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Shiraishi R, Shiraishi N, Fujimoto Y, Ogawa T. Malnutrition suppresses improvements in depression symptoms in older adult patients with stroke undergoing convalescent rehabilitation. Clin Nutr ESPEN 2024; 63:508-514. [PMID: 39053700 DOI: 10.1016/j.clnesp.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/22/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND & AIMS Depression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation. METHODS This was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated. RESULTS The malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (β: -0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (β: -0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms. CONCLUSION Malnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.
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Affiliation(s)
- Ryo Shiraishi
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Clinical Research and Quality Management, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa 903-0215, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi 480-1103, Japan.
| | - Nami Shiraishi
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan.
| | - Yuta Fujimoto
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan.
| | - Takahiro Ogawa
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi 480-1103, Japan.
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Wu W, Guo Z, Gu Z, Mao Y, She C, Gu J, Lv B, Xu W, Li L. GLIM criteria represent a more suitable tool to evaluate the nutritional status and predict postoperative motor functional recovery of older patients with hip fracture: A retrospective study. Medicine (Baltimore) 2024; 103:e37128. [PMID: 38335434 PMCID: PMC10860930 DOI: 10.1097/md.0000000000037128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Early recognition of malnutrition is essential to improve the prognosis of older patients with hip fracture. The Nutritional Risk Screening 2002 (NRS-2002), the Short-Form Mini Nutritional Assessment (MNA-SF) and the Global Leadership Initiative on Malnutrition (GLIM) are widely used in malnutrition diagnosis. However, criteria for predicting postoperative hip joint motor function in older patients with hip fractures are still necessary. The objective of this study was to select the most appropriate criteria from the NRS-2002, the MNA-SF and the GLIM in predicting the postoperative hip joint motor function recovery 1 year after surgery. This retrospective observational study included 161 patients aged ≥ 65 years with hip fractures. The nutritional status of patients was determined by the NRS-2002, MNA-SF and GLIM. The Harris hip joint score (HHS), the primary outcome of this study, was used to evaluate hip joint motor function. HHS was classified as excellent (HHS > 75) or non-excellent outcomes (HHS ≤ 75). Logistic regression models for hip joint motor function recovery were constructed. Both the receiver operating characteristic curve and the decision curve analysis were used to select the most predictive criteria. The overall mean age of the 161 patients was 77.90 ± 8.17. As a result, NRS-2002 (OR:0.06, 95%CI [0.01, 0.17]), MNA-SF (OR:0.05, 95%CI [0.00, 0.23]) and GLIM (OR of moderate: 0.03, 95%CI [0.01, 0.11]; OR of severe: 0.02 [0.00, 0.07]) were predictive for recovery of hip joint motor function. Additionally, both the area under curve of the receiver operating characteristic curve (NRS-2002: 81.2 [73.8, 88.6], MNA-SF: 76.3 [68.5, 84.2], GLIM: 86.2 [79.6,92.8]) and the decision curve analysis showed the GLIM was better than others. Compared with NRS-2002 and MNA-SF, GLIM was a more suitable nutritional assessment criteria to predict the postoperative recovery of hip joint motor function for older patients with hip fracture 1 year after surgery.
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Affiliation(s)
- Weicheng Wu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhening Guo
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zenghui Gu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Gu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Lv
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
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Ninomiya S, Fujii W, Matsumoto E, Yamaguchi K, Hiratsuka M. Association between tongue pressure and oral status and activities of daily living in stroke patients admitted to a convalescent rehabilitation unit. Clin Exp Dent Res 2024; 10:e825. [PMID: 38037529 PMCID: PMC10860403 DOI: 10.1002/cre2.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Clarifying how tongue pressure in convalescent stroke patients affects oral condition and activities of daily living (ADL) is important for developing oral rehabilitation programs and for rehabilitation care to reacquire ADL. OBJECTIVE To clarify how tongue pressure is associated with oral status, ADL, and nutritional status in stroke patients. METHODS Sixty-eight patients aged 77.9 ± 10.0 years participated. The Japanese version of the Oral Health Assessment Tool was used to evaluate oral status. Data such as the ADL index functional independence measure (FIM), nutritional intake method, serum albumin, and body mass index were extracted from medical records. To examine factors associated with tongue pressure, multiple regression analysis was performed adjusting for confounding factors. The level of statistical significance was set at p < .05. RESULTS In recovery phase stroke patients, tongue pressure was significantly lower in the total assistance group than in the partial assistance/independent group. In addition, tongue pressure was significantly lower in tube feeding patients than in oral feeding patients. FIM cognition score was an independent factor that had a significant effect on tongue pressure. CONCLUSION These findings suggest that ADL status also affects tongue pressure, thus patients' ADL including the FIM cognition subscale should also be evaluated while measuring tongue pressure.
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Affiliation(s)
- Shizuka Ninomiya
- Division of DentistryFukuoka Rehabilitation HospitalFukuokaJapan
- Graduate School of Dentistry, Department of Oral Health SciencesKyushu Dental UniversityKitakyushuJapan
| | - Wataru Fujii
- Unit of Interdisciplinary Promotion, School of Oral Health Sciences, Faculty of DentistryKyushu Dental UniversityKitakyushuJapan
| | - Erika Matsumoto
- Graduate School of Dentistry, Department of Oral Health SciencesKyushu Dental UniversityKitakyushuJapan
| | | | - Masao Hiratsuka
- Division of DentistryFukuoka Rehabilitation HospitalFukuokaJapan
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Nishioka S, Kokura Y, Momosaki R, Taketani Y. Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review. Nutrients 2024; 16:223. [PMID: 38257116 PMCID: PMC10820477 DOI: 10.3390/nu16020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
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.
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, 4-11, Gin-yamachi, Nagasaki 850-0854, Japan
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
| | - Yoji Kokura
- Department of Nutrition Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, 15-39-8, Mugigaura, Anamizu, Hosu-gun 927-0023, Japan;
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Mie, Japan;
| | - Yutaka Taketani
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
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Moritoyo R, Nakagawa K, Yoshimi K, Yamaguchi K, Ishii M, Yanagida R, Namiki C, Tohara H. Relationship between the jaw-closing force and dietary form in older adults without occlusal support requiring nursing care. Sci Rep 2023; 13:22551. [PMID: 38110442 PMCID: PMC10728115 DOI: 10.1038/s41598-023-49059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
In clinical practice, we encounter cases wherein older adults lacking occlusal support consume foods requiring mastication and adequate swallowing function. This study investigated the relationship between jaw-closing force (JCF) and dietary form in older adults without occlusal support requiring nursing care. This prospective cross-sectional study included 123 older adults requiring nursing care who lost their molar occlusal support and consumed food orally without dentures. JCF was defined as the force required for crushing food with the edentulous ridges or with the tooth and edentulous ridge while closing the mouth. Participants were classified into four groups based on the International Dysphagia Diet Standardization Initiative framework for recommended dietary forms. Basic information was collected, and tongue pressure and JCF were measured. Differences in JCF were analyzed using one-way analysis of variance, while factors related to dietary form were evaluated using ordinal logistic regression analysis. Significant differences in JCF were observed among the four groups. Factors such as the Barthel Index, tongue pressure, and JCF were dietary form-related. Our findings suggest that older adults requiring nursing care tend to have higher JCF when consuming meals requiring mastication. Therefore, JCF could serve as an index for determining appropriate dietary forms in this population.
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Affiliation(s)
- Rieko Moritoyo
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kazuharu Nakagawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Kanako Yoshimi
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kohei Yamaguchi
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Miki Ishii
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Ryosuke Yanagida
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Chizuru Namiki
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Haruka Tohara
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Shimizu A, Ohno T, Fujishima I, Kayashita J, Momosaki R, Nishioka S, Wakabayashi H. Impact of Poor Oral Health Status on Swallowing Function Improvement in Older Dysphagic Patients. Cureus 2023; 15:e51249. [PMID: 38288242 PMCID: PMC10823192 DOI: 10.7759/cureus.51249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
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.
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Affiliation(s)
- Akio Shimizu
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, JPN
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, JPN
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, JPN
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, JPN
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Shinjuku-ku, JPN
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Yoshinaka S, Yamaguchi K, Yanagida R, Ishii M, Nakagawa K, Yoshimi K, Nakane A, Matsuyama Y, Aida J, Tohara H. Tongue Strength of Older Adults Requiring Long-Term Care Varies throughout the Day. Geriatrics (Basel) 2023; 8:107. [PMID: 37987467 PMCID: PMC10660863 DOI: 10.3390/geriatrics8060107] [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: 07/25/2023] [Revised: 10/05/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
Physical performance shows approximately 30% diurnal variation; however, diurnal variation in oral function remains unclear. This study aimed to determine the diurnal variation in oral and swallowing function in older adults requiring long-term care. The participants included 13 adults aged >60 years (3 men and 10 women, mean age: 77.2 ± 6.3 years, age range: 62-90 years) requiring long-term care. Tongue strength (TS) and oral mucosal moisture were measured as indices of oral and swallowing function, while hand grip strength was measured as an index of general muscle strength. The patients were asked to participate in a "test" after breakfast, lunch, and dinner on the same day. Multilevel linear regression analysis was used to examine diurnal differences in each item. Multilevel linear regression analysis with adjustment for age and sex revealed that TS was significantly higher at noon (p = 0.001) than in the morning. Therefore, caregivers who provide support during meals to older people requiring long-term care should consider the possibility of swallowing function differing according to the time of the day. In conclusion, it may be beneficial to establish a nutritional therapy that accounts for the diurnal variation in TS.
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Affiliation(s)
- Shin Yoshinaka
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Miki Ishii
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
| | - Yusuke Matsuyama
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (J.A.)
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (J.A.)
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (S.Y.); (R.Y.); (M.I.); (K.N.); (K.Y.); (A.N.); (H.T.)
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Kakehi S, Isono E, Wakabayashi H, Shioya M, Ninomiya J, Aoyama Y, Murai R, Sato Y, Takemura R, Mori A, Masumura K, Suzuki B. Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update. Ann Rehabil Med 2023; 47:337-347. [PMID: 37907225 PMCID: PMC10620494 DOI: 10.5535/arm.23101] [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: 07/25/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient's pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.
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Affiliation(s)
- Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Eri Isono
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Moeka Shioya
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Junki Ninomiya
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Yohei Aoyama
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Ryoko Murai
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Yuka Sato
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Ryohei Takemura
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Amami Mori
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Kei Masumura
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Bunta Suzuki
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
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Fukuma K, Kamada M, Yamamoto K, Yokota C, Abe S, Nakazawa S, Tanaka T, Chichikawa T, Nakaoku Y, Nishimura K, Koga M, Takaya S, Sugimoto K, Nishioka S, Wakabayashi H, Fujishima I, Ihara M. Pre-existing sarcopenia and swallowing outcomes in acute stroke patients. Clin Nutr 2023; 42:1454-1461. [PMID: 37451157 DOI: 10.1016/j.clnu.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND & AIMS This study aimed to investigate the associations of pre-existing sarcopenia with swallowing function, oral intake level, and aspiration pneumonia in patients with acute stroke. METHODS This observational study included patients (≥60 years of age) with acute ischemic stroke or intracerebral hemorrhage within 7 days of onset who were screened for sarcopenia, malnutrition, and swallowing difficulties in a stroke-care unit within 48 h of admission. Sarcopenia was defined by the Asian Working Group on Sarcopenia 2019 as having a low calf circumference, handgrip strength, and appendicular muscle mass index. The primary outcome was impaired oral intake (functional oral intake scale <5 points) at 3, 7, and 14 days after admission, and the secondary outcome was aspiration pneumonia during hospitalization. RESULTS We enrolled 350 patients (median age of 77 years; 63% males) who underwent the aforementioned screening. Sarcopenia was diagnosed in 34% of patients, and malnutrition was found in 66% of patients with sarcopenia. When compared with the comparison group (defined as patients with either or both normal calf circumference and handgrip strength), the sarcopenia group had significantly lower tongue pressure and a higher prevalence of dysphagia. Sarcopenia was associated with functional oral intake scale <5 at 7 days (adjusted odds ratio [OR], 4.72; 95% confidence interval [CI], 1.91-11.71); p = 0.002) and 14 days (adjusted OR, 3.93; 95% CI, 1.47-10.53; p = 0.006) and with aspiration pneumonia during hospitalization (adjusted OR, 6.12; 95% CI, 1.63-22.94; p = 0.007). CONCLUSION Acute stroke patients with sarcopenia may have weakness of the swallowing-related muscles which may lead to impaired oral intake and aspiration pneumonia.
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Affiliation(s)
- Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masatoshi Kamada
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular, Osaka, Japan
| | - Kazuya Yamamoto
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular, Osaka, Japan
| | - Chiaki Yokota
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular, Osaka, Japan
| | - Soichiro Abe
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shinsaku Nakazawa
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuro Chichikawa
- Department of Clinical Nutrition, National Cerebral and Cardiovascular, Osaka, Japan
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shigetoshi Takaya
- Department of Neurology and Rehabilitation Medicine, Senri Rehabilitation Hospital, Osaka, Japan
| | - Ken Sugimoto
- Department of General and Geriatric Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
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10
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Shimizu A, Maki H, Ohno T, Nomoto A, Fujishima I, Kayashita J, Momosaki R, Nishioka S, Wakabayashi H. Association of poor oral health status and faecal incontinence in patients with dysphagia: A cross-sectional analysis from the Sarcopenic Dysphagia Database. J Oral Rehabil 2023; 50:286-292. [PMID: 36609695 DOI: 10.1111/joor.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/08/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Poor oral health status may alter oral and gut microbiota. Previous studies have shown that poor oral health can exacerbate gut inflammation. Therefore, poor oral health status may be related to faecal incontinence via changes in the gut. OBJECTIVE To investigate the association between poor oral health status and faecal incontinence in inpatients with dysphagia. METHODS This multicentre cross-sectional study included 423 patients (mean age 79.8 ± 11.5 years, 48.2% female) with dysphagia. Oral health status was assessed at each facility using the Oral Health Assessment Tool (OHAT) or the Revised Oral Assessment Guide (ROAG). Poor oral health status was defined as an OHAT score of ≥3 or a ROAG score of ≥13. A multivariate logistic model was used to analyse the association between poor oral health status and faecal incontinence. RESULTS A total of 351 (83.0%) patients had poor oral health and 97 (22.7%) had faecal incontinence. Patients with poor oral health status had a higher proportion of faecal incontinence than those with normal oral health status (25.4% vs. 11.1%, p = .009). A multivariate logistic model revealed an association between faecal incontinence and poor oral health status (adjusted odds ratio = 2.501, 95% confidence interval = 1.065-5.873, p = .035). CONCLUSIONS Poor oral health status assessed by OHAT or ROAG in inpatients with dysphagia may adversely affect faecal incontinence. Further studies are needed to determine the causal relationship between poor oral health status and faecal incontinence.
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Affiliation(s)
- Akio Shimizu
- Department of Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Hiroki Maki
- Department of Pharmacy, Kofu Municipal Hospital, Kofu, Yamanashi, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
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11
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Effects of Undernutrition on Swallowing Function and Activities of Daily Living in Hospitalized Patients: Data from the Japanese Sarcopenic Dysphagia Database. Nutrients 2023; 15:nu15051291. [PMID: 36904290 PMCID: PMC10005210 DOI: 10.3390/nu15051291] [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: 02/02/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
This retrospective cohort study examined the effects of undernutrition on swallowing function and activities of daily living in hospitalized patients. Data from the Japanese Sarcopenic Dysphagia Database were used, and hospitalized patients aged ≥20 years with dysphagia were included in the analysis. Participants were assigned to the undernutrition or normal nutritional status group based on the Global Leadership Initiative on Malnutrition criteria. The primary outcome was the Food Intake Level Scale change, and the secondary outcome was the Barthel Index change. Among 440 residents, 281 (64%) were classified under the undernutrition group. The undernutrition group had a significantly higher Food Intake Level Scale score at baseline and Food Intake Level Scale change (p = 0.001) than the normal nutritional status group. Undernutrition was independently associated with the Food Intake Level Scale change (B = -0.633, 95% confidence interval = -1.099 to -0.167) and the Barthel Index change (B = -8.414, 95% confidence interval = -13.089 to -3.739). This was defined as the period from the date of admission to the hospital until discharge or 3 months later. Overall, our findings indicate that undernutrition is associated with reduced improvement in swallowing function and the ability to perform activities of daily living.
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12
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Yanagida R, Hara K, Namiki C, Okumura T, Saiki A, Nakagawa K, Yamaguchi K, Yoshimi K, Nakane A, Mauclaire JM, Tohara H. Effects of tongue right positioner use on tongue pressure: a pilot study. Sci Rep 2023; 13:3289. [PMID: 36841869 PMCID: PMC9968309 DOI: 10.1038/s41598-023-30450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/23/2023] [Indexed: 02/27/2023] Open
Abstract
The effectiveness of the tongue right positioner (TRP) use on oral and swallowing functions remains unclear. To investigate the effects of TRP use on tongue function in patients with dysphagia. This interventional study included eight participants with dysphagia who visited a university dental hospital. The measurement variables included tongue pressure (TP) as the primary outcome and lip and tongue movements, peak nasal inspiratory flow, and changes in the tongue and suprahyoid muscle regions on ultrasonography as the secondary outcomes. Each participant was asked to use a TRP for at least 8 h every night for 2 months. The measurement variables before and after the intervention were compared using the paired t test and Wilcoxon signed-rank test. TP after intervention (31.5 ± 13.1 kPa) was significantly higher than that before intervention (23.0 ± 13.4 kPa), while other measurement variables did not significantly improve. Numerous exercises have been suggested to improve TP; however, most require patients' adherence to instructions. In contrast, although participants did not perform active exercises, most participants in this study observed an improved TP. Our findings show that TRP can greatly improve TP after 2 months of usage.Trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN000040253, date of first registration: 27/04/2020).
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Affiliation(s)
- Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Hara
- Department of Dentistry for the Special Patient, Kanagawa Dental University, 82 Inaokacho, Yokosuka, Kanagawa, 238-8580, Japan.
| | - Chizuru Namiki
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Dentistry for the Special Patient, Kanagawa Dental University, 82 Inaokacho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Takuma Okumura
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akino Saiki
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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13
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Yamaguchi K, Nakagawa K, Yoshimi K, Ariya C, Nakane A, Okumura T, Tohara H. Higher extracellular water/total body water ratio is associated with lower tongue and grip strength: a cross-sectional study. J Prosthodont Res 2022; 67:231-237. [PMID: 35732420 DOI: 10.2186/jpr.jpr_d_21_00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between tongue factors (tongue strength and tongue volume), systemic factors (grip strength and walking speed), and the extracellular water/total body water ratio. METHODS This cross-sectional study included community-dwelling adults. Body water composition and skeletal muscle mass index were measured using bioelectrical impedance analysis. Moreover, tongue grip strength, tongue volume, occlusal support condition (Eichner classification), and walking speed were measured. Multiple linear regression analysis was performed to investigate the relationship between the tongue and systemic factors as dependent variables and body water composition. RESULTS We included 171 community-dwelling adults (62 men and 109 women) aged 70.0 years (interquartile range: 8). Tongue strength (r=-0.22, p=0.004) and grip strength (r=-0.39, p<0.001) were correlated with the extracellular water/total body water ratio. In multiple linear regression analysis, tongue strength was associated with the extracellular water/total body water ratio (β=-0.20, p=0.034), and grip strength was associated with the extracellular water/total body water ratio (β=-0.12, p=0.047), sex, body mass index, skeletal muscle mass index, and occlusal support condition. CONCLUSIONS A higher extracellular water/total body water ratio indicates lower tongue and grip strength. Dentists and dental hygienists should be aware of systemic factors present in patients with lower tongue and grip strength. These findings may lead to further medical investigations and diagnosis of other systemic diseases.
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Affiliation(s)
- Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Chantaramanee Ariya
- Department of Preventive Dentistry, Naresuan University, 99 Moo 9, Phitsanulok-Nakhon Sawan Road, Tha Pho, Mueang Phitsanlok 65000, Thailand
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Takuma Okumura
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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14
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Effect of tongue strength on clinical outcomes of patients: A systematic review. Arch Gerontol Geriatr 2022; 102:104749. [PMID: 35724534 DOI: 10.1016/j.archger.2022.104749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Whether decreased tongue strength is associated with poor clinical outcomes is unclear. This systematic review investigated the effect of decreased tongue strength on the clinical outcomes of adults requiring medical treatment. DESIGN Systematic review. SETTING AND PARTICIPANTS Systematic reviews, randomized control trials, intervention studies, and longitudinal observational studies involving patients with decreased tongue strength requiring medical treatment were included. METHODS Articles published between January 2000 and June 2021 were retrieved from MEDLINE, CINAHL, Ichushi-web (in Japanese), Web of Science, ClinicalTrials.gov, UMIN, the Cochrane Library, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies. The study protocol was pre-registered in XXX. RESULTS After screening 3040 articles and excluding duplicates, 74 articles were retrieved; after full-text evaluation of the 74 articles, seven articles (with 787 patients) were found to meet the inclusion criteria. The cut-off values for determining decreased tongue strength ranged from 13.8 to 21.6 kPa. Patients with decreased tongue strength had poorer recovery of their swallowing function, higher incidence of pneumonia, and poorer life expectancy than those with high tongue strength. However, tongue strength in older patients with decreased tongue strength increased when they performed physical exercise interventions and followed strict nutritional management plans. CONCLUSIONS Decreased tongue strength was related to poor clinical outcomes in in- and outpatients. Oral frailty in older patients should be given increased attention in hospitals, and further research is needed to improve the clinical outcomes for older people with reduced tongue strength.
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15
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Kagaya H, Inamoto Y. Possible Rehabilitation Procedures to Treat Sarcopenic Dysphagia. Nutrients 2022; 14:778. [PMID: 35215427 PMCID: PMC8878994 DOI: 10.3390/nu14040778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
Sarcopenic dysphagia requires the presence of both dysphagia and generalized sarcopenia. The causes of dysphagia, except for sarcopenia, are excluded. The treatment for sarcopenic dysphagia includes resistance training along with nutritional support; however, whether rehabilitation procedures are useful remains unclear. In this narrative review, we present possible rehabilitation procedures as a resistance training for managing sarcopenic dysphagia, including Shaker exercise, Mendelsohn maneuver, tongue-hold swallow exercise, jaw-opening exercise, swallow resistance exercise, lingual exercise, expiratory muscle strength training, neuromuscular electrical stimulation, and repetitive peripheral magnetic stimulation. We hope that some procedures mentioned in this article or new methods will be effective to treat sarcopenic dysphagia.
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Affiliation(s)
- Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake 470-1192, Japan;
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16
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Taguchi K, Wakabayashi H, Fujimoto M, Obayashi S, Yamamoto M, Nishioka S, Momosaki R. Association between Malnutrition Severity and Swallowing Function in Convalescent Rehabilitation Wards: A Multi-Center Cohort Study in Malnourished Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:469-476. [PMID: 35587759 DOI: 10.1007/s12603-022-1782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the characteristics of sarcopenic dysphagia (SD) and the prognosis of swallowing function in convalescent rehabilitation hospital patients; and to investigate the association between malnutrition severity and SD. DESIGN A prospective, multi-center, cohort study. SETTING We extracted registry data from the Japanese Sarcopenic Dysphagia Database, focusing on patients admitted to convalescent rehabilitation hospitals. PARTICIPANTS A total of 207 participants were recruited and stratified according to the presence or absence of SD. Next, the participants were divided into groups based on nutrition status using the Global Leadership Initiative on Malnutrition criteria: normal nutrition, moderate malnutrition, and severe malnutrition. We also compared the outcomes between patients with SD (SD group) and those without SD (no-SD group) according to malnutrition status. MEASUREMENTS The Food Intake LEVEL Scale (FILS) score was the outcome measure. Higher scores on the FILS indicate better swallowing function. We compared the patient characteristics between the SD and non-SD groups among all patients and then according to the severity of malnutrition. RESULTS A total of 207 patients were recruited. 11 were diagnosed with normal nutrition, 72 with moderate malnutrition, and 124 with severe malnutrition. There were 128 participants with SD and 79 participants without SD; the prevalence of SD was 61.8%. Hip fracture was the most common disease among the SD patients (34.4%). The median time to the end of follow-up was 73.5 days for the SD group and 84.0 days for the no-SD group. There was no significant difference in the FILS score between the SD and no-SD groups, but the increase in the FILS score was significantly lower in the SD group than the no-SD group among patients with severe malnutrition after adjusting for confounding factors (age, sex, FILS at admission, BMI, cognitive functional independence measure, and care level before onset) (β = -0.206, p = 0.011, 95% confidence interval = -0.723, -0.098). CONCLUSION Orthopedic diseases are the most common type of disease among SD patients in convalescent rehabilitation hospitals. Swallowing dysfunction was particularly severe in malnourished patients with SD. This result suggests the importance of the definition of SD for malnourished patients. We should practice nutritional management as soon as possible in severely malnourished patients diagnosed with SD.
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Affiliation(s)
- K Taguchi
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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17
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Imamura Y, Chebib N, Ohta M, Maria Schulte-Eickhoff R, Mekki M, Schimmel M, Arakawa I, Graf C, Sato Y, Müller F. Validation of a novel diagnostic tool for decreased tongue pressure. J Oral Rehabil 2021; 48:1219-1225. [PMID: 34425018 PMCID: PMC9291622 DOI: 10.1111/joor.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reduced tongue pressure may render eating and swallowing difficult. The purpose of this study was to investigate whether the tongue training device can also be used as a diagnostic device and whether its sensitivity and specificity are equal to the numerical tongue pressure measuring device. MATERIAL AND METHODS The target group is patients aged 70 years and over who are hospitalised for rehabilitation. Tongue pressure was measured by both, a tongue pressure measuring instrument and a tongue training tool. The diagnosis of the reduced tongue pressure was made with the tongue pressure measuring instrument and set the verified with the novel tongue training tool. RESULTS Sixty-two participants were included in the study. Forty-five were classified by the tongue pressure measuring device and 53 by the tongue training device as 'low tongue pressure'. Spearman correlation confirmed a positive correlation between the tongue pressure measuring device and the tongue training device rs = 0.800, p = 0.01 level (2-tailed). The tongue training device test identified sensitivity was 100%, and its specificity was 52.9%. The AUC of the ROC curve is 0.901. CONCLUSION The tongue training device seems a simple, safe and readily available alternative to the tongue pressure measuring device for the diagnosis of low tongue pressure, with an excellent sensitivity and very good specificity.
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Affiliation(s)
- Yoshiki Imamura
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Geriatric Dentistry, School of Dentistry, Showa University, Tokyo, Japan.,Yoshiki Imamura Meikai University, School of Dentistry, Division of Fixed Prosthodontics, Saitama, Japan
| | - Najla Chebib
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Midori Ohta
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | | | - Mustapha Mekki
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Itsuka Arakawa
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, University Hospitals Geneva, Geneva, Switzerland
| | - Yuji Sato
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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18
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Shimizu A, Fujishima I, Maeda K, Murotani K, Ohno T, Nomoto A, Nagami S, Nagano A, Sato K, Ueshima J, Inoue T, Shimizu M, Ishida Y, Kayashita J, Suenaga M, Mori N. Delayed Dysphagia May Be Sarcopenic Dysphagia in Patients After Stroke. J Am Med Dir Assoc 2021; 22:2527-2533.e1. [PMID: 34389335 DOI: 10.1016/j.jamda.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke. DESIGN A multicenter prospective observational cohort study. SETTING AND PARTICIPANTS Participants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation. METHODS Swallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia. RESULTS Delayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400-13.974, P = .011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078-0.986, P = .047). CONCLUSIONS AND IMPLICATIONS The development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.
| | | | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Ayano Nagano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Keisuke Sato
- Department of Rehabilitation, Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Shinagawa, Japan
| | - Tatsuro Inoue
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Midori Shimizu
- Department of Nutrition, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Masaki Suenaga
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Matsumoto, Okinawa, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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