Polypharmacy and Its Association with Dysphagia and Malnutrition among Stroke Patients with Sarcopenia

Abstract

Evidence on polypharmacy in patients with sarcopenia is lacking. We aimed to examine the association of polypharmacy with swallowing function and nutritional risk in post-stroke patient with sarcopenia. This retrospective cohort study included hospitalized patients diagnosed with sarcopenia who needed convalescent rehabilitation following stroke onset. Study outcomes were the Food Intake Level Scale (FILS) as dysphagia assessment and geriatric nutritional risk index (GNRI) as nutritional status at hospital discharge, respectively. To examine the impact of admission polypharmacy, multivariate linear regression analyses were used to determine whether the number of drugs prescribed at hospital admission was associated with these outcomes. As a result, of the 586 patients enrolled, 257 (mean age 79.3 years, 44.0% male) were diagnosed with sarcopenia and were finally analyzed high admission drug prescription numbers were independently associated with FILS (β = −0.133, p = 0.017) and GNRI (β = −0.145, p = 0.003) at hospital discharge, respectively. Polypharmacy is associated with dysphagia and malnutrition in post-stroke patients with sarcopenia. In addition to the combination of nutritional and exercise therapies, review and optimization of prescription medications may be warranted to treat sarcopenia in order to maximize improvement in outcomes for these patients.

High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit

“…In the group of patients we studied, nutritional risk (for each of the three screening tools) was negatively influenced by sex, age and dysphagia, whereas BMI, atrial fibrillation, hypertension, diabetes mellitus, heart disease, hyperlipemia, previous stroke, type of stroke and time from stroke onset were not found to be prognostic factors. This finding is in line with recent papers showing that younger age and hyperlipemia were independently associated with lower CONUT scores [26] and that dysphagia was associated with high nutritional risk according to GNRI [25,[27][28][29]. Although diabetes is a nutritional disorder that might negatively affect the clinical outcomes in stroke patients, it does not seem to have an effect on the nutritional risk in the patients we studied.…”

The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients

“…The studies that applied GNRI to stroke patients have been carried out (since 2016) in Far Eastern Asian countries [ 7 , 14 , 15 , 16 , 27 , 29 , 30 , 31 , 32 , 34 , 37 , 42 , 43 , 45 , 46 , 47 , 48 , 50 , 53 , 54 , 55 , 57 , 58 , 63 , 64 , 66 , 68 , 70 , 71 ], as shown in Table 1 . A significant risk of malnutrition has usually been defined by a GNRI score <92, with some exceptions (for example, a score <98 [ 7 ] or <100 [ 27 ]).…”

Deprescribing psychotropic medications is associated with improvements in activities of daily living in post‐stroke patients

“…Accordingly, it may not indicate that deprescribing psychotropic medications is not effective in improving swallowing function in convalescent rehabilitation patients after stroke. Polypharmacy is associated with dysphagia and malnutrition, 18 and deprescribing to reduce polypharmacy has been reported to positively influence energy intake 29 . Psychotropic medications have anticholinergic effects that are closely related to dysphagia.…”

“…The number of older patients suffering from stroke is increasing in line with the aging population. 24 Recent studies have demonstrated a negative association between polypharmacy, PIM (including psychotropic medications) use, improved nutritional status, 3,16,25 swallowing function, 6,18 and ADLs 26,27 in convalescent rehabilitation settings. Therefore, optimizing polypharmacy, including the use of psychotropic medications, is of clinical significance in maximizing patient outcomes.…”

“…Managing the multimorbidity commonly observed in older patients often necessitates the administration of numerous medications 15 . Polypharmacy in older adults has been consistently associated with worse outcomes, including an increased risk of ADEs, 16 decreased activities of daily living (ADLs), 17 malnutrition, 18,19 and dysphagia 19 . Additionally, polypharmacy escalates the likelihood of PIMs, 20 which are defined as medications with a high risk/benefit ratio or uncertain therapeutic effects for which safer alternatives exist for older adults 21 .…”