Yoshihiro Yoshimura

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.

Dysphagia is associated with functional decline during acute-care hospitalization of older patients

Physical function is considered to be associated with dysphagia: however, there is little data regarding the association between dysphagia and functional decline during hospitalization among older patients. The aim of the present study was to investigate the prevalence of dysphagia, and the association between dysphagia and functional status during hospitalization in older acute‐care patients.

Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients

BACKGROUND The purpose of this study was to investigate the prevalence of sarcopenia following stroke, musculoskeletal disease, or hospital-associated deconditioning in convalescent rehabilitation ward inpatients. The association between the activities of daily living (ADLs), dysphagia, and sarcopenia was also assessed. METHODS A cross-sectional study was performed in consecutive patients admitted to convalescent rehabilitation wards. Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength. The primary outcome was the Functional Independence Measure (FIM) score. Body mass index, Mini Nutritional Assessment-Short Form score, Food Intake Level Scale (FILS) score, Charlson Comorbidity Index, premorbid modified Rankin scale, time from onset, reason for admission, bioelectrical impedance analysis for skeletal muscle mass and fat mass, and handgrip strength were also assessed. Univariate and multivariate analyses were used to determine whether ADLs and dysphagia were associated with sarcopenia. RESULTS The study included 637 patients (mean age: 74 years; 271 men and 366 women). Sarcopenia was diagnosed in 343 (53.0%) patients (141 men and 202 women). Sarcopenia was identified in 53.6% (125/233) of stroke patients (59.8%, 50.0%, and 34.6% of patients with brain infarctions, brain hemorrhages, and subarachnoid hemorrhages, respectively). Sarcopenia was found in 51.3% (154/300) of patients with musculoskeletal diseases (59.5%, 53.6%, and 36.5% of patients with hip fractures, vertebral compression fractures, and total knee arthroplasty, respectively). Of patients with hospital-associated deconditioning, 61.5% (64/104) had sarcopenia (95.1% and 39.7% of patients with pneumonia and other acute diseases, respectively). Multivariate analysis showed that FIM motor domain and FILS scores were independently associated with skeletal muscle mass loss and decreased muscle strength. CONCLUSIONS The prevalence of sarcopenia in convalescent rehabilitation ward inpatients was 53.0%. ADLs and dysphagia were independently associated with sarcopenia in this study population. Sarcopenia with disabilities should be assessed for all patients in rehabilitation settings.

Effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia: A randomized controlled trial

OBJECTIVES The aim of this study was to investigate the effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia. METHODS We conducted an eight-wk, two-parallel group intervention, randomized controlled, blinded outcome assessment among 44 post-stroke older patients with sarcopenia. Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength according to the Asian Working Group for Sarcopenia criteria. The intervention group (n = 21) received a leucine-enriched amino acid supplement; the control group (n = 23) did not. Both groups performed low-intensity resistance training in addition to a post-stroke rehabilitation program. A primary outcome of physical function by using the motor domain of Functional Independence Measure (FIM), and secondary outcomes of appendicular muscle mass (skeletal muscle mass index [SMI]) measured via bioelectrical impedance analysis and muscle strength as handgrip strength were measured at baseline and at the end of the intervention. RESULTS The FIM score increased significantly in both groups over time (P < 0.01), with significantly greater improvement in the intervention group than in the control group (P < 0.045). Handgrip strength also increased significantly over time (P <0.05), with significantly greater improvement in the intervention group (P < 0.01). The SMI increased significantly in the intervention group but not in the control group over time, with significantly greater improvement in the intervention group (median estimated difference, 0.50 kg/m2; 95% confidence interval, 0.01-2.11). CONCLUSIONS We demonstrated that an eight-wk intervention consisting of a leucine-enriched amino acid supplementation and low-intensity resistance training increased muscle mass, strength, and physical function in post-stroke patients with sarcopenia.

Risk of malnutrition is associated with poor physical function in patients undergoing cardiac rehabilitation following heart failure: Malnutrition and function in heart failure

AIM Patients who experience heart failure are prone to malnutrition. The aim of this study was to determine the association between risk of malnutrition and physical function in patients undergoing cardiac rehabilitation following heart failure. METHODS A cross-sectional study was performed in consecutive patients hospitalised for cardiac rehabilitation following heart failure. Risk of malnutrition was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF). Physical function was evaluated using the Barthel index (BI). Univariate and multivariate analyses were used to determine whether nutritional status was associated with BI in these patients. RESULTS The present study included 105 patients (mean age of 77.3 years, 56 men and 49 women) for analysis. The median (interquartile range) scores of the MNA-SF and BI were 11 (9-13) and 75 (45-90), respectively. Patients with high risk of malnutrition (MNA-SF score < 7) were significantly older, had a lower body mass index, exhibited lower muscle mass and strength, could walk shorter distances, and had lower BI scores (all P < 0.05). On multivariate analysis, the MNA-SF score was independently associated with BI (β = 0.409, P < 0.001) after adjusting for age, sex, muscle mass and strength, brain natriuretic peptide levels, ejection fraction of the left ventricle, and reason for admission. CONCLUSIONS Risk of malnutrition is associated with physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection of malnutrition and commencement of nutritional support may improve functional recovery in these patients.

Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: A multicenter randomized controlled trial: BCAA and rehabilitation

To investigate the effects of branched‐chain amino acids and vitamin D supplementation on physical function, muscle strength, muscle mass, and nutritional status in sarcopenic older adults undergoing hospital‐based rehabilitation.

Chapter 4 Treatment of sarcopenia: Intervention for sarcopenia

National Center for Geriatrics and Gerontology, Obu, Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Department of Lifespan Developmental Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, and Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan

Calf circumference is associated with dysphagia in acute-care inpatients

ABSTRACT The aim of the study was to determine the association between decreased muscle mass and dysphagia in older acute‐care patients. A cross‐sectional study was performed on 103 patients aged ≥65 years who were consecutively admitted to acute‐care wards. Muscle mass and strength were evaluated by assessing calf circumference (CC) and handgrip strength, respectively. Dysphagia and swallowing difficulty were assessed using the Dysphagia Severity Scale (DSS). Univariate and multivariate analyses were used to determine whether CC was associated with dysphagia. There were 58 women and 45 men (mean age, 80 ± 8 years) with a mean CC of 28.2 ± 4.4 cm, and a mean HG of 11.8 kg. Dysphagia was observed in eight patients (8%). Based on the multivariate analysis, CC was independently associated with DSS after adjusting for possible confounders. Future studies to evaluate dysphagia in acute‐care older patients with low skeletal muscle mass (i.e., sarcopenia) are required.

PP058-SUN: Oral Cavity Function is Associated with Skeletal Muscle Mass, Nutritional Status, and Physical Function in Hospitalized Elderly

PP058-SUN ORAL CAVITY FUNCTION IS ASSOCIATED WITH SKELETAL MUSCLE MASS, NUTRITIONAL STATUS, AND PHYSICAL FUNCTION IN HOSPITALIZED ELDERLY Y. Yoshimura1, A. Shiraishi2, Y. Tsuji2, S. Shimazu3, S. Saito1, T. Bise4, N. Satoh5, K. Hirano5. 1Departmento of Rehabilitation Medicine, 2Department of Dental Surgery, 3Department of Nutrition, 4Department of Rehabilitation, 5Department of Nursing, Kumamoto Rehabilitation Hospital, Kumamoto, Japan

PP035-MON: Effects of Concomitant Rehabilitation and Nutritional Support on Sarcopenia – A Multicenter RCT

PP035-MON EFFECTS OF CONCOMITANT REHABILITATION AND NUTRITIONAL SUPPORT ON SARCOPENIA A MULTICENTER RCT I. Takeuchi1, S. Yorimitsu2, S. Shimazu3, Y. Yoshimura4. 1Department of Rehabilitation, 2Department of Orthopedics, Heisei Tohya Hospital, 3Department of Nutrition, Kumamoto Rehabilitation Hospital, 4Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Sakura Jyuuji Hospital, Kumamoto-city, Japan