Poor oral status is associated with rehabilitation outcome in older people

Impaired oral status is associated with sarcopenic obesity in post-stroke patients

PURPOSE

Oral problems and muscle health are indeed significant concerns in ageing populations. However, there is limited evidence concerning the association between these issues. The study's focus was to investigate the association between oral problems and sarcopenic obesity, wherein sarcopenia and obesity coexist concurrently, in post-stroke patients.

METHODS

This retrospective, observational, cross-sectional study included patients hospitalised for post-stroke rehabilitation. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). Sarcopenic obesity was diagnosed according to the European Society of Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. Multiple linear regression analysis was used to examine the association between the ROAG and sarcopenic obesity after adjusting for confounding factors.

RESULTS

A total of 760 patients were included, with a mean (SD) age of 71 (9) years, of whom 408 (54.7%) were male. The median (interquartile range, 25th and 75th percentiles) ROAG was 11 [9, 13]. Sarcopenic obesity was diagnosed in 16 (3.9%) men, 18 (5.1%) women, and 34 (4.5%) patients overall. Multivariate linear analysis showed that ROAG was significantly and positively associated with sarcopenic obesity (β = .091, P = .023), followed by obesity alone (β = .084, P = .044), and sarcopenia alone (β = .081, P = .037).

CONCLUSION

Oral problems were associated with sarcopenic obesity in post-stroke. Oral assessment and intervention may have a positive impact on ADL and QOL in post-stroke patients with sarcopenic obesity.

Prevention of Aspiration: Oral Care, Antibiotics, Others

Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different mechanisms. Prevention of this condition is directed at the mechanism by which it occurs. The elderly are the most likely to suffer from aspiration pneumonia, occasionally due to issues related to poor dental health, but more frequently due to abnormal swallowing, which may appear after a stroke, a functional impairment related to aging, or may be part of a specific disease such as Parkinson's disease or some other nervous system condition. People with dysphagia complicated by pneumonia have limited feeding and become debilitated, and aspiration pneumonia in these individuals has a high mortality rate at 90 days. Dietary modifications, assistance with feeding, use of postures that facilitate a normal deglutition, rehabilitation, and use of medications to improve swallowing defects are the tools of medicine to overcome the obstacles to swallowing normally and prevent the development of aspiration pneumonia and its consequences.

Impaired oral health associations with cognitive and motor decline in activities of daily living independence during hospitalization: insights from a post-stroke cohort

PURPOSE

Evidence is scarce on the associations between impaired oral health and cognitive level related to independence in activities of daily living (ADLs) among hospitalized older patients. We aimed to evaluate the associations between baseline oral problems and changes in cognitive level in post-stroke patients.

METHODS

A retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Revised Oral Assessment Guide (ROAG) as a measure of oral health and function was assessed at admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the motor domain of FIM (FIM-motor). Multivariate linear regression analyses were employed to assess the association between baseline ROAG and the designated outcomes, adjusting for potential confounding factors.

RESULTS

Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median ROAG was 10 [9, 12], with 811 patients (84.9%) presenting oral problems. After fully adjusting for confounding factors, the ROAG was significantly and negatively associated with FIM-cognition at discharge (β = -0.107, p = 0.031) and FIM-cognition gain (β = -0.093, p = 0.018). Further, the ROAG was independently and negatively associated with FIM-motor at discharge (β = -0.043, p = 0.013) and FIM-motor gain (β = -0.065, p = 0.013).

CONCLUSION

Oral problems were associated with compromised cognitive levels and a decline in physical function during the hospitalization in post-stroke patients. These results underscore the critical importance of addressing oral health in this patient population.

Impact of Hospital Dentistry on Patients' Food Intake Status in Convalescent Rehabilitation Ward

BACKGROUND

Treating oral problems with dentist intervention during hospitalisation may improve patients' food intake status.

OBJECTIVES

This study aimed to clarify whether convalescent rehabilitation ward inpatients in a hospital with hospital dentistry (HHD) had a better diet at discharge than those in a hospital without hospital dentistry (HNHD).

METHODS

Retrospective observational study including inpatients with dental involvement in a HHD with dentists and dental hygienists and HNHD with dental hygienist and visiting dental service between 1 March and 31 August 2022. Data included age, sex, body mass index (BMI), Functional Independent Measure (FIM) motor and cognitive, Oral Health Assessment Tool (OHAT) score, Food Intake LEVEL Scale (FILS), whether the FILS ≥8 (indicating that patient eats also a non-texture-modified diet), remained and functional tooth numbers and speech language hearing therapist (SLHT) and dentist interventions. Comparisons between the two hospitals and factors that affected the FILS ≥8 were examined.

RESULTS

A total of 333 and 89 inpatients were included in the HHD and HNHD groups, respectively. After propensity score matching, the HHD group had a significantly higher rate of FILS ≥8, functional tooth numbers at discharge, and SLHT and dentist intervention rates. The multivariable logistic regression analysis for propensity score matching participants showed that the significant independent variables for FILS ≥8 were age, BMI, FILS, FIM motor (all at admission) and SLHT and dentist interventions. Odds ratio for dentist intervention was 14.46 (95% CI: 4.36-48.01).

CONCLUSIONS

Dentists are necessary to improve patients' food intake status in convalescent rehabilitation wards.

Coexistence of low body mass index and poor oral health negatively affects activities of daily living, swallowing, and cognition after stroke

AIM

Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post-stroke older patients.

METHODS

A retrospective cohort study was conducted on 708 hospitalized post-stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m2, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure-motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure-cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest.

RESULTS

The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023-0.718), worse swallowing level (B = -0.878, 95% CI -1.280 to -0.476), and poorer cognitive status (B = -1.872, 95% CI -2.960 to -0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone.

CONCLUSIONS

The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 24: 1045-1052.

A preventive care approach for oral health in nursing homes: a qualitative study of healthcare workers' experiences

BACKGROUND

Oral health problems are common among care-dependent older adults living in nursing homes. Developing strategies to prevent the deterioration of oral health is therefore crucial to avoid pain and tooth loss. A standardized work widely used in nursing homes in Sweden is the quality register Senior Alert (SA), which assesses age-related risks concerning e.g. pressure sores, falls, malnutrition and oral health. The oral health assessment is performed with the Revised Oral Assessment Guide-Jönköping (ROAG-J), which also includes planning and implementation of preventive oral care interventions with the goal of achieving good quality care. However, what facilitates and hinders healthcare workers in working with oral health in SA remains unexplored. The aim of this study was to describe healthcare workers' experiences of assessing oral health with the ROAG-J, planning and performing preventive oral health care actions in accordance with SA in nursing homes.

METHODS

Healthcare workers (n = 28) in nursing homes in two Swedish municipalities participated and data was collected through six focus group interviews. Reflexive thematic analysis was used to identify patterns of meaning in the data.

RESULTS

Themes generated in the analysis were: (1) A structured process promotes communication and awareness and stresses the importance of oral health; (2) Oral care for frail older adults is challenging and triggers ethical dilemmas; (3) Unclear responsibilities, roles and routines in the organization put oral health at risk; (4) Differences in experience and competence among healthcare staff call for educational efforts.

CONCLUSIONS

The structured way of working increases staff awareness and prioritization of oral health in nursing homes. The main challenges for the healthcare workers were residents' reluctance to participate in oral care activities and oral care being more complicated since most older adults today are dentate. Organizational challenges lay in creating good routines and clarifying staff roles and responsibilities, which will require continuous staff training and increased management involvement.

Triad of rehabilitation, nutrition support, and oral management improves activities of daily living and muscle health in hospitalized patients after stroke

BACKGROUND AND AIMS

The triad approach combining rehabilitation, nutrition support, and oral management has garnered increasing interest for improving outcomes in older adults. However, evidence is limited regarding its effectiveness in post-stroke patients, who are at high risk for malnutrition, sarcopenia, oral problems, and dysphagia. This study aims to investigate the association between the triad approach and improvement in activities of daily living (ADL), muscle strength, and skeletal muscle mass in these patients.

METHODS

A retrospective cohort study was conducted using post-stroke patients. Patients were divided into groups based on their exposure to the triad approach, defined as a combination of intensive chair-stand exercise (rehabilitation), personalized food prescriptions (nutrition support), and oral management by dental professionals. We investigated the association between the triad approach and outcomes using multiple linear regression analysis adjusted for covariates. Primary outcome was Functional Independence Measure motor score (FIM-motor) at discharge and its gain. Secondary outcomes were handgrip strength (HGS) and skeletal muscle mass index (SMI) at discharge.

RESULTS

The study included 1012 post-stroke patients (median age 75.6 years; 54.1% men). Multiple linear regression analysis revealed that the triad approach had the strongest association with higher FIM-motor at discharge (β = 0.262, p < 0.001) and FIM-motor gain (β = 0.272, p < 0.001) compared to the individual or combined interventions. The triad also showed the strongest associations with higher HGS (β = 0.090, p = 0.017) and SMI (β = 0.041, p = 0.028) at discharge.

CONCLUSIONS

The triad approach of intensive rehabilitation, personalized nutrition support, and oral management by dental professionals is strongly associated with improved ADL, muscle strength, and skeletal muscle mass in post-stroke rehabilitation patients. Implementing this multidisciplinary strategy may maximize functional and muscle health recovery.

Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients

BACKGROUND AND AIMS

Sarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients.

METHODS

A retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status.

RESULTS

The prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge.

CONCLUSION

The dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.

Effect of Chair-stand Exercise on Improving Urinary and Defecation Independence in Post-stroke Rehabilitation Patients with Sarcopenia

Objectives

There is a lack of evidence regarding the association between whole-body exercise and independence in urination and defecation. This study aimed to evaluate the effect of chair-stand exercise on improving urination and defecation independence in post-stroke patients with sarcopenia.

Methods

A retrospective study was conducted on stroke patients admitted to a community rehabilitation hospital between 2015 and 2021. Patients diagnosed with sarcopenia who required assistance with bladder and bowel management were included. The primary outcomes were the Functional Independence Measure (FIM) scores for urination (FIM-Bladder) and defecation (FIM-Bowel) at discharge. Multiple regression analysis was used to examine the association between chair-stand exercise and the outcomes, adjusting for potential confounders.

Results

Of 586 patients, 187 patients (mean age 79.3 years, 44.9% male) were included in the urination analysis, and 180 patients (mean age 79.3 years, 44.4% male) were included in the defecation analysis. Multiple regression analysis showed that the number of chair-stand exercises was independently positively associated with FIM-Bladder at discharge (β=0.147, P=0.038) and FIM-Bladder gain (β=0.168, P=0.038). Similarly, the number of chair-stand exercises was independently positively associated with FIM-Bowel at discharge (β=0.149, P=0.049) and FIM-Bowel gain (β=0.166, P=0.049).

Conclusions

Chair-stand exercise was positively associated with improved urination and defecation independence in post-stroke patients with sarcopenia. Incorporating whole-body exercises, such as chair-stand exercise, in addition to conventional rehabilitation programs may help improve voiding independence, reduce incontinence, and enhance quality of life in these patients.

Systemic and Oral Characteristics of Convalescent Inpatients Requiring Oral-Health Management by a Dental Specialist during Hospitalization

Older adults often experience poor oral functions, hindering rehabilitation post-acute disease treatment. However, characteristics of hospitalized patients who would benefit from professional oral-health management (POHM) have not been clarified. Therefore, we aimed to elucidate systemic and oral characteristics of patients requiring POHM during hospitalization in a convalescent hospital. This study included 312 participants admitted to the rehabilitation department of a convalescent hospital for a year. The patients were categorized according to POHM requirements (no-POHM group: 137 patients; POHM group: 175 patients) by discharge. Age, sex, primary disease at admission, Glasgow coma scale (GCS), Functional Independence Measurement (FIM), Mini nutritional assessment-short form (MNA-SF), Functional oral intake scale (FOIS), number of present and functional teeth, Oral Health Assessment Tool (OHAT) scores, and POHM details provided during patient hospitalization were compared. Binomial logistic-regression analysis identified patients requiring POHM as those who had suffered a stroke and had a low number of present teeth, poor overall oral health, low food form, and low motor skills at admission. A high percentage of POHM interventions comprised oral-hygiene care and denture treatment. In summary, patients whose oral health has deteriorated and those experiencing oral-intake difficulties upon admission to a convalescent hospital may require oral-health management.

The relationship between oral frailty and oral dysbiosis among hospitalized patients aged older than 50 years

OBJECTIVE

This study aimed to clarify the relationship between oral frailty and oral dysbiosis among hospitalized patients aged ≥ 50 years.

METHODS

A prospective observational study was conducted. Number of teeth, masticatory ability, articulatory oral motor skill, tongue pressure, swallowing pressure, and choking were used to assess oral frailty. Saliva samples were collected from the oral cavity for bacterial culture.

RESULTS

A total 103 in patients enrolled and 53.4% suffered from oral frailty. Oral frailty was found to have a 3.07-fold correlation with the presence of Enterobacterales in the oral cavity (p = 0.037), especially in poor articulatory oral motor skill, which showed at greater risk of Enterobacterales isolated from the oral cavity by 5.58-fold (p = 0.01).

CONCLUSION

Half of hospitalized patients was found to have oral frailty that was related to more Enterobacterales in the oral cavity. This evidence suggests that the enhancement of articulatory oral motor skills may serve as a potential strategy for mitigating the presence of Enterobacterales within the oral cavity.

Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review

Malnutrition is a common condition in geriatric rehabilitation settings; however, the accuracy and predictive validity of the measures to identify malnutrition have not been established. The current scoping review followed the Joanna Briggs Institute's evidence synthesis manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Literature published through September 2023 was searched using MEDLINE and CINAHL. The inclusion criteria selected studies reporting malnutrition measures, which include static body weight and weight loss. Identified tools were classified as nutritional screening tools, nutritional assessment tools, or diagnostic criteria. The domains of each tool/criterion and their accuracy and predictive validity were extracted. Fifty-six articles fulfilled the inclusion criteria, and six nutritional screening tools, three nutritional assessment tools, and three diagnostic criteria for malnutrition were identified. These measures consisted of various phenotypes, e.g., weight loss, causes such as inflammation/disease, and risk factors of malnutrition, e.g., functional impairment. The predictive validity of nutritional screening tools (n = 6) and malnutrition diagnostic criteria (n = 5) were inconsistently reported, whereas those for nutritional assessment tools were scarce (n = 1). These findings highlight the need to distinguish the functional impairment of nutritional origin from that of non-nutritional origin in nutritional assessment procedures, and the need to study the accuracy and the predictive validity of these measures in geriatric rehabilitation patients.

Exploring Oral Function, Protein Intake, and Risk of Sarcopenia: A Scoping Review

INTRODUCTION

Sarcopenia is loss of both muscle mass and function with age and is associated with inadequate protein intake. However, evidence to suggest an association with oral health is less clear.

OBJECTIVE

To scope peer-reviewed published evidence (2000-2022) pertaining to oral function in relation to sarcopenia and/or protein intake in older people.

METHODS

CINAHL, Embase, PubMed, and Scopus were searched. Included were peer-reviewed studies measuring oral function (e.g., tooth loss, salivary flow masticatory function, strength of muscles of mastication, and tongue pressure) and a measure of protein intake and/or a measure of sarcopenia (appendicular muscle mass and function). Full article screening was conducted by 1 reviewer with a random 10% screened in duplicate by a second reviewer. Relevant content pertaining to study type, country of origin, measures of exposure, and outcomes and key findings was mapped and the balance of data showing a positive versus null association of oral health with outcomes charted.

RESULTS

Of 376 studies identified, 126 were screened in full, yielding 32 included texts, of which 29 were original articles. Seven reported intake of protein and 22 reported measures of sarcopenia. Nine distinct oral health exposures were identified, with ≤4 studies relating to any one of these measures. Most data were cross-sectional in nature (27 studies) and from Japan (20 studies). The balance of data showed associations between tooth loss and measures of sarcopenia and protein intake. However, the balance of data pertaining to any association between chewing function, tongue pressure, or indices of oral hypofunction and sarcopenia was mixed.

CONCLUSION

A broad range of oral health measures have been studied in relation to sarcopenia. The balance of data suggests that tooth loss is associated with risk, but data pertaining to the oral musculature and indices of oral hypofunction are mixed.

KNOWLEDGE TRANSFER STATEMENT

The findings of this research will increase awareness among clinicians of the amount and nature of evidence pertaining to the relationship between oral health and risk of compromised muscle mass and function, including data showing that loss of teeth is associated with increased risk of sarcopenia in older people. The findings highlight to researchers the gaps in the evidence and where further research and clarification of the relationship between oral health and risk of sarcopenia is warranted.

Impact of Poor Oral Health Status on Swallowing Function Improvement in Older Dysphagic Patients

Background This study aimed to explore the relationship between poor oral health status and improvement in swallowing function in older patients with dysphagia across various clinical settings, including acute and post-acute care environments. Methods This retrospective cohort study encompassed patients aged 65 years and older with dysphagia. Oral health status was assessed using the oral health assessment tool (OHAT) or the revised oral assessment guide (ROAG). In this study, an OHAT score of ≥3 or an ROAG score of ≥13 indicated poor oral health status. The primary outcome measured was the change in the food intake level scale (FILS) score, which reflects swallowing function, during the observation period. The association between changes in FILS score and poor oral health status was analyzed using a multivariable linear regression model. Results The study included 361 older patients with dysphagia (mean age 82.7 ± 7.7 years; 47.3% male), of whom 82.5% had poor oral health. A negative association was found between poor oral health status and improvement in FILS score at the endpoint (partial regression coefficient: -0.523, 95% confidence interval: -0.99 to -0.06, P=0.026). Conclusions Our findings underscore the negative impact of poor oral health status on the improvement of swallowing function and emphasize the importance of oral health interventions for older patients. Further study on oral health interventions' effects on improving swallowing function in older patients with dysphagia is warranted.

Improvement in sarcopenia is positively associated with recovery of independence in urination and defecation in patients undergoing rehabilitation after a stroke

OBJECTIVES

This study aimed to examine the association between improvement in sarcopenia and the recovery of urinary and defecatory independence in patients undergoing convalescent rehabilitation.

METHODS

A retrospective cohort study was conducted of 849 older inpatients after a stroke. Of these, patients with sarcopenia and dependent voiding movements were targeted. Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019, and diagnosed using handgrip strength (HGS) and skeletal muscle-mass index. Outcomes were sphincter control items of the Functional Independence Measure (FIM) at the time of discharge: urinary (FIM-Bladder) and defecation (FIM-Bowel). A score of six or higher was considered independent. A logistic regression analysis was used to determine whether sarcopenia improvement was associated with outcomes.

RESULTS

Of the patients recruited, 151 were diagnosed with sarcopenia at baseline, of whom patients dependent in urination (109 patients) and defecation (102 patients) were included in the analysis. The multivariate analysis showed that improvement in sarcopenia (odds ratio [OR]: 3.28; 95% confidence interval [CI],1.01-10.70; P = 0.048) and HGS (OR: 6.25; 95% CI, 1.45-26.90; P = 0.014) were independently associated with FIM-Bladder at the time of discharge. Improvement in HGS (OR: 4.33; 95% CI, 0.99-18.90; P = 0.048) was independently associated with FIM-Bowel at the time of discharge CONCLUSIONS: Improvement in sarcopenia and muscle strength during hospitalization may have a positive effect on urinary independence in stroke patients undergoing convalescent rehabilitation, and improvement in muscle strength may have a positive effect on defecation independence. Multidisciplinary sarcopenia treatment should be implemented in addition to conventional rehabilitation for these patients.

Using the Oral Assessment Guide to Predict the Onset of Pneumonia in Residents of Long-Term Care and Welfare Facilities: A One-Year Prospective Cohort Study

Appropriate oral health care, depending on oral assessments, reduces the onset of pneumonia. However, the relationship between risk evaluation using an oral assessment tool and pneumonia in residents of long-term care facilities has not been fully elucidated. In the present study, we aim to examine the relationship between the total scores of the Oral Assessment Guide (OAG) and the incidence of pneumonia after a one-year baseline study of residents in long-term care facilities. The settings for sampling include nine long-term care facilities in Hokkaido. At baseline, there were 267 study subjects. A total of 72 individuals dropped out and 11 individuals met the exclusion criteria. Therefore, the subject sample included 184 individuals. Among the subjects included in our analyses, eight individuals developed pneumonia (six males and two females). A multiple logistic regression analysis was performed with the risk factors for developing pneumonia. Evaluations were performed based on the odds ratio (OR) and 95% confidence interval (CI). We observed that the OR for pneumonia onset was 2.29 (CI: 1.27-4.14) after being adjusted for pneumonia risk factors. Therefore, it was suggested that the total scores of the OAG could be used to screen for the risk of pneumonia onset in residents of long-term care and welfare facilities.

Factors Affecting the Career Continuation of Newly Graduated and Reinstated Dental Hygienists Who Participated in a Technical Training Program in Japan

This study aimed to identify (1) what newly graduated dental hygienists and reinstated dental hygienists consider important for preventing early turnover in their own professions and for encouraging them to continue in the profession more generally and (2) relevant factors among hygienists intending to continue working in the field. An anonymous, self-administered questionnaire survey was distributed to 215 Japanese dental hygienists who participated in the technical training programs (response rate: 72.6%). Of them, 143 participants were classified into two groups: newly graduated (NGDH, n = 32) and those reinstated to work (RDH, n = 111). Follow-up for lack of skills was most often selected as important for preventing early turnover among both groups and follow-up for lack of knowledge was significantly selected in the RDH group (p < 0.001). Regarding factors important for career continuation, NGDHs significantly selected gaining job satisfaction, whereas RDHs significantly selected working support. Relevant factors contributing to participants' intentions to continue in the profession were job satisfaction (NGDH, OR = 8.37; RDH, OR = 8.83), career outlook (RDH, OR = 3.11), and job turnover experience because of marriage and parenting (RDH, OR = 2.70), thereby suggesting the importance of raising awareness regarding career progression and job-related rewards among dental hygienists, their educators, and the government through ongoing career education.

Oral health status and its associated factors among post-stroke inpatients: a cross-sectional study in Hungary

Background

Post-stroke inpatients are at risk of poor oral health for a number of reasons. The aim of this study was to assess the oral health status of post-stroke patients and also to explore the factors that may influence it.

Methods

This cross-sectional study was organised at National Institute for Medical Rehabilitation in Hungary. Altogether 410 post-stroke patients were enrolled in the survey. Personal medical history and functional assessment was obtained from the final medical reports of the patients. The clinical examination and data collection were conducted according to the World Health Organization (2013) criteria. Socio-demographic background and behaviours related to oral health were assessed using a questionnaire. The dental status was explained by the number of Decayed, Missing and Filled Teeth (DMFT). The association of socio-demographic factors, stroke and functional assessment with oral health status and behaviour was evaluated. Chi-square test, Fisher’s exact test, Welch test, Mann–Whitney U test, Kruskal–Wallis test, ANOVA model and correlation analysis were used to analyse our data. The level of significance was set at p < 0.05.

Results

Mean age of stroke patients was 59.21(Standard Deviation [SD] 14.74) years. Mean DMFT score was 20.13 (8.08), including 3.28 (4.24) decayed teeth, 15.02 (10.29) missing teeth and 1.83 (2.94) filled teeth score. Factors that influenced the oral health status were gender, age, occupational status, level of education, type and risk factors for stroke. Significant correlation was found between the Functional Independence Measure and oral health-related behaviours with patients brushing their teeth once a month showing the lowest value.

Conclusion

According to the results, low socio-demographic and economic status, low level of education and the Functional Independence Measure score, unemployment, the combination of risk factors for stroke and residual dysfunctions are associated with poor oral health status. The data indicate that a series of changes are needed, for special attention and care in oral health for patients who have had a stroke. Based on the findings of this research, a new model of prevention and care can be developed, with an interdisciplinary collaboration, to promote the quality of life of these individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02259-2.

Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke

Oishi K, Nishioka S, Okazaki Y, Hirakawa K, Nakamura M, Ichinose A, Kurihara M. Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke. Jpn J Compr Rehabil Sci 2022; 13: 17-25.

Objective

This study was designed to examine the relationship between improvement in oral hygiene and function and activities of daily living (ADLs) at discharge in patients admitted to convalescent rehabilitation wards.

Methods

Eligible criteria were patients with stroke with a score of 13 or higher (i.e., severe oral problems) on the Revised Oral Assessment Guide (ROAG) at admission. Age, gender, primary diseases, rehabilitation dose, dentist visits and denture status, Eichner classification, eating status at admission and discharge, and body mass index at admission were collected. The patients were classified into two groups: those with ROAG scores of less than 9 points at discharge (good ROAG group) and those with scores of 9 points or more (poor ROAG group), and Functional Independence Measure (FIM) gain and total FIM discharge scores were compared using univariate and multivariate analyses.

Results

The good and poor ROAG groups comprised 126 and 366 patients, respectively. The good ROAG group had significantly higher total FIM score, FIM efficiency, and FIM gain at discharge than the poor ROAG group (112 vs. 82; P < 0.001). The ROAG scores at discharge were independently associated with FIM gain (partial regression coefficient = -9.889, 95% confidence interval = -13.499 to -6.279) and total FIM score at discharge.

Conclusion

Improvement in oral hygiene and function in convalescent patients with stroke was associated with ADLs at hospital discharge.

Association of Oral Health and Mini Nutritional Assessment in Older Adults: A Systematic Review with Meta-analyses

PURPOSE

To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults.

STUDY SELECTION

For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale.

RESULTS

A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p<0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p<0.05).

CONCLUSION

These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.

Hospital-associated deconditioning: Not only physical, but also cognitive

INTRODUCTION

Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization. Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions.

MATERIALS AND METHODS

We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality.

RESULTS

From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation.

DISCUSSION

In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.

Sarcopenia is associated with incontinence and recovery of independence in urination and defecation in post-acute rehabilitation patients

OBJECTIVE

The aim of this study was to examine the association between sarcopenia and recovery of independence in urination and defecation in patients undergoing convalescent rehabilitation.

METHODS

This single-center, retrospective cohort study included post-acute rehabilitation patients. Sarcopenia was diagnosed using the muscle mass index and handgrip strength according to the updated criteria of the Asian Working Group for Sarcopenia 2019. Study outcomes and the recovery of independence in urination and defecation were evaluated using the sphincter control items of the Functional Independence Measure (FIM) at discharge: urination (FIM-Bladder) and defecation (FIM-Bowel), respectively. Multivariate regression analyses were used to determine whether sarcopenia at baseline was associated with the study outcomes. Statistical significance was set at P < 0.05.

RESULTS

After enrollment, 917 patients (mean age 74.7 ± 13.5 y; 58% women) were included in the final analyses. Sarcopenia was present in 451 patients (49.2%). The median FIM-Bladder and FIM-Bowel scores at admission were 5 [2-7] and 5 [3-7], respectively. Multivariate analyses showed that the presence of sarcopenia at admission was independently and negatively associated with FIM-Bladder and FIM-Bowel at discharge (all P < 0.001), respectively, after adjusting for potential confounders including baseline outcome variables, FIM, and disease.

CONCLUSIONS

Sarcopenia was negatively associated with the recovery of independence in urination and defecation in a post-acute rehabilitation setting. This relationship was independent of physical and cognitive level and disease. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented to predict and maximize improvement in toileting independence in this population.

Poor oral health and anorexia in older rehabilitation patients

OBJECTIVE

To investigate the association between anorexia and comprehensive oral health status in older inpatients.

BACKGROUND

Anorexia in older inpatients is a major concern, but whether it is associated with oral problems is currently unclear.

METHODS

This cross-sectional study included 160 participants (42.5% men) aged ≥65 years (mean age 78.6 ± 7.9) who had been admitted to a rehabilitation hospital. A score of ≤14 on the Simplified Nutritional Appetite Questionnaire for Japanese Elderly indicated anorexia. A score of ≥3 on the Oral Health Assessment Tool (OHAT) indicated poor oral health. Malnutrition was diagnosed according to the criteria set out by the Global Leadership Initiative on Malnutrition. Multivariate logistic regression was used to investigate the association between poor oral health and anorexia and, additionally, which subcategory of the OHAT (represented by a score ≥1) was associated with anorexia.

RESULTS

Anorexia and poor oral health status were observed in 86 (53.8%) and 85 (53.1%), respectively. Poor oral health was associated with anorexia after adjusting for potential confounders (adjusted odds ratio [AOR] 2.7; 95% confidence interval [CI]: 1.3-5.9). Additionally, poor status of dentures (AOR 2.6; 95% CI: 1.2-5.7) and poor oral cleanliness (AOR 3.0; 95% CI: 1.4-6.4) were independently associated with anorexia.

CONCLUSIONS

Poor oral health was associated with anorexia in older inpatients. Detection of poor oral health status using a comprehensive oral health assessment may be useful for anorexic patients. Early detection for poor oral health using comprehensive oral health assessments and oral care and prosthetic treatment may be useful for anorexic patients.

Deep Learning-Based Functional Independence Measure Score Prediction After Stroke in Kaifukuki (Convalescent) Rehabilitation Ward Annexed to Acute Care Hospital

Introduction

Prediction models of functional independent measure (FIM) score after kaifukuki (convalescent) rehabilitation ward (KRW) are needed to decide the treatment strategies and save medical resources. Statistical models were reported, but their accuracies were not satisfactory. We made such prediction models using the deep learning (DL) framework, Prediction One (Sony Network Communications Inc., Tokyo, Japan).

Methods

Of the 559 consecutive stroke patients, 122 patients were transferred to our KRW. We divided our 122 patients’ data randomly into halves of training and validation datasets. Prediction One made three prediction models from the training dataset using (1) variables at the acute care ward admission, (2) those at the KRW admission, and (3) those combined (1) and (2). The models’ determination coefficients (R²), correlation coefficients (rs), and residuals were calculated using the validation dataset.

Results

Of the 122 patients, the median age was 71, length of stay (LOS) in acute care ward 23 (17-30) days, LOS in KRW 53 days, total FIM scores at the admission of KRW 85, those at discharge 108. The mean FIM gain and FIM efficiency were 19 and 0.417. All patients were discharged home. Model (1), (2), and (3)’s R² were 0.794, 0.970, and 0.972. Their mean residuals between the predicted and actual total FIM scores were -1.56±24.6, -4.49±17.1, and -2.69±15.7.

Conclusion

Our FIM gain and efficiency were better than national averages of FIM gain 17.1 and FIM efficiency 0.187. We made DL-based total FIM score prediction models, and their accuracies were superior to those of previous statistically calculated ones. The DL-based FIM score prediction models would save medical costs and perform efficient stroke and rehabilitation medicine.

Improvement in Oral Health Enhances the Recovery of Activities of Daily Living and Dysphagia after Stroke

OBJECTIVE

Oral problems affect rehabilitation outcomes. This study aimed to examine the association between improvement in oral health and functional outcomes in patients after stroke.

MATERIALS AND METHODS

This retrospective cohort study included post-acute rehabilitation patients who presented with oral problems at admission. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). The ROAG score change during hospitalization was calculated by subtracting the score at admission from the score at discharge; oral problems were defined as "improved", when the score change value was lower than the median value. Study outcomes were the activities of daily living assessed by the motor domain of the Functional Independence Measure (FIM-motor) scores and dysphagia as assessed by the Food Intake Level Scale (FILS). Multivariate regression analyses were used to determine whether improved oral problems were associated with study outcomes. P-values of <0.05 were considered statistically significant.

RESULTS

This study included 300 patients (mean age, 72.0 years; 51.7% men). The median [IQR] baseline ROAG score and its change value during hospitalization were 11 [10, 14] and -1[-3, 0] points, respectively. Multivariate analyses showed that improved oral problems was independently associated with FIM-motor score (β = 0.144, p = 0.001) and FILS score (β = 0.227, p < 0.001) at discharge, after adjusting for potential confounders.

CONCLUSIONS

Improvement in oral health was positively associated with recovery of the ADL and dysphagia after stroke. Early detection of oral problems and oral treatment should be implemented in these patients to maximize functional recovery.

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0–100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1–t2, t2–t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2–t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.

Daily Tasks and Willingness to Work of Dental Hygienists in Nursing Facilities Using Japanese Dental Hygienists' Survey 2019

Oral health care by dental hygienists contributes to the maintenance of nutritional and general health for older people in nursing facilities. This study aimed to investigate daily tasks and willingness to work among dental hygienists working in nursing facilities in Japan. In 2019, using a self-administered questionnaire, a postal cross-sectional survey was conducted among members of the Japanese Dental Hygienists' Association. Questionnaires were distributed to all 16,722 Association members (responses, n = 8932; return rate, 53.4%). We analysed data from 368 dental hygienists currently working in nursing facilities. Item response theory and correspondence analyses were performed. In total, >90% of dental hygienists undertook oral examinations and provided oral hygiene instructions to residents and facility staff. In contrast, the implementation rate of tasks related to interprofessional collaboration was relatively low (approximately 50%), and 72.6% of dental hygienists indicated that they wanted to continue working in nursing facilities. Their willingness to work was closely associated with work involving interprofessional collaboration. Our study findings showed that dental hygienists' work content in nursing facilities was diverse, but that there was variation in implemented tasks. Willingness to continue working in nursing facilities was associated with interprofessional collaboration among dental hygienists.

Association of impaired oral health status with chronic kidney disease in post-acute rehabilitation

BACKGROUND

Despite the growing interest in oral health and chronic disease in geriatric medicine, the evidence of an association between the two variables is limited.

OBJECTIVES

This study sought to examine the association between oral health status and chronic kidney disease (CKD) in this setting.

MATERIALS AND METHODS

This retrospective study included consecutive post-acute patients in a rehabilitation hospital. Oral health status was evaluated using the Revised Oral Assessment Guide (ROAG). Renal function or CKD stage was assessed by measurement of the estimated glomerular filtration rate (eGFR). Multivariate logistic regression analysis was used to determine which subcategories of ROAG were independently associated with advanced CKD stages (vs. early CKD stages). Multiple linear regression analysis was used to clarify whether eGFR on admission was independently associated with ROAG score after adjusting for potential confounders.

RESULTS

A total of 1056 (mean age 70 years; 52% women) were included in the analysis. Slight and moderate-to-severe oral health problems were detected in 57.7% and 15.4% of patients, respectively. Patients with oral problems had a more severe stage of CKD (P = .036) and a lower eGFR (P = .028). Among subitems of ROAG, tongue (OR = 1.40, P = .041), saliva (OR = 1.72, P = .039) and oral cavity mucosa (OR = 1.37, P = .013) status was independently associated with the presence of CKD stages 3, 4 and 5. Furthermore, eGFR was independently associated with ROAG score (β = -0.180, P = .034) after adjusting for possible confounders.

CONCLUSIONS

Impaired oral health status is common and closely associated with CKD in post-acute inpatients.

Relationship between oral intake level and oral health assessment tool scores in the convalescent ward

PURPOSE

To examine the relationship between oral intake function and oral health status in convalescent inpatients.

METHODS

Subjects were 222 patients admitted to a convalescent hospital between 1 January and 30 June 2018. Investigation items were age, sex, causative disease, body mass index, functional oral intake scale (FOIS), functional independence measure, occlusal contact, assistance with oral cleaning, and oral health assessment tool (OHAT) scores. Multiple regression analysis was performed with FOIS as the dependent variable, and investigation items were related to FOIS as independent variables.

RESULTS

Results of multiple regression analysis for all patients suggested that saliva and denture scores were significantly associated with FOIS. However, analysis excluding non-oral feeding patients did not show a significant association between FOIS and OHAT scores.

CONCLUSION

The results of this study suggest that oral health status is associated with oral intake function. In addition, the oral health status of inpatients may be strongly related to whether or not they are eating orally. Therefore, it is necessary to take good care of oral health in non-oral feeding patients in the convalescent ward.

Introducing Standardized Assessment and Management of Oral Cares in a Rehabilitation Unit: Patient Outcomes and Experiences

PURPOSE

The aim of this study was to improve patient oral hygiene outcomes in a rehabilitation unit by implementing a nursing education package and oral hygiene assessment tool.

DESIGN

A case-control design with 50 rehabilitation patients was performed.

METHODS

Nursing staff received education and training in applying the Modified Oral Health Assessment Tool. Clinician assessment of patient oral hygiene occurred on admission and at days 5-7. Each patient reported their perceptions of oral hygiene and comfort prior to hospitalization, while in the hospital, and after transfer to the rehabilitation unit.

FINDINGS

Oral hygiene rating scores improved significantly from admission to the rehabilitation unit to days 5-7 (p = .00). The mean score of patient perceived cleanliness improved from hospital admission to admission to the rehabilitation unit.

CONCLUSION

Oral hygiene was improved following admission to a rehabilitation unit with a consistent and individualized approach to oral hygiene.

CLINICAL RELEVANCE

The introduction of a consistent and individualized approach to oral hygiene demonstrates positive patient outcomes and high patient acceptance.

Nurses' educational needs in the oral health of inpatients at Yazd Province in Iran: a Delphi study

Background

Oral hygiene is an integral part of general health of a person. Nurses qualified about oral care can play an important role in improving the quality of oral health in hospitalized patients. This study investigated the educational needs of nurses in the field of oral health of hospitalized patients.

Methods

The study used the modified Delphi method in three rounds. Fifty faculty members of the School of Dentistry and Nursing were selected via purposive sampling. The data collection tool was a demographic form and an open-ended questionnaire in the first round and a structured questionnaire in the next rounds. The analysis was performed using both content and descriptive analysis techniques.

Results

The top ten oral health education priorities for nurses were greater than 75% with a consensus level: oral anatomy and physiology, learning the signs and symptoms of common oral diseases, learning of oral medications and administration, learning the drugs that cause damage to the mouth and teeth, training in managing dental emergencies, patient education for tooth brushing and taking care of the mouth, especially in the elderly patient, providing oral and dental care, training for unconscious and fasting patients, undergoing chemotherapy and radiotherapy, and hospitalization in intensive care unit.

Conclusion

The findings of the study emphasized the need for interdisciplinary cooperation between nursing and dental professionals for the development of an oral health curriculum for nurses to promote and improve oral health and prevent dental diseases in hospitalized patients and the community.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00517-8.

Impact of polypharmacy on oral health status in elderly patients admitted to the recovery and rehabilitation ward

AIM

The oral health status of elderly adults has implications for general health problems. Polypharmacy for elderly adults is associated with an increased risk of potentially inappropriate medicines and many adverse drug events; however, no report has shown that polypharmacy itself is associated with complex oral problems. This study aimed to determine the association between polypharmacy and oral health status in patients admitted to the recovery and rehabilitation ward.

METHODS

This cross-sectional study included 471 patients (age: 81.9 ± 7.7 years, women: n = 346). Oral health status was measured using the Oral Health Assessment Tool and poor oral health status was defined as a score of ≥3. Cases of patients taking six or more medications were defined as polypharmacy. Logistic regression analysis was performed to examine the relationship between polypharmacy and oral health status. Age, sex, body mass index, number of comorbidities, cognitive and motor functions, and potentially inappropriate medicines were set as confounding factors.

RESULTS

Using the Oral Health Assessment Tool, 51.0% (n = 240) of patients scored ≥3. The prevalence of patients with polypharmacy was 56.9% (n = 268). Polypharmacy was significantly associated with poor oral health status (odds ratio = 1.65, 95% confidence interval = 1.14-2.39, P = 0.007; adjusted odds ratio = 1.65, 95% confidence interval = 1.12-2.43, P = 0.011).

CONCLUSIONS

This study showed that polypharmacy was associated with poor oral health status. Focusing on the number of medications may be helpful in detecting oral problems. Geriatr Gerontol Int 2021; 21: 66-70.

Frequent and personalized nutritional support leads to improved nutritional status, activities of daily living, and dysphagia after stroke

OBJECTIVES

Evidence for appropriate nutritional assessment, energy prediction, and adaptation and their effect on outcomes after stroke is scarce. We sought to determine the frequency of individualized dietary prescriptions issued for individuals undergoing rehabilitation after stroke and to analyze the effect of diet-prescription frequency on outcomes after stroke.

METHODS

This single-center prospective cohort study included poststroke patients newly admitted to convalescent rehabilitation wards. The frequency and content of dietary prescriptions issued as part of nutritional assessments were examined. Study outcomes were nutritional status assessed using changes in skeletal muscle mass, physical function assessed using the Functional Independence Measure motor score, dysphagia status assessed using the Food Intake LEVEL Scale (score < 7), and length of hospital stay. Multivariate analyses were performed to determine whether the frequency of dietary prescriptions issued during hospitalization was independently associated with outcomes of interest, after adjusting for potential confounders.

RESULTS

A total of 454 participants (mean age = 71.8 y; 53.1% men, 46.9% women) were included in the final analysis data set. A median of five (range, 2-11) dietary prescriptions were issued per participant during the median 96 d of hospitalization, with the most common items being diet-texture modification for dysphagia and oral energy/protein enhancement. In multivariate analyses, the frequency of dietary prescriptions was independently associated with the change in skeletal muscle mass (β = 0.165, P = 0.028), Functional Independence Measure motor scores at discharge (β = 0.104, P = 0.045), length of stay (β = -0.056, P = 0.019), and presence of dysphagia at discharge (odds ratio = 0.949, P = 0.032).

CONCLUSIONS

Frequent and individualized nutritional support is associated with improved nutritional status, physical function, and dysphagia after stroke. Intensive nutritional support through multidisciplinary discussion plays a central role in the prevention and management of malnutrition to maximize the improvement of patient outcomes. This study is the first to report this association.

Hemoglobin Improvement is Positively Associated with Functional Outcomes in Stroke Patients with Anemia

OBJECTIVES

The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke.

METHODS

This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders.

RESULTS

Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (β = 0.114, p = 0.031), and negatively associated with length of stay (β = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (β = 0.267, p = 0.001).

CONCLUSIONS

A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.

Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

PURPOSE

Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality.

METHODS

Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed.

RESULTS

62 out of 1717 references were eligible for inclusion. Pooled prevalence [95% confidence interval (CI)] of malnutrition and risk of malnutrition were 13 (5-20) % and 47 (40-54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2-24.5) kg/m². Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40-76% in this population.

CONCLUSIONS

Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.

Oral Management in Rehabilitation Medicine: Oral Frailty, Oral Sarcopenia, and Hospital-Associated Oral Problems

Oral health is a crucial but often neglected aspect of rehabilitation medicine. Approximately 71% of hospitalized rehabilitation patients and 91% of hospitalized acute care patients have impaired oral health. Poor oral condition in hospitalized patients can be attributed to factors such as age, physical dependency, cognitive decline, malnutrition, low skeletal muscle mass and strength, and multimorbidity. Another major factor is a lack of knowledge and interest in oral problems among health care workers. Recently, new concepts have been proposed, such as oral frailty, oral sarcopenia, and hospital-associated oral problems. Oral frailty, the accumulation of a slightly poor status of oral conditions and function, strongly predicts physical frailty, dysphagia, malnutrition, need for long-term care, and mortality in community-dwelling older adults. Oral sarcopenia refers to sarcopenia associated with oral conditions and function, although its definition has not yet been fully discussed. Hospital-associated oral problems are caused by disease, disease treatment, surgery, endotracheal intubation, poor self-care abilities, lack of care by medical staff, drugs, and iatrogenic factors during hospitalization. Furthermore, oral problems have negative impacts on rehabilitation outcomes, which include functional recovery, length of hospital stay, discharge home, and in-hospital mortality. Oral health management provided by dental hygienists improves not only oral status and function, swallowing function, and nutritional status but also activities of daily living, discharge home, and in-hospital mortality in post-acute rehabilitation. Oral rehabilitation, promotion, education, and medical-dental collaboration can be effective interventions for oral problems and therefore are necessary to improve rehabilitation outcomes.

Assignment of Dental Hygienists Improves Outcomes in Japanese Rehabilitation Wards: A Retrospective Cohort Study

OBJECTIVES

To clarify the effectiveness of ward-assigned dental hygienists (DHs) on rehabilitation outcomes in rehabilitation wards.

DESIGN

Retrospective cohort study.

SETTING

The registry data from the Japanese Rehabilitation Nutrition Database.

PARTICIPANTS

656 patients with hip fracture or stroke admitted to convalescent rehabilitation wards.

MEASUREMENTS

The main outcome measures were the Functional Independence Measure (FIM), the Food Intake Level Scale (FILS), and the home discharge rate. Patients were divided into two groups based on the ward setting: with an assigned DH (DH group) and without an assigned DH (NDH group). Clinical characteristics and outcomes were compered between the groups. Between-facility differences were adjusted by generalized estimating equation. We performed post-hoc power analysis to confirm that there were enough samples included in this study to detect a significant difference.

RESULTS

Of 656 patients (mean age, 77 years; 57.1% female; 65.5% stroke) from 10 facilities, 454 patients (69.2%) from 4 facilities were in the DH group. FIM score at discharge (107 vs 90, P<0.001), percentage improvement in FILS score from admission to discharge (44.5% vs 22.8%, P<0.001) and home discharge rate (72.5% vs 61.4%, P<0.001) were significantly higher in the DH group than in the NDH group. After multivariate analysis, the FIM score at discharge (P=0.007), FILS score at discharge (P=0.024), and home discharge rate (P=0.007) were significantly higher in the DH group than in the NDH group.

CONCLUSIONS

ADL and swallowing function were significantly improved at discharge and the home discharge rate was higher among patients in rehabilitation wards with DHs. Having a ward-assigned DH may lead to better rehabilitation outcomes in rehabilitation wards.

Occlusal support is associated with nutritional improvement and recovery of physical function in patients recovering from hip fracture

OBJECTIVE

This study aimed to elucidate the association between occlusal support and nutritional improvement and recovery of activities of daily living (ADLs) among elderly patients recovering from hip fracture.

BACKGROUND

Many patients with hip fracture are malnourished, and malnutrition is associated with poor functional outcomes. Poor oral status is one reason for malnutrition because loss of occlusal support leads to masticatory disorders and can cause nutrient deficiencies.

METHODS

We evaluated 202 elderly patients aged 65 years and older (mean age, 84.9 ± 7.9 years). We assessed nutritional status using the Mini Nutritional Assessment-Short Form and ADLs using functional independence measure (FIM) scores. Occlusal support was recorded in accordance with the Eichner Index. We categorised participants into two groups according to the presence or absence of occlusal support, and statistical analyses were performed to investigate the differences between the groups.

RESULTS

One group contained 152 participants (mean age, 85.5 ± 7.4 years) with occlusal support, and the other group contained 50 participants (mean age, 83.0 ± 8.9 years) without occlusal support. The group with occlusal support had greater gain of FIM and higher FIM efficiency than did the other group. Multivariate analyses showed that occlusal support was independently associated with nutritional improvement [odds ratio (OR) = 4.00, 95% confidence intervals (CI) = 1.90-8.43] and motor FIM efficiency (R²  = .338, P < .001).

CONCLUSIONS

Our findings suggest that occlusal support is associated with nutritional improvement and the recovery of ADLs in patients recovering from hip fracture.

Survey on Nursing Home Caregivers' Basic Knowledge of Oral Health Management: Dental Terminology

With the increasing numbers of the elderly requiring care in Japan, the management of their oral health care will require cooperation between medical and dental professionals, and we need to transfer dental knowledge from dental professionals to caregivers. With the help of a questionnaire, we examined 181 caregivers' depth of understanding regarding 20 typical dental terms with a view to improving the educational instruction provided to them. It was found that except for "clasp", popular dental terms have largely been accepted. The differences in their degrees of understanding could be owing to the lack of systematic education for caregivers.

Systemic Inflammation in the Recovery Stage of Stroke: Its Association with Sarcopenia and Poor Functional Rehabilitation Outcomes

Objective

The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke.

Methods

A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge.

Results

The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=-0.131, P=0.031).

Conclusion

Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.