Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients.

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.

Hyponatremia as a predictor of cognitive deterioration in hospitalized post-stroke patients.

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.

Improved systemic inflammation is associated with functional prognosis in post-stroke patients.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living (ADL) in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1-2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1490 patients recruited, 158 (median age, 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 [1.1, 3.8] mg/dL. Multivariate analysis revealed that improvements in mGPS (ß = 0.125, p = 0.012) and CRP levels (ß = 0.108, p = 0.108) were independently and positively associated with FIM-motor at discharge. Conclusions: Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

Impaired oral status is associated with sarcopenic obesity in post-stroke patients.

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.

Exploring the impact of anticholinergic burden on urinary independence: insights from a post-stroke cohort of older adults.

BACKGROUND: Anticholinergic burden is associated with adverse events in the older adults. However, there is a lack of evidence regarding its effect on urinary independence in stroke patients. AIM: This study examined the association between increased anticholinergic burden during hospitalization and urinary independence in post-stroke patients undergoing rehabilitation. METHOD: This observational cross-sectional study included stroke patients admitted to a post-acute rehabilitation hospital between 2020 and 2022 who were not independently urinating. The degree of urinary independence was assessed using the Functional Independence Measure-Bladder (FIM-Bladder), a subscale of the motor domain of the FIM, and urinary independence was defined as FIM-Bladder ≥ 6. Anticholinergic burden was assessed using the anticholinergic risk scale (ARS), and changes in ARS during hospitalization were calculated by subtracting the value at admission from the value at discharge. The study outcome was urinary independence at discharge. Logistic regression analysis was used to examine whether change in ARS score was independently associated with the outcome. Statistical significance was set at P < 0.05. RESULTS: Of the 573 patients enrolled, 312 patients (mean age 77.5 years, 51.9% male) were included in the analysis. ARS increased during hospitalization in 57 patients (18.3%). Change in ARS score was independently associated with urinary independence (odds ratio: 0.432, 95% confidence interval: 0.247-0.756, P = 0.003). CONCLUSION: Increased anticholinergic burden in post-stroke patients who require assistance with urination is significantly associated with less independent urination. Anticholinergic agents may need to be introduced cautiously in patients who require assistance with urination.

Low hemoglobin levels are associated with compromised muscle health: Insights from a post-stroke rehabilitation cohort.

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.

Prognostic Value of Dysphagia for Activities of Daily Living Performance and Cognitive Level after Stroke.

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.

Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication).

Psychological aspects of rehabilitation nutrition affect physical, cognitive, and social rehabilitation nutrition. When depression is recognized, not only pharmacotherapy and psychotherapy, but also non-pharmacological therapies such as exercise, nutrition, psychosocial, and other interventions can be expected to improve depression. Therefore, accurate diagnosis and intervention without overlooking depression is important. Psychological aspects of preventive rehabilitation nutrition is also important because depression can be partially prevented by appropriate exercise and nutritional management. Even in the absence of psychological negatives, increasing more psychological positives from a positive psychology perspective can be useful for both patients and healthcare professionals. Positive rehabilitation nutrition interventions can increase more psychological positives, such as well-being, through cognitive-behavioral therapy and mindfulness on their own, as well as through interventions on environmental factors. Consequently, physical, cognitive, and social positives are also expected to be enhanced.

Phase angle is associated with sarcopenic obesity in post-stroke patients.

BACKGROUND & AIMS: Evidence is limited concerning the association between bioimpedance analysis-derived phase angle and sarcopenic obesity. This study examined this association in patients who underwent convalescent rehabilitation after stroke. METHODS: This cross-sectional study included hospitalized patients with post-acute stroke. The phase angle was measured using a multifrequency bioimpedance analysis. Sarcopenic obesity was diagnosed according to the European Society of Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. A multiple linear regression analysis was used to examine the association between the phase angle and sarcopenic obesity after adjusting for confounding factors. A receiver operating characteristic curve was used to calculate the optimal phase angle cutoff value for predicting sarcopenic obesity. RESULTS: A total of 760 patients (median age 71 years; 352 women) were analyzed. The median (interquartile range, 25th and 75th percentiles) phase angle was 4.45° (4.10°, 4.88°). Sarcopenic obesity was diagnosed in 16 (3.9%) men, 18 (5.1%) women, and 34 (4.5%) patients overall. The multiple linear regression analysis showed that sarcopenic obesity (ß = -0.185, p = 0.017) and sarcopenia (ß = -0.121, p = 0.012) were significantly and negatively associated with the phase angle. Obesity was not significantly associated with the phase angle (ß = -0.078, p = 0.094). The optimal cutoff value of the phase angle for diagnosing sarcopenic obesity was 4.29° (sensitivity 0.65, specificity 0.80, area under the curve [AUC] 0.79, 95% CI 0.77-0.87, p < 0.001) in men and 3.84° (sensitivity 0.67, specificity 0.84, AUC 0.81, 95% CI 0.79-0.86, p < 0.001) in women. CONCLUSION: The phase angle was associated with sarcopenic obesity, and the cutoff values of the phase angle that could predict sarcopenic obesity were 4.29° for men and 3.84° for women. This simple and practical phase angle-based prediction of sarcopenic obesity can be useful in clinical practice.

Statin use impairs muscle strength recovery in post-stroke patients with sarcopenia.

AIM: The effects of statins on muscle health are not well established. Therefore, this study investigated the impact of statin use on muscle strength and mass recovery in patients with sarcopenia after stroke. METHODS: This retrospective cohort study included stroke patients with sarcopenia hospitalized between 2015 and 2021 at a post-acute rehabilitation hospital. Sarcopenia was diagnosed using handgrip strength and skeletal muscle mass index measured using bioelectrical impedance analysis according to the 2019 criteria of the Asian Working Group for Sarcopenia. The study outcomes included handgrip strength and skeletal muscle mass index at hospital discharge. We used multivariate analyses to examine whether statin use was independently associated with the outcomes. Statistical significance was set at P < 0.05. RESULTS: Of the 586 patients enrolled, 241 (mean age 79.3 years, 44.4% men) presented with sarcopenia and were included in the analysis. Statin use was observed in 61 (25.3%) patients. Statin use was independently negatively associated with handgrip strength at discharge (ß = -0.095, P = 0.032), but not with skeletal muscle mass index at discharge (ß = 0.019, P = 0.692). CONCLUSIONS: Statin use was negatively associated with muscle strength recovery, but not with muscle mass in patients with sarcopenia who underwent rehabilitation after stroke. To maximize outcomes, sufficient consideration is needed for statin use in these patients. Geriatr Gerontol Int 2023; 23: 676-683.

Cut-off values for severe low muscle strength and skeletal muscle mass in post-acute patients with sarcopenia.

AIM: This study aimed to calculate the cut-off values for severe decline in muscle strength and skeletal muscle mass in post-acute patients with sarcopenia and to determine their effect on activities of daily living. METHODS: This retrospective cohort study included patients with sarcopenia consecutively admitted to a Japanese rehabilitation hospital between 2014 and 2016. Sarcopenia was diagnosed based on handgrip strength and skeletal muscle mass index. The outcome was the functional independence measure of motor function at discharge. Cut-off values for predicting severe decline in handgrip strength and skeletal muscle mass index were calculated separately by sex. Values below the cut-off were used to define severely low handgrip strength and severely low skeletal muscle mass index. RESULTS: Overall, 451 patients (median age, 83 years; 61.4% women) were evaluated. The median functional independence measure of motor function score at discharge was 57. The optimal cut-off values for severely low handgrip strength were 9.0 kg for women and 14.6 kg for men, and those for severely low skeletal muscle mass index were 4.6 kg/m2 for women and 5.6 kg/m2 for men. Severely low handgrip strength and skeletal muscle mass index were independently associated with the functional independence measure of motor function score at discharge (ß = -0.178, P = 0.005). CONCLUSIONS: In post-acute patients with sarcopenia, a severe decline in muscle strength and skeletal muscle mass is further negatively associated with an improvement in activities of daily living. The cut-off values herein can serve as indicators to assess sarcopenia severity. Geriatr Gerontol Int 2023; 23: 493-499.

Improvement in sarcopenia is positively associated with recovery of independence in urination and defecation in patients undergoing rehabilitation after a stroke.

OBJECTIVES: This study aimed to examine the association between improvement in sarcopenia and the recovery of urinary and defecatory independence in patients undergoing convalescent rehabilitation. METHODS: A retrospective cohort study was conducted of 849 older inpatients after a stroke. Of these, patients with sarcopenia and dependent voiding movements were targeted. Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019, and diagnosed using handgrip strength (HGS) and skeletal muscle-mass index. Outcomes were sphincter control items of the Functional Independence Measure (FIM) at the time of discharge: urinary (FIM-Bladder) and defecation (FIM-Bowel). A score of six or higher was considered independent. A logistic regression analysis was used to determine whether sarcopenia improvement was associated with outcomes. RESULTS: Of the patients recruited, 151 were diagnosed with sarcopenia at baseline, of whom patients dependent in urination (109 patients) and defecation (102 patients) were included in the analysis. The multivariate analysis showed that improvement in sarcopenia (odds ratio [OR]: 3.28; 95% confidence interval [CI],1.01-10.70; P = 0.048) and HGS (OR: 6.25; 95% CI, 1.45-26.90; P = 0.014) were independently associated with FIM-Bladder at the time of discharge. Improvement in HGS (OR: 4.33; 95% CI, 0.99-18.90; P = 0.048) was independently associated with FIM-Bowel at the time of discharge CONCLUSIONS: Improvement in sarcopenia and muscle strength during hospitalization may have a positive effect on urinary independence in stroke patients undergoing convalescent rehabilitation, and improvement in muscle strength may have a positive effect on defecation independence. Multidisciplinary sarcopenia treatment should be implemented in addition to conventional rehabilitation for these patients.

The Applicability of the ESPEN and EASO-Defined Diagnostic Criteria for Sarcopenic Obesity in Japanese Patients after Stroke: Prevalence and Association with Outcomes.

Sarcopenic obesity is of growing research and clinical interest; however, validated diagnostic criteria are lacking. We therefore aimed to examine the prevalence of sarcopenic obesity as diagnosed by the criteria recently proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), and its association with outcomes among patients after stroke. This study was based on a cohort of 760 Japanese patients after stroke admitted to a post-acute rehabilitation hospital. Sarcopenic obesity was diagnosed at admission according to the ESPEN and EASO criteria using reference values specific to Asians. Outcomes included the motor domain of the functional independence measure (FIM-motor) and the food intake level scale (FILS) at discharge. Multivariate linear regression models were used to assess the associations between sarcopenic obesity and outcomes. Among 760 patients (median age, 73 years; 352 women and 408 men), sarcopenic obesity was diagnosed in 34 patients (4.5%; 5.4% of women and 4.1% of men). In multivariate analyses, sarcopenic obesity was independently and negatively associated with FIM-motor (ß = −0.048, p = 0.031) and FILS at discharge (ß = −0.095, p = 0.046) in women. In contrast, in men, sarcopenic obesity showed an independent negative association with FIM-motor at discharge (ß = −0.117, p < 0.001) but no statistically significant association with FILS at discharge (ß = −0.004, p = 0.323). In conclusion, the prevalence of sarcopenic obesity diagnosed by the ESPEN and EASO-defined criteria was as low as 4.5% among Japanese patients after stroke. Furthermore, sarcopenic obesity was negatively associated with improvements in activities of daily living and dysphagia.

Polypharmacy and Its Association with Dysphagia and Malnutrition among Stroke Patients with Sarcopenia.

Evidence on polypharmacy in patients with sarcopenia is lacking. We aimed to examine the association of polypharmacy with swallowing function and nutritional risk in post-stroke patient with sarcopenia. This retrospective cohort study included hospitalized patients diagnosed with sarcopenia who needed convalescent rehabilitation following stroke onset. Study outcomes were the Food Intake Level Scale (FILS) as dysphagia assessment and geriatric nutritional risk index (GNRI) as nutritional status at hospital discharge, respectively. To examine the impact of admission polypharmacy, multivariate linear regression analyses were used to determine whether the number of drugs prescribed at hospital admission was associated with these outcomes. As a result, of the 586 patients enrolled, 257 (mean age 79.3 years, 44.0% male) were diagnosed with sarcopenia and were finally analyzed high admission drug prescription numbers were independently associated with FILS (ß = -0.133, p = 0.017) and GNRI (ß = -0.145, p = 0.003) at hospital discharge, respectively. Polypharmacy is associated with dysphagia and malnutrition in post-stroke patients with sarcopenia. In addition to the combination of nutritional and exercise therapies, review and optimization of prescription medications may be warranted to treat sarcopenia in order to maximize improvement in outcomes for these patients.

Potentially inappropriate medications are negatively associated with functional recovery in patients with sarcopenia after stroke.

BACKGROUND: Evidence is scarce for potentially inappropriate medications (PIMs) in rehabilitation medicine. AIM: To examine the effect of PIMs on functional recovery in older patients with sarcopenia after stroke. METHODS: We conducted a retrospective cohort study in a post-acute rehabilitation hospital. All patients diagnosed with sarcopenia aged ≥ 65 years among all post-stroke patients hospitalized from 2015 to 2020 were included. PIMs were defined based on the 2019 Beers criteria. Sarcopenia was diagnosed using handgrip strength (HG) and skeletal muscle mass index (SMI), according to the criteria of the Asian Working Group for Sarcopenia 2019. The outcomes included functional independence measure motor (FIM-motor), HG, and SMI values at discharge. Multiple linear regression analyses were used to determine whether PIMs used at admission were independently associated with outcomes. RESULTS: Of the eligible patients, 361 were 65 years or older, of whom 196 (mean age 81.0 years, 44.4% male) presented with sarcopenia and were included in the analysis. Of these, 131 (66.8%) were prescribed PIMs at admission. The most frequently prescribed PIMs were proton pump inhibitors, antipsychotics, benzodiazepines, and nonsteroidal anti-inflammatory drugs. The number of PIMs on admission was independently associated with FIM-motor (ß = - 0.132, P = 0.001) and HG (ß = - 0.091, P = 0.048) at discharge, but not with SMI (ß = - 0.055, P = 0.256). CONCLUSIONS: High admission PIMs prescription numbers are negatively associated with favorable discharge functional status and muscle strength in older patients with sarcopenia after stroke.

Polypharmacy and potentially inappropriate medications in stroke rehabilitation: prevalence and association with outcomes.

Background Evidence is scarce regarding polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine. Aim To investigate the prevalence of polypharmacy and PIMs and their association with outcomes in stroke rehabilitation. Method A retrospective cohort study was conducted with 849 older inpatients post-stroke. Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included functional independence measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay, and the rate of home discharge. To consider the effect of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes. Results After enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed in 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (ß = - 0.062, P = 0.049), FIM-cognitive score (ß = - 0.076, P = 0.014), energy intake (ß = - 0.143, P = 0.005), and home discharge (OR: 0.458; 95% CI: 0.248, 0.847; P = 0.013). PIMs were negatively associated with home discharge (OR: 0.375; 95% CI: 0.195, 0.718; P = 0.003). Conclusion Polypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy was negatively associated with activities of daily living (ADL) but not with PIMs and ADLs, and both were associated with home discharge.

Muscle Strength Gain is Positively Associated with Functional Recovery in Patients with Sarcopenic Obesity After Stroke.

OBJECTIVE: Evidence regarding the effect of sarcopenic obesity on recovery in stroke patients is scarce in rehabilitation medicine. The aim of this study was to examine the association between changes in muscle strength and functional outcomes in patients with sarcopenic obesity undergoing rehabilitation after stroke. MATERIALS AND METHODS: This study was a retrospective cohort study of stroke patients, consecutively admitted to post-acute rehabilitation wards of a single hospital, of which, only those diagnosed with sarcopenic obesity at admission were included in the final analysis. Bioimpedance analysis was used to measure skeletal muscle mass and body fat mass. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Sarcopenia was diagnosed using muscle mass index and handgrip strength. Obesity was diagnosed using body fat percentage (men ≥30%, women ≥35%). The evaluated outcomes were Functional Independence Measure (FIM)-motor score at discharge and its gain. Multiple regression analysis was used to verify whether changes in hand grip strength during hospitalization were associated with functional outcomes. RESULTS: Sixty-two patients (29 men) with a mean age of 78 years, were analyzed. The mean change in the hand grip strength was 3.9 kg. In multiple regression analysis, changes in the hand grip strength were significantly associated with FIM-motor at discharge (ß = 0.34, P < 0.01) and FIM-motor gain (ß = 0.58, P < 0.01). CONCLUSIONS: Muscle strength gain was associated with improved functional recovery in stroke patients with sarcopenic obesity.

Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke.

Evidence is scarce regarding the polypharmacy in patients with sarcopenia. The aim of this study was to investigate the effect of deprescribing for polypharmacy on the improvement of nutritional intake and sarcopenia in older patients with sarcopenia. A retrospective cohort study was conducted with hospitalized older patients with sarcopenia undergoing rehabilitation after stroke. Study outcomes included energy intake, protein intake, handgrip strength (HG) and skeletal muscle mass index (SMI) at hospital discharge. To consider the effects of deprescribing for polypharmacy, we used multivariate analyses to examine whether the change in the number of medications during hospitalization was associated with outcomes. Of 361 patients after enrollment, 91 (mean age 81.0 years, 48.4% male) presented with sarcopenia and polypharmacy and were eligible for analysis. The change in the number of medications was independently associated with energy intake (ß = -0.237, p = 0.009) and protein intake (ß = -0.242, p = 0.047) at discharge, and was not statistically significantly associated with HG (ß = -0.018, p = 0.768) and SMI (ß = 0.083, p = 0.265) at discharge, respectively. Deprescribing was associated with improved nutritional intake in older sarcopenic patients with polypharmacy undergoing stroke rehabilitation.