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 10

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 8

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 25

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

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.