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Inayama M, Goto T, Kokabu S, Okubo M. Weaning from Tube Feeding Post Stroke by Eating, Swallowing, and Nutritional Support In-Home: A Case Report. Home Healthc Now 2023; 41:221-225. [PMID: 37417574 DOI: 10.1097/nhh.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
In many cases, enteral tube feeding is begun after stroke without adequate assessment of feeding ability, swallowing function, and nutritional status. A 72-year-old man was recovering at home after a stroke and consulted us because he wanted to resume taking food by mouth. He had tube feeding for 13 months after the stroke. We offered him feeding and swallowing training and proper nutrition guidance by visiting dental staff and managerial dietitians at home and concluded the patient was sufficiently able to take oral food. After 4 months, the patient was completely weaned from tube feeding.
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Otsubo H, Okita I, Suzuki M, Nakanishi S, Asai H, Inaoka PT. The Kuchi-kara Taberu index as a predictive marker of oral intake recovery in patients with aspiration pneumonia. Geriatr Gerontol Int 2023; 23:221-226. [PMID: 36748651 DOI: 10.1111/ggi.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
AIM In recent years, the Kuchi-kara Taberu (KT) index has been used as a new tool for the evaluation of dysphagia; however, its predictive ability remains unknown. This study was conducted to examine the validity of oral intake recovery prediction using the KT index in patients with aspiration pneumonia. METHODS The subjects were older inpatients admitted to an acute-care hospital for the treatment of aspiration pneumonia. A logistic regression analysis was conducted to clarify factors significantly associated with oral intake recovery. In addition, cut-off values of the predictors were calculated using a receiver operating characteristic curve analysis with the area under the curve (P < 0.05). RESULTS A total of 124 patients (mean age 84.3 ± 7.9 years old, 70 males, 54 females) were enrolled in this study and divided into two groups at discharge: the oral intake group (62.1%) and the non-oral intake group (37.9%). The significant predictors of the recovery of oral intake were the pre-treatment period, treatment period, and the total score of the KT index; the respective odds ratios were 1.082 (95% confidence interval [CI] 1.013-1.156), 1.018 (1.003-1.033) and 0.850 (0.780-0.927), and the respective areas under the curve were 0.407 (95% CI 0.300-0.515), 0.304 (0.208-0.399), and 0.732 (0.640-0.824). The cut-off value of the total score of the KT index was 30. The model showed 85.7% sensitivity and 57.4% specificity. CONCLUSION The KT index is suggested to be a valid variable for predicting whether or not a patient with aspiration pneumonia can recover their oral intake ability during acute-care hospitalization. Geriatr Gerontol Int 2023; 23: 221-226.
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Affiliation(s)
- Hisanori Otsubo
- Department of Rehabilitation, Kanazawa City Hospital, Kanazawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Ikumi Okita
- Department of Rehabilitation, Kanazawa City Hospital, Kanazawa, Japan
| | - Madoka Suzuki
- Department of Rehabilitation, Kanazawa City Hospital, Kanazawa, Japan
| | - Sayaka Nakanishi
- Department of Otorhinolaryngology, Kanazawa City Hospital, Kanazawa, Japan
| | - Hitoshi Asai
- Department of Physical Therapy, Graduate Course of Rehabilitation Science School of Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Pleiades T Inaoka
- Department of Physical Therapy, Graduate Course of Rehabilitation Science School of Health Sciences, Kanazawa University, Kanazawa, Japan
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Hansen T, Rasmussen SAF, Fabricius J, Grove LMD, Simpelaere I. Measuring mealtime performance in older adults with suspected oropharyngeal dysphagia: an updated systematic review of psychometric properties. Disabil Rehabil 2023:1-15. [PMID: 36790118 DOI: 10.1080/09638288.2023.2178033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD). MATERIALS AND METHODS Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN). RESULTS Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five. CONCLUSIONS There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted.Implication for rehabilitationAssessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information.Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable.Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments.Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD.
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Affiliation(s)
- Tina Hansen
- Department of Occupational and Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Sophia Alberte Fisker Rasmussen
- Department of Occupational and Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Fabricius
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Linda-Maria Delgado Grove
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Ingeborg Simpelaere
- Department of Paramedical Professions, VIVES University of Applied Sciences, University of Louvain, Brugge, Louvain-la-Neuve, Belgium
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Notomi S, Kitamura M, Horita N, Yamaguchi K, Harada T, Nishino T, Funakoshi S, Abe Y. Importance of feeding status evaluation in older patients undergoing hemodialysis. PLoS One 2023; 18:e0279199. [PMID: 36595498 PMCID: PMC9810173 DOI: 10.1371/journal.pone.0279199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023] Open
Abstract
Older hospitalized patients undergoing hemodialysis are increasingly experiencing malnutrition caused by dysphagia. However, only a few studies have focused on this problem. We used the Kuchikara Taberu Balance Chart (KTBC) to evaluate the patients' feeding status and examined its association with their nutritional status and prognosis. This study included elderly patients undergoing hemodialysis who were hospitalized at Nagasaki Renal Center for > 3 days between June 2021 and February 2022. In total, 82 inpatients were included [mean age, 73.4 ± 10.0 years; men, 57.3%; median dialysis vintage, 79.0 months (interquartile range, 37.3-164.8)]. We classified patients with lower than the median KTBC score (57 points) as being at risk for dysphagia; 37 patients (45.1%) were at risk for dysphagia. Spearman's rank correlation coefficient (ρ) elucidated that the KTBC total score was significantly associated with each nutritional indicator [serum albumin level (ρ = 0.505, p < 0.001); geriatric nutritional risk index (ρ = 0.600, p < 0.001); and nutritional risk index (ρ = -0.566, p < 0.001)]. The KTBC score was also closely associated with the body mass index (ρ = 0.228, p = 0.04). Patients with a lower KTBC score showed poor prognosis (log-rank test: p = 0.001), and age- and sex-adjusted Cox proportional analysis showed that the KTBC score was associated with life prognosis (hazard ratio, 0.90; 95% confidential interval, 0.86-0.94; p < 0.001). Therefore, we concluded that the patients at risk of dysphagia, identified using the KTBC score, were malnourished and had a poor prognosis. Hence, the evaluation of dysphagia using the KTBC is encouraged to prevent malnutrition in vulnerable older patients undergoing hemodialysis.
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Affiliation(s)
| | - Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
- * E-mail:
| | - Noriko Horita
- Nishikyushu University Graduate School of Human Care Sciences, Saga, Japan
| | - Kosei Yamaguchi
- Nagasaki Renal Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Tomoya Nishino
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Yasuyo Abe
- Nishikyushu University Graduate School of Human Care Sciences, Saga, Japan
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Hidaka Y, Watanabe S, Nishikawa Y, Irie I. A Comprehensive Oral Intake Evaluation Tool (the Kuchi-kara Taberu Index) Facilitated Functional Eating Rehabilitation: A Case Report in a Frail Older Patient with Malnutrition and Suspected Iatrogenic Sarcopenia. Gerontol Geriatr Med 2022; 8:23337214221090284. [PMID: 35434205 PMCID: PMC9008842 DOI: 10.1177/23337214221090284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/15/2022] Open
Abstract
Frail older hospital patients are susceptible to malnutrition and iatrogenic sarcopenia. This can be linked to the decreased appetite and oral intake that can arise in largely bed-bound patients who do not get up even for rehabilitation and meals. The KT index was devised as an easy-to-use evaluation tool to address oral intake issues, and it has potential utility for expediting a multidisciplinary comprehensive rehabilitation program. To our knowledge, no reports have described real-world evidence on multidisciplinary team interventions with this tool. Herein, we report the case of a frail older patient whose oral intake improved following a KT Index-based intervention.
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Affiliation(s)
- Yoshifumi Hidaka
- Department of Surgery, Tanegashima Medical Center, Nishinoomote, Japan
| | - Satomi Watanabe
- Department of Nutrition, Tanegashima Medical Center, Nishinoomote, Japan
| | - Yumiko Nishikawa
- Department of Nursing, Tanegashima Medical Center, Nishinoomote, Japan
| | - Iroha Irie
- Department of Rehabilitation, Tanegashima Medical Center, Nishinoomote, Japan
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Undernutrition at Admission Suppresses Post-Stroke Recovery of Trunk Function. J Stroke Cerebrovasc Dis 2022; 31:106354. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022] Open
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Shimizu A, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Kayashita J, Fujishima I. Sarcopenic Dysphagia with Low Tongue Pressure Is Associated with Worsening of Swallowing, Nutritional Status, and Activities of Daily Living. J Nutr Health Aging 2021; 25:883-888. [PMID: 34409966 DOI: 10.1007/s12603-021-1641-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES According to the recently proposed diagnostic criteria for sarcopenic dysphagia, sarcopenic dysphagia can be classified as probable or possible based on tongue pressure. However, it is unclear whether patients with probable and possible sarcopenic dysphagia have different characteristics. Therefore, this study aimed to investigate whether patients with possible and probable sarcopenic dysphagia have different clinical characteristics. DESIGN A cross-sectional study. SETTING A rehabilitation hospital. PARTICIPANTS In total, 129 patients aged ≥65 years with sarcopenic dysphagia were included. METHODS A tongue pressure of <20 kPa was indicative of probable sarcopenic dysphagia, and a tongue pressure of ≥20 kPa was indicative of possible sarcopenic dysphagia. Kuchi-Kara Taberu (KT) index scores were compared between the probable or possible sarcopenic dysphagia groups. RESULTS According to the tongue pressure, 76 and 53 patients were classified into the probable and possible sarcopenic dysphagia groups, respectively. In multiple linear regression analysis, the presence of probable sarcopenic dysphagia was independently associated with the total KT index score (standardized coefficient: -0.313, regression coefficient: -4.500, 95% confidence interval [CI], -6.920 to -2.080, P < 0.001). The presence of probable sarcopenic dysphagia was independently associated with some subitems of the KT index (willingness to eat, cognitive function while eating, oral preparatory and propulsive phase, severity of pharyngeal dysphagia, eating behavior, and daily living activities). CONCLUSIONS Patients with probable sarcopenic dysphagia were characterized by poor overall eating-related conditions, especially poor swallowing ability, ability to perform activities of daily living, and nutritional status.
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Affiliation(s)
- A Shimizu
- Keisuke Maeda, M.D., Ph.D., Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan, Phone: +81-562-46-2311; Fax: +81-562-44-8518, E-mail:
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Yoshimi K, Nakagawa K, Hara K, Yamaguchi K, Nakane A, Kubota K, Furuya J, Tohara H. Relationship between tongue pressure and back muscle strength in healthy elderly individuals. Aging Clin Exp Res 2020; 32:2549-2555. [PMID: 32006384 DOI: 10.1007/s40520-020-01484-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Aging is associated with a decrease in muscle mass and strength in swallowing muscles, as well as in whole-body muscles. A decrease in tongue pressure (TP) is related with whole-body function, and the trunk, including abdominal and back muscles, forms the core of the body. However, the direct relationship between TP and trunk muscle strength remains unclear. AIMS To clarify the association between back muscle strength, an indicator of trunk muscle strength, and TP in healthy elderly individuals. METHODS In all, 112 healthy community-dwelling individuals aged ≥ 60 years (men: 35, median age 74.0; women: 77, median age 69.0) were included. Body mass index (BMI), TP, and back muscle strength (BMS) were measured. Tooth loss pattern was evaluated by the Eichner classification. Participants were divided into two groups based on the median of the BMS and classified into three groups based on the Eichner index (Eichner A, B, and C). The effects of BMS and occlusal support on TP were analyzed. RESULTS In the low BMS group, there was a significant difference in TP between the Eichner B and Eichner C (p = 0.017) groups. However, in the high BMS group, occlusal support did not affect TP. Moreover, the explanatory factors for TP were BMS (β = 0.373, p = 0.001) and the Eichner index (β = 0.190, p = 0.036). CONCLUSIONS TP was correlated more with BMS than aging and occlusal support in healthy elderly individuals. This study indicated that the clinical evaluation of the whole body is important when assessing oral and swallowing function.
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Tonosaki K, Yonenaga K, Ono S, Itai S, Oyama S, Mizuno T, Watanabe R, Hoshi K. Swallowing evaluation by the Kuchikara Taberu Balance Chart and videoendscopic examination reveals that respiratory conditions, chewing, and position are strongly related to dysphagia. Odontology 2020; 109:448-452. [PMID: 33108554 DOI: 10.1007/s10266-020-00561-5] [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: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
This study focused on the Kuchikara Taberu Balance Chart (KTBC) as a tool for swallowing function evaluation. To clarify the relationship between videoendoscopic (VE) examination of swallowing function and the KTBC, we compared median KTBC scores with and without laryngeal penetration identified by VE. Sixty-five patients with a mean age of 84.3 ± 7.9 years were examined at the Towada City Hospital. The patients were classified into groups based on laryngeal penetration, including 28 patients with and 37 patients without penetration. We found no significant differences in patient backgrounds. The median KTBC score (interquartile range) was 36.5 (31-44.5) in the group with laryngeal penetration and 42 (35-48.5) in the group without penetration, but the scores were not significantly different (level of statistical significance at α = 0.0036 determined by the Bonferroni correction method) when compared with the Mann-Whitney U test (36.5 vs. 42, z = -2.33, p = 0.020). The median respiratory condition (3 vs. 4, z = - 3.23; p < 0.0036), oral preparatory and propulsive phases (3 vs. 4, z = - 2.96; p < 0.0036), and position and endurance (1 vs. 3, z = - 3.25; p < 0.0036) scores were significantly lower in the group with laryngeal penetration. This study revealed a correlation between laryngeal penetration confirmed by VE and KTBC scores. Consequently, respiratory condition, oral preparatory and propulsive phases, and position and endurance may be useful as tools for the assessment of swallowing. In particular, we recommend adding respiratory status to dysphagia screening.
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Affiliation(s)
- Kanata Tonosaki
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of General Medicine, Towada City Hospital, Aomori, Japan
| | - Kazumichi Yonenaga
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of General Medicine, Towada City Hospital, Aomori, Japan.
| | - Sachiko Ono
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunsuke Itai
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeto Oyama
- Department of General Medicine, Towada City Hospital, Aomori, Japan
| | - Takashi Mizuno
- Department of General Medicine, Towada City Hospital, Aomori, Japan
| | - Rinji Watanabe
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuto Hoshi
- Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Shamoto H, Koyama T, Momosaki R, Maeda K, Wakabayashi H. The effects of promoting oral intake using the Kuchi-kara Taberu index, a comprehensive feeding assistant tool, in older pneumonia patients: a cluster randomized controlled trial. BMC Geriatr 2020; 20:36. [PMID: 32005104 PMCID: PMC6995043 DOI: 10.1186/s12877-020-1447-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background The multidisciplinary comprehensive care (MDCC) program promotes the improvement of oral intake for older patients. The Kuchi-kara Taberu (ingesting orally in Japanese, KT) index was developed to objectively assess patient conditions in the MDCC program. This trial examined the effects of the index in promoting oral intake in older patients with pneumonia. Methods A cluster randomized controlled trial was conducted in 10 local hospitals targeting older patients with pneumonia (≥65 years). Ten hospitals were allocated randomly to either the intervention or the control group. Both groups (each with five hospitals) received the MDCC program for oral feeding, which consisted of professional assessment, care, and treatment. The KT index was used by the intervention group, focusing on improving low score items. The primary outcome was determined using the Functional Oral Intake Scale (FOIS) at discharge or 1 month after admission. Results One hundred and twelve patients (46 women and 66 men) who participated from 10 hospitals, with a median age of 88 years (interquartile range [IQR], 80–91), were examined. The median FOIS level and the number of patients with oral intake (FOIS ≥ level 4) at discharge were 4 (IQR, 4–6) and 89 (79.5%), respectively. The duration of nil per os was 2 (IQR, 1–5) days. Clusters were not matched in the presence of Kuchi-kara Taberu Shiawase-wo Mamoru-kai-certified medical staff promoting oral intake in patients with dysphagia in each hospital. The median FOIS levels of 53 patients in the intervention group and 59 patients in the control group were 5 (IQR, 4–6) and 4 (IQR, 4–5), respectively, showing no statistically significant difference (P = 0.76). According to a multivariate analysis, the KT index had no positive effect on FOIS levels. Conclusions This trial was not able to demonstrate the usefulness of the KT index due to random assignment failure. However, both the intervention and control groups showed a high prevalence of oral intake (FOIS ≥ level 4) at discharge. Trial registration UMIN-Clinical Trial Registry, UMIN000025172, December 17, 2016.
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Affiliation(s)
- Hiroshi Shamoto
- Department of Geriatric Internal Medicine, Takano Hospital, 214 Higashi-machi, shimokitaba, Hirono-machi, Futaba-County, Fukushima, 960-0402, Japan. .,Department of Disaster and Comprehensive Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Tamami Koyama
- Chairman, Kuchi-kara Taberu Shiawase-wo Mamoru-kai (KTSM, an incorporated nonprofit organization), 509, 722-1,Ishida, Isehara City, Kanagawa, 259-1116, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama City, Kanagawa, 232-0024, Japan
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Waza M, Maeda K, Katsuragawa C, Sugita A, Tanaka R, Ohtsuka A, Matsui T, Kitagawa K, Kishimoto T, Fukui H, Kawai K, Yamamoto M, Isono M. Comprehensive Tool to Assess Oral Feeding Support for Functional Recovery in Post-acute Rehabilitation. J Am Med Dir Assoc 2019; 20:426-431. [DOI: 10.1016/j.jamda.2018.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 01/07/2023]
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Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:103. [PMID: 30922363 PMCID: PMC6438038 DOI: 10.1186/s13054-019-2400-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centered clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed, the underlying exact mechanisms in ICU patients remain incompletely understood and no current consensus exists on how to best approach ICU patients at risk.From a clinical perspective, dysphagia is well-known to be associated with an increased risk of aspiration and aspiration-induced pneumonia, delayed resumption of oral intake/malnutrition, decreased quality of life, prolonged ICU and hospital length of stay, and increased morbidity and mortality. Moreover, the economic burden on public health care systems is high.In light of high mortality rates associated with the presence of dysphagia and the observation that dysphagia is not systematically screened for on most ICUs, this review describes epidemiology, terminology, and potential mechanisms of dysphagia on the ICU. Furthermore, the impact of dysphagia on affected individuals, health care systems, and society is discussed in addition to current and future potential therapeutic approaches.
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Affiliation(s)
- Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland.
| | - Céline S Moret
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
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Comprehensive Geriatric Assessment and Nutrition-Related Assessment: A Cross-Sectional Survey for Health Professionals. Geriatrics (Basel) 2019; 4:geriatrics4010023. [PMID: 31023991 PMCID: PMC6473726 DOI: 10.3390/geriatrics4010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 01/06/2023] Open
Abstract
(1) Background: It is important to assess physical and nutritional status using the Comprehensive Geriatric Assessment (CGA). However, the correlation between the CGA usage and nutritional-related assessments remain unclear. This study aims to clarify the correlation between the CGA usage and other nutritional-related assessments. (2) Methods: We conducted a questionnaire survey on clinical use of CGA, assessment of sarcopenia/sarcopenic dysphagia/cachexia, and defining nutritional goals/the Nutrition Care Process/the International Classification of Functioning, Disability, and Health (ICF)/the Kuchi–Kara Taberu Index. (3) Results: The number of respondents was 652 (response rate, 12.0%), including 77 who used the CGA in the general practice. The univariate analyses revealed that participants using the CGA tended to assess sarcopenia (P = 0.029), sarcopenic dysphagia (P = 0.001), and define nutritional goals (P < 0.001). Multivariate logistic regression analyses for the CGA usage revealed that using ICF (P < 0.001), assessing sarcopenia (P = 0.001), sarcopenic dysphagia (P = 0.022), and cachexia (P = 0.039), and defining nutritional goals (P = 0.001) were statistically significant after adjusting for confounders. (4) Conclusions: There are correlations between the use of CGA and evaluation of sarcopenia, sarcopenic dysphagia, and cachexia and nutritional goals.
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Perren A, Zürcher P, Schefold JC. Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia 2019; 34:475-486. [PMID: 30684017 DOI: 10.1007/s00455-019-09977-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness-related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.
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Affiliation(s)
- Andrea Perren
- Department of Physiotherapy, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Patrick Zürcher
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Nagano A, Nishioka S, Wakabayashi H. Rehabilitation Nutrition for Iatrogenic Sarcopenia and Sarcopenic Dysphagia. J Nutr Health Aging 2019; 23:256-265. [PMID: 30820514 DOI: 10.1007/s12603-018-1150-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sarcopenia is a very important issue in rehabilitation medicine and nutritional care. The prevalence of sarcopenia in older people is approximately 50% in the rehabilitation setting, and also approximately 15% of inpatients without sarcopenia upon admission developed sarcopenia during hospitalization. There is a concern that secondary sarcopenia may occur iatrogenically during hospitalization. Iatrogenic sarcopenia is defined as sarcopenia caused by the activities of medical staff including doctors, nurses, or other health care professionals in healthcare facilities. Iatrogenic sarcopenia is categorized into activity-related, nutrition-related and disease-related-iatrogenic sarcopenia. Especially in acute phase hospitals, concentrating on the treatment of diseases with less attention to nutrition and activity is more likely to cause iatrogenic sarcopenia. Sarcopenic dysphagia is also an important aspect in rehabilitation medicine and nutritional care. Sarcopenic dysphagia is characterized by swallowing difficulty because of a loss of mass and function in whole-body skeletal and swallowing muscles. Sarcopenic dysphagia can be diagnosed using a 5-step algorithm for the condition. Iatrogenic sarcopenia and sarcopenic dysphagia are affected by nutrition, activity and diseases in a complex manner. Therefore, treatment of iatrogenic sarcopenia and sarcopenic dysphagia requires comprehensive interventions through nutrition management and rehabilitation. Rehabilitation nutrition is effective for preventing and treating iatrogenic sarcopenia and sarcopenic dysphagia. Rehabilitation nutrition can be practiced more effectively and comprehensively by using the rehabilitation nutrition care process, which is a systematic problem-solving method. Further research is required to verify the efficacy of rehabilitation nutrition for preventing or improving iatrogenic sarcopenia and/or sarcopenic dysphagia.
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Affiliation(s)
- A Nagano
- Hidetaka Wakabayashi, Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami ward, Yokohama, Kanagawa, Japan, Tel: +81-45-261-5656 Fax: +81-45-253-9955, E-mail:
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Relationship between swallowing muscles and trunk muscle mass in healthy elderly individuals: A cross-sectional study. Arch Gerontol Geriatr 2018; 79:21-26. [DOI: 10.1016/j.archger.2018.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 01/27/2023]
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Maeda K, Koga T, Akagi J. Nutritional variables predict chances of returning home and activities of daily living in post-acute geriatric care. Clin Interv Aging 2018; 13:151-157. [PMID: 29416323 PMCID: PMC5790089 DOI: 10.2147/cia.s154129] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about the association between malnutrition and the chances of returning home from post-acute facilities in older adult patients. This study aimed to understand whether malnutrition and malnutrition-related factors would be determinants for returning home and activities of daily living (ADL) at discharge after post-acute care. Methods Patients aged ≥65 years living at home before the onset of an acute disease and admitted to a post-acute ward were enrolled (n=207) in this prospective observational study. Malnutrition was defined based on the criteria of the European Society for Clinical Nutrition and Metabolism. Nutritional parameters included the nutritional intake at the time of admission and oral conditions evaluated by the Oral Health Assessment Tool (OHAT). The Barthel Index was used to assess daily activities. A Cox regression analysis of the length of stay was performed. Multivariable linear regression analyses to determine associations between malnutrition, returning home, and ADL at discharge were performed, after adjusting the variables of acute care setting. Results The mean patient age was 84.7±6.7 years; 38% were men. European Society for Clinical Nutrition and Metabolism-defined malnutrition was observed in 129 (62.3%) patients, and 118 (57.0%) of all patients returned home. Multivariable regression analyses showed that malnutrition was a negative predictor of returning home (hazard ratio: 0.517 [0.351–0.761], p=0.001), and an increase in the nutritional intake (kcal/kg/d) was a positive predictor of the Barthel Index at discharge (coefficient: 0.34±0.15, p=0.021). The OHAT was not associated with returning home and ADL. Conclusion Malnutrition and nutritional intake are associated with returning home and ADL at discharge, respectively, after post-acute care. Further studies investigating the effects of a nutritional intervention for post-acute patients would be necessary.
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Affiliation(s)
- Keisuke Maeda
- Palliative Care Center, Aichi Medical University, Aichi, Japan.,Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto, Japan
| | - Takayuki Koga
- Department of Swallowing and Nutritional Therapy, Tamana Regional Health Medical Center, Kumamoto, Japan
| | - Junji Akagi
- Department of Surgery, Tamana Regional Health Medical Center, Kumamoto, Japan
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Maeda K, Koga T, Akagi J. Interferential current sensory stimulation, through the neck skin, improves airway defense and oral nutrition intake in patients with dysphagia: a double-blind randomized controlled trial. Clin Interv Aging 2017; 12:1879-1886. [PMID: 29158670 PMCID: PMC5683771 DOI: 10.2147/cia.s140746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Neuromuscular electrical stimulation with muscle contraction, administered through the skin of the neck, improves a patient’s swallowing ability. However, the beneficial effects of transcutaneous electrical sensory stimulation (TESS), without muscle contraction, are controversial. We investigated the effect of TESS, using interferential current, in patients undergoing dysphagia rehabilitation. Methods This double-blind, randomized controlled trial involved 43 patients who were prescribed in-hospital dysphagia rehabilitation for ≥3 weeks. Patients were randomly assigned to the sensory stimulation (SS) or sham groups; all received usual rehabilitative care plus 2 weeks of SS or sham intervention. Outcome measures included cough latency times against a 1% citric acid mist, functional oral intake scale (FOIS) scores, and oral nutritional intake – each determined after the second and third week following treatment initiation. Results Mean patient age was 84.3±7.5 years; 58% were women. The SS and sham groups had similar baseline characteristics. Changes in cough latency time at 2 weeks (−14.1±14.0 vs −5.2±14.2 s, p=0.047) and oral nutrition intake at 3 weeks (437±575 vs 138±315 kcal/day, p=0.042) improved more in the SS group than in the sham group. Changes in cough frequency and FOIS scores indicated better outcomes in the SS group, based on substantial effect sizes. Conclusion TESS, using interferential current through the neck, improved airway defense and nutrition in patients suffering from dysphagia. Further large-scale studies are needed to confirm the technique’s effect on swallowing ability.
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Affiliation(s)
- Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto.,Palliative Care Center, Aichi Medical University, Nagakute
| | | | - Junji Akagi
- Department of Surgery, Tamana Regional Health Medical Center, Tamana, Tamana City, Kumamoto, Japan
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Aruga Y, Saito A, Aoki Y. Nursing care using KT (Kuchi-kara Taberu) index radar chart enabling elderly patients with dysphagia to live like human beings after initiating gastrostomy feeding. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817740374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Some patients with severe dysphagia need to undergo percutaneous endoscopic gastrostomy (gastrostomy feeding), which improves nutrition but leads them to feel they are not living like human beings. The KT (Kuchi-kara Taberu, or ingesting orally in Japanese) index was developed in order to comprehensively assess and intervene in problems with eating and swallowing. We present three cases where the KT index improved quality of life after gastrostomy feeding. Through continued nursing care using the KT index, the patient in Case 1 was able to eat orally again; the patient in Case 2 could eat a piece of jelly and communicate a little; and the patient in Case 3 was able to ingest a small amount of food orally, with support from her husband. Thus, the feeding support provided by the KT index radar chart improves quality of life, even after the implementation of gastrostomy feeding. Further studies are needed to investigate how the KT index best helps elderly patients with severe dysphagia live like human beings while taking into account the perspectives of patients and their family members.
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Affiliation(s)
- Yumiko Aruga
- Ward E3 of Nursing Department, National Hospital Organization Matsumoto Medical Center Matsumoto Hospital, Japan
| | - Ayako Saito
- Department of Nutrition Management, National Hospital Organization Matsumoto Medical Center Matsumoto Hospital, Japan
| | - Yuji Aoki
- Department of Internal Medicine, National Hospital Organization Matsumoto Medical Center Matsumoto Hospital, Japan
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Maeda K, Wakabayashi H, Shamoto H, Akagi J. Cognitive impairment has no impact on hospital-associated dysphagia in aspiration pneumonia patients. Geriatr Gerontol Int 2017; 18:233-239. [DOI: 10.1111/ggi.13164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/23/2017] [Accepted: 07/18/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation; Tamana Regional Health Medical Center; Kumamoto Japan
- Department of Cancer Center; Aichi Medical University; Aichi Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Kanagawa Japan
| | - Hiroshi Shamoto
- Department of Neurosurgery; Minamisoma Municipal General Hospital; Fukushima Japan
| | - Junji Akagi
- Department of Surgery; Tamana Regional Health Medical Center; Kumamoto Japan
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