Predictors associated with poor outcomes

This study aimed to determine predictive factors associated with poor outcomes among older adult inpatients in the convalescent rehabilitation ward. We also examined the validity of factors that were identified as predictive of poor outcomes. Study subjects were 104 older adult inpatients in the convalescent rehabilitation ward, divided into two groups based on outcome at discharge. Group I included the outcomes of death or transfer to an acute care hospital and Group II included all other outcomes. Data were retrospectively collected from older adults’ medical records, including: activities of daily living, swallowing grade, nutritional index, and blood biochemistry data. Logistic regression analysis was used to extract predictive factors associated with poor outcomes. Next, we calculated the Stratum-specific likelihood ratio (SSLR) for each extracted factor. Two items were extracted as predictive factors with AUCs ≥ 0.7 : N-terminal pro-brain natriuretic peptide (NT-proBNP) and days from onset to hospitalization. The SSLRs showed the risk for a poor outcome increased when NT-proBNP was ≥ 2500 pg / ml, and when there were ≥ 35 days from onset to hospitalization. Our findings suggest these predictive factors provide a valid index to predict poor outcomes among older adults from the early stage of admission

長期療養病棟入院の摂食嚥下障害患者における嚥下反射と誤嚥性肺炎の発症率との関連性 : 60日間の前向きコホート研究

Objective: To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. Design: The study design was a prospective cohort study. Participants were followed for 60 days from admission. Setting: LTC wards. Participants: Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. Interventions: Not applicable. Main Outcome Measures: The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. Results: The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. Conclusions: Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards

Anthropometrics estimates renal function

In recumbent elderly patients, creatinine clearance (eCCr) estimated by the Cockcroft-Gault (CG) equation may not necessarily reflect renal function. We aimed to develop a novel formula to revise the CG equation using anthropometric measurements in bedridden elderly patients and evaluate its clinical utility. The subjects included 77 bedridden Japanese patients aged ≥ 65, hospitalized at Naruto Yamakami Hospital. The actual CCr (mCCr) value was measured using the 24-hour urine collection method. Anthropometric data, such as skeletal muscle mass, body fat mass (BFM), and triceps skinfold thickness (TSF), were collected. We established a novel formula to estimate CCr(BFM) or CCr(TSF) by correcting the eCCr(Enz + 0.2) value with BFM or TSF. The stage of classification of renal dysfunctions in patients with eGFR(BFM) or eGFR(TSF) was equivalent to the GFR(control) based on the mCCr. Notably, the novel equation for eCCr based on TSF (eCCr(TSF)), dubbed the “Naruto” formula, can be useful to evaluate renal function in bedridden elderly patients without expensive equipment or additional costs. In this study, mCCr was considered to be the true renal function of the patient, but whether and to what extent mCCr correlates with inulin clearance is unknown

呼気筋トレーニングが在宅要介護認定者の呼吸指標および嚥下機能に与える効果

Expiratory muscle training（EMT） for improving cough function and prevention of aspiration pneumonia in healthy elderly individuals as well as patients with neurological disorders has received recent attention. Although 2 studies elucidated its effects on swallowing function in a small population of patients with Parkinson’s disease, its overall efficacy remains uncertain. The purpose of this study was to examine the effects of EMT on respiratory indices and swallowing function in elderly individuals receiving home care. The subjects were 22 community-dwelling elderly individuals receiving home care. An EMT training device（Threthold IMT） was applied with reversed use and the training period was 4 weeks. The loading pressure was 30% of baseline MEP and the training sessions were performed for 15 minutes twice a day. Each training session was monitored by a family member and recorded. Respiratory function［forced-vital capacity（FVC） and %FVC］ and respiratory muscle strength ［maximal expiratory pressure （MEP） and maximal inspiratory pressure （MIP）］ were measured at baseline and after 1, 2, 3 and 4 weeks of EMT, while swallowing function ［repetitive saliva swallowing test （RSST）］ was measured at baseline and after 4 weeks. Two-way ANOVA was performed with the factors of ADL score and measurement week. Statistical analysis showed that both factors had effects, though there was no correlation between them. MEP was significantly improved at 3 and 4 weeks after EMT as compared to the baseline, whereas other respiratory indices and RSST were unchanged after EMT. Our findings indicate that EMT can strengthen expiratory muscles and suggest the need for higher expiratory loading pressure. Further research should define the target population more clearly and establish an effective EMT protocol to improve swallowing function