著者

Yoshihiro Yoshimura Ayaka Matsumoto Ryo Momosaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220025, 2022 (Released:2022-05-14)

参考文献数

133

被引用文献数

25

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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.

著者

Yusuke Ito Yoshihiro Yoshimura Fumihiko Nagano Ayaka Matsumoto Shin Nomura

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230044, 2023 (Released:2023-12-09)

参考文献数

48

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Objectives: This study aimed to determine whether the phase angle is associated with physical function at discharge and discharge destination in patients with osteoporotic fragile fractures.Methods: This retrospective cohort study included patients with fragile osteoporotic fractures who were admitted to a convalescent rehabilitation ward. The phase angle was calculated using a body composition meter and bioelectrical impedance analysis. The primary outcome was the Functional Independence Measure motor (FIM-motor) score at discharge, and the secondary outcome was discharge to home. Multivariate analysis was used to determine the association between phase angle and FIM-motor scores at discharge and discharge to home.Results: The study included 127 patients (108 women, age 81.2 ± 9.7 years). The median phase angle on admission was 4.1° for men and 3.6° for women. The median FIM-motor score at discharge was 83, with 92 (72.4%) patients discharged home and 35 (27.6%) discharged to a destination other than home. Multiple regression analysis adjusted for confounders revealed a significant independent association between the phase angle and FIM-motor score at discharge (β=0.262, P=0.019). However, no significant association was found between phase angle and discharge destination (odds ratio, 1.350; 95% confidence interval: 0.680–2.670, P=0.391).Conclusions: Phase angle was independently associated with physical function at discharge in patients with fragile osteoporotic fractures. For patients with a reduced phase angle on admission, a multidisciplinary approach, including exercise, nutrition, oral health, and medication, should be implemented to maximize improvement in physical function.

著者

Takafumi ABE Yoshihiro YOSHIMURA Yoichi SATO Fumihiko NAGANO Ayaka MATSUMOTO

出版者

Center for Academic Publications Japan

雑誌

Journal of Nutritional Science and Vitaminology (ISSN:03014800)

巻号頁・発行日

vol.69, no.6, pp.454-462, 2023-12-31 (Released:2023-12-31)

参考文献数

46

被引用文献数

1

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Few reports have described sarcopenic obesity in patients with stroke. This study aimed to investigate the prevalence of sarcopenic obesity, as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) consensus statement, in patients with acute stroke and to determine whether it was associated with improved physical function at discharge. This retrospective cohort study was conducted from May 2020 to November 2021 in patients with acute stroke. Sarcopenic obesity was determined using the ESPEN and EASO consensus statement. The main outcome was physical function based on the Functional Independence Measure motor score at discharge. Multiple regression analysis was conducted to evaluate the association between sarcopenic obesity and the Functional Independence Measure motor score. This study included 276 patients (182 men; mean age, 72.4 y). Sarcopenic obesity screened for obesity with body mass index >27.5 was found in 11 (4%) patients. Multiple regression analysis revealed that sarcopenic obesity screened for obesity with body mass index >27.5 was not significantly associated with the Functional Independence Measure motor score at discharge (β=0.038; 95% confidence interval: −0.046, 0.123; p=0.369). This study revealed a prevalence rate of 4% for sarcopenic obesity diagnosed by the ESPEN and EASO criteria and showed that sarcopenic obesity was not statistically associated with activities of daily living at acute discharge in patients with stroke.