = 0.006). Data from seven studies were continuous variables, resulting in a negative association between the prevalence of dysphagia and ADLs in older adults (SMD = -0.80, 95% CI: -1.08 to -0.51, p < 0.001), with high heterogeneity (I2 = 94%, p < 0.001). Sensitivity analysis showed robust results, funnel plots and Egger's test indicated no publication bias. CONCLUSION Dysphagia is significantly associated with the capacity to perform ADL. Prevention and screening of dysphagia in older patients dependent on others for daily care are needed. Further long-term studies are needed in the future to prove causality.
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Affiliation(s)
- Wenfeng Xue
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Xiaona He
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Jie Su
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Sihan Li
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Huafang Zhang
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China.
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Suzuki M, Nagano A, Ueshima J, Saino Y, Kawase F, Kobayashi H, Murotani K, Inoue T, Nagami S, Maeda K. Prevalence of dysphagia in patients after orthopedic surgery. Arch Gerontol Geriatr 2024; 119:105312. [PMID: 38101112 DOI: 10.1016/j.archger.2023.105312] [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: 09/12/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Oropharyngeal dysphagia is one of the most prevalent health complications in older adults. The prevalence of postoperative dysphagia is expected to rise with the increasing number of older patients undergoing orthopedic surgery; however, the specific prevalence and contributing factors remain unclear. This scoping review aimed to identify the prevalence and factors related to postoperative dysphagia in older orthopedic patients. METHODS This review included studies published up to September 2022 on postoperative patients aged ≥ 60 years who underwent orthopedic surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web. RESULTS In total, 21 of the 2158 identified studies were reviewed. The studies were classified into the three categories according to the surgical site: cervical spine disease (n = 12), hip fracture (n = 7), and others (n = 2). The estimated dysphagia prevalence rates [95 % confidence interval] of cervical spine disease, hip fractures, and others were 16 % [8-27], 32 % [15-54], and 6 % [4-8], respectively. Factors related to postoperative dysphagia included cervical alignment in cervical spine disease, being older within the cohort, preoperative health status, malnutrition, and sarcopenia in hip fractures. CONCLUSIONS The prevalence of postoperative dysphagia after orthopedic surgery was highest for hip fractures, followed by cervical spine and others. These results suggest non-neurogenic dysphagia in older patients undergoing orthopedic surgery and indicate that sarcopenia may contribute to postoperative dysphagia in this population. Therefore, further research should clarify the trajectory of postoperative dysphagia and the effectiveness of rehabilitation for postoperative dysphagia after orthopedic surgery.
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Affiliation(s)
- Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied Health Sciences, Yamato university, Osaka, Japan
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, Japan
| | - Junko Ueshima
- Department of Nutritional Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoko Saino
- Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan
| | - Haruko Kobayashi
- General Incorporated Association Manabi Public Library, Aichi, Japan
| | | | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Shinsuke Nagami
- Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
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Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [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: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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Ogawa N, Ohno T, Kunieda K, Watanabe M, Fujishima I. A Novel Exercise to Improve Suprahyoid Muscle Area and Intensity as Evaluated by Ultrasonography. Dysphagia 2024:10.1007/s00455-024-10667-5. [PMID: 38324169 DOI: 10.1007/s00455-024-10667-5] [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: 08/14/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Insufficient suprahyoid muscle strength with poor opening of the upper esophageal sphincter can cause dysphagia. This study investigated whether an exercise of the suprahyoid muscle, named forehead exercise for suprahyoid muscles (FESM, "Enge-Odeko-Taiso" in Japanese), improves the geniohyoid muscle area and intensity using ultrasonography. Sixty-four participants (15 men and 49 women, 82.8 ± 6.0 years) living independently with no symptoms of swallowing difficulties were enrolled. The participants were divided into the FESM and the control group. The FESM is an isometric exercise involving repetitions of looking into the navel as if the chin is pulled back with little neck motion using a hand pushed against the forehead for resistance. This exercise is performed five times in 10 courses a day (total 50 times) for 8 weeks. Participants in the control group did not conduct any exercises. Body mass index, hand grip strength, gait speed, calf circumference, Mini Nutritional Assessment short-form, eating assessment tool, repetitive saliva swallowing test (RSST), and Food Intake LEVEL Scale scores were examined. The ultrasonographic geniohyoid muscle area, intensity, and RSST were investigated before and after the program. In the FESM group, the geniohyoid muscle area increased from 2.24 to 2.52 cm2 (P < 0.05), intensity decreased from 34.6 to 32.0 (P < 0.05), and the median RSST increased from 5 to 6 (P < 0.05) significantly. Conversely, no significant differences were observed in the control group. The FESM was effective to increase the area and decrease the intensity of the geniohyoid muscle and may improve swallowing function.
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Affiliation(s)
- Nami Ogawa
- Department of Dentistry, Sakaue Dental Office, 3F-3-14-8, Tamagawa, Setagaya-Ku, Tokyo, 158-0094, Japan.
| | - Tomohisa Ohno
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu-City, Gifu, 501-1194, Japan
| | - Masato Watanabe
- Department of Internal Medicine and Respiratory Medicine, Ohisamagenki Clinic, 2F-5-2-5, Futako, Takatsu-Ku, Kawasaki-Shi, Kanagawa, 213-0002, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
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Mao L, Wang J, Li Y, Zheng J, Fan D, Wei S, Wu X, Yang X, Wang D. Risk factors for dysphagia in patients with acute and chronic ischemic stroke: A retrospective cohort study. Heliyon 2024; 10:e24582. [PMID: 38304775 PMCID: PMC10830548 DOI: 10.1016/j.heliyon.2024.e24582] [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: 06/05/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
Background Dysphagia is a common and clinically significant complication of ischemic stroke. The prevalence and risk factors for dysphagia may vary at different stages following an ischemic stroke. Methods This study included patients with acute and chronic ischemic stroke who were treated at the Department of Rehabilitation, First Affiliated Hospital, Zhejiang University School of Medicine from 2019 to 2022. Various demographic, clinical, and laboratory parameters were collected, and statistical analyses were performed to investigate their association with dysphagia. Results Among the 399 ischemic stroke patients included in the study, 165 (41.4 %) experienced dysphagia, with 72 (38.7 %) in the acute phase and 93 (43.7 %) in the chronic phase. Univariate analysis revealed significant associations (p < 0.05) between dysphagia and factors such as pulmonary infection, aphasia, NIHSS score, ADL score, NLR score, lower extremity Brunnstrom's stages, and sit-to-stand balance. Multiple logistic regression analysis, after adjusting for confounding factors, identified the ADL score as an independent predictor of dysphagia. These findings were consistent across three time-windows: the acute phase, the chronic phase, and 180 days after stroke onset. Additionally, the lymphocyte count and pulmonary infection were identified as potential independent indicators. Conclusions This study investigated the prevalence and risk factors for dysphagia in ischemic stroke patients at different time-windows. A low ADL score (<40) may serve as a valuable and reliable predictor for poststroke dysphagia in clinical settings.
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Affiliation(s)
- Lin Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juehan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yubo Li
- Information and Electronic Engineering College, Zhejiang University School, Hangzhou, China
| | - JinJin Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Denghuang Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohong Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Yang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Daming Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sato R, Sawaya Y, Ishizaka M, Shiba T, Hirose T, Yin L, Urano T. Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care. Geriatr Gerontol Int 2023; 23:906-911. [PMID: 37861100 DOI: 10.1111/ggi.14704] [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: 07/22/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
AIM Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care. METHODS The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs. RESULTS Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001). CONCLUSIONS Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumference is suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.
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Affiliation(s)
- Ryo Sato
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Yohei Sawaya
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Takahiro Shiba
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Tamaki Hirose
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Lu Yin
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Tomohiko Urano
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Nagano A, Onaka M, Maeda K, Ueshima J, Shimizu A, Ishida Y, Nagami S, Miyahara S, Nishihara K, Yasuda A, Satake S, Mori N. Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults. Nutrients 2023; 15:4371. [PMID: 37892446 PMCID: PMC10609669 DOI: 10.3390/nu15204371] [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: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1, Imazuyamanaka-cho, Nishinomiya 663-8211, Japan;
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
| | - Masami Onaka
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Nutrition Therapy Support Center, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano 380-8525, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Nutrition, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki 701-0193, Japan;
| | - Shuzo Miyahara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keiji Nishihara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Akiyuki Yasuda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Shosuke Satake
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
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Namasivayam-MacDonald A, Lam B, Ma J, Affoo R. Prevalence, Incidence, and Predictors of Self-reported Swallowing Difficulties in Community-Dwelling Adults: A Population-Based Study from the Canadian Longitudinal Study on Aging (CLSA). Dysphagia 2023; 38:1406-1420. [PMID: 37031453 DOI: 10.1007/s00455-023-10570-5] [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: 09/20/2022] [Accepted: 03/28/2023] [Indexed: 04/10/2023]
Abstract
There is a paucity of evidence from population-based studies identifying prevalence and incidence of dysphagia, as well as health and sociodemographic risk factors that may contribute to its development. As such, the current study aimed to determine prevalence, incidence, and associated predictors of dysphagia in adults. The Canadian Longitudinal Study on Aging is a nationally representative population study that follows 51,338 Canadians over 45 years of age. Biological, medical, psychological, social, lifestyle and economic data are collected. A secondary analysis of the data was conducted to determine prevalence, incidence, and the predictors of self-reported swallowing difficulty in adults between 45 and 85 years of age. Rates of swallowing difficulty by demographic risk factor, as well as lifestyle and health factors were analyzed using descriptive statistics. Associations between lifestyle and health variables with dysphagia were tested using Chi-square tests or t tests, as appropriate. Logistic regression was used to determine the predictors of self-reported swallowing difficulties. Overall prevalence of self-reported swallowing difficulties in adults over the age of 45 was 10.6% and increased to 13.7% after 3 years. Significant differences (p < 0.001) in self-reported swallowing difficulty at baseline were apparent across smoking status, requiring help to prepare meals, life satisfaction, social participation, all disease categories except dementia, number of medications, cognition, oral health status, and frailty. Incidence of dysphagia was 8.6%. Regression analyses suggested the following independent predictors of reports of swallowing difficulty: older age; non-white ethnicity; female sex; poor oral health; malnutrition; and frailty. These predictors should be carefully considered to ensure we are screening at-risk populations. Social determinants of health, such as ethnicity, must also be considered to ensure equitable care across the population.
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Affiliation(s)
- Ashwini Namasivayam-MacDonald
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada.
| | - Bonnie Lam
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Canada
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Ogawa M, Satomi-Kobayashi S, Hamaguchi M, Komaki K, Izawa KP, Miyahara S, Inoue T, Sakai Y, Hirata KI, Okada K. Postoperative dysphagia as a predictor of functional decline and prognosis after undergoing cardiovascular surgery. Eur J Cardiovasc Nurs 2023; 22:602-609. [PMID: 36099478 DOI: 10.1093/eurjcn/zvac084] [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: 05/18/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/14/2022]
Abstract
AIMS Post-extubation dysphagia (PED), an often overlooked problem, is a common and serious complication associated with mortality and major morbidity after cardiovascular surgery. Dysphagia is considered an age-related disease, and evaluating its long-term effects is a pressing issue with rapidly progressing ageing worldwide. Therefore, we examined the effect of PED on functional status and long-term cardiovascular events in patients undergoing cardiovascular surgery. METHODS AND RESULTS This single-centre, retrospective cohort study included 712 patients who underwent elective cardiovascular surgery and met the inclusion criteria. Patients were divided into PED and non-PED groups based on their post-operative swallowing status. The swallowing status was assessed using the Food Intake Level Scale. Functional status was evaluated as hospital-associated disability (HAD), defined as a decrease in activities of daily living after hospital discharge compared with preoperative values. The patients were subsequently followed up to detect major adverse cardiac and cerebrovascular events (MACCEs). Post-extubation dysphagia was present in 23% of the 712 patients and was independently associated with HAD (adjusted odds ratio, 2.70). Over a 3.5-year median follow-up period, MACCE occurred in 14.1% of patients. Multivariate Cox proportional hazard analysis revealed HAD to be independently associated with an increased risk of MACCE (adjusted hazard ratio, 1.85), although PED was not significantly associated with MACCE. CONCLUSION Post-extubation dysphagia was an independent HAD predictor, with the odds of HAD occurrence being increased by 2.7-fold due to PED. Hospital-associated disability accompanied by PED is a powerful predictor of poor prognosis. Perioperative evaluation and management of the swallowing status, and appropriate therapeutic interventions, are warranted.
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Affiliation(s)
- Masato Ogawa
- Division of Rehabilitation Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan
| | - Seimi Satomi-Kobayashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Mari Hamaguchi
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Kodai Komaki
- Division of Rehabilitation Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan
| | - Shunsuke Miyahara
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Takeshi Inoue
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
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11
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Wan SN, Thiam CN, Ang QX, Engkasan J, Ong T. Incident sarcopenia in hospitalized older people: A systematic review. PLoS One 2023; 18:e0289379. [PMID: 37531398 PMCID: PMC10395895 DOI: 10.1371/journal.pone.0289379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
Hospitalization has been associated with the development of sarcopenia. This study aimed to examine the new incidences of hospital sarcopenia, associated risk factors and health outcomes, as defined by internationally recognized diagnostic criteria in hospitalized older people. Pre-defined search terms were run through five databases. Six studies that assessed sarcopenia on two separate time points during hospitalization on older inpatients were included. Prevalence of sarcopenia varied from 14.1% to 55% depending on diagnostic criteria and cut-off points used. New sarcopenia occurred between 12% to 38.7% patients following hospitalization. Risk factors were older age, longer duration of bed rest, lower baseline body mass index, cognitive impairment and activities of daily living disability. None of the studies reported health outcomes associated with newly developed sarcopenia in hospital.
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Affiliation(s)
- Safiyyah Nurnajah Wan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Chiann Ni Thiam
- Department of Medicine, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Qi Xuan Ang
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Julia Engkasan
- Department of Rehabilitation Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
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12
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Hägglund P, Karlsson P, Karlsson F. The Timed Water Swallow Test (TWST): Normative data on swallowing capacity for healthy people aged 60 years and older. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:479-485. [PMID: 35819269 DOI: 10.1080/17549507.2022.2096925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To provide normative data on swallowing capacity (mL/s) in people older than 60 years using the Timed Water Swallow Test (TWST), stratified by sex. Intra- and inter-rater reliability for swallowing time in TWST was further investigated. METHOD A total of 165 participants, aged 60 years and above, were included in the study. The time taken to consume 150 mL of tap water and the swallowing capacity (mL/s) was observed in a clinical context using the TWST. Video recordings of the performances were collected for 118 of the 165 participants for inter-rater reliability testing, of which a random set of 25 performances were assessed for intra-rater reliability. Analysis of the agreement between TWST rated by an in-person clinician and rated from a video recording was further evaluated. RESULT There were significant age and sex effects observed for swallowing capacity. The average reduction in swallowing capacity in the investigated age range (60-92 years) was 8.8 and 7.3 mL/s, for women and men respectively. The results showed high inter-and intra-rater reliability and agreement between the clinical assessment and the video recording. CONCLUSION The presented measurements indicate a clear effect of age on swallowing capacity and that women may be expected to have lower capacity scores than men when tested using TWST. The provided norms can be used as reference points in the clinical identification of people at risk of dysphagia in the older population.
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Affiliation(s)
- Patricia Hägglund
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden
| | - Pernilla Karlsson
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden
| | - Fredrik Karlsson
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden
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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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Calles M, Wirth R, Labeit B, Muhle P, Suntrup-Krueger S, Dziewas R, Lueg G, Trampisch US. Sarcopenic Dysphagia Revisited: A Cross-Sectional Study in Hospitalized Geriatric Patients. Nutrients 2023; 15:2662. [PMID: 37375566 PMCID: PMC10302961 DOI: 10.3390/nu15122662] [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: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia as a causative factor for OD, which is occasionally referred to as "sarcopenic dysphagia" in the absence of a neurogenic etiology. In most of the previous studies on sarcopenic dysphagia, the diagnosis was based only on clinical assessment. In this study, flexible endoscopic evaluation of swallowing (FEES) was used as an objective method to evaluate the presence of OD, its association with sarcopenia, and the presence of pure sarcopenic dysphagia. In this retrospective cross-sectional study, 109 acute care geriatric hospital patients with suspected OD received FEES examination and bioimpedance analysis (BIA) in clinical routine. 95% of patients had at least one neurological disease, 70% fulfilled the criteria for sarcopenia, and 45% displayed moderate or severe OD. Although the prevalence of sarcopenia and OD was high, there was no significant association between OD and sarcopenia. Considering these results, both the association between sarcopenia and OD and pure sarcopenic dysphagia appear questionable. Further prospective studies are needed to elucidate if sarcopenia is merely an epiphenomenon of severe disease or whether it plays a causative role in the development of OD.
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Affiliation(s)
- Marcel Calles
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Bendix Labeit
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Paul Muhle
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, 49076 Osnabrück, Germany;
| | - Gero Lueg
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Ulrike Sonja Trampisch
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
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15
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Wang L, Qiao J, Sun F, Wei X, Dou Z. Demographic and clinical factors associated with recovery of poststroke dysphagia: A meta-analysis. Brain Behav 2023; 13:e3033. [PMID: 37190927 PMCID: PMC10275539 DOI: 10.1002/brb3.3033] [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: 02/15/2023] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Poststroke dysphagia (PSD) recovery depends on various factors. We aimed to provide evidence concerning predictive variables for the recovery of PSD. METHODS PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP database of Chinese periodicals, Chinese biomedical literature service system (SinoMed), and Cochrane Library databases were systematically searched up to September 21, 2022. According to the inclusion criteria, the literature searched in the database was screened. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed to identify the factors prognostic for PSD. RESULTS Twenty-eight studies were eligible, and pooled analyses were allowed for 12 potential prognostic factors. We identified older age, higher National Institutes of Health Stroke Scale (NIHSS) score, lower activities of daily living (ADL) score, lower body mass index (BMI), severe dysphagia on admission, aspiration, brainstem stroke, severe cognitive impairment, and bilateral hemispheric stroke were negative factors for the recovery of PSD, while early intervention and Modified Rankin Scale (mRS) = 0 before onset were protective factors for the recovery of PSD. There was no significant association between stroke type and prognosis of PSD. CONCLUSION Prognostic factors of PSD summarized in this meta-analysis could be useful for developing reasonable treatment plan to better promote recovery of swallowing function after stroke.
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Affiliation(s)
- Lian Wang
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jia Qiao
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Fang Sun
- Clinical Medical of Acupuncture Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouChina
| | - Xiaomei Wei
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Zulin Dou
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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16
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Jung J, Lee J, Lim JH, Kim YC, Ban TH, Park WY, Kim KM, Kim K, Lee SW, Shin SJ, Han SS, Kim DK, Ko Y, Kim KW, Kim H, Park JY. The effects of muscle mass and quality on mortality of patients with acute kidney injury requiring continuous renal replacement therapy. Sci Rep 2023; 13:7311. [PMID: 37147326 PMCID: PMC10162987 DOI: 10.1038/s41598-023-33716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
This study examined the effects of muscle mass on mortality in patients with acute kidney injury requiring continuous renal replacement therapy. It was conducted in eight medical centers between 2006 and 2021. The data of 2200 patients over the age of 18 years with acute kidney injury who required continuous renal replacement therapy were retrospectively collected. Skeletal muscle areas, categorized into normal and low attenuation muscle areas, were obtained from computed tomography images at the level of the third lumbar vertebra. Cox proportional hazards models were used to investigate the association between mortality within 1, 3, and 30 days and skeletal muscle index. Sixty percent of patients were male, and the 30-day mortality rate was 52%. Increased skeletal muscle areas/body mass index was associated with decreased mortality risk. We also identified a 26% decreased risk of low attenuation muscle area/body mass index on mortality. We established that muscle mass had protective effects on the mortality of patients with acute kidney injury requiring continuous renal replacement therapy. This study showed that muscle mass is a significant determinant of mortality, even if the density is low.
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Affiliation(s)
- Jiyun Jung
- Clinical Trial Center, Dongguk University Ilsan Hospital, Goyang, South Korea
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Jangwook Lee
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Jeong-Hoon Lim
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Tae Hyun Ban
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo Yeong Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Kyeong Min Kim
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, South Korea
| | - Kipyo Kim
- Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-Do, South Korea
| | - Sung Joon Shin
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jae Yoon Park
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.
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17
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Willemsen ACH, Pilz W, Hoeben A, Hoebers FJP, Schols AMWJ, Baijens LWJ. Oropharyngeal dysphagia and cachexia: Intertwined in head and neck cancer. Head Neck 2023; 45:783-797. [PMID: 36583567 DOI: 10.1002/hed.27288] [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: 05/24/2022] [Revised: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study aims to investigate the relationship between cancer cachexia and oropharyngeal dysphagia (OD) in patients with head and neck cancer (HNC) prior to chemoradiotherapy or bioradiotherapy (CRT/BRT). METHODS A prospective cohort study with patients with HNC undergoing CRT/BRT (2018-2021) was conducted. Body composition and skeletal muscle function were evaluated using bioelectrical impedance analysis, handgrip strength, and the short physical performance battery (SPPB). The M. D. Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT)-10 questionnaire, and patient characteristics were collected. A standardized videofluoroscopic swallowing study was offered to patients. RESULTS Sixty-six patients were included. Twenty-six patients scored EAT-10 ≥ 3 and seventeen were cachectic. ACE-27 score >1, cachexia, abnormal SPPB-derived repeated chair-stand test, lower MDADI scores, and higher overall stage grouping showed potential predictive value (p ≤ 0.10) for EAT-10 ≥ 3. Using multivariable regression analysis, only cachexia remained a significant predictor of EAT-10 ≥ 3 (HR 9.000 [95%CI 2.483-32.619], p = 0.001). CONCLUSION Cachexia independently predicted the presence of patient-reported OD.
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Affiliation(s)
- Anna C H Willemsen
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Walmari Pilz
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,School for Mental Health and Neuroscience - MHeNs, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ann Hoeben
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank J P Hoebers
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Laura W J Baijens
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
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18
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Associations of swallowing-related muscle quantity and quality with sarcopenic parameters. Eur Geriatr Med 2023; 14:195-201. [PMID: 36626038 DOI: 10.1007/s41999-023-00747-4] [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: 11/06/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE To examine the associations between swallowing-related muscle characteristics and sarcopenic parameters. METHODS We included 147 community-dwelling older adults (age: 71.6 ± 4.7 years, body mass index: 23.0 ± 2.7 kg/m2 (mean ± standard deviation), men: 50; women: 97) and categorized them into robust (n = 125), low-function (n = 17), and sarcopenia (n = 5) groups based on the diagnostic criteria of the Asia Working Group for Sarcopenia 2019. We evaluated the geniohyoid muscle (GHM) and tongue characteristics (muscle quantity and quality). The cross-sectional area (CSA) indicated the muscle quantity, and echo intensity (EI) values indicated the muscle quality. A multiple regression analysis was performed to clarify the relationship of swallowing-related muscle characteristics and strength with sarcopenic parameters. RESULTS The grip strength (CSA of GHM: β = 1.64, p = 0.03) and skeletal muscle mass index (CSA of tongue: β = 74.81, p = 0.003, EI of tongue: β = 1.92, p = 0.009) were better indicators of swallowing-related muscle characteristics. CONCLUSION These findings may facilitate the early detection of aging-related deterioration in swallowing-related musculature through the diagnostic process of sarcopenia and increase our understanding of muscle physiology.
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19
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Shen ZL, Liu Z, Zang WF, Zhang P, Zou HB, Dong WX, Chen WH, Yan XL, Yu Z. Thoracic sarcopenia predicts clinical outcomes in patients undergoing coronary artery bypass grafting: A 6-year cohort study. Asian J Surg 2023; 46:291-298. [PMID: 35414459 DOI: 10.1016/j.asjsur.2022.03.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The relationship between thoracic sarcopenia and clinical outcomes in patients underwent coronary artery bypass grafting (CABG) is unclear. This study aims to evaluate whether thoracic sarcopenia has a satisfactory prognostic effect on adverse outcomes after CABG. METHODS From December 2015 to May 2021, 338 patients who underwent isolated CABG at our institution were recruited in this study. Skeletal muscle area at T12 level acquired by chest computed tomography (CT) was normalized to assess thoracic sarcopenia. Univariate and multivariate analyses were performed to evaluate the risk factors of postoperative complications and overall survival (OS). RESULTS The prevalence of thoracic sarcopenia in patients underwent CABG was 13.02%. The incidence of total major complication was significantly higher in thoracic sarcopenia group (81.8% vs 61.9%, p = 0.010). Thoracic sarcopenic patients also had longer postoperative hospital stays (p = 0.047), intensive care unit (ICU) stays (p = 0.001), higher costs (p = 0.001) and readmission rates within 30 days of discharge (18.2% vs 4.4%, p = 0.001). Patients without thoracic sarcopenia showed significantly higher OS at the 2-year follow-up period (93.9% vs 72.7%, p<0.001). Multivariate analyses demonstrated that thoracic sarcopenia was significantly and independently associated with postoperative complications and long-term OS after CABG. CONCLUSION Thoracic sarcopenia is an effective clinical predictor of adverse postoperative complications and long-term OS in patients underwent CABG. Thoracic sarcopenia based on chest CT should be included in preoperative risk assessment of CABG.
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Affiliation(s)
- Zi-Le Shen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhang Liu
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wang-Fu Zang
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peng Zhang
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong-Bo Zou
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Gastrointestinal Surgery, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Wen-Xi Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wen-Hao Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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20
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Song X, Chen X, Bai J, Zhang J. Association between pre-stroke sarcopenia risk and stroke-associated infection in older people with acute ischemic stroke. Front Med (Lausanne) 2023; 10:1090829. [PMID: 36910490 PMCID: PMC9995446 DOI: 10.3389/fmed.2023.1090829] [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: 12/05/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Background Stroke-associated infection (SAI) is a common complication after a stroke. The incidence of infection was higher in people with sarcopenia than in the general population. However, the relationship between pre-stroke sarcopenia risk and SAI in older patients has not been confirmed. This study aimed to investigate the association between pre-stroke sarcopenia risk and SAI in older patients with acute ischemic stroke (AIS). Methods This retrospective study was conducted by the Peking University People's Hospital. We evaluated the pre-stroke sarcopenia risk by applying the SARC-F questionnaire. Multivariate logistic regression was applied to explore the association between pre-stroke sarcopenia risk and SAI. Results A total of 1,002 elder patients with AIS (592 men; 72.9 ± 8.6 years) were enrolled in our study. Pre-stroke sarcopenia risk was found in 29.1% of the cohort. The proportion of patients with pre-stroke sarcopenia risk was larger in the SAI group than in the non-SAI group (43.2 vs. 25.3%, p < 0.001). In multivariate logistic analysis, pre-stroke sarcopenia risk was shown to be independently associated with SAI (OR = 1.454, 95% CI: 1.008-2.097, p = 0.045) after adjusting for potential factors. This association remained consistent across the subgroups based on age, sex, body mass index, smoking status, drinking status, diabetes, hypertension, and dyslipidemia. Conclusion Pre-stroke sarcopenia risk was independently associated with SAI in older patients with AIS. Our findings highlight the significance of pre-stroke sarcopenia identification in the prevention and management of SAI in this population.
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Affiliation(s)
- Xiaodong Song
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Xufeng Chen
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Bai
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, China
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21
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The Relationship Between Lingual Strength and Functional Swallowing Outcomes in Parkinson’s Disease. Dysphagia 2022:10.1007/s00455-022-10543-0. [DOI: 10.1007/s00455-022-10543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
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22
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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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23
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Wu XS, Miles A, Braakhuis A. Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial. BMC Geriatr 2022; 22:905. [PMID: 36434542 PMCID: PMC9700874 DOI: 10.1186/s12877-022-03622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets. METHODS This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6-6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance. RESULTS The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment - Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption. CONCLUSIONS As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents' dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents' acceptance. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).
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Affiliation(s)
- Xiaojing Sharon Wu
- grid.9654.e0000 0004 0372 3343Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142 New Zealand
| | - Anna Miles
- grid.9654.e0000 0004 0372 3343Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- grid.9654.e0000 0004 0372 3343Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142 New Zealand
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24
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Huang S, Guo Y, Chen L, Wang Y, Chen X. Clinical muscle mass-related biomarkers that predict mortality in older patients with community-acquired pneumonia. BMC Geriatr 2022; 22:880. [PMCID: PMC9675073 DOI: 10.1186/s12877-022-03626-y] [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: 03/27/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Community-acquired pneumonia (CAP) is associated with elevated morbidity and mortality, and it usually occurs in older adults. Our goal here was to assess the efficacies of muscle mass-related biomarkers, such as, aspartate transaminase/alanine transaminase (AST/ALT) and creatinine/cystatin C*100 (Cr/CysC*100), in predicting 1-, 2-, and 3-year mortalities of older CAP patients. Methods Design: Retrospective cohort study. Setting and Participants: A teaching hospital in western China. Hospitalized CAP patients, aged≥60 years. We separated patients into a high or low muscle mass group, according to the median AST/ALT and Cr/CysC*100, respectively. We acquired data from medical records and local government mortality databases, as well as telephonic interviews. We analyzed the association between low muscle mass (AST/ALT and Cr/CysC*100) and all-cause mortality at 1, 2, and 3 years in older patients with CAP. Results We enrolled 606 patients (58.58% male; median age: 81 years) for analysis. The 1-, 2-, and 3-year mortality in older patients with CAP in the low muscle mass group (AST/ALT) was higher than in the high muscle mass group (AST/ALT) (1-year: 51.16% vs. 36.96%, p < 0.001; 2-year: 54.46% vs. 41.25%, p = 0.001; 3-year: 54.79% vs. 42.9%, p = 0.003). Upon adjustment of potential confounding factors, we revealed, using cox regression analysis, that the low muscle mass group (AST/ALT) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow-ups, compared to the high muscle mass group (AST/ALT) (1-year: hazard ratios (HR) = 1.46, 95% confidence interval (CI): 1.13–1.88; 2-year: HR = 1.39, 95% CI: 1.09–1.77; 3-year: HR = 1.35, 95% CI: 1.06–1.72). The 1-, 2-, and 3-year mortality of older CAP patients in the low muscle mass group (Cr/CysC*100) was also higher than the high muscle mass group (Cr/CysC*100) (1-year: 56.29% vs. 31.91%, p < 0.001; 2-year: 60.26% vs. 35.53%, p < 0.001; 3-year: 61.26% vs. 36.51%, p < 0.001). Compared to the high muscle mass group (Cr/CysC*100), the low muscle mass group (Cr/CysC*100) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow ups (1-year: HR = 1.9, 95% CI: 1.46–2.48; 2-year: HR = 1.85, 95% CI: 1.44–2.39; 3-year: HR = 1.85, 95% CI: 1.44–2.37). Conclusions Low muscle mass (AST/ALT and Cr/CysC*100) were associated with enhanced 1-, 2-, and 3-year mortality risk in older patients with CAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03626-y.
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Affiliation(s)
- Sha Huang
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Yan Guo
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Lanlan Chen
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Yan Wang
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Xiaoyan Chen
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
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25
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Sun L, Ma H, Du G, Fan D, Liu J, Wang X, Zhang W, Liu B, Yin F. Low Skeletal Muscle Area at the T12 Paravertebral Level as a Prognostic Marker for Community-Acquired Pneumonia. Acad Radiol 2022; 29:e205-e210. [PMID: 35094949 DOI: 10.1016/j.acra.2021.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/10/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate whether the dorsal skeletal muscle area at 12th thoracic level (T12SMA) could be used as a predictor of in-hospital mortality and long-term survival among patients with community-acquired pneumonia (CAP). MATERIALS AND METHODS A retrospective study was conducted on 1701 CAP patients who underwent chest computed tomography (CT) examinations at the First Hospital of Qinhuangdao. The primary outcome was in-hospital mortality. The T12SMA was analyzed. Multivariate regression logistic models were constructed to identify the prognostic markers of hospital mortality. Cox regression logistic models were constructed to identify the risk factors of long-term survival. RESULTS The multiple logistic regression analysis showed that T12SMA [odds ratio (OR) = 0.946; p = 0.007], CURB-65 (OR = 1.521; p = 0.008), creatinine (OR = 1.003; p = 0.001), albumin (OR = 0.908; p = 0.001) and intensive care unit (ICU) (OR = 2.715; p = 0.007) were independent risk factors for predicting the in-hospital mortality. The cox regression logistic analysis showed that T12SMA (OR = 0.968; p = 0.000), age (OR= 1.036; p = 0.000), sex (OR= 1.435; p = 0.002), CURB-65 (OR = 1.311; p = 0.000), albumin (OR = 0.952; p = 0.000), creatinine (OR = 1.002; p = 0.000) and ICU (OR = 1.606; p = 0.001) were prognostic markers of long-term survival. CONCLUSION T12SMA, CURB-65, creatinine, albumin and ICU were independent risk factors for in-hospital mortality among patients with CAP. And low T12SMA affected the in-hospital mortality and long-term survival of patients with CAP.
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Affiliation(s)
- Lina Sun
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Huifang Ma
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Guohui Du
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Dongmei Fan
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Junru Liu
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Xing Wang
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Weinan Zhang
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Bowei Liu
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Fuzai Yin
- Department of Internal Medicine (L.S., F.Y.), Hebei Medical University, Zhongshan Road, Shijiazhuang, Hebei, 050010, People's Republic of China; Department of Internal Medicine (H.M.), Chengde Medical College, Chengde, Hebei, People's Republic of China; Department of Endocrinology (G.D., D.F., J.L., X.W., W.Z., B.L.), The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China.
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26
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Huppertz VAL, Pilz W, Pilz Da Cunha G, de Groot LCPGM, van Helvoort A, Schols JMGA, Baijens LWJ. Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase. Front Neurol 2022; 13:939735. [PMID: 36247786 PMCID: PMC9554502 DOI: 10.3389/fneur.2022.939735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Oropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life. Methods A cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI). Results Forty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score≥2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores. Conclusion In this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD.
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Affiliation(s)
- V. A. L. Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - W. Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands
| | - G. Pilz Da Cunha
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - L. C. P. G. M. de Groot
- Division of Human Nutrition and Health, Wageningen University and Research Centre, Wageningen, Netherlands
| | - A. van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - J. M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, Netherlands
| | - L. W. J. Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
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Ueshima J, Shimizu A, Maeda K, Uno C, Shirai Y, Sonoi M, Motokawa K, Egashira F, Kayashita J, Kudo M, Kojo A, Momosaki R. Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People. J Am Med Dir Assoc 2022; 23:1676-1682. [PMID: 35985419 DOI: 10.1016/j.jamda.2022.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
This position paper prepared by the Japanese Working Group on Integrated Nutrition for Dysphagic People (JWIND) aims to summarize the need for nutritional management in adult patients with dysphagia, the issues that nutrition professionals should address, and the promising approaches as well as to propose a vision for the future of nutritional care for adult patients with dysphagia. JWIND is a joint certification system recognized by the Japan Dietetic Association and the Japanese Society of Dysphagia Rehabilitation; its members are mostly experts known as "Certified Specialist of Registered Dietitian for Dysphagia Rehabilitation." Malnutrition and dysphagia are associated with each other. Therefore, malnutrition detection and intervention are essential for patients with dysphagia. However, evidence on the usefulness nutritional assessment and intervention to ensure appropriate nutritional care remains insufficient. Here, we present current knowledge of the relationship between primary diseases causing dysphagia and malnutrition, the indicators used for nutritional assessment, and nutritional interventions such as texture-modified diet (TMD) quality improvement, oral nutritional supplementation, and comprehensive intervention. We also discuss the current status and issues in nutritional care for adult patients with dysphagia. Furthermore, we have proposed measures that nutrition professionals should consider based on 3 perspectives: nutritional assessment, TMD, and nutritional intervention. Individualized and specialized nutritional management by registered dietitians (RDs) through appropriate assessment of the nutritional status of adult patients with dysphagia is needed. To maintain and improve swallowing function and nutritional status, RDs should intervene from the state of risk or early dysphagia onset, providing individualized care per their expertise as part of a multidisciplinary team. However, systematic clinical practice and research regarding the association of nutrition with dysphagia are currently insufficient. Therefore, further clinical practice and evidence building, including the verification of the efficacy on nutritional support through intervention research, are needed.
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Affiliation(s)
- Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan; Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Akio Shimizu
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Nagano, Japan
| | - Keisuke Maeda
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Chiharu Uno
- Institutes of innovation for Future Society, Nagoya University, Nagoya, Aichi, Japan
| | - Yuka Shirai
- Department of Clinical Nutrition Unit, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Mika Sonoi
- Department of Foods and Human Nutrition, Faculty of Human Life Sciences, Notre Dame Seishin University, Okayama, Okayama, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Fumie Egashira
- PEACH Atsugi of Community Nutritional Care Center, Kanagawa, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Mika Kudo
- Department of Health and Nutrition Sciences, Komazawa Women's University, Tokyo, Japan
| | - Akiko Kojo
- Division of Medical Nutrition, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu Mie, Japan
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Oguma J, Ozawa S, Ishiyama K, Daiko H. Clinical significance of sarcopenic dysphagia for patients with esophageal cancer undergoing esophagectomy: A review. Ann Gastroenterol Surg 2022; 6:738-745. [PMID: 36338588 PMCID: PMC9628224 DOI: 10.1002/ags3.12603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
The relationships among esophagectomy for esophageal cancer, dysphagia, and sarcopenia are still unclear. We considered appropriate interventions for patients with resectable esophageal cancer for the purpose of reducing postoperative dysphagia and aspiration pneumonia. Dysphagia in patients with esophageal cancer is caused by patient characteristics, such as pathophysiology and age, or complications after esophagectomy. Recently, sarcopenic dysphagia, defined as dysphagia associated with whole‐body sarcopenia, has attracted attention in various fields, and a large proportion of patients with esophageal cancer are expected to have sarcopenic dysphagia. Our systematic review and meta‐analysis suggested that preoperative sarcopenia in patients with esophageal cancer is related to pulmonary complications after esophagectomy, and some reports also suggested that sarcopenia in swallowing‐related muscles, such as the geniohyoid muscle and tongue, might be associated with postoperative pneumonia or dysphagia after esophagectomy. However, clinical studies on sarcopenic dysphagia in patients with esophageal cancer have been limited. To prevent sarcopenic dysphagia after esophagectomy, perioperative interventions involving not only swallowing rehabilitation, but also physical exercise and nutritional support are important. Moreover, several reports have suggested that the chin‐down maneuver might be effective for preventing aspiration after an esophagectomy. To inhibit the progression of sarcopenic dysphagia after esophagectomy, evaluations and interventions by multidisciplinary staff are likely to be necessary.
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Affiliation(s)
- Junya Oguma
- Esophageal Surgery Division National Cancer Center Hospital Tokyo Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, School of Medicine Tokai University Tokyo Japan
| | - Koshiro Ishiyama
- Esophageal Surgery Division National Cancer Center Hospital Tokyo Japan
| | - Hiroyuki Daiko
- Esophageal Surgery Division National Cancer Center Hospital Tokyo Japan
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Effect of tongue strength on clinical outcomes of patients: A systematic review. Arch Gerontol Geriatr 2022; 102:104749. [PMID: 35724534 DOI: 10.1016/j.archger.2022.104749] [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: 12/29/2021] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Whether decreased tongue strength is associated with poor clinical outcomes is unclear. This systematic review investigated the effect of decreased tongue strength on the clinical outcomes of adults requiring medical treatment. DESIGN Systematic review. SETTING AND PARTICIPANTS Systematic reviews, randomized control trials, intervention studies, and longitudinal observational studies involving patients with decreased tongue strength requiring medical treatment were included. METHODS Articles published between January 2000 and June 2021 were retrieved from MEDLINE, CINAHL, Ichushi-web (in Japanese), Web of Science, ClinicalTrials.gov, UMIN, the Cochrane Library, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies. The study protocol was pre-registered in XXX. RESULTS After screening 3040 articles and excluding duplicates, 74 articles were retrieved; after full-text evaluation of the 74 articles, seven articles (with 787 patients) were found to meet the inclusion criteria. The cut-off values for determining decreased tongue strength ranged from 13.8 to 21.6 kPa. Patients with decreased tongue strength had poorer recovery of their swallowing function, higher incidence of pneumonia, and poorer life expectancy than those with high tongue strength. However, tongue strength in older patients with decreased tongue strength increased when they performed physical exercise interventions and followed strict nutritional management plans. CONCLUSIONS Decreased tongue strength was related to poor clinical outcomes in in- and outpatients. Oral frailty in older patients should be given increased attention in hospitals, and further research is needed to improve the clinical outcomes for older people with reduced tongue strength.
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Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Mori T, Ogawa N, Nishioka S, Momosaki R, Yamada M, Ogawa S. Prevalence of Hoarseness and Its Association with Severity of Dysphagia in Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:266-271. [PMID: 35297470 PMCID: PMC8883003 DOI: 10.1007/s12603-022-1754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 10/29/2022]
Abstract
OBJECTIVES To investigate the prevalence of hoarseness and its association with the severity of dysphagia in patients with sarcopenic dysphagia. DESIGN Cross-sectional study using the Japanese sarcopenic dysphagia database. SETTING 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team. PARTICIPANTS 287 patients with sarcopenic dysphagia, aged 20 years and older. MEASUREMENTS Sarcopenic dysphagia was diagnosed using a reliable and validated diagnostic algorithm for the condition. The presence and characteristics of hoarseness classified as breathy, rough, asthenic, and strained were assessed. The prevalence of hoarseness and the relationship between hoarseness and Food Intake LEVEL Scale (FILS) were examined. Order logistic regression analysis adjusted for age, sex, naso-gastric tube, and handgrip strength was used to examine the relationship between hoarseness and FILS at baseline and at follow-up. RESULTS The mean age was 83 ± 10 years. Seventy-four (26%) patients had hoarseness, while 32 (11%), 20 (7%), 22 (8%), and 0 (0%) patients had breathy, rough, asthenic, and strained hoarseness, respectively. Median FILS at the initial evaluation was 7 (interquartile range, 5-8). Hoarseness (β=0.747, 95% confidence intervals= 0.229, 1.265, p=0.005), age, sex, naso-gastric tube, and handgrip strength were associated independently with baseline FILS, while hoarseness (β=0.213, 95% confidence intervals= -0.324, 0.750, p=0.438) was not associated independently with the FILS at follow-up. CONCLUSIONS Hoarseness was associated with the severity of dysphagia at baseline, however not a prognostic factor for sarcopenic dysphagia. Resistance training of swallowing and respiratory muscles and voice training as part of rehabilitation nutrition might be useful for treating sarcopenic dysphagia.
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Affiliation(s)
- H Wakabayashi
- 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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Bricio-Barrios JA, Ríos-Silva M, Huerta M, Cárdenas-María RY, García-Ibáñez AE, Díaz-Mendoza MG, Jiménez-Leal HM, Chávez-Torres LA, Islas-Piza L, García-García S, Toro-Equihua MD, García-Rodríguez R, Carrazco-Peña KB, López-Alcaraz F, Trujillo X. Impact on the Nutritional and Functional Status of Older Mexican Adults in the Absence of Recreational Activities due to COVID-19: A Longitudinal Study From 2018 to 2021. J Appl Gerontol 2022; 41:2096-2104. [PMID: 35503553 PMCID: PMC9066228 DOI: 10.1177/07334648221099278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A longitudinal study, from 2018 to 2021, identified impacts on the nutritional and functional status of older adults when face-to-face activities at a social assistance center in Mexico were suspended due to the COVID-19 pandemic. A total of 71 older adults were evaluated at three different periods: 18 months prior, three months before the pandemic, and 12 months after the onset of the pandemic. Seventy-one older adults completed follow up. Anthropometric measurements, dietary intake, physical tests, and health screening for malnutrition, dependence, and physical frailty, were evaluated. There was a significant decrease in lean body mass and body water in the older adults assessed, in addition to a significant reduction in the frailty scale and gait speed. Finally, a significant reduction in ingested energy and several nutrients such as protein, and carbohydrates, was found, yet an increase in sugar and cholesterol intake was noted.
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Affiliation(s)
| | - Mónica Ríos-Silva
- University Center for Biomedical Research, University of Colima-CONACyT, Colima, Mexico
| | - Miguel Huerta
- University Center for Biomedical Research, University of Colima, Colima, Mexico
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- University Center for Biomedical Research, University of Colima, Colima, Mexico
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Cho HJ, Hwang Y, Yang SY, Kim M. CT anthropometric analysis of the prognosis of traumatic brain injury: A retrospective study to compare between psoas muscle and abdominal skeletal muscle. Injury 2022; 53:1652-1657. [PMID: 35241285 DOI: 10.1016/j.injury.2022.02.043] [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: 07/26/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent studies have suggested that skeletal muscle area (SMA) and psoas muscle area (PMA), markers for sarcopenia, are associated with the prognosis of many diseases. However, it remains unclear which of the two is a superior prognostic marker. Thus, the objective of this study was to analyse these markers in patients with traumatic brain injury (TBI). METHODS Patients with TBI [abbreviated injury scale (AIS) score of 4 or 5] were selected. Those with an AIS score of 4 or 5 for chest, abdomen, or extremity lesion were excluded. Clinical data, including Glasgow Outcome Scale (GOS), mortality, and anthropometric data, were collected. SMA and PMA were measured. Skeletal muscle index (SMI) and psoas muscle index (PMI) were calculated for each muscle area divided by height squared. The good prognosis group was defined as patients with a GOS score of 4 to 5. The poor prognosis group was defined as those with a GOS score of 1-3. Data of both groups were analysed for the overall prognosis. After excluding patients with a hospital stay of 1 or 2 days, the modified prognosis and mortality of patients were analysed. RESULTS A total of 212 patients were enrolled in the statistical analysis. Patients with good prognosis showed a larger PMA (17.4 cm2 vs. 15.0 cm2, P = 0.002) and PMI (6.1 cm2/ m2 vs. 5.3 cm2/ m2, P = 0.001). After modification, patients with good prognosis showed a larger PMA (17.4 cm2 vs. 14.9 cm2, P = 0.002) and PMI (6.1 cm2/ m2 vs. 5.3 cm2/ m2, P = 0.01). On binary logistic regression analysis, PMI was found to be a significant risk factor for the modified prognosis (Odds ratio (OR) (95% confidence interval (CI)): 0.763 (0.633 - 0.921), P = 0.005) and modified mortality (OR (95% CI): 0.740 (0.573 - 0.957), P = 0.022). CONCLUSION Less amount of psoas muscle (PM) was found to be a significant risk factor for the prognosis of patients with TBI. PM was a better prognostic marker than skeletal muscle (SM) in patients with TBI. Further studies are needed to increase our understanding of sarcopenia and TBI.
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Affiliation(s)
- Hang Joo Cho
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yunsup Hwang
- Department of Radiology, Myongji St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sei-Yun Yang
- Department of Neurosurgery, G-Sam Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Maru Kim
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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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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Yuan J, Lin Y, Song J, Xia R, Jiang Y, Yang X, Li Y, Dong B. Associations of Sarcopenic Parameters with Dysphagia in Older Nursing Home Residents: A Cross-Sectional Study. J Nutr Health Aging 2022; 26:339-345. [PMID: 35450989 DOI: 10.1007/s12603-022-1768-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate the prevalence of sarcopenia and dysphagia in nursing homes and to analyze the associations between sarcopenic parameters and dysphagia. DESIGN A cross-sectional study. SETTING Nursing homes in Chengdu, Sichuan, China. PARTICIPANTS The study included 365 participants (122 men and 243 women) aged 60 years or older who could walk independently or with walking aids for at least 50 meters. MEASUREMENTS Dysphagia was defined by the water swallow test and sarcopenia and its components were evaluated by the criteria of the Asian Working Group for Sarcopenia, 2019. The values and percentages of sarcopenia associated parameters in relation to dysphagia were analyzed in both male and female residents. The Benjamini-Hochberg method was used to adjust for multiple comparisons. The relationship between sarcopenic components and dysphagia was analyzed using multivariate logistic regression analysis by sex. RESULTS A total of 365 residents (mean age: 84.28 years; 122 men and 243 women) were included in the study. Sarcopenia was diagnosed in 63.0% (n=230) and dysphagia in 75.3% (n = 275) of residents. For men, the percentage of sarcopenia was higher in residents with dysphagia. However, the sarcopenia percentage did not differ significantly between women with and without dysphagia. In both men and women, the handgrip strength (HGS) values were significantly lower in the dysphagic residents. The calf circumference (CC) value and appendicular skeletal muscle index (ASMI) were significantly lower in dysphagic men, while the SARC-CalF scores were higher. In women, the SPPB score was lower in residents with dysphagia. Furthermore, multivariate logistic regression analysis showed that low calf circumference (OR 4.415, 95% CI 1.561-12.490) and sarcopenia (OR 2.968, 95% CI 1.121-7.858) were significantly associated with dysphagia in men after adjusting for co-factors. CONCLUSION There is a high percentage of both dysphagia and sarcopenia in nursing home residents in West China. Low calf circumference and sarcopenia had strong associations with dysphagia among male nursing home residents.
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Affiliation(s)
- J Yuan
- Ying Li, The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China,
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35
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Chen M, Lei X, Zhu T, Li Q, Chen X. Evaluation of the Accuracy of Six Simple Screening Tools for Sarcopenia in Schizophrenic Patients. J Nutr Health Aging 2022; 26:571-575. [PMID: 35718865 DOI: 10.1007/s12603-022-1799-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our objective was to evaluate if SARC-F, SARC-CalF, SARC-F-EBM, calf circumference (CC), mid-upper-arm circumference (MUAC) and Ishii test can be used to accurately screen for sarcopenia in schizophrenic patients. METHOD We enrolled schizophrenic patients aged 50 or older, who were regularly taking antipsychotic medications, at two mental health centres. Bioimpedance-based muscle-mass was analysed with an InBody 770 instrument, while muscle strength was measured with a digital grip-strength dynamometer. The physical performance of the patients was gauged from their gait speed over 6 m. Standard AWGS2019 diagnostic criteria were used, and the accuracies of the six screening methods were indicated by the sensitivity, negative predictive value (NPV), and area under receiver operating characteristic curve (AUC). RESULTS A total of 339 stable schizophrenic patients were enrolled. The overall prevalence of sarcopenia was 53.1%, and the prevalence was 55.6% and 47.66%, respectively, for males and females. The prevalence of sarcopenia obesity in the total population was 16.22%, and that of males and females was 18.97% and 10.28%, respectively. The SARC-F, SARC-CalF, SARC-F-EBM, CC, MUAC and Ishii test sensitivity/NPV in screening for sarcopenia were 41.86%/0.52, 79.07%/0.7, 28.68%/0.51, 78.3%/0.71, 76.74%/0.7, 89.92%/0.84, respectively, in males and 45.1%/0.59, 94.12%/0.91, 54.9%/0.7, 92.16%/60.91, 74.51%/0.77, 96.08%/0.94, respectively, in females. In males, the AUCs of the SARC-F, SARC-CalF, SARC-F-EBM, CC, MUAC and Ishii test were 0.601 (95%CI, 0.528-0.673), 0.754 (95%CI,0.69-0.817), 0.657 (95%CI,0.588-0.727), 0.8 (95%CI, 0.744-0.856), 0.781 (95%CI, 0.721-0.84) and 0.88 (95%CI, 0.837-0.922), respectively, and in females, they were 0.587(95%CI,0.479-0.696), 0.794 (95%CI,0.709-0.878), 0.799 (95%CI,0.71-0.888), 0.893 (95%CI, 0.833-0.953), 0.843 (95%CI, 0.772-0.915) and 0.855 (95%CI, 0.784-0.926), respectively. CONCLUSION The prevalence of sarcopenia in schizophrenic patients is high. Clinical doctors should screen for sarcopenia in schizophrenic patients and provide timely interventions to reduce the occurrence of adverse events. The above six tools can be used as screening tools, and the Ishii test is the most suitable for screening.
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Affiliation(s)
- M Chen
- Xiaoyan Chen, MD; Southwest Medical University Zigong Affiliated Hospital; Zigong Mental Health Center; Zigong, Sichuan Province, China;
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Garand KL, Beall J, Hill EG, Davidson K, Blair J, Pearson W, Martin-Harris B. Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies. J Nutr Health Aging 2022; 26:973-980. [PMID: 36437764 PMCID: PMC10324474 DOI: 10.1007/s12603-022-1854-0] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study. DESIGN Cross-sectional study. SETTING Adult fluoroscopy suite in a metropolitan hospital at an academic center. PARTICIPANTS 195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years. MEASUREMENTS 17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile. RESULTS Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01). CONCLUSION Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.
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Affiliation(s)
- K L Garand
- Kendrea Garand, University of South Alabama, Mobile, AL, USA,
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Mori T, Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Ogawa N, Nishioka S, Momosaki R, Shimizu A, Saito Y, Yamada M, Ogawa S. Association between Inflammation and Functional Outcome in Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:400-406. [PMID: 35450997 DOI: 10.1007/s12603-022-1769-9] [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: 10/18/2022]
Abstract
OBJECTIVES This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia. DESIGN A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database. SETTING The database was constructed using data from 19 hospitals and one home visiting rehabilitation team. PARTICIPANTS Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included. MEASUREMENTS Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function. RESULTS A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (< 5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up. CONCLUSIONS Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.
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Affiliation(s)
- T Mori
- 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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Banda KJ, Chu H, Chen R, Kang XL, Jen HJ, Liu D, Shen Hsiao ST, Chou KR. Prevalence of Oropharyngeal Dysphagia and Risk of Pneumonia, Malnutrition, and Mortality in Adults Aged 60 Years and Older: A Meta-Analysis. Gerontology 2021; 68:841-853. [PMID: 34903688 DOI: 10.1159/000520326] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is a serious health condition associated with poor survival and quality of life in adults aged 60 years and older. Comprehensive assessment and management of OD could lead to better and improved health outcomes for older adults. Therefore, we performed the first meta-analysis to determine the pooled prevalence of OD and risk of pneumonia, malnutrition, and mortality. METHODS Databases including Ovid-MEDLINE, Web of Science, Embase, PubMed, Cochrane, and CINAHL were searched up to January 2021. Data analysis was conducted using logistic-normal for prevalence rate and DerSimonian-Lard random-effects models for outcomes and associated factors of OD, providing odds ratio (OR) and corresponding 95% confidence interval (CI). RESULTS The pooled prevalence of OD in 39 studies with 31,488 participants was 46% associated with higher pooled OR for risk of pneumonia 2.07 (95% CI, 1.58-2.72), malnutrition 2.21 (95% CI, 1.43-3.41), and mortality 2.73 (95% CI, 1.62-4.60). Geriatric syndromes including fecal incontinence 6.84 (4.955-9.44), immobility syndrome 6.06 (5.28-6.96), pressure ulcers 4.02 (2.46-6.56), sarcopenia 3.10 (1.89-5.09), urinary incontinence 2.75 (1.81-4.19), frailty 2.66 (1.16-6.13), delirium 2.23 (1.73-2.87), and falls 1.47 (1.19-1.81) and comorbidities including dementia 3.69 (2.36-5.78) and stroke 1.92 (1.47-2.52) were associated with OD. CONCLUSION Early identification and management of OD should consider geriatric syndromes and neurogenic comorbidities to prevent malnutrition and pneumonia and reduce mortality in adults aged 60 years and older.
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Affiliation(s)
- Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Superintendent Office of Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Swallowing difficulty in the older adults: presbyphagia or dysphagia with sarcopenia? Int J Rehabil Res 2021; 44:336-342. [PMID: 34545853 DOI: 10.1097/mrr.0000000000000494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Oropharyngeal dysphagia is an important cause of mortality and morbidity in older adults. It has been reported in the literature that 11-68% of older adults experience swallowing difficulties. This study aimed to investigate the presence of dysphagia in older adults, whether this dysphagia is related to age (presbyphagia) or sarcopenia by comparing it with adults. Two hundred twenty-five patients were included in this cross-sectional study. The participants were divided into two groups by age as 'adults' and 'older adults'. Sarcopenia, dysphagia and malnutrition evaluations were performed. Older adult and adult groups were compared in terms of malnutrition, dysphagia and sarcopenia. The number of patients with dysphagia was significantly higher (P = 0.007) in the older adults. In older adults, all sarcopenic evaluation parameters were found significantly lower than adults (P < 0.05). The number of older adults with malnutrition was significantly lower in patients with normal swallowing (P < 0.05). The swallowing difficulty can be detected in older adults even if it does not cause any complaint. While most swallowing disorders may be due to age-related changes, about a third may be accompanied by sarcopenia.
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Faniyi AA, Hughes MJ, Scott A, Belchamber KBR, Sapey E. Inflammation, Ageing and Diseases of the Lung: Potential therapeutic strategies from shared biological pathways. Br J Pharmacol 2021; 179:1790-1807. [PMID: 34826882 DOI: 10.1111/bph.15759] [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: 06/27/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
Lung diseases disproportionately affect elderly individuals. The lungs form a unique environment: a highly elastic organ with gaseous exchange requiring the closest proximity of inhaled air containing harmful agents and the circulating blood volume. The lungs are highly susceptible to senescence, with age and "inflammageing" creating a pro-inflammatory environment with a reduced capacity to deal with challenges. Whilst lung diseases may have disparate causes, the burden of ageing and inflammation provides a common process which can exacerbate seemingly unrelated pathologies. However, these shared pathways may also provide a common route to treatment, with increased interest in drugs which target ageing processes across respiratory diseases. In this review, we will examine the evidence for the increased burden of lung disease in older adults, the structural and functional changes seen with advancing age and assess what our expanding knowledge of inflammation and ageing pathways could mean for the treatment of lung disease.
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Affiliation(s)
- A A Faniyi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - M J Hughes
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - A Scott
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - K B R Belchamber
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - E Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
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Chen KC, Jeng Y, Wu WT, Wang TG, Han DS, Özçakar L, Chang KV. Sarcopenic Dysphagia: A Narrative Review from Diagnosis to Intervention. Nutrients 2021; 13:nu13114043. [PMID: 34836299 PMCID: PMC8621579 DOI: 10.3390/nu13114043] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
Sarcopenia, defined as a decline in muscle mass and function related to aging, affects both limb and swallowing-related muscles. Sarcopenic dysphagia is characterized by decreased swallowing function; therefore, early detection of subclinical dysphagia and subsequent intervention appear to be crucial in the elderly. Numerous tools have been employed to measure the function, strength, and mass of swallowing-related muscles in sarcopenic elderly. The swallowing function can be evaluated by questionnaires like Eating Assessment Tool, Functional Oral Intake Scale, and Food Intake Level Scale, and tests such as the modified water swallowing test and videofluoroscopic swallowing study. Surface electromyography and high-resolution manometry can be applied for quantifying swallowing-related muscle strength. Modalities such as ultrasonography and magnetic resonance imaging are capable of estimating the swallowing muscle mass. In patients with sarcopenic dysphagia, a thorough assessment should be given followed by an integrated intervention combining swallowing muscle strengthening, nutrition support, food texture modification, physical, and occupational therapies. This article aimed to comprehensively summarize the diagnostic criteria/tools as well as their associations/performance in sarcopenic dysphagia. The intervention strategy will also be narrated in this review.
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Affiliation(s)
- Kuan-Cheng Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital, New Taipei 22000, Taiwan
| | - Ying Jeng
- Department of Medical Image, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan;
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence: ; Tel.: +886-223717101 (ext. 5309)
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Moncayo-Hernández BA, Herrera-Guerrero JA, Vinazco S, Ocampo-Chaparro JM, Reyes-Ortiz CA. Sarcopenic dysphagia in institutionalised older adults. ENDOCRINOL DIAB NUTR 2021; 68:602-611. [PMID: 34906340 DOI: 10.1016/j.endien.2021.11.023] [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: 08/23/2020] [Accepted: 02/20/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Sarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. MATERIAL AND METHODS An observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants' grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. RESULTS The median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72-0.99) and a better functional performance status (OR 0.98, 95% CI 0.97-0.98). CONCLUSION Sarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.
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Affiliation(s)
| | | | - Steven Vinazco
- Programa de Medicina Familiar, Universidad del Valle, Cali, Colombia
| | - José Mauricio Ocampo-Chaparro
- Departamento de Medicina Interna, Grupo Interinstitucional de Medicina Interna (GIMI 1), Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, FL, United States.
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Izumi M, Akifusa S. Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives. J Oral Rehabil 2021; 48:1395-1403. [PMID: 34612518 DOI: 10.1111/joor.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
Abstract
Oral dysfunction, including oral uncleanness and decline in tongue motor function, tongue pressure and swallowing function, precedes frailty. The tongue's dorsum is a reservoir of oral microbiota, desquamated epithelial mucosa and leukocytes due to the multi-papillate anatomy, and leads to tongue coating. The tongue coating is frequently found in older adults because of hyposalivation, immunity's hypoactivity, diminished motor function and compromised tongue's pressure with age. Anaerobe-driven volatile sulphur compounds in tongue coating are a major cause of intra-oral malodor. Dysbiosis of the tongue-coating microbiome rather than the amount of microorganisms is associated with a risk of aspiration pneumonia. Daily tongue cleaning with a brush or scraper is an easy way to control tongue coating deposits and quality. Using mouth wash or rinse-containing germicides is also a way to control the microbiota of tongue coating. The tongue function is closely related to swallowing. Tongue and suprahyoid muscles are linked with respiratory muscles through the endothoracic fascia. The mechanical stimulation during the cleaning of the tongue may stimulate the respiratory muscles. An intervention trial revealed that tongue cleaning by mucosal brush improves tongue pressure, swallowing and respiratory function in old residents of nursing homes, suggesting a rehabilitative effect of tongue cleaning on the swallowing and respiratory functions, preventing aspiration pneumonia. This narrative review assesses the tongue-cleaning benefits for respiratory and swallowing functions and the possibility of preventing aspiration pneumonia.
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Affiliation(s)
- Maya Izumi
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | - Sumio Akifusa
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
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Bae SJ, Kim K, Yun SJ, Lee SH. Sarcopenia measured with paraspinous muscle using computed tomography for predicting prognosis in elderly pneumonia patients. HONG KONG J EMERG ME 2021. [DOI: 10.1177/10249079211041872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In the elderly, diagnostic findings of pneumonia are often atypical. Computed tomography was recommended for the diagnosis of pneumonia in elderly patients. Recently, the usage of computed tomography as a screening tool for pneumonia in emergency departments has increased. Sarcopenia is defined as the loss of skeletal muscle mass and strength with aging. In this study, the association between sarcopenia and prognosis measured through computed tomography was evaluated compared to CURB-65. Methods: This study was conducted on patients diagnosed with pneumonia through computed tomography from 1 March 2018 to 31 March 2020. The paraspinous muscle size and attenuation were measured at a level located at the T12 pedicle level on axial computed tomography images. Paraspinous muscle size was presented as paraspinous muscle index. Differences in the prognostic performance among the paraspinous muscle size and attenuation, and CURB-65 were evaluated by the area under the receiver operating characteristic curve. Results: A total of 509 patients were included and 132 patients (25.9%) were admitted to the ICU, and 58 patients (11.4%) died in hospital. Paraspinous muscle index was the significant factor for predicting in-hospital mortality and ICU admission. The area under the receiver operating characteristic value of paraspinous muscle index for prediction of mortality was 0.738 and CURB-65 was 0.707. The area under the receiver operating characteristic of paraspinous muscle index and CURB-65 for predicting ICU admission were 0.766 and 0.704, respectively. Conclusion: As a method of measuring sarcopenia, paraspinous muscle index was superior to CURB-65 in elderly pneumonia patients. The use of computed tomography in predicting prognosis for elderly pneumonia patients will ease the economic burden.
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Affiliation(s)
- Sung Jin Bae
- Chung-Ang University Hospital, Department of Emergency Medicine, College of Medicine, Seoul, Chung-Ang University, Seoul, Republic of Korea
| | - Keon Kim
- Ewha Womans University Seoul Hospital, Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, G SAM Hospital, Gunpo, Republic of Korea
| | - Sun Hwa Lee
- Ewha Womans University Mokdong Hospital, Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Shimizu A, Fujishima I, Maeda K, Murotani K, Ohno T, Nomoto A, Nagami S, Nagano A, Sato K, Ueshima J, Inoue T, Shimizu M, Ishida Y, Kayashita J, Suenaga M, Mori N. Delayed Dysphagia May Be Sarcopenic Dysphagia in Patients After Stroke. J Am Med Dir Assoc 2021; 22:2527-2533.e1. [PMID: 34389335 DOI: 10.1016/j.jamda.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke. DESIGN A multicenter prospective observational cohort study. SETTING AND PARTICIPANTS Participants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation. METHODS Swallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia. RESULTS Delayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400-13.974, P = .011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078-0.986, P = .047). CONCLUSIONS AND IMPLICATIONS The development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population.
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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, Hospital, 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, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.
| | | | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Ayano Nagano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Keisuke Sato
- Department of Rehabilitation, Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Shinagawa, Japan
| | - Tatsuro Inoue
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Midori Shimizu
- Department of Nutrition, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Masaki Suenaga
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Matsumoto, Okinawa, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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Tajitsu M, Ishihata K, Tezuka M, Yoshimura T, Ichiki M, Ohta H, Nohara K, Nakamura N. Effectiveness of fibreoptic endoscopic evaluation of swallowing and dietary intervention during home-visit dental care in older individuals. Gerodontology 2021; 39:273-281. [PMID: 34240454 DOI: 10.1111/ger.12581] [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: 10/19/2020] [Revised: 04/11/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, patients with dysphagia are receiving dietary management that deviates from their original swallowing function. OBJECTIVE To evaluate the clinical significance of fibreoptic endoscopic evaluation of swallowing (FEES) and dietary intervention (DI) by multi-professional collaboration during visit care for determining the actual oral intake status in patients with dysphagia. METHODS Five hundred and eighteen patients with dysphagia underwent FEES, focusing on the penetration-aspiration scale, and DI. Oral intake status was categorised using the functional oral intake scale (FOIS). FOIS scores at the first visit, after FEES, and at the reassessment were compared. RESULTS At the first visit, 34.7% of the patients had an FOIS score of level 1 (no oral intake) and 65.3% had a score of level 2 or higher (capable of oral intake). Following FEES, 7.1% of patients had an FOIS score of level 1, and 44.4% had a score of level 2 with resumption of oral intake. At the reassessment, 489 patients (94.4%) were capable of oral ingestion (FOIS level 2 or higher). There were significant differences between the distributions of FOIS scores at the first visit and following FEES (P < .01) and between those at the first visit and at the reassessment (P < .01). Regarding tube feeding, 17 (5.9%) of 289 patients, who had received tube feeding at the first visit, were completely capable of oral intake following FEES and at the reassessment. CONCLUSION Appropriate evaluation of swallowing function using FEES and DI helps to understand the definite swallowing function in patients with dysphagia.
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Affiliation(s)
- Megumi Tajitsu
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Japan.,Medical Corporation Jinjikai, Ohta Dental Clinic, Kagoshima, Japan
| | - Kiyohide Ishihata
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Masahiro Tezuka
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Takuya Yoshimura
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Misaki Ichiki
- Medical Corporation Jinjikai, Ohta Dental Clinic, Kagoshima, Japan
| | - Hiromi Ohta
- Medical Corporation Jinjikai, Ohta Dental Clinic, Kagoshima, Japan
| | - Kanji Nohara
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Norifumi Nakamura
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
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Moncayo-Hernández BA, Herrera-Guerrero JA, Vinazco S, Ocampo-Chaparro JM, Reyes-Ortiz CA. Sarcopenic dysphagia in institutionalised older adults. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00146-4. [PMID: 34219050 PMCID: PMC8720107 DOI: 10.1016/j.endinu.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Sarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. MATERIAL AND METHODS An observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants' grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. RESULTS The median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72-0.99) and a better functional performance status (OR 0.98, 95% CI 0.97-0.98). CONCLUSION Sarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.
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Affiliation(s)
| | | | - Steven Vinazco
- Programa de Medicina Familiar, Universidad del Valle, Cali, Colombia
| | - José Mauricio Ocampo-Chaparro
- Departamento de Medicina Interna, Grupo Interinstitucional de Medicina Interna (GIMI 1), Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida, EE. UU..
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Can B, İsmagulova N, Enver N, Tufan A, Cinel İ. Sarcopenic dysphagia following COVID-19 infection: A new danger. Nutr Clin Pract 2021; 36:828-832. [PMID: 34161626 PMCID: PMC8441725 DOI: 10.1002/ncp.10731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Oropharyngeal dysphagia is one of the complications of endotracheal intubation. As expected, cases of dysphagia following coronavirus disease 2019 (COVID‐19) reported to date have all been intubated. We here report a case of sarcopenic dysphagia following severe COVID‐19 pneumonia in a nonintubated older adult. The patient was an 85‐year‐old male who was readmitted to the hospital with dysphagia and subsequent aspiration pneumonia in the first week after his discharge from the COVID‐19 unit. On physical examination, the patient was sarcopenic and malnourished. Flexible endoscopic evaluation of swallowing (FEES) revealed aspiration into the airway. Enteral feeding was initiated and the infusion rate gradually increased to achieve the desired protein‐energy targets. Control FEES 2 months after discharge showed recovery of swallowing function, with no apparent penetration or aspiration. Clinicians caring for patients with COVID‐19 should be aware that dysphagia, which is associated with increased mortality in older adults, may occur even in the absence of intubation. We recommend that the evaluation of dysphagia be part of the clinical assessment in older COVID‐19 patients with malnutrition or sarcopenia.
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Affiliation(s)
- Büşra Can
- Division of Geriatrics, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Narkiza İsmagulova
- Department of Infectious Diseases, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Necati Enver
- Department of Otorhinolaryngology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Aslı Tufan
- Division of Geriatrics, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - İsmail Cinel
- Department of Anesthesiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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Ma Y, He M, Hou LS, Xu S, Huang ZX, Zhao N, Kang Y, Yue JR, Wu C. The role of SARC-F scale in predicting progression risk of COVID-19 in elderly patients: a prospective cohort study in Wuhan. BMC Geriatr 2021; 21:355. [PMID: 34112103 PMCID: PMC8190739 DOI: 10.1186/s12877-021-02310-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Since the outbreak of COVID-19, it has been documented that old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, it is unknown whether sarcopenia, a common geriatric syndrome, is associated with poor prognosis among older COVID-19 patients. The aim of our prospective cohort study is to investigate the association between sarcopenia risk and severe disease among COVID-19 patients aged ≥60 years. METHOD A prospective cohort study of 114 hospitalized older patients (≥60 years) with confirmed COVID-19 pneumonia between 7 February, 2020 and 6 April, 2020. Epidemiological, socio-demographic, clinical and laboratory data on admission and outcome data were extracted from electronic medical records. All patients were assessed for sarcopenia on admission using the SARC-F scale and the outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards model to identify the association between sarcopenia and progression of disease defined as severe cases in a total of 2908 person-days. RESULT Of 114 patients (mean age 69.52 ± 7.25 years, 50% woman), 38 (33%) had a high risk of sarcopenia while 76 (67%) did not. We found that 43 (38%) patients progressed to severe cases. COVID-19 patients with higher risk sarcopenia were more likely to develop severe disease than those without (68% versus 22%, p < 0.001). After adjustment for demographic and clinical factors, higher risk sarcopenia was associated with a higher hazard of severe condition [hazard ratio = 2.87 (95% CI, 1.33-6.16)]. CONCLUSION We found that COVID-19 patients with higher sarcopenia risk were more likely to develop severe condition. A clinician-friendly assessment of sarcopenia could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.
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Affiliation(s)
- Yao Ma
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- COVID-19 Medical Assistance Teams (Hubei) of West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- COVID-19 Medical Assistance Teams (Hubei) of West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Li-Sha Hou
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shen Xu
- COVID-19 Medical Assistance Teams (Hubei) of West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zhi-Xin Huang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Na Zhao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yan Kang
- COVID-19 Medical Assistance Teams (Hubei) of West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Ji-Rong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
- COVID-19 Medical Assistance Teams (Hubei) of West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Suzhou, Jiangsu Province, China
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Sakai K, Katayama M, Nakajima J, Inoue S, Koizumi K, Okada S, Suga S, Nomura T, Matsuura N. Temporal muscle thickness is associated with the severity of dysphagia in patients with acute stroke. Arch Gerontol Geriatr 2021; 96:104439. [PMID: 34090127 DOI: 10.1016/j.archger.2021.104439] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-stroke dysphagia is a common and expensive complication of acute stroke. The relationship between dysphagia and skeletal muscle loss (sarcopenia) has been recently highlighted. This study aimed to determine the relationship between temporal muscle thickness (TMT) measured by head magnetic resonance imaging (MRI) and dysphagia in patients with acute stroke. METHODS Seventy participants (43 men and 27 women; mean age, 75.6 ± 12.7 years) were included in this study. TMT was measured by T2-magnetic resonance images within seven days of hospitalization. The severity of dysphagia was assessed using the Functional Oral Intake Scale (FOIS). Participants were classified into three categories according to the severity of dysphagia (severe: FOIS score, 1-3; mild: FOIS score, 4-6; normal: FOIS score, 7). Linear regression analysis was used to determine the independent explanators of dysphagia severity. RESULTS Twenty participants (28.6%) had severe dysphagia, 31 participants (44.3%) had mild dysphagia, and 19 participants (27.1%) had normal swallowing function at discharge. The results of the linear regression analysis showed that TMT was a significant explanator of dysphagia severity following stroke, along with age and National Institute of Health Stroke Scale (NIHSS) score (P < 0.05, effect size: f2 = 0.72). CONCLUSIONS TMT was an independent risk factor for dysphagia in patients with acute stroke. Skeletal muscle loss may be secondarily involved in dysphagia with acute stroke, and measurement of TMT with head MRI is a useful method to assess skeletal muscle loss.
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Affiliation(s)
- Katsuhiko Sakai
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba 272-8513, Japan.
| | - Masateru Katayama
- Division of Neurosurgery, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa city, Chiba 272-8513, Japan
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba 272-8513, Japan
| | - Satoshi Inoue
- Division of Neurosurgery, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa city, Chiba 272-8513, Japan
| | - Kenzo Koizumi
- Division of Neurology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa city, Chiba 272-8513, Japan
| | - Satoshi Okada
- Division of Neurology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa city, Chiba 272-8513, Japan
| | - Sadao Suga
- Division of Neurosurgery, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa city, Chiba 272-8513, Japan
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba 272-8513, Japan
| | - Nobuyuki Matsuura
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba 272-8513, Japan
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