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Objectives: There is a lack of evidence regarding the association between whole-body exercise and independence in urination and defecation. This study aimed to evaluate the effect of chair-stand exercise on improving urination and defecation independence in post-stroke patients with sarcopenia. Methods: A retrospective study was conducted on stroke patients admitted to a community rehabilitation hospital between 2015 and 2021. Patients diagnosed with sarcopenia who required assistance with bladder and bowel management were included. The primary outcomes were the Functional Independence Measure (FIM) scores for urination (FIM-Bladder) and defecation (FIM-Bowel) at discharge. Multiple regression analysis was used to examine the association between chair-stand exercise and the outcomes, adjusting for potential confounders. Results: Of 586 patients, 187 patients (mean age 79.3 years, 44.9% male) were included in the urination analysis, and 180 patients (mean age 79.3 years, 44.4% male) were included in the defecation analysis. Multiple regression analysis showed that the number of chair-stand exercises was independently positively associated with FIM-Bladder at discharge (ß=0.147, P=0.038) and FIM-Bladder gain (ß=0.168, P=0.038). Similarly, the number of chair-stand exercises was independently positively associated with FIM-Bowel at discharge (ß=0.149, P=0.049) and FIM-Bowel gain (ß=0.166, P=0.049). Conclusions: Chair-stand exercise was positively associated with improved urination and defecation independence in post-stroke patients with sarcopenia. Incorporating whole-body exercises, such as chair-stand exercise, in addition to conventional rehabilitation programs may help improve voiding independence, reduce incontinence, and enhance quality of life in these patients.

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We investigated the relationship between three nutritional indicators, the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutrition Status (CONUT), and physical activity at discharge in patients admitted to convalescent rehabilitation wards. The study included 1601 patients (77 ± 12 years, male 46.2%) discharged from convalescent rehabilitation wards between April 2018 and September 2023. MNA-SF, GNRI, and CONUT scores were obtained on admission. Patients were divided into two groups according to their level of Functional Independence Measure (FIM) walk score at discharge. The walking group (n = 1181, FIM walk score ≥ 5, 76 ± 13 years, male 47.2%) was significantly younger than the wheelchair group (n = 420, 79 ± 12 years, FIM walk score < 5, male 43.8%) and had significantly higher MNA-SF (6.5 ± 2.5 vs. 4.7 ± 2.4) and GNRI (93.1 ± 12.4 vs. 86.7 ± 10.9) scores and significantly lower CONUT (3.1 ± 2.3 vs. 3.9 ± 2.3) scores than the wheelchair group (all p < 0.01). Multivariate logistic regression analysis showed that age, handgrip strength, Functional Oral Intake Scale, and MNA-SF score were independently associated with walking ability at discharge (all p < 0.01). In addition, MNA-SF scores were independently associated with Rehabilitation Effectiveness. These results suggest that nutritional status, particularly MNA-SF scores on admission, is associated with improvement of physical activity at discharge.

Asunto(s)

Ejercicio Físico , Evaluación Geriátrica , Evaluación Nutricional , Estado Nutricional , Humanos , Masculino , Anciano , Femenino , Ejercicio Físico/fisiología , Anciano de 80 o más Años , Evaluación Geriátrica/métodos , Alta del Paciente , Centros de Rehabilitación , Caminata/fisiología , Persona de Mediana Edad

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BACKGROUND AND AIMS: The triad approach combining rehabilitation, nutrition support, and oral management has garnered increasing interest for improving outcomes in older adults. However, evidence is limited regarding its effectiveness in post-stroke patients, who are at high risk for malnutrition, sarcopenia, oral problems, and dysphagia. This study aims to investigate the association between the triad approach and improvement in activities of daily living (ADL), muscle strength, and skeletal muscle mass in these patients. METHODS: A retrospective cohort study was conducted using post-stroke patients. Patients were divided into groups based on their exposure to the triad approach, defined as a combination of intensive chair-stand exercise (rehabilitation), personalized food prescriptions (nutrition support), and oral management by dental professionals. We investigated the association between the triad approach and outcomes using multiple linear regression analysis adjusted for covariates. Primary outcome was Functional Independence Measure motor score (FIM-motor) at discharge and its gain. Secondary outcomes were handgrip strength (HGS) and skeletal muscle mass index (SMI) at discharge. RESULTS: The study included 1012 post-stroke patients (median age 75.6 years; 54.1% men). Multiple linear regression analysis revealed that the triad approach had the strongest association with higher FIM-motor at discharge (ß = 0.262, p < 0.001) and FIM-motor gain (ß = 0.272, p < 0.001) compared to the individual or combined interventions. The triad also showed the strongest associations with higher HGS (ß = 0.090, p = 0.017) and SMI (ß = 0.041, p = 0.028) at discharge. CONCLUSIONS: The triad approach of intensive rehabilitation, personalized nutrition support, and oral management by dental professionals is strongly associated with improved ADL, muscle strength, and skeletal muscle mass in post-stroke rehabilitation patients. Implementing this multidisciplinary strategy may maximize functional and muscle health recovery.

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AIM: Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post-stroke older patients. METHODS: A retrospective cohort study was conducted on 708 hospitalized post-stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m2, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure-motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure-cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest. RESULTS: The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023-0.718), worse swallowing level (B = -0.878, 95% CI -1.280 to -0.476), and poorer cognitive status (B = -1.872, 95% CI -2.960 to -0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone. CONCLUSIONS: The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 00: 000-000. Geriatr Gerontol Int 2024; ••: ••-••.

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BACKGROUND: Treating oral problems with dentist intervention during hospitalisation may improve patients' food intake status. OBJECTIVES: This study aimed to clarify whether convalescent rehabilitation ward inpatients in a hospital with hospital dentistry (HHD) had a better diet at discharge than those in a hospital without hospital dentistry (HNHD). METHODS: Retrospective observational study including inpatients with dental involvement in a HHD with dentists and dental hygienists and HNHD with dental hygienist and visiting dental service between 1 March and 31 August 2022. Data included age, sex, body mass index (BMI), Functional Independent Measure (FIM) motor and cognitive, Oral Health Assessment Tool (OHAT) score, Food Intake LEVEL Scale (FILS), whether the FILS ≥8 (indicating that patient eats also a non-texture-modified diet), remained and functional tooth numbers and speech language hearing therapist (SLHT) and dentist interventions. Comparisons between the two hospitals and factors that affected the FILS ≥8 were examined. RESULTS: A total of 333 and 89 inpatients were included in the HHD and HNHD groups, respectively. After propensity score matching, the HHD group had a significantly higher rate of FILS ≥8, functional tooth numbers at discharge, and SLHT and dentist intervention rates. The multivariable logistic regression analysis for propensity score matching participants showed that the significant independent variables for FILS ≥8 were age, BMI, FILS, FIM motor (all at admission) and SLHT and dentist interventions. Odds ratio for dentist intervention was 14.46 (95% CI: 4.36-48.01). CONCLUSIONS: Dentists are necessary to improve patients' food intake status in convalescent rehabilitation wards.

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PURPOSE: Evidence is scarce on the associations between impaired oral health and cognitive level related to independence in activities of daily living (ADLs) among hospitalized older patients. We aimed to evaluate the associations between baseline oral problems and changes in cognitive level in post-stroke patients. METHODS: A retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Revised Oral Assessment Guide (ROAG) as a measure of oral health and function was assessed at admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the motor domain of FIM (FIM-motor). Multivariate linear regression analyses were employed to assess the association between baseline ROAG and the designated outcomes, adjusting for potential confounding factors. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median ROAG was 10 [9, 12], with 811 patients (84.9%) presenting oral problems. After fully adjusting for confounding factors, the ROAG was significantly and negatively associated with FIM-cognition at discharge (ß = -0.107, p = 0.031) and FIM-cognition gain (ß = -0.093, p = 0.018). Further, the ROAG was independently and negatively associated with FIM-motor at discharge (ß = -0.043, p = 0.013) and FIM-motor gain (ß = -0.065, p = 0.013). CONCLUSION: Oral problems were associated with compromised cognitive levels and a decline in physical function during the hospitalization in post-stroke patients. These results underscore the critical importance of addressing oral health in this patient population.

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BACKGROUND & AIMS: Depression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation. METHODS: This was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated. RESULTS: The malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (ß: -0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (ß: -0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms. CONCLUSION: Malnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.

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PURPOSE: Evidence is scarce regarding the association between anemia and alterations in cognitive level among hospitalized older patients. We aimed to evaluate the associations between baseline hemoglobin (Hb) levels and changes in cognitive level in patients undergoing rehabilitation after stroke. METHODS: A retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Data on serum Hb levels were extracted from medical records, specifically tests conducted within 24 hours of admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the length of hospital stay. Multivariate linear regression analyses were employed to assess the association between Hb levels at admission and the designated outcomes, adjusting for potential confounding factors. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median Hb level at admission was 13.3 [11.9, 14.5] g/dL. After fully adjusting for confounding factors, the baseline Hb level was significantly and positively associated with FIM-cognition at discharge (ß = 0.045, p = 0.025) and its gain (ß = 0.073, p = 0.025). Further, the baseline Hb level was independently and negatively associated with length of hospital stay (ß = -0.013, p = 0.026). CONCLUSION: Elevated baseline Hb levels are correlated with preserved cognitive level and shorter hospital stays in post-stroke patients. Evaluating anemia at the outset serves as a crucial prognostic indicator.

Asunto(s)

Anemia , Biomarcadores , Cognición , Evaluación de la Discapacidad , Estado Funcional , Hemoglobinas , Tiempo de Internación , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Anciano , Estudios Retrospectivos , Hemoglobinas/metabolismo , Anciano de 80 o más Años , Anemia/sangre , Anemia/diagnóstico , Biomarcadores/sangre , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Factores de Edad , Factores de Riesgo , Resultado del Tratamiento , Recuperación de la Función , Evaluación Geriátrica , Pronóstico

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Background: Recent studies have reported an association between sarcopenia and depression symptoms. To date, no reports have investigated the association between sarcopenia and depression symptoms evaluated using the Geriatric Depression Screening Scale (GDS)-15 in patients with stroke. Therefore, this study aimed to investigate the association between sarcopenia and its components and the improvement of depression symptoms in patients with stroke admitted to a convalescent rehabilitation ward. Methods: Patients with stroke aged ≥65 years admitted to a convalescent rehabilitation ward were included in the study. Participants were categorized into sarcopenia and non-sarcopenia groups based on the 2019 Asian Working Group for Sarcopenia. Here, depression symptoms were evaluated using the GDS-15, in addition to demographic characteristics. This study's primary outcome was the GDS change from admission to discharge. Multiple regression analysis was performed to investigate the association between GDS change and sarcopenia and its components. Results: Overall, 118 participants were included, with a mean age of 78.7±8.1, and 58 (49%) were classified in the sarcopenia group. Multiple regression analysis showed that sarcopenia (ß: -0.283, 95% confidence interval [CI]: -1.140 to -0.283, p < 0.001) and handgrip strength (ß: -0.317, 95% CI: -0.162 to -0.014, p = 0.021) were independently associated with GDS change. Conclusion: Sarcopenia and handgrip strength were significantly associated with improved depression symptoms in patients with stroke admitted to a convalescent rehabilitation ward. However, further prospective studies should investigate the association between sarcopenia and depression symptoms in patients with stroke.

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BACKGROUND & AIMS: The utilization of recommended nutritional assessment measures in rehabilitation settings remains unclear. This study explored methods for identifying nutritional disorders using data from a nationwide survey conducted in convalescent rehabilitation wards. METHODS: This cross-sectional study analyzed the annual survey, including methods for identifying malnutrition, the risk of malnutrition, and overnutrition in Kaifukuki (convalescent) rehabilitation wards. Methods identifying malnutrition and risk of malnutrition were grouped into nutritional screening tools (NSTs), nutritional assessment tools (NATs), diagnostic criteria for malnutrition (DCM), and suboptimal methods (e.g., hypoalbuminemia). NSTs, NATs, and DCM were further categorized as "acceptable tools." The association between applying acceptable tools, hospital-based data (e.g., the number of beds), and ward-based data (e.g., assessor for nutritional status) was analyzed by logistic regression analysis with multiple imputations. RESULTS: In total, 885 hospitals with Kaifukuki rehabilitation wards responded to the survey, and 754 hospitals were included in the analysis. Registered dietitians assessed the nutritional status in 88% of the hospitals, whereas other professionals (e.g., nurses) evaluated the nutritional status in the remainder. NSTs (e.g., Mini Nutritional Assessment Short-Form), NATs (e.g., Subjective Global Assessment), DCM (e.g., Global Leadership Initiative on Malnutrition criteria), and suboptimal tools were used in 13.1%, 5.4%, 4.8%, and 74.6% of cases, respectively. Most hospitals used acceptable measures (e.g., body mass index) for overnutrition (91.2%). Multiple logistic regression analysis showed that assessments by registered dietitians (adjusted odds ratio[OR]: 2.20.95% confidence interval[CI]: 1.09-4.45) and hospital-owned food services, a proxy for limited clinical practice time of dietitians, were associated with a low likelihood of implementing acceptable measures (adjusted OR: 0.64, 95%CI: 0.43-0.97). CONCLUSIONS: Acceptable malnutrition measures, including the NSTs, NATs, and DCM, have not been widely applied in convalescent rehabilitation settings. The implementation of recommended tools for identifying malnutrition may be promoted when registered dietitians assess the patients' nutritional status.

Asunto(s)

Desnutrición , Evaluación Nutricional , Estado Nutricional , Humanos , Desnutrición/diagnóstico , Estudios Transversales , Femenino , Masculino , Encuestas y Cuestionarios , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Anciano , Persona de Mediana Edad

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Objectives: Evidence is scarce regarding the association between hyponatremia and functional outcomes among older hospitalized patients. We aimed to evaluate the associations between baseline hyponatremia and improvement in activities of daily living (ADL) and muscle health in hospitalized post-stroke patients. Methods: This retrospective cohort study included hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration below135 mEq/L. Primary outcome was the discharge ADL as assessed by the motor domain of the Functional Independence Measure (FIM-motor) and its corresponding gain during hospitalization. Other outcomes encompassed the discharge scores for skeletal muscle mass (SMI) and handgrip strength (HGS). Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. Results: Data from 955 patients (mean age 73.2 years; 53.6% men) were analyzed. The median baseline blood sodium level was 139 [interquartile range: 137, 141] mEq/L, and 84 patients (8.8%) exhibited hyponatremia. After full adjustment for confounders, baseline hyponatremia was significantly and negatively associated with FIM-motor at discharge (ß=-0.036, P=0.033) and its gain during hospital stay (ß=-0.051, P=0.033). Baseline hyponatremia exhibited an independent and negative association with discharge HGS (ß=-0.031, P=0.027), whereas no significant association was found between baseline hyponatremia and discharge SMI (ß=-0.015, P=0.244). Conclusions: Baseline hyponatremia demonstrated a correlation with compromised ADL and muscle health in individuals undergoing rehabilitation after stroke.

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PURPOSE: Evidence is scarce regarding the association between hyponatremia and alterations in cognitive function among hospitalized older patients. We aimed to investigate the associations between hyponatremia and the baseline cognitive status, as well as the improvement in cognitive function, in hospitalized post-stroke patients. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration < 135 mEq/L. The main outcomes included admission and discharge scores for cognitive levels, assessed through the cognitive domain of the Functional Independence Measure (FIM-cognition), as well as the score changes observed during the hospitalization period. Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6 % men) were included in the analysis. The median baseline blood sodium level was 139 [137, 141], and 84 patients (8.8 %) exhibited hyponatremia. After full adjustment for confounders, the baseline hyponatremia was significantly and negatively associated with FIM-cognition values at admission (ß = -0.009, p = 0.016), discharge (ß = -0.038, p = 0.043), and the gain during hospital stay (ß = -0.040, p = 0.011). CONCLUSION: Baseline hyponatremia has demonstrated a correlation with decline in cognitive level over the course of rehabilitation in individuals after stroke. Assessing hyponatremia at the outset proves to be a pivotal prognostic indicator.

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Disfunción Cognitiva , Hospitalización , Hiponatremia , Accidente Cerebrovascular , Humanos , Hiponatremia/etiología , Hiponatremia/sangre , Masculino , Femenino , Anciano , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/sangre , Anciano de 80 o más Años , Disfunción Cognitiva/etiología , Disfunción Cognitiva/sangre , Disfunción Cognitiva/diagnóstico , Persona de Mediana Edad , Sodio/sangre

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PURPOSE: Oral problems and muscle health are indeed significant concerns in ageing populations. However, there is limited evidence concerning the association between these issues. The study's focus was to investigate the association between oral problems and sarcopenic obesity, wherein sarcopenia and obesity coexist concurrently, in post-stroke patients. METHODS: This retrospective, observational, cross-sectional study included patients hospitalised for post-stroke rehabilitation. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). Sarcopenic obesity was diagnosed according to the European Society of Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. Multiple linear regression analysis was used to examine the association between the ROAG and sarcopenic obesity after adjusting for confounding factors. RESULTS: A total of 760 patients were included, with a mean (SD) age of 71 (9) years, of whom 408 (54.7%) were male. The median (interquartile range, 25th and 75th percentiles) ROAG was 11 [9, 13]. Sarcopenic obesity was diagnosed in 16 (3.9%) men, 18 (5.1%) women, and 34 (4.5%) patients overall. Multivariate linear analysis showed that ROAG was significantly and positively associated with sarcopenic obesity (ß = .091, P = .023), followed by obesity alone (ß = .084, P = .044), and sarcopenia alone (ß = .081, P = .037). CONCLUSION: Oral problems were associated with sarcopenic obesity in post-stroke. Oral assessment and intervention may have a positive impact on ADL and QOL in post-stroke patients with sarcopenic obesity.

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BACKGROUND AND OBJECTIVES: It is well known that more than 40% of patients in the convalescent rehabilitation settings suffer from malnutrition, and that appropriate nutrition management can improve rehabilitation outcomes. METHODS AND STUDY DESIGN: In this study, we used a change in motor score of Functional Independent Measure (FIM-M) of convalescent rehabilitation to investigate whether daily energy intake could influence the rehabilitation outcomes. Of the 217 patients hospitalized in our convalescent rehabilitation ward (CRW) between September 2016 and February 2017, 162 met the eligibility criteria for this study. RESULTS: For a 25 kcal/ ideal body weight (IBW)/day cutoff point, 76 patients consumed more than 25 kcal/IBW/day of energy (H-E group), and 86 patients consumed up to 25 kcal/IBW/day of energy (L-E group). Patients in the L-E group had poorer nutritional status than those in the H-E group at CRW admission. Moreover, patients in the L-E group lost some body weight (BW) during hospitalization, whereas patients in the H-E group gained some BW. Furthermore, the FIM-M efficiency in the L-E group was significantly lower than that in the H-E group. CONCLUSIONS: We concluded that appropriate nutritional management given to rehabilitation patients for adequate energy intake to maintain or gain their BW could maximize the outcome of convalescent rehabilitation.

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Desnutrición , Estado Nutricional , Humanos , Recuperación de la Función , Actividades Cotidianas , Ingestión de Energía

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AIM: There is limited evidence concerning the association between anemia and alterations in muscle health among hospitalized older patients. We aimed to evaluate the associations between baseline hemoglobin (Hb) levels and changes in muscle function in patients undergoing rehabilitation after stroke. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients. Data on serum Hb level were extracted from medical records on tests performed within 24 h of admission. The main outcomes were discharge score for the skeletal muscle mass index (SMI) obtained through bioimpedance analysis and the corresponding change in SMI during hospitalization. Other outcomes were handgrip strength (HGS) at discharge and the alteration in HGS during hospitalization. Multivariate linear regression analyses were used to determine the association between Hb levels at admission and outcomes of interest, adjusted for potential confounders. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median Hb level at admission was 13.3 [11.9, 14.5] g/dL. After fully adjusting for confounding factors, the baseline Hb level was significantly and positively associated with SMI at discharge (ß = 0.046, P = 0.039) and with SMI gain (ß = 0.010, P = 0.039). Further, the baseline Hb level was independently and positively associated with HGS at discharge (ß = 0.058, P = 0.014) and with its change from baseline (ß = 0.100, P = 0.014). CONCLUSION: Diminished baseline Hb levels were demonstrated be correlated with compromised muscle health in patients after stroke. Evaluating anemia at the outset serves as a crucial prognostic indicator. Geriatr Gerontol Int 2024; 24: 305-311.

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Anemia , Sarcopenia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Masculino , Humanos , Anciano , Femenino , Estudios Retrospectivos , Fuerza de la Mano/fisiología , Accidente Cerebrovascular/complicaciones , Músculo Esquelético , Anemia/etiología , Hemoglobinas

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Objectives: The purpose of this study was to examine the association between baseline dysphagia and the improvement of activities of daily living performance and cognitive level among inpatients after stroke. Methods: This was a retrospective cohort study of patients undergoing convalescent rehabilitation after stroke. Dysphagia was assessed using the Food Intake LEVEL Scale. Outcomes were the motor and cognitive scores of the Functional Independence Measure (FIM) at discharge. Multiple regression analysis was performed to examine the association between dysphagia at admission and these outcomes. Results: There were 499 participants with a median age of 74 years. A multiple regression analysis was carried out after adjusting for potential confounders including age and sex. Dysphagia at admission was independently and negatively associated with motor (ß=-0.157, P<0.001) and cognitive (ß=-0.066, P=0.041) FIM scores at discharge. Conclusions: Baseline dysphagia in patients after stroke was negatively associated with improvement in performance of activities of daily living and cognitive level.

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Objectives: To predict falls by adding an adherence assessment to a static balance ability assessment, and to evaluate fall prediction accuracy. Methods: This study included 416 patients who were admitted to a 45-bed convalescent rehabilitation ward over a 2-year period. The patients were assessed at the time of admission using the Standing Test for Imbalance and Disequilibrium (SIDE) and three additional, newly developed adherence items. Patients were divided into two groups: a group that experienced falls (fall group) and a group that did not experience falls (non-fall group) within 14 days of admission. The sensitivity and specificity of the assessment items for predicting falls were calculated. Results: Sensitivity was 0.86 and specificity was 0.42 when the cutoff was between SIDE levels 0-2a and 2b-4. Combining balance assessment using the SIDE with the memory and instruction adherence items improved fall prediction accuracy such that the sensitivity was 0.75 and the specificity was 0.64. Conclusions: Our analysis suggested that adherence assessment can improve fall risk prediction accuracy.

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OBJECTIVE: Assessment of the association between anemia and recovery of physical disability in patients with functional impairment. DESIGN: A retrospective cohort study. SETTING: A convalescent rehabilitation ward. PARTICIPANTS: The subjects were patients undergoing convalescent rehabilitation due to neurologic disease, musculoskeletal disorders, or hospital-associated deconditioning. Patients were classified into 3 groups (no anemia; mild anemia [men: hemoglobin of 11.0-12.9 g/dL; women: hemoglobin of 11.0-11.9 g/dL]; and moderate/severe anemia [hemoglobin < 11.0 g/dL]) based on hemoglobin levels. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The study outcomes were functional independence measures for motor function (FIM-M) score at discharge, changes in the FIM-M score between hospital admission and discharge, length of stay, and FIM-M efficiency score (change in FIM-M score divided by length of stay). A linear regression model was constructed to explore the association of anemia with the FIM-M efficiency score. As a subgroup analysis, we constructed a linear regression model to explore the association of anemia with the FIM-M efficiency score in patients with or without stroke. RESULTS: Of 376 consecutive patients with a mean age of 80 years, 258 (69%) had mild or moderate/severe anemia. There were no significant differences between the 3 groups in the FIM-M score at discharge, changes in the FIM-M score, length of stay, and FIM-M efficiency score. A multiple linear regression model showed that the FIM-M efficiency score was not associated with anemia (mild anemia group: ß=-0.02, P=.8; moderate/severe anemia group: ß=-0.005, P=.9). In the subgroup analysis of patients with or without stroke, the multiple regression model also showed no significant association between anemia and FIM-M efficiency score in each group. CONCLUSIONS: Anemia on admission was common among patients in a convalescent rehabilitation ward but was not associated with improvement of FIM-M after rehabilitation.

Asunto(s)

Anemia , Accidente Cerebrovascular , Masculino , Humanos , Femenino , Anciano de 80 o más Años , Estudios Retrospectivos , Resultado del Tratamiento , Hemoglobinas

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AIMS: Many patients who are transferred to the convalescent rehabilitation ward of Kawasaki Kokoro Hospital (hereinafter, our hospital) are on psychotropics prescribed for delirium by their physicians at acute care hospitals. In this study, psychiatrists and pharmacists collaborated with rehabilitation physicians to reduce the use of psychotropics. METHODS: The basic information and psychotropics prescription statuses of 88 patients discharged from the convalescent rehabilitation ward of our hospital between April 1, 2021 and March 31, 2022 were derived from their medical records. RESULTS: At admission, psychotropics were prescribed to 55 patients and the number of prescribed drugs was 2 (median). At discharge, psychotropics were prescribed to 41 patients and the number of prescribed drugs was 1 (median), showing a significant decrease (p < 0.05). Compared with those at admission, prescribed psychotropic doses at discharge were significantly higher for lemborexant but significantly lower for antipsychotics, benzodiazepine/nonbenzodiazepine hypnotics, antidepressants, suvorexant, ramelteon, and sodium valproate (p < 0.05). CONCLUSIONS: These results suggest that it may be possible to reduce the types and doses of psychotropics prescribed at acute care hospitals in convalescent rehabilitation wards. However, further investigation is needed because the number of patients in this study was limited, and selection bias due to different patient characteristics cannot be ruled out.

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Antipsicóticos , Psicotrópicos , Humanos , Antidepresivos , Hospitales , Alta del Paciente

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Objective：To evaluate the reliability and concurrent validity of the Walking LEVEL Scale (WaLS) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Design：The WaLS was used as an assessment scale to categorize the walking ability of patients in a CRW.Subjects/Patients：A total of 103 patients in a CRW were included in the study.Methods：Retest and inter-rater reliability were evaluated by using the WaLS to assess patients by the same rater and by two independent raters using the weighted kappa coefficient. Spearman correlation was used to assess the correlation between the WaLS and FIM-walk item scores and the WaLS and FAC scores (i.e., concurrent validity).Results：The retest and inter-rater reliability of the WaLS (weighted kappa coefficient) was 0.989 (p＜0.01) and 0.951 (p＜0.01), respectively. The WaLS scores were also significantly correlated with the FIM-walk item (p＝0.916, p＜0.01) and FAC scores (p＝0.919, p＜0.01)．Conclusion：The WaLS was found to demonstrate good reliability and concurrent validity in patients hospitalized in CRW.