Association Between the Swallowing Reflex and the Incidence of Aspiration Pneumonia in Patients With Dysphagia Admitted to Long-term Care Wards: A Prospective Cohort Study of 60 Days.

OBJECTIVE: To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. DESIGN: The study design was a prospective cohort study. Participants were followed for 60 days from admission. SETTING: LTC wards. PARTICIPANTS: Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. RESULTS: The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. CONCLUSIONS: Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

Predictive factors associated with poor outcomes for older adult inpatients in the convalescent rehabilitation ward.

This study aimed to determine predictive factors associated with poor outcomes among older adult inpatients in the convalescent rehabilitation ward. We also examined the validity of factors that were identified as predictive of poor outcomes. Study subjects were 104 older adult inpatients in the convalescent rehabilitation ward, divided into two groups based on outcome at discharge. Group I included the outcomes of death or transfer to an acute care hospital and Group II included all other outcomes. Data were retrospectively collected from older adults' medical records, including: activities of daily living, swallowing grade, nutritional index, and blood biochemistry data. Logistic regression analysis was used to extract predictive factors associated with poor outcomes. Next, we calculated the Stratum-specific likelihood ratio (SSLR) for each extracted factor. Two items were extracted as predictive factors with AUCs ≥ 0.7 : N-terminal pro-brain natriuretic peptide (NT-proBNP) and days from onset to hospitalization. The SSLRs showed the risk for a poor outcome increased when NT-proBNP was ≥ 2500 pg / ml, and when there were ≥ 35 days from onset to hospitalization. Our findings suggest these predictive factors provide a valid index to predict poor outcomes among older adults from the early stage of admission. J. Med. Invest. 67 : 304-310, August, 2020.

Novel formula using triceps skinfold thickness to revise the Cockcroft-Gault equation for estimating renal function in Japanese bedridden elderly patients.

In recumbent elderly patients, creatinine clearance (eCCr) estimated by the Cockcroft-Gault (CG) equation may not necessarily reflect renal function. We aimed to develop a novel formula to revise the CG equation using anthropometric measurements in bedridden elderly patients and evaluate its clinical utility. The subjects included 77 bedridden Japanese patients aged ≦ 65, hospitalized at Naruto Yamakami Hospital. The actual CCr (mCCr) value was measured using the 24-hour urine collection method. Anthropometric data, such as skeletal muscle mass, body fat mass (BFM), and triceps skinfold thickness (TSF), were collected. We established a novel formula to estimate CCr(BFM) or CCr(TSF) by correcting the eCCr(Enz+0.2) value with BFM or TSF. The stage of classification of renal dysfunctions in patients with eGFR(BFM) or eGFR(TSF) was equivalent to the GFR(control) based on the mCCr. Notably, the novel equation for eCCr based on TSF (eCCr(TSF)), dubbed the "Naruto" formula, can be useful to evaluate renal function in bedridden elderly patients without expensive equipment or additional costs. In this study, mCCr was considered to be the true renal function of the patient, but whether and to what extent mCCr correlates with inulin clearance is unknown. J. Med. Invest. 65:195-202, August, 2018.

N-terminal Pro-brain Natriuretic Peptide Level as a Prognostic Predictor in Elderly Patients in a Convalescent Rehabilitation Ward.

OBJECTIVE: N-terminal pro-brain natriuretic peptide (NTproBNP) levels were investigated to predict outcomes for elderly patients in a convalescent rehabilitation ward. METHODS: The study included 75 patients aged at least 75 years who were admitted to the convalescent rehabilitation ward of Naruto-Yamakami Hospital. Based on NTproBNP levels on admission, the patients were divided into those with NTproBNP levels ≥400 pg/ml (Group A) and those with NTproBNP levels <400 pg/ml (Group B). Patients were also divided into three groups according to their outcomes: Group I, death-related discharge or emergency transfer; Group II, home discharge; and Group III, medical/nursing care continuation. Group A patients were further divided, according to the time course of NTproBNP levels, into Group A-I (levels increased) and A-II (levels unchanged/decreased). The correlation coefficients between outcomes and each measurement index were determined, and discriminant analysis was performed among the groups. RESULTS: The NTproBNP level on hospitalization was significantly higher in Group I than in Groups II and III. There were significantly more death-related discharges and emergency transfers in Group A than in Group B and in Group A-I than in Group A-II. In discriminant analysis, assuming the outcome to be a dependent variable in Group A-I and Group A-II, the canonical correlation was 0.81 (P<0.05). CONCLUSION: The study findings suggest that NTproBNP levels are useful for predicting patient outcomes.