Profiles of polypharmacy in older adults and medication associations with signs of aspiration

Pu, Dandan; Wong, Michael C H; Yiu, Eml; Chan, Karen M. K.

doi:10.1080/17512433.2021.1909474

Cited by 9 publications

(4 citation statements)

References 45 publications

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“…Dysphagia is an important problem in stroke patients. Dysphagia can be caused by diseases, such as stroke, but also by aging, muscle weakness, such as in the case of sarcopenia [ 7 ], cognitive decline [ 8 ], and drug side effects [ 9 , 10 ], and can lead to aspiration pneumonia and malnutrition. Dysphagia occurs in 27–64% of stroke patients, and 15% have residual dysphagia up to 1 month after stroke [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Matsumoto¹,

Yoshimura²,

Nagano³

et al. 2022

Nutrients

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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.

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Section: Introductionmentioning

confidence: 99%

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

Matsumoto¹,

Yoshimura²,

Nagano³

et al. 2022

Nutrients

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“…Older patients admitted under internal medicine tend to have multimorbidity and require comprehensive care from various professionals and multiple medicines to control their symptoms. This approach to multimorbidity can cause polypharmacy, relating to dysphagia [ 59 , 60 , 61 ]. This study also shows that admission for the reason of internal medicine could impinge on discharge to home.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study

Ohta¹,

Weiss

Mekky

et al. 2022

IJERPH

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Dysphagia refers to swallowing difficulty, which impacts patients’ quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20–0.73), polypharmacy (OR = 0.5, 95% CI: 0.32–0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26–0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05–1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.

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“…Benzodiazepines are one of the most common drugs responsible for drug-induced dysphagia. They are commonly used to treat sleep disorders, anxiety, spasticity due to central nervous system disorders, and some forms of depression ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Several mechanisms have been proposed to explain the possible association between benzodiazepines and pneumonia ( 2 - 4 ). The underlying mechanisms of dysphagia have been reported to include sedation; hypoventilation ( 5 ); suppression of saliva secretion, especially during sleep due to its anticholinergic effects ( 6 , 7 ); esophageal dysmotility; pharyngeal dysfunction; discoordinated breathing and swallowing ( 8 ); and muscle relaxation of the lower esophageal sphincter (LES) ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

The Evaluation of Benzodiazepine-induced Dysphagia Using High-resolution Manometry

et al. 2023

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We evaluated the pathophysiology of dysphagia considered to be induced by benzodiazepine using highresolution manometry (HRM). A 53-year-old man with Parkinson disease had had dysphagia for over 3 months. He had been taking several benzodiazepines for more than four years. Two weeks after discontinuation of the benzodiazepines, HRM revealed increased pharyngeal contractility and residual pressure at the upper esophageal sphincter. A video-fluoroscopic swallowing study showed improved pharyngeal bolus passage. Benzodiazepine-induced dysphagia may be due to the muscle relaxant effects on the swallowing muscles and attenuation of the barrier function which prevents reflux from the esophagus into the pharynx.

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Profiles of polypharmacy in older adults and medication associations with signs of aspiration

Cited by 9 publications

References 45 publications

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

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

Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study

The Evaluation of Benzodiazepine-induced Dysphagia Using High-resolution Manometry

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