The Relationship Between Pulmonary Function and Physical Function and Mobility in Community-Dwelling Elderly Women Aged 75 Years or Older

Risk of an Adverse Event in Individuals Who Aspirate: A Review of Current Literature on Host Defenses and Individual Differences

PURPOSE

The presence of oropharyngeal dysphagia increases the likelihood of prandial aspiration, and aspiration increases the likelihood of a dysphagia-related pulmonary sequelae such as aspiration pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, and even death. Although these outcomes are unfortunate, it is important to point out that these consequences are not solely determined by the presence of aspiration. The purpose of this tutorial is to provide current information on pulmonary defenses and the variables that increase risk of an adverse outcome in individuals who aspirate.

METHOD

This tutorial reviews the basics of lung defenses and summarizes the literature to make the case that the host is a central theme in dysphagia management. Case studies are employed to highlight the key variables.

RESULTS

Based on a literature review, a series of questions are proposed for consideration in dysphagia management. These questions, which take the focus away from the presence of aspiration and toward the associated risks within an individual, are then applied to two case studies.

CONCLUSIONS

A guiding framework is proposed to encourage clinicians to assess more than the presence of aspiration and consider the individual's ability to cope with the aspirated material. In the presence of aspiration, clinicians are urged to focus on the risk factors that can lead to a negative consequence, identify which factors are modifiable, and determine when a level of risk is acceptable.

Comparison of respiratory function, physical function, and activities of daily living among community-dwelling patients with respiratory and non-respiratory disease

[Purpose] The purpose of this study was to investigate the differences in respiratory function, physical function, and Activities of Daily Living (ADL) between respiratory and non-respiratory patients using community-based home rehabilitation. [Participations and Methods] Maximum Phonation Time (MPT), upper and lower limb muscle strength, and ADL were compared in two groups: a respiratory disease group including respiratory patients and those with respiratory comorbidities, and a non-respiratory disease group. Cutoff values were determined for items that showed significant differences between groups. [Results] There were no significant differences between the two groups in assessments other than MPT. MPT was significantly lower in the respiratory disease group, with an MPT cutoff value of 10.1 sec and an area under the curve of 0.74. [Conclusion] Use of the MPT cutoff value may help to determine whether respiratory function is impaired in patients with respiratory disease.

Association between Trunk Muscle Strength and Fall Risk in Older Men and Women with Lumbar Spondylosis

Various factors significantly affect the risk of falls among older adults with lumbar spondylosis. However, the relationship between falls and trunk muscle strength in older men is poorly explored. Thus, we aimed to investigate the relationship between back muscle strength and fall risk in older men and women with lumbar spondylosis. Based on self-reported fall scores, 39 outpatients were classified into two groups. Back and abdominal muscle strength, among other data, were compared between the two groups. Spearman's rank correlation analysis was used to assess the relationship between fall scores and selected variables. Back (r = -0.491, p = 0.002) and abdominal muscle strength (r = -0.415, p = 0.009) were related to the fall score. Furthermore, back and abdominal muscle strength were related to the fall score in women with a high risk of falls, whereas back muscle strength, erector spinae, and lumbar multifidus cross-sectional areas, and visual analog scale were related to the fall score in men with a high risk of falling. Back muscle strength and fall scores may be useful to assess the risk of falls in older patients with lumbar spondylosis. However, evaluating this relationship may require separate sex-specific analyses.

The change of lung capacity in elderly women caused by life span

[Purpose] Although lung capacity in the elderly is affected by age, little research has been performed studying decreasing lung capacity in relation to increasing life expectancy. The aim of this study was to examine the effects of increased life span on the lung capacity of women. [Subjects and Methods] The subjects of this study were 55 healthy elderly women over 60 years of age who were living in Busan. Subjects were classified in the following age categories: 60s, 70s and 80s. For the pulmonary function test, a spirometry (Pony FX, COSMED Inc., Italy) was used. The item for measurement of pulmonary function in elderly women was maximum-effort expiratory spirogram (MES). The pulmonary function test was performed 3 times, and its mean value was used for analysis. [Results] Among items of maximum-effort expiratory spirogram, a significant difference according to age was demonstrated in forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximum expiratory flow 75%, maximum expiratory flow 50%, and inspiratory capacity. [Conclusion] According to this study, lung capacity decreases remarkably as age increases. In conclusion, a continuous exercise program beginning at an early age is essential to prevent decrease in lung capacity as age progresses.

Reliability and validity of the sequential weight-shifting test: a new functional approach to the assessment of the sitting balance of older adults

[Purpose] The evaluation of sitting balance is important for the prevention of falls in older adults, especially those who have a disability involving the lower extremities. However, no studies have been designed to assess a patient's dynamic sitting balance using a sequential protocol. The objective of this study was to investigate the psychometric properties of the sequential weight-shifting (SWS) test. [Subjects and Methods] Twenty-three older adults who were physically dependent with regard to ambulation were recruited by convenience sampling. In study 1, 10 participants performed the SWS test and repeated the procedure 1 week later. In study 2, 23 participants were assessed using the SWS test, forward and lateral reach tests in a sitting position, tests of shoulder flexor and hand grip strength, an eye-hand coordination test, mobility tests, and pulmonary function tests. The test-retest reliability of the SWS test and its correlations with the different physical dimensions were examined. [Results] The intraclass correlation coefficient (3,1) of the SWS test was 0.67. The results of the SWS test correlated significantly with forward reach in the sitting position, arm muscle strength, eye-hand coordination, mobility, and pulmonary function (all p<0.05). [Conclusion] The SWS test demonstrated satisfactory psychometric properties and can be considered a useful functional approach for the measurement of sitting balance.

Factors associated with the annual change in forced expiratory volume in 1 second of officially acknowledged victims of pollution-related illness in improved environments: a longitudinal study

[Purpose] We examined factors affecting annual change in pulmonary function in residents previously exposed to air pollution in an area where pollution has been reduced and a long time period has elapsed. [Subjects and Methods] Data of 730 officially acknowledged victims of pollution-related illness from an annual survey during 2000 to 2009 were analyzed. The primary outcome was forced expiratory volume in 1 second (FEV₁), along with factors such as age, body composition, smoking habits, respiratory symptoms, and classification of medical management (an index of the need for treatment). Multiple regression analyses were used to identify factors associated with the annual change in FEV₁. [Results] Three significant factors were identified: smoking habit, classification of medical management, and gender. Smoking habits and classification of medical management had stronger effects on the annual change in FEV₁ than gender. [Conclusion] With an improved environment, continuation of smoking accelerates the decline in FEV₁.

Activity performance problems of patients with cardiac diseases and their impact on quality of life

[Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1±12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study. Activity limitations and participation restrictions as perceived by the individual were measured by the Canadian Occupational Performance Measure (COPM). The Nottingham Extended Activities of Daily Living (NEADL) Scale was used to describe limitations in daily living activities. To detect the impact of activity limitations on quality of life the Nottingham Health Profile (NHP) was used. [Results] The subjects described 46 different types of problematic activities. The five most identified problems were walking (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%). The associations between COPM performance score with all subgroups of NEADL and NHP; total, energy, physical abilities subgroups, were statistically significant. [Conclusion] Our results showed that patients with cardiac diseases reported problems with a wide range of activities, and that also quality of life may be affected by activities of daily living. COPM can be provided as a patient-focused outcome measure, and it may be a useful tool for identifying those problems.

Physical Function Traits of Long-term Officially Acknowledged Victims of Pollution-related Illnesses Compared with Elderly Patients with Chronic Obstructive Pulmonary Disease

[Purpose] To examine the long-term effects of air pollution on the physical functioning of a group of officially acknowledged victims of pollution-related illnesses (Victims group) who were exposed to air pollution more than 50 years ago, we compared them with age-matched patients with chronic obstructive pulmonary disease (COPD group). [Subjects and Methods] The Victims group comprised 34 subjects and the COPD group 24, all of whom were aged over 65 years. Respiratory function, muscle strength, exercise capacity and physical activity were measured and compared between the groups. [Results] The Victims group had significantly higher forced expiratory volume in the first second (FEV1), proportion of predicted FEV1, proportion of predicted vital capacity (VC), and ratio of FEV1 to forced VC than the COPD group. Surprisingly, the muscle strength of the Victims group was significantly weaker, their incremental shuttle walking test distance was significantly shorter, and their physical activity was significantly less than those of the COPD group. [Conclusion] Although the pulmonary function of Victims was better than that of the COPD group, their physical functioning was worse. Exposure to air pollution 50 years ago appears to continue to adversely affect their physical function. It is particularly important to offer Victims rehabilitation to improve their exercise performance and physical activity.