Polypharmacy, Potentially Inappropriate Medications, and Dysphagia in Older Inpatients: A Multi-Center Cohort Study

Background Although the relationship between medication status, symptomatology, and outcomes has been evaluated, data on the prevalence of polypharmacy and potentially inappropriate medications (PIMs) and the association of polypharmacy and PIMs with swallowing function during follow-up are limited among hospitalized patients aged ≥65 years with dysphagia. Methods In this 19‐center cohort study, we registered 467 inpatients aged ≥65 years and evaluated those with the Food Intake LEVEL Scale (FILS) scores ≤8 between November 2019 and March 2021. Polypharmacy was defined as prescribing ≥5 medications and PIMs were identified based on the 2023 Updated Beers Criteria. We applied a generalized linear regression model to examine the association of polypharmacy and PIMs with FILS score at discharge. Results We analyzed 399 participants (median age, 83.0 years; males, 49.8%). The median follow‐up was 51.0 days (interquartile range, 22.0–84.0 days). Polypharmacy and PIMs were present in 67.7% of and 56.1% of patients, respectively. After adjusting for covariates, neither polypharmacy (β = 0.05; 95% confidence interval [CI], -0.04–0.13, p=0.30) nor non‐steroidal anti‐inflammatory medications (β = 0.09; 95% CI, -0.02–0.19; p=0.10) were significantly associated with FILS score at discharge. Conclusions The results of this study indicated a high proportion of polypharmacy and PIMs among inpatients aged ≥65 years with dysphagia. Although these prescribed conditions were not significantly associated with swallowing function at discharge, our findings suggest the importance of regularly reviewing medications to ensure the appropriateness of prescriptions when managing older inpatients

Relationship between swimming performance and maximal oxygen debt, maximal oxygen uptake, and oxygen requirement

エネルギー代謝能力と水泳記録との関係に及ぼす水泳効率(e)の影響, 浮力の影響, および無酸素的代謝と有酸素的代謝の関与の影響について検討することを目的とした. 無酸素的および有酸素的代謝能力の指標として, 最大酸素負債量(O2debtmax)と最大酸素摂取量(V̇O2max)をそれぞれ回流水槽泳で測定した. 毎分酸素需要量(Ė)とeはO2debtmax, V̇O2maxおよび水泳記録から算出した. 被検者は性・年齢・水泳記録の異なるクロール泳者44名であった. 100mの水泳速度とO2debtmaxとの相関は全被検者群でr=0.551(p<0.01)であったものが, e1(100m水泳のe)≦3.33の群(n=14)ではr=0.739(p<0.01), 3.33<e1≦4.19の群(n=17)ではr=0.912(p<0.01), 4.19<e1の群(n=13)ではr=0.645(p<0.05)となった. 400mの水泳速度とV̇O2maxとの相関は全被検者群でr=0.554(p<0.01)であったものが, e4(400m水泳のe)≦5.24の群(n=14)ではr=0.730(p<0.01), 5.24<e4≦6.56の群(n=17)ではr=0.927(p<0.01), 6.56<e4の群(n=13)ではr=0.486となった. 以上のように, 水泳記録と代謝能力との相関はeの不均一な全被検者群よりeのほぼ均一な集団において高くなったことから, 両者の関係はeの要因によって顕著に影響されると結論した. 代謝能力は体重当りの値で示すよりも絶対値で示した場合に水泳記録との相関が高かった. これは, 水泳では浮力の作用により体重が支えられるために生じたと考えられた. 100mと400mの水泳記録は, O2debtmaxあるいはV̇O2maxに対するよりĖに対して, より高い相関を示した. したがって, 短距離泳における有酸素的代謝量の貢献を, また中・長距離泳における無酸素的代謝量の貢献を無視できないと考えられる.The purpose of this study was to discuss the effect of swimming efficiency (e), buoyancy, and participation of aerobic and anaerobic metabolism on the relationship between swimming performance and energy metabolic capacity. The maximal oxygen debt (O_2 debt_max) and maximal oxygen uptake (V̇o_2max) were measured after and during swimming in a swimming flume, as a parameter of anaerobic and aerobic capacity, respectively. Oxygen requirement (Ė) and swimming efficiency (e) were calculated from O_2 debt_max, V̇o_2max, and swimming record. The subjects consisted of 44 freestyle swimmers with different sex, age and swimming record. The correlation between O_2 debt_max and 100m swimming speed was r=0.551 (p<0.01) for the group) of whole subjects, while the coefficients for the three groups classified in terms of e_1 (e in 100m swimming) were r=0.739 (p<0.01) for the low e_1 group (N=14, e_1=3.33), r=0.912 (p<0.01) for the intermediate e_1 group (N=17, 3.33<e_1=4.19), and r=0.645 (p<0.05) for the high e_1 group (N=13,4.19<e_1). The correlation coefficient between V̇o_2max and 400m swimming speed was r=0.554 (p<0.01) for the whole group including all the subjects, while these coefficients for the sub-groups formed for e_4 (e in 400m swimming) were r=0.730 (p<0.01) for the low e_4 group (N=14, e_4≦5.24), r=0.927 (p<0.01) for the intermediate e_4 group (N=17, 5.24<e_4≦6.56) and r=0.486 for the high e_4 group (N=13, 6.56<e_4). Thus, correlations between swimming performance and metabolic capacity became higher for the group of subjects with homogeneous e than for the group of whole subjects with greater variability in their e. This result suggests that the relationship between swimming performance and metabolic capacity is markedly effected by the factor of e. Correlations between swimming performance and metabolic capacity were higher in absolute value than in relative value (/kg). This is probably because body weight is supported by buoyancy in swimming. Swimming performances in 100m and 400m races correlated higher with E than with O_2 debt_max or V̇o2_max. This suggests that contributions of aerobic metabolism in sprint race, and of anaerobic metabolism in middle and long distance races should not be underestimated