Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke

Matsumoto, Ayaka; Yoshimura, Yoshihiro; Wakabayashi, Hidetaka; Kose, Eiji; Nagano, Fumihiko; Bise, Takahiro; Kido, Yasumasa; Shimazu, Sayuri; Shiraishi, Ai

doi:10.3390/nu14030443

Cited by 29 publications

(37 citation statements)

References 36 publications

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“…Among patients aged ≥65 years undergoing convalescent rehabilitation after stroke, approximately 42% were taking six or more medications at the time of admission and thereby exhibited polypharmacy. 104 ) Approximately 58% of patients with polypharmacy were diagnosed with sarcopenia. Among 144 stroke patients with chronic kidney disease admitted to a convalescent rehabilitation ward, 48 (33.3%) exhibited polypharmacy and took six or more drugs; the improvement in ADL was significantly lower in these patients than that in the non-polypharmacy group.…”

Section: Pharmacotherapy and Rehabilitation Outcomesmentioning

confidence: 99%

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Yoshimura¹,

Matsumoto²,

Momosaki

2022

PRM

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Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson’s syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

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Section: Pharmacotherapy and Rehabilitation Outcomesmentioning

confidence: 99%

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Yoshimura¹,

Matsumoto²,

Momosaki

2022

PRM

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“…Furthermore, pre-stroke sarcopenia is also associated with poor functional outcomes [ 4 , 5 ]. Therefore, evaluating muscle mass and function among stroke patients is important [ 6 , 7 ], and aggressive nutrition therapy [ 8 , 9 , 10 ], deprescribing [ 11 ], and rehabilitation [ 12 , 13 ] re applicable for those with stroke, as well as those at high risk for muscle loss.…”

Section: Introductionmentioning

confidence: 99%

Temporal Muscle and Stroke—A Narrative Review on Current Meaning and Clinical Applications of Temporal Muscle Thickness, Area, and Volume

et al. 2022

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Background: Evaluating muscle mass and function among stroke patients is important. However, evaluating muscle volume and function is not easy due to the disturbances of consciousness and paresis. Temporal muscle thickness (TMT) has been introduced as a novel surrogate marker for muscle mass, function, and nutritional status. We herein performed a narrative literature review on temporal muscle and stroke to understand the current meaning of TMT in clinical stroke practice. Methods: The search was performed in PubMed, last updated in October 2021. Reports on temporal muscle morphomics and stroke-related diseases or clinical entities were collected. Results: Four studies reported on TMT and subarachnoid hemorrhage, two studies on intracerebral hemorrhage, two studies on ischemic stroke, two studies on standard TMT values, and two studies on nutritional status. TMT was reported as a prognostic factor for several diseases, a surrogate marker for skeletal muscle mass, and an indicator of nutritional status. Computed tomography, magnetic resonance imaging, and ultrasonography were used to measure TMT. Conclusions: TMT is gradually being used as a prognostic factor for stroke or a surrogate marker for skeletal muscle mass and nutritional status. The establishment of standard methods to measure TMT and large prospective studies to further investigate the relationship between TMT and diseases are needed.

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“…However, some cases exist in which the ability to swallow does not improve, when it is necessary to consider the patient’s underlying disease and general condition, as well as the effects of medications, especially those containing anticholinergics. A previous deprescribing report was associated with improved nutritional intake in older adults, sarcopenic patients with polypharmacy undergoing stroke rehabilitation [ 28 ]. As such, deprescribing is another option to improve feeding and swallowing ability.…”

Section: Discussionmentioning

confidence: 99%

Anticholinergic Load Is Associated with Swallowing Dysfunction in Convalescent Older Patients after a Stroke

et al. 2022

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This study aimed to establish whether anticholinergic load affects the swallowing function of geriatric stroke patients in convalescent stages, as no proven association between the anticholinergic load-based Anticholinergic Risk Scale and the swallowing dysfunction in Japanese patients was known. A retrospective cohort study was conducted on hospitalized older patients undergoing rehabilitation after stroke. The study outcomes included evaluating the patients at hospital discharge using the Functional Oral Intake Scale. To evaluate the effects of an increased anticholinergic load, we used a multivariate analysis to examine whether the change in the Anticholinergic Risk Scale during hospitalization was associated with the outcome. Of 542 enrolled patients, 345 (63.7%) presented with cerebral infarction, 148 (27.3%) with intracerebral hemorrhage, and 49 (9%) with subarachnoid hemorrhage. The change in the Anticholinergic Risk Scale was independently associated with the Functional Oral Intake Scale (β = −0.118, p = 0.0164) at discharge. Among anticholinergics, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc., increased significantly from admission to discharge. An increased anticholinergic load was associated with swallowing dysfunction in older patients undergoing stroke rehabilitation.

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Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke

Cited by 29 publications

References 36 publications

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Temporal Muscle and Stroke—A Narrative Review on Current Meaning and Clinical Applications of Temporal Muscle Thickness, Area, and Volume

Anticholinergic Load Is Associated with Swallowing Dysfunction in Convalescent Older Patients after a Stroke

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