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Nagano A, Onaka M, Maeda K, Ueshima J, Shimizu A, Ishida Y, Nagami S, Miyahara S, Nishihara K, Yasuda A, Satake S, Mori N. Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults. Nutrients 2023; 15:4371. [PMID: 37892446 PMCID: PMC10609669 DOI: 10.3390/nu15204371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1, Imazuyamanaka-cho, Nishinomiya 663-8211, Japan;
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
| | - Masami Onaka
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Nutrition Therapy Support Center, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano 380-8525, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Nutrition, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki 701-0193, Japan;
| | - Shuzo Miyahara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keiji Nishihara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Akiyuki Yasuda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Shosuke Satake
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
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Nishioka S, Nakahara S, Takasaki M, Shiohama N, Kokura Y, Suzuki T, Yokoi-Yoshimura Y, Nii M, Maeda K, Wakabayashi H. The concept of aggressive nutrition therapy and clinical indication: A position paper. Clin Nutr ESPEN 2022; 52:322-330. [PMID: 36513472 DOI: 10.1016/j.clnesp.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 01/28/2023]
Abstract
Aggressive nutrition therapy is a nutritional management method that sets energy intake requirements by adding the amount of energy accumulated to energy consumption. It is used to treat patients with undernutrition and sarcopenia. However, evidence for aggressive nutrition therapy is insufficient, and validation through high-quality clinical research is essential. Therefore, this paper aimed to clarify the concept of aggressive nutrition therapy, present indications and contraindications; and describe the effects, limitations, and the need to individualize aggressive nutrition therapy for different pathological conditions. Aggressive nutrition therapy should be accompanied by the etiology of undernutrition, sarcopenia, and nutritional metabolism in various states. In addition to calculating nutritional requirements, the nutritional management methods of oral intake, tube feeding, and parenteral nutrition should be appropriately selected. A nutrition plan with the amount of energy accumulated should also be a vital issue. This position paper was authored by the Registered Dietitian Subcommittee of the Japanese Association of Rehabilitation Nutrition and was approved by the Japanese Association of Rehabilitation Nutrition.
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, 4-11 Ginyamachi, Nagasaki City, Nagasaki, 850-0854, Japan.
| | - Saori Nakahara
- Department of Nutrition, Suzuka General Hospital, 1275-53 Yamanohana, Yasuzuka-cho, Suzuka, Mie, 513-8630, Japan
| | - Miyuki Takasaki
- Department of Nutrition, Tokatsu-clinic Hospital, 865-2 Hinokuchi, Matsudo, Chiba, 271-0067, Japan
| | - Nahoko Shiohama
- Department of Nutrition, Saiseikai Kyoto Hospital, 101 Shimokaiinji-Shimouchida, Nagaokakyo, Kyoto, 617-8617, Japan
| | - Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-term Care, 15-39 Mugigaura, Anamizumachi, Hosugun, Ishikawa, 927-0023, Japan
| | - Tatsuro Suzuki
- Department of Nutrition, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka, 808-0024, Japan
| | - Yuri Yokoi-Yoshimura
- Nutrition Support Section, Nakajima Pharmacy, 7-2-6 Nishi-Nanajo-Minami, Obihiro, Hokkaido, 080-0017, Japan
| | - Maria Nii
- Department of Nutrition and Food Service, Sakurakai Hospital, 5-2610-1 Handa, Osaka-Sayama, Osaka, 589-0011, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Graduate School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Mori T, Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Ogawa N, Nishioka S, Momosaki R, Shimizu A, Saito Y, Yamada M, Ogawa S. Association between Inflammation and Functional Outcome in Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:400-406. [PMID: 35450997 DOI: 10.1007/s12603-022-1769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia. DESIGN A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database. SETTING The database was constructed using data from 19 hospitals and one home visiting rehabilitation team. PARTICIPANTS Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included. MEASUREMENTS Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function. RESULTS A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (< 5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up. CONCLUSIONS Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.
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Affiliation(s)
- T Mori
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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Diagnosis and Treatment of Sarcopenic Dysphagia: A Scoping Review. Dysphagia 2021; 36:523-531. [PMID: 33620563 DOI: 10.1007/s00455-021-10266-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sarcopenic dysphagia is a swallowing disorder due to sarcopenia involving the whole-body skeletal muscles and swallowing muscles. This scoping review aimed to explore the currently known information on the diagnosis and treatment of sarcopenic dysphagia and to clarify the types of research required to develop the field. METHODS We searched the PubMed, MEDLINE, CINAHL, and Cochrane databases from their inception to October 2020, using the search terms "(sarcopenia or sarcopenic or myopenia or dynapenia) and (dysphagia or swallowing or deglutition) and (diagnosis or treatment)". Articles reporting diagnosis method and treatment of sarcopenic dysphagia were included. RESULTS Twenty-one and eight articles reported on the diagnostic and treatment method, respectively. A diagnostic algorithm for sarcopenic dysphagia was most frequently used (n = 10). Other diagnostic methods included consensus diagnostic criteria for sarcopenic dysphagia (n = 4), sarcopenia and dysphagia without other causes of dysphagia (n = 4), and both sarcopenia and dysphagia (n = 3). The medical treatments for patients with sarcopenic dysphagia were described in single-patient case reports (n = 8) only. There were six articles reporting on a combination of rehabilitation and nutritional support. These reports showed the importance of interdisciplinary rehabilitation nutrition for improving patients' nutritional status and sarcopenia. CONCLUSIONS A reliable and validated diagnostic algorithm was the most widely used diagnostic method for sarcopenic dysphagia. Only case reports have been published for the medical treatment of patients with sarcopenic dysphagia. Interdisciplinary rehabilitation nutrition may be useful for treating patients with sarcopenic dysphagia.
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Nagano A, Maeda K, Koike M, Murotani K, Ueshima J, Shimizu A, Inoue T, Sato K, Suenaga M, Ishida Y, Mori N. Effects of Physical Rehabilitation and Nutritional Intake Management on Improvement in Tongue Strength in Sarcopenic Patients. Nutrients 2020; 12:nu12103104. [PMID: 33053651 PMCID: PMC7601202 DOI: 10.3390/nu12103104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
The study aimed to investigate the impact of physical intervention and the amount of nutritional intake on the increase in tongue strength and swallowing function in older adults with sarcopenia. From November 2018 and May 2019, older patients with sarcopenia who were admitted for rehabilitation were analyzed. The intervention employed in the study was the usual physical and occupational therapy for two months. Tongue strength was measured before and after two months of treatment. Data on tongue strength, the amount of energy and protein intake, intervention time, and swallowing function were examined. A total of 95 sarcopenic older patients were included (mean age 83.4 ± 6.5 years). The mean tongue strength after the intervention was significantly increased from 25.4 ± 8.9 kPa to 30.5 ± 7.6 kPa as a result of the treatment (p < 0.001). After adjusting the confounding factors in the multivariable models, an energy intake of ≥30 kcal/kg/day and a protein intake of ≥1.2 g/kg/day based on the ideal body weight had a significant impact on the increase in tongue strength after the treatment (p = 0.011 and p = 0.020, respectively). Swallowing function assessed using the Mann Assessment of Swallowing Ability was significantly increased after the treatment (mean difference between pairs: 1.12 [0.53-1.70]; p < 0.001). Physical intervention and strict nutritional management for older inpatients with sarcopenia could be effective to improve tongue strength and swallowing function.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan;
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-78-6364
| | - Masaki Koike
- Division of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahimachi, Kurume 830-0011, Japan;
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan;
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wago-kita, Naka-ku, Hamamatsu, Shizuoka 433-8127, Japan;
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan;
| | - Keisuke Sato
- Okinawa Chuzan Hospital Clinical Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Masaki Suenaga
- Department of Rehabilitation Medicine, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
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Wakabayashi H, Takahashi R, Murakami T. The Prevalence and Prognosis of Sarcopenic Dysphagia in Patients Who Require Dysphagia Rehabilitation. J Nutr Health Aging 2019; 23:84-88. [PMID: 30569074 DOI: 10.1007/s12603-018-1117-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation. DESIGN Prospective cohort study. SETTING Tertiary-care acute general hospital. PARTICIPANTS One hundred and eight patients referred to the Department of Rehabilitation Medicine for dysphagia rehabilitation. MEASUREMENTS The Food Intake Level Scale (FILS), a 5-step diagnostic algorithm for sarcopenic dysphagia. RESULTS The study included 72 males and 36 females (mean age, 76±7 years). Comorbid diseases included brain and nervous system disease (36%), cardiovascular disease (25%), respiratory disease (14%), and cancer (11%). Median energy intake was 1159 kcal (interquartile range: 648, 1502). Median FILS at admission and discharge was 4 (interquartile range: 2, 7) and 8 (interquartile range: 5, 8), respectively. Sarcopenic dysphagia was observed in 35 patients (32%). Sarcopenic dysphagia was associated with lower FILS at referral and discharge, lower calf circumference, lower handgrip strength, lower body mass index, lower serum albumin, and higher C-reactive protein at referral. Tongue pressure, energy intake, and Barthel index did not differ significantly between patients with or without sarcopenic dysphagia. Ordered logistic regression analysis of the FILS at discharge adjusted for presence of sarcopenic dysphagia, age, sex, and the FILS at admission revealed that presence of sarcopenic dysphagia (β=-1.603, 95% confidence intervals= -2.609, -0.597, p=0.002), sex, and the FILS at admission were independently associated with the FILS at discharge. CONCLUSIONS The prevalence of sarcopenic dysphagia in patients who require dysphagia rehabilitation was quite high. Sarcopenic dysphagia was independently associated with poor swallowing function at discharge.
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Affiliation(s)
- H Wakabayashi
- Hidetaka Wakabayashi, Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama City, Japan 232-0024, E-mail: , Tel: +81-45-261-5656; Fax: +81-45-253-9955
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Shimizu Y, Fujiura T, Wakabayashi H. Prevalence of nutritional risk and its impact on functional recovery in older inpatients on maintenance hemodialysis: a retrospective single-center cohort study. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0191-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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