著者

Anna YAMANOUCHI Yoshihiro YOSHIMURA Yumi MATSUMOTO Seungwon JEONG

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.62, no.4, pp.229-234, 2016 (Released:2016-10-05)

参考文献数

24

被引用文献数

13 11

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Sarcopenia is known to increase the risk of adverse outcomes, including disability, loss of independence, hospitalization, longer length of hospital stay, and mortality, but there is little data about the prevalence of sarcopenia and the factors associated with increased physical dependency and cognitive decline among older patients hospitalized in a long-term care (LTC) ward in Japan. A cross-sectional study was conducted in 79 consecutive patients (34 men, 45 women) with a median age of 81 y hospitalized in an LTC hospital. Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia. Skeletal muscle mass index (SMI) was assessed by using bioelectrical impedance analysis. Physical dependency and cognitive decline were evaluated by the Functional Independence Measure (FIM). Nutritional status was evaluated by using the Mini Nutritional Assessment-Short Form and daily intake of energy and protein. Multivariate analyses were applied to examine factors associated with increased physical dependency and cognitive decline. Median SMI was 4.9 kg/m2 (interquartile range [IQR], 4.0-5.3 kg/m2) in men and 3.3 kg/m2 (IQR, 2.9-3.8 kg/m2) in women, showing that all participants had an SMI below the cut-off value. Seventy participants (88.6%) were unable to perform the hand grip strength test, and all participants were unable to perform the gait speed test. Multivariate analysis showed that oral nutritional access and daily energy intake were associated both with physical and cognitive level (p<0.05).

著者

Yoshihiro Yoshimura Hidetaka Wakabayashi Ryo Momosaki Fumihiko Nagano Sayuri Shimazu Ai Shiraishi

出版者

Tohoku University Medical Press

雑誌

The Tohoku Journal of Experimental Medicine (ISSN:00408727)

巻号頁・発行日

vol.252, no.1, pp.15-22, 2020 (Released:2020-08-25)

参考文献数

34

被引用文献数

4 18

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As Japan’s population ages, there is a growing interest in regional health care coordination. Our study aimed to evaluate whether the interval between onset and admission to convalescent rehabilitation wards (onset-admission) was associated with outcomes in ischemic stroke patients. We conducted a retrospective cohort study in a single rehabilitation hospital. Ischemic stroke patients consecutively admitted to the wards were eligible to enroll. Outcomes included Functional Independence Measure (FIM)-motor gain, the Food Intake Level Scale (FILS) and a discharge rate to home. FIM assesses functional independence, including motor (FIM-motor) and cognitive domains, and is a measure of activities of daily living (ADLs). The FIM-motor gain indicates the difference between the FIM-motor scores at admission and discharge. FILS is a 10-point observer-rated scale to measure swallowing. After enrollment, 481 patients (mean age 74.4 years; 45.7% women) were included. The median [interquartile range] onset-admission interval was 13 [10-20] days and the median National Institute of Health Stroke Scale score, a measure of stroke severity, was 8 [3-13]. In multivariate analysis, the onset-admission interval was independently associated with FIM-motor gain (β = −0.107, p = 0.024), FILS score at discharge (β = −0.159, p = 0.041), and the rate of discharge to home (odds ratio: 0.946, p = 0.032). In conclusion, a shorter interval between stroke onset and admission to convalescent rehabilitation wards contributes to improved outcomes, including ADLs, dysphagia, and a discharge rate to home, in ischemic stroke patients, regardless of stroke severity.

著者

Yoshihiro Yoshimura Takahiro Bise Fumihiko Nagano Sayuri Shimazu Ai Shiraishi Makio Yamaga Hiroaki Koga

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180011, 2018 (Released:2018-05-18)

参考文献数

53

被引用文献数

1 43

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Objective: The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. Methods: A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. Results: The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=−0.131, P=0.031). Conclusion: Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.

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

Yoshihiro Yoshimura Ai Shiraishi Yuri Tsuji 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.20220019, 2022 (Released:2022-04-12)

参考文献数

15

被引用文献数

19

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.