Impact of registered dietitian and dental hygienist involvement on functional outcomes in patients with dysphagia: triad of rehabilitation, nutrition, and oral management

Wakabayashi, Hidetaka; Kakehi, Shingo; Kishima, Masako; Itoda, Masataka; Nishioka, Shinta; Momosaki, Ryo

doi:10.1007/s41999-023-00833-7

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…Given that electrolyte abnormalities, malnutrition, and sarcopenia are frequently found in older patients undergoing post-stroke rehabilitation, 41 , 42 ) it may be necessary to implement the triad of rehabilitation, nutrition, and oral management. 43 , 44 , 45 ) This multifaceted approach aims to enhance nutritional status, oral health, and overall functional recovery, highlighting the significance of integrated patient care through perspectives such as rehabilitation nutrition 46 , 47 , 48 ) and rehabilitation pharmacotherapy. 19 , 49 , 50 )…”

Section: Discussionmentioning

confidence: 99%

Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients

Yoshimura,

Wakabayashi,

Nagano

et al. 2024

PRM

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Objectives: Evidence is scarce regarding the association between hyponatremia and functional outcomes among older hospitalized patients. We aimed to evaluate the associations between baseline hyponatremia and improvement in activities of daily living (ADL) and muscle health in hospitalized post-stroke patients. Methods: This retrospective cohort study included hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration below135 mEq/L. Primary outcome was the discharge ADL as assessed by the motor domain of the Functional Independence Measure (FIM-motor) and its corresponding gain during hospitalization. Other outcomes encompassed the discharge scores for skeletal muscle mass (SMI) and handgrip strength (HGS). Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. Results: Data from 955 patients (mean age 73.2 years; 53.6% men) were analyzed. The median baseline blood sodium level was 139 [interquartile range: 137, 141] mEq/L, and 84 patients (8.8%) exhibited hyponatremia. After full adjustment for confounders, baseline hyponatremia was significantly and negatively associated with FIM-motor at discharge (β=−0.036, P=0.033) and its gain during hospital stay (β=−0.051, P=0.033). Baseline hyponatremia exhibited an independent and negative association with discharge HGS (β=−0.031, P=0.027), whereas no significant association was found between baseline hyponatremia and discharge SMI (β=−0.015, P=0.244). Conclusions: Baseline hyponatremia demonstrated a correlation with compromised ADL and muscle health in individuals undergoing rehabilitation after stroke.

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Section: Discussionmentioning

confidence: 99%

Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients

Yoshimura,

Wakabayashi,

Nagano

et al. 2024

PRM

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“…Our findings showed a significant impact of time on FILS improvement, with a smaller trend in polypharmacy. According to previous studies, 25,35,36,47) polypharmacy may inhibit the recovery of swallowing function by causing sarcopenia, malnutrition, and impaired activities of daily living. Moreover, these associations were modified using rehabilitation therapy and nutritional support.…”

Section: Discussionmentioning

confidence: 99%

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

Togashi,

Ohinata,

Noguchi

et al. 2024

Ann Geriatr Med Res

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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.

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“…Sarcopenic dysphagia reduces swallowing function, ADL and life prognosis. The triad of rehabilitation, nutrition, and oral management may be useful for patients with dysphagia [92]. The triad of rehabilitation, nutrition and oral management requires a multimodal approach based on collaboration among different professions, institutions, and communities.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update

Kakehi,

Isono,

Wakabayashi

et al. 2023

Ann Rehabil Med

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Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

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Impact of registered dietitian and dental hygienist involvement on functional outcomes in patients with dysphagia: triad of rehabilitation, nutrition, and oral management

Cited by 13 publications

References 27 publications

Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients

Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients

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

Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update

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