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

Abstract

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.

Development of the ward nurses' discharge‐oriented dietary support scale for older adult patients in Japan

“…Eating behavior is defined as a series of actions that lead to food intake (Mahmood et al, 2021). There are five food intake processes: anticipatory, preparatory, lingual, pharyngeal, and esophageal (Ohta et al, 2022). This process involves recognizing food, putting food in the mouth, and transferring the bolus of food to the stomach via the pharynx and esophagus.…”

Multimorbidity, consisting of a combination of chronic diseases and geriatric syndromes, predicts the risk of difficulty in discharge home in older patients admitted to acute care hospital

“…Although depression, constipation, chronic pain, polypharmacy, low BMI, and cognitive impairment as geriatric syndromes have been assessed in another study, 14 we added dysphagia, hypoalbuminemia, and functional limitation (DASC‐21) into the assessment items in this study. This is because dysphagia in hospitalized patients is associated with aspiration pneumonia 23 and is one of the most significant causes of discharge difficulty 24 . Hypoalbuminemia, a marker of inflammation and the risk of malnutrition, affects the prognosis of infections in older inpatients 25 .…”

Association between Survival Duration of Older Patients with Advanced Unresectable Pancreatic Cancer and Appetite Loss: A Retrospective Cohort Study

“…In 2020, the total population of Unnan was 37,638 (18,145 males and 19,492 females), with 39% individuals aged >65 years, and this is expected to reach 50% by 2025. There are 16 clinics, 12 home care stations, 3 visiting nursing stations, and only 1 public hospital (Unnan City Hospital) in the city [ 20 ]. Unnan City Hospital has 281 beds comprising 160 acute and 43 comprehensive care beds, 30 rehabilitation beds, and 48 chronic care beds.…”

“…Unnan City Hospital has 281 beds comprising 160 acute and 43 comprehensive care beds, 30 rehabilitation beds, and 48 chronic care beds. There are 14 medical specialties, and the nurse-to-patient ratio is 1:10 for acute care, 1:13 for comprehensive care, 1:15 for rehabilitation, and 1:25 for chronic care [ 20 ].…”

“…The following data from the electronic health records of Unnan City Hospital were also collected: age, sex, body mass index (BMI), albumin (g/dL) for the assessment of nutrition and serum creatinine, estimated glomerular filtration rate (eGFR) for the assessment of renal function, hemoglobin level, care level based on the Japanese long-term insurance system [ 21 ], Charlson comorbidity index (CCI) based on their past medical histories to assess their severities (the presence of heart failure, myocardial infarction, asthma, chronic obstructive pulmonary diseases, kidney diseases, liver diseases, diabetes mellitus, brain infarction, brain hemorrhage, hemiplegia, connective tissue diseases, dementia, and cancer) [ 22 ], and cognitive and motor components; Functional Independence Measure (FIM) total score at admission, which were measured by therapists as an indicator of patients’ ADL; time of diagnosis of pancreatic cancer and death and the presence of chemotherapy; and care level based on the Japanese long-term insurance system (numbered from 1 to 5, with 1 being the least dependent and 5 being severely dependent) [ 20 ]. Care level was divided into two groups (dependent: ≥1 and non-dependent: <1) based on the burden on caregivers and families.…”