Hidetaka Wakabayashi

Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study.

OBJECTIVE To investigate the association between nutritional status and rehabilitation outcome in elderly inpatients with hospital-associated deconditioning. DESIGN A prospective cohort study. SUBJECTS/PATIENTS One hundred sixty-nine consecutive elderly inpatients diagnosed with hospital-associated deconditioning. METHODS Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center. Body mass index, haemoglobin, albumin, total lymphocyte count, C-reactive protein, cause of malnutrition, and feeding route were also investigated. Primary outcome was Barthel Index score at discharge. RESULTS A total of 148 patients (87.6%) were malnourished, and 21 were at risk for malnutrition. There were no patients with normal nutritional status. Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition. Chronic disease-related malnutrition, oral intake, and parenteral nutrition were associated with the Barthel Index score at discharge. There were significant correlations between the Barthel Index score at discharge and nutritional score, albumin, and total lymphocyte count. In multiple regression analysis, Mini Nutritional Assessment Short Form, albumin, and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge. CONCLUSION Most elderly inpatients with hospital-associated deconditioning are malnourished. Nutritional status, albumin, and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning.

Comprehensive approach to sarcopenia treatment.

Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Primary sarcopenia is considered to be age-related when no other cause is evident, other than ageing itself. Secondary sarcopenia should be considered when one or more other causes are evident, such as activity-, disease-, or nutrition-related sarcopenia. In this narrative review that focused on human studies, we summarize the pharmaceutical therapies (testosterone, dehydroepiandrosterone, estrogen, growth hormone, ghrelin, vitamin D, angiotensin converting enzyme inhibitor, and eicosapentaenoic acid) and nonpharmaceutical therapies (resistance training, protein and amino acid supplementation, and non-smoking) for counteracting primary sarcopenia. Testosterone and growth hormone improve muscle mass and muscle strength, but have several side effects. Although there are some intriguing pharmaceutical therapies to combat sarcopenia, resistance training combined with supplements containing amino acids are the most effective for preventing and treating age-related muscle wasting and weakness. The etiology of sarcopenia in the elderly is multi-factorial. Patients with disuse syndrome and deconditioning often complicate the diagnosis, of not only activity-related sarcopenia, but also age-, disease-, and nutrition-related sarcopenia. In these cases a comprehensive approach to sarcopenia treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking. The effect of pharmaceutical therapies for sarcopenia can be enhanced by this comprehensive approach. Future research on pharmaceutical therapies for counteracting sarcopenia should consider non-pharmaceutical therapies and also the causes of sarcopenia.

Dysphagia assessed by the 10-item Eating Assessment Tool is associated with nutritional status and activities of daily living in elderly individuals requiring long-term care

OBJECTIVES The 10-item Eating Assessment Tool (EAT-10) is a self-administered questionnaire for dysphagia screening, with each item scored from 0 to 4. We assessed the associations among the EAT-10 score, nutritional status and activities of daily living (ADL) in elderly individuals requiring long-term care. DESIGN Cross-sectional study. SETTING Geriatric health services facilities, acute hospitals, and the community. PARTICIPANTS Elderly individuals ≥65 years of age with dysphagia or possible dysphagia (N=237). MEASUREMENTS The EAT-10, the Mini Nutritional Assessment Short Form (MNA-SF) and the Barthel Index. RESULTS There were 90 males and 147 females. Mean age was 82 ± 8 years. Eighty-nine were in geriatric health services facilities, 28 were in acute hospitals, and 120 were community-dwelling. The median Barthel Index score was 55 (interquartile range: 25, 80). The median EAT-10 score was 1 (interquartile range: 0, 9), and 101 respondents a score > 3, indicating the presence of dysphagia. The MNA-SF revealed that 81 were malnourished, 117 were at risk of malnutrition, and 39 had a normal nutritional status. The Barthel Index score and MNA-SF score were significantly lower in those with an EAT-10 score between 3 and 40, compared to those with an EAT-10 score between 0 and 2. The EAT-10 has an independent effect on the Barthel Index and the MNA-SF by adjusting for covariates such as age, gender, and setting in multiple regression analysis. CONCLUSIONS Dysphagia assessed by the EAT-10 is associated with nutritional status and ADL in elderly individuals requiring long-term care.

Skeletal muscle mass is associated with severe dysphagia in cancer patients

The purpose of this study was to assess the association between skeletal muscle mass, activities of daily living (ADLs) and severe dysphagia in cancer patients.

Nutritional Improvement and Energy Intake Are Associated with Functional Recovery in Patients after Cerebrovascular Disorders

BACKGROUND Malnutrition affects the activities of daily living (ADLs) in convalescent patients with cerebrovascular disorders. We investigated the relationship between nutritional improvement, energy intake at admission, and recovery of ADLs. METHODS We evaluated 67 patients with cerebrovascular disorders admitted to our rehabilitation hospital between April 2013 and April 2015. These patients received interventions from the rehabilitation nutritional support team according to the following criteria: weight loss of 2 kg or more and body mass index of 19 kg/m(2) or lower. Exclusion criteria included a body mass index of 25 kg/m(2) or higher, duration of intervention of less than 14 days, or transfer to an acute care hospital because of clinical deterioration. We assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI) and ADL using the Functional Independence Measure (FIM) score, FIM gain, and FIM efficiency. RESULTS The mean age of the patients was 78.7 ± 8.0 years. The numbers of patients in each category of cerebrovascular disorder were 39 with cerebral infarction, 16 with intracerebral hemorrhage, 8 with subarachnoid hemorrhage, and 4 others. Compared with the counterpart group, the group with an improvement in GNRI had a greater gain in FIM (median 17 and 20, respectively; P = .036) and a higher FIM efficiency (.14 and .22, respectively; P = .020). Multivariate stepwise regression analysis showed that an improvement in GNRI, increasing energy intake at admission, and intracerebral hemorrhage were associated independently with greater FIM efficiency. CONCLUSIONS This study suggested that nutritional improvement and energy intake at admission are associated with recovery of ADL after cerebrovascular disorders.

Head lifting strength is associated with dysphagia and malnutrition in frail older adults

The purpose of the present study was to assess the association between head lifting strength, dysphagia and malnutrition in frail older adults.

Early Commencement of Oral Intake and Physical Function are Associated with Early Hospital Discharge with Oral Intake in Hospitalized Elderly Individuals with Pneumonia

job: A qualitative study of medical student reflections on safe hospital discharge. J Am Geriatr Soc 2014;62:1147–1154. 12. Kripalani S, LaFevre F, Philips CO et al. Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA 2007;297:831–841. 13. Careyva B, Snyderman D, Diemer G. Medical student perceptions of hospital discharge transitions in care. Med Teach 2013;36:967. 14. Daugherty SR, DeWitt BC, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: A national survey of working conditions. JAMA 1998;279:1194–1199. 15. De SK, Henke PK, Ailawadi G et al. Attending, house officer, and medical student perceptions about teaching in the third-year medical school general surgery clerkship. J Am Coll Surg 2004;199:932–942.

Poor oral status is associated with rehabilitation outcome in older people

Poor oral status is associated with increased physical dependency and cognitive decline. Malnutrition, a potential result of poor oral status, is associated with poorer rehabilitation outcome and physical function. However, the association between oral status and rehabilitation outcome is not fully understood. The present study investigated the association of poor oral status with rehabilitation outcome in older patients.

Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study

BACKGROUND A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. METHOD This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight <18.5 kg/m(2), standard 18.5-<23 kg/m(2), overweight 23-<27.5 kg/m(2), obese ≥27.5 kg/m(2)). The primary outcome was the FIM gain, and the secondary outcome was the FIM score at discharge. Multiple regression analysis was performed to analyze the relationship between BMI and functional recovery. RESULTS In total, 897 participants (males 484, females 413; mean age 71.6 years) were analyzed and classified as underweight (134), standard (432), overweight (277), and obese (54). The median FIM gain and the FIM score at discharge were 30 and 114, respectively. The FIM gain in the obese group was significantly higher than those in the other groups. Multiple regression analysis revealed that obesity was independently correlated with the FIM gain, and those at discharge after adjusting for confounders such as age, gender, and FIM score on admission. CONCLUSIONS Obese Japanese convalescent patients with stroke may have some advantages for functional recovery in rehabilitation wards.

Rehabilitation Nutrition for Possible Sarcopenic Dysphagia After Lung Cancer Surgery: A Case Report.

Sarcopenic dysphagia is characterized by the loss of swallowing muscle mass and function associated with generalized loss of skeletal muscle mass and function. In this report, the authors describe a patient with possible sarcopenic dysphagia after lung cancer surgery and was treated subsequently by rehabilitation nutrition. A 71-year-old man with lung cancer experienced complications of an acute myocardial infarction and pneumonia after surgery. He was ventilated artificially, and a tracheotomy was performed. The patient received diagnoses of malnutrition, severe sarcopenia, and possible sarcopenic dysphagia. His dysphagia was improved by a combination of dysphagia rehabilitation including physical and speech therapy and an improvement in nutrition initiated by a nutrition support team. Finally, he no longer had dysphagia and malnutrition. Sarcopenic dysphagia should be considered in patients with sarcopenia and dysphagia. Rehabilitation nutrition using a combination of both rehabilitation and nutritional care management is presumptively useful for treating sarcopenic dysphagia.