Misako Higashijima

Association of sarcopenia with swallowing problems, related to nutrition and activities of daily living of elderly individuals

[Purpose] The purpose of the current study was to clarify problems associated with swallowing, related to nutrition and activities of daily living (ADL), in elderly individuals with sarcopenia. [Subjects and Methods] Seventy-seven subjects were assigned to a sarcopenia or a non-sarcopenia group according to a definition used by the European Working Group on Sarcopenia in Older People. Analyses were conducted including and excluding subjects with a central nervous system disorders in order to focus on the influence of sarcopenia. The swallowing ability, ADL, and nutrition levels were compared between the 2 groups. [Results] Swallowing function as well as ADL and nutrition levels were significantly lower in the sarcopenia group than in the non-sarcopenia group. [Conclusion] It is important to include dimensions of swallowing, nutrition, and ADL in the assessment and treatment of swallowing problems in elderly individuals with sarcopenia.

Using Party Horns to Test Respiratory Function in Patients With Dementia

This study assessed the utility of party horns for quick, simple respiratory function testing in 66 inpatients with dementia to maintain safe eating activity. Relationships of forced vital capacity (FVC) to Mini-Mental State Examination (MMSE) score and complete extension when blowing 40- and 80-cm party horns were examined. The FVC differed significantly by both MMSE score (P = .000) and party horn score (P = .000). Significant differences in FVC were found between groups categorized by MMSE score and in groups categorized by the ability to extend both party horns. Multiple regression analyses performed on possible FVC indicators identified a significant correlation for the party horn examination (regression coefficient: .562). Breathing is always coordinated with swallowing. Party horns seem highly effective as a simple tool for testing respiratory function in patients with early-stage dementia, and the ability to offer breathing rehabilitation for patients in need is likely to result in safer eating activity.

Clinical Study of Respiratory Function and Difference in Pneumonia History between Alzheimer's Disease and Vascular Dementia Groups.

[Purpose] This study compared respiratory function and differences in pneumonia history between Alzheimer’s disease and vascular dementia groups. [Subjects] Fifty-eight inpatients in the dementia treatment ward in a psychiatric facility were enrolled. [Methods] Patients underwent respiratory function testing twice using an 80-cm party horn. The Mini-Mental State Examination was also performed and motor functions were evaluated. Patient characteristics were obtained from medical records. [Results] Significant differences were noted between Alzheimer’s disease and vascular dementia groups in the ability to blow the party horn to full length, pneumonia history, and presence of impaired mobility. [Conclusion] Party horn evaluation may be useful for determining the risk of pneumonia in patients with dementia.

The Influence of Changed Life Environment on Swallowing and Respiration in Healthy Elderly: A Comparison of Disaster Victim and Non-Victim Elderly Individuals

The purpose of the current study was to clarify problems that the swallowing and respiratory functions of victim elderly individuals in Fukushima. Participants were healthy elderly individuals, who were living in Fukushima or Nagasaki in Japan. The subjects in the Fukushima group were 50 elderly individuals, and the subjects in the Nagasaki group were 19 elderly individuals. The swallowing and respiratory functions were compared between the 2 groups, and the 5 groups (4 areas in the Fukushima group and 1 area in the Nagasaki group). The swallowing and respiratory functions were significantly lower in the Fukushima group than in the Nagasaki group. We conclude that it is important to include social environment in the assessment of and intervention for respiratory and swallowing problems in victims of disaster.

The Efficacy of Intervention for the Prevention of Aspiration Pneumonitis in Recipients of Non-oral Nutrition

Objective: We provided continuous training targeting the oral cavity and neck region to elderly, bedridden recipients of non-oral nutrition in addition to conventional physical interventions, with the aim of investigating changes in feeding and swallowing function. Method: Bedridden (and caregiver’s extensive care-requiring), non-tracheotomized patients with a conscious level of 1 or 2 on the Japan Coma Scale (three inclusion criteria) were eligible. We enrolled 13 patients (5 men, 8 women; mean age: 85.2 ± 6.4 years) meeting the three criteria specified in the Setting, who had been receiving nutrition nasogastrically, via a gastrostomy tube, or by central venous hyperalimentation. Intervention was provided three times weekly, as additional interventions to conventional physical function training. The interventions were 1) neck stretching, 2) facilitation of swallowing response, 3) stimulation of the oral cavity, and 4) positioning into an anti-gravity posture (in a position with the back elevated 60° from the bed). Comparative assessments covered 1) intraoral saliva volume, 2) swallowing response time, 3) neck muscle hardness, 4) lip opening width, and 5) aspiration pneumonitis status at the initiation of training and the completion of training three months later. Results: All assessments showed significant changes in a beneficial direction post-training relative to pretraining. Additionally, no participant experienced recurrent aspiration pneumonitis. Conclusion: Selection of suitable training for the target function site, and continuous implementation of that training, are important for achieving efficacy.