Factors Affecting Hospitalization and Death of Older Patients Who Need Long-Term Care-The Necessity of the Support for Dysphagia in Home Dental Care.

The demand for home dental care is increasing, but how it should be involved in the continuation of life at home for elderly people who need care has not been examined. Therefore, we examined whether items examined by dentists can affect hospitalization and death. The study included 239 patients with oral intake. They were divided into regular and non-regular diet groups, and ages, nutritional statuses, activities of daily living (ADLs), Charlson Comorbidity Indexes (CCI) and swallowing functions were compared. The nutritional statuses and ADLs of the three groups at the first visit and after one year were compared. The groups included those with stable, declined and improved diet forms. Factors influencing hospitalization and death over three years were examined. Nutritional status, swallowing function, CCI and ADLs were worse in the non-regular diet group. The declined diet form group had lower ADL levels and nutritional statuses at the first visit. A proportional hazards analysis showed significant differences in the changes in diet form for the stable and declined groups related to hospitalization (hazard ratio (HR): 6.53) and death (HR: 3.76). Changes in diet form were thought to affect hospitalization and death, and it is worthwhile to assess swallowing function in home dental care.

Measurement of laryngeal elevation time using a flexible surface stretch sensor.

BACKGROUND: Dysphagia is a growing health problem in aging societies. An observational cohort study targeting community-dwelling populations revealed that 16% of elderly subjects present with dysphagia. There is a need in elderly communities for systematic dysphagia assessment. OBJECTIVE: This study aimed to verify whether laryngeal elevation in the pharyngeal phase could be measured from the body surface using thin and flexible stretch sensors. METHODS: Thirty-two elderly subjects (17 males, 15 females; mean age ± SD: 89.2 ± 6.2 years) with suspected dysphagia underwent a swallowing contrast examination in which seven stretch sensors were attached to the front of the neck. The elongation of the sensors was measured and compared to the laryngeal elevation time values obtained using videofluorography. The sensor signal detected the laryngeal elevation start time, conclusion of the descent of the larynx, and the laryngeal elevation time. The respective laryngeal elevation times obtained using videofluorography and using the sensor were compared using the Bland-Altman method. RESULTS: The laryngeal elevation time was 1.34 ± 0.46 s with the stretch sensor and 1.49 ± 0.56 s with videofluorography. There was a significant positive correlation between the duration obtained by both methods (r = .69, P < .0001). A negative additional significant bias of -0.15 s (95% confidence interval -0.30 to -0.03, P = .046) was noted in the laryngeal elevation time from the videofluorography measurement. CONCLUSION: Laryngeal elevation time can be measured non-invasively from the neck surface using stretch sensors.

What Factors Affect Changes in Body Composition and Swallowing Function in Patients Hospitalized for Oral Cancer Surgery?

PURPOSE: There are few studies about sarcopenia before and after surgery for oral cancer. Therefore, we examined body composition during hospitalization and factors affecting weight loss, skeletal muscle mass index (SMI) reduction, and swallowing function at discharge in this patient group. PATIENTS AND METHODS: A prospective survey was conducted at Tokyo Medical and Dental University Dental Hospital for patients who underwent primary surgery for oral cancer and reconstruction using free flaps. We compared body weight, SMI, grip strength, and walking speed at admission and discharge. We also examined factors affecting weight loss and SMI reduction and the functional oral intake scale (FOIS) score at discharge. RESULTS: There were 26 patients that we could survey during the period. As a result of Wilcoxon's signed-rank test, body weight, SMI, and grip strength were significantly reduced during hospitalization, but no reduction was noted for sarcopenia. As a result of multiple regression analysis, postoperative chemoradiotherapy was a risk factor for weight loss, reduced SMI, and low FOIS score at discharge. CONCLUSION: Postoperative chemoradiotherapy is a risk factor for weight loss, muscle mass loss, and dysphagia at discharge, and chemoradiotherapy may affect rather than an invasion of surgery. After surgery, besides follow-ups for cancer, oral cancer patients should be followed up to assess dysphagia, undernutrition, and sarcopenia.

[Survey of Anticancer Drug Exposure to Attendant Families in Pediatric Medical Centers].

The occupational exposure to hazardous drugs(HD)has already been investigated; however, the actual exposure of the attendant family members of patients with childhood cancer has remained unknown. Here, we analyzed cyclophosphamide (CPM)exposure in attendant family members and the environment after the administration of CPM to patients with pediatric cancer. CPM of 320(8.39-1,510)ng from infant-families and 0(0-58.4)ng from adolescent-families were detected(p= 0.01). The exposure of infant-families was significantly greater than those of adolescent-families. In addition, CPM were detected in the hot water after bathing the infant, underwear, and sheets. We elucidated that the exposures take place through body fluid and excretions of the children. In the field of childhood cancer, HD exposure measures should be taken according to the age of the child to minimize health damage to medical personnel, family members, and other children who share the room. Nurses are recommended to educate the patients and their family members about preventing exposure to HD in pediatric medical centers.

High-speed jaw-opening exercise in training suprahyoid fast-twitch muscle fibers.

PURPOSE: This study was aimed to examine the effectiveness of a high-speed jaw-opening exercise, which targets the contraction of fast-twitch muscle fibers, in improving swallowing function. SUBJECTS AND METHODS: Twenty-one subjects (mean age 74.0±5.7 years) with dysphagia-related symptoms, such as coughing or choking during eating, performed the exercise. None of the included subjects had neurological symptoms or history of surgery that could cause significant dysphagia. All subjects took regular meals, and maintained independent activities of daily life. The exercise schedule consisted of 3 sets of 20 repetitions each of rapid and maximum jaw-opening movement with a 10-second interval between sets. The exercise was performed twice daily for 4 weeks. RESULTS: Following the intervention, there was a significant increase in the vertical position of the hyoid bone at rest. Furthermore, during swallowing, the elevation of the hyoid bone and the velocity of its movement and esophageal sphincter opening increased significantly while the duration of the hyoid elevation and the pharyngeal transit time reduced significantly. CONCLUSIONS: Our results demonstrated that high-speed jaw-opening exercise resulted in increased elevation velocity of the hyoid bone during swallowing, indicating its role in effectively strengthening the fast-twitch muscle fibers of suprahyoid muscles. Furthermore, since the rest position of the hyoid bone appeared to have improved, this exercise may be especially useful in elderly individuals with a lower position of the hyoid bone at rest and those with decreased elevation of the hyoid bone during swallowing, which are known to be associated with an increased risk of aspiration.

Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in adults.

Purpose: This study aimed to determine whether excessive neck muscle tone affects hyoid bone kinetics during swallowing using videofluorography (VF) in an unnatural posture in adults. Subjects and methods: Subjects were 28 adults (12 men, 16 women; mean age, 39.75±9.50 years) who were suspected to have some symptom of swallowing disorders but did not have swallowing dysfunctional from the result of videofluorography. We first established the participant's posture a reclining wheelchair that was adjusted to a 30-degree angle with the headrest (without excessive neck muscle tone) or without headrest (with excessive neck muscle tone), used an electromyogram above the mylohyoid muscle to represent the suprahyoid muscles and above the sternohyoid muscle to represent the infrahyoid muscles to confirm neck muscle tone, and then conducted VF of swallowing measurements. Videofluorographic images were obtained when 5 mL of 50% (w/v) barium sulfate was being swallowed, and hyoid bone coordinate (the resting position and the elevated position), extent of horizontal and vertical hyoid bone elevation, as well as duration and velocity of hyoid bone elevation were evaluated (x-axis and y-axis coordinates for the resting position of hyoid bone are referred to as Xr and Yr, respectively; those for the elevated hyoid bone position induced during swallowing are referred to as Xs and Ys, respectively). Results: In the resting position of the hyoid bone, the Yr coordinates in those with excessive neck muscle tone were significantly lower than in those without excessive neck muscle tone. Vertical hyoid bone elevation and hyoid bone elevation velocity were significantly higher with excessive neck muscle tone than without excessive neck muscle tone, whereas horizontal elevation showed no significant differences. Conclusion: Our findings suggest that the generation of neck muscle tone due to inappropriate posture may encourage hyoid depression and increase the extent of hyoid bone elevation, thereby increasing the risk of aspiration.

Can grip strength and/or walking speed be simple indicators of the deterioration in tongue pressure and jaw opening force in older individuals?

OBJECTIVES: Swallowing-related muscle strength decreases due to sarcopenia, and older people are at risk for sarcopenia and the resultant dysphagia. However, no studies have assessed the direct relationships between whole-body strength and swallowing-related muscles. Therefore, this study investigates the relationships between decreased whole-body strength, which is easily evaluated, and swallowing-related muscle strength. MATERIALS AND METHODS: A total of 197 elderly individuals (97 men aged 78.5 ± 6.6 years and 100 women aged 77.8 ± 6.2 years) were enrolled. Grip strength, walking speed, tongue pressure and jaw opening force were measured, and the effects of age and the relationships between whole-body strength and swallowing-related muscle strength were investigated. RESULTS: With respect to age-related changes, tongue pressure, jaw opening force, grip strength and walking speed decreased with age in men and women. The relationships between whole-body strength and swallowing-related muscle strength were analysed, with age used as the control variable. Among men, tongue pressure was correlated with grip strength and walking speed, whereas jaw opening force was correlated with grip strength. Among women, neither tongue pressure nor jaw opening force was correlated with grip strength or walking speed. CONCLUSIONS: There was a sex-based difference in the correlations between whole-body strength and swallowing-related muscle strength. Among men, swallowing-related muscle strength was correlated with whole-body strength, and grip strength could thus serve as a simple indicator for swallowing-related muscle strength. CLINICAL RELEVANCE: Decreased swallowing-related muscle strength can be inferred in cases involving male patients for whom decreased grip strength is measured during physical examination or is otherwise suggested (eg, by an inability to open plastic bottles).

Relationship between jaw opening force and hyoid bone dynamics in healthy elderly subjects.

PURPOSE: This study aimed to examine the relationship between jaw opening force and hyoid bone dynamics and resting position in elderly individuals based on gender. SUBJECTS AND METHODS: Subjects were 36 healthy elderly individuals aged ≥65 years without dysphagia (16 men and 20 women; mean age 75.5 years, range 65-88 years). Videofluorographic images during the swallowing of 10 mL of 40% (w/v) barium sulfate were obtained and the degrees of anterior, superior, and hypotenuse displacements of the hyoid bone and maximum/resting hyoid position were evaluated. Jaw opening force was measured three times using a jaw opening force sthenometer; the mean of these three measurements was used for analysis. RESULTS: In men, there was a positive correlation between jaw opening force and resting hyoid position and negative correlations among all the degrees of anterior, superior, and hypotenuse displacements of the hyoid bone. In women, there was no statistically significant correlation between jaw opening force and any of the measurement items. There was no statistically significant correlation between jaw opening force and maximum hyoid position in either men or women. CONCLUSION: Our findings suggest that low jaw opening force leads to low resting hyoid position only in elderly men, and a lower hyoid position in healthy elderly men results in a larger total amount of hyoid displacement during swallowing. Moreover, a maximum hyoid position in healthy individuals of either gender does not differ depending on their jaw opening force.

Effects of aging and sarcopenia on tongue pressure and jaw-opening force.

AIM: Aging and sarcopenia reduce not only body strength, but also the strength of swallowing muscles. We examined how aging and sarcopenia affect tongue pressure and jaw-opening force. METHODS: A total of 97 older adults (97 men, mean age 78.5 ± 6.6 years; 100 women, mean age 77.8 ± 6.2 years) were enrolled. Classification of sarcopenia was based on the Criteria of Asian Working Group for Sarcopenia. To investigate which variable between aging and sarcopenia was a significant independent variable on tongue pressure and jaw-opening force, multivariate linear regression analysis was carried out. RESULTS: The mean tongue pressure was 26.3 ± 7.8 kPa in men and 24.6 ± 7.2 kPa in women. The mean jaw-opening force was 6.3 ± 1.6 kg in men and 5.2 ± 1.3 kg in women. Tongue pressure in men, aging and sarcopenia were significant independent variables, whereas only sarcopenia was a significant independent variable in women. Jaw-opening force in men and sarcopenia were significant independent variables, whereas neither aging nor sarcopenia were significant independent variables in women. CONCLUSIONS: We found different characteristics in the effects of aging and sarcopenia based on site and sex. We suggested that aging decreased tongue pressure more than jaw-opening force, and affected men more than women. Sarcopenia affected tongue pressure and jaw-opening force, with the exception of jaw-opening force in women. Considering these characteristics is useful to predict the decline of swallowing function, and provide appropriate interventions preventing dysphagia. Geriatr Gerontol Int 2017; 17: 295-301.

Usefulness of a handheld nebulizer in cough test to screen for silent aspiration.

Cough test to screen for silent aspiration (SA) was reported, and the effectiveness was excellent. However, the device was rather large so that the portability was poor. So, the purpose of this study is to investigate the usefulness of a handheld nebulizer for the test and verify the reproducibility of the method. The subjects were 160 patients who were suspected of having dysphagia and underwent videofluorography (VF) or videoendoscopy (VE). They inhaled 1.0 % citric acid-physiologic saline orally for 1 min using a handheld nebulizer, and the examiner observed the number of coughs: more than five coughs was considered as negative (normal), while less than four coughs was regarded as positive. Among the subjects, 70 patients administered the cough test and VF or VE twice or more at some intervals. The k coefficient was calculated in reproducibility. Using the results of the VF or VE examination as the standards, for SA detection, the sensitivity was 0.86, specificity was 0.71, positive predictive value was 0.53, and negative predictive value was 0.93. The k coefficient was 0.79. In conclusion, the handheld nebulizer was useful in the cough test to screen for SA. Furthermore, satisfactory reproducibility was shown.

Screening test for silent aspiration at the bedside.

Many screening tests for dysphagia can be given at bedside. However, they cannot accurately screen for silent aspiration (SA). We studied the usefulness of a cough test to screen for SA and combined it with the modified water swallowing test (MWST) to make an accurate screening system. Patients suspected of dysphagia (N = 204) were administered a cough test and underwent videofluorography (VF) or videoendoscopy (VE). Sensitivity of the cough test for detection of SA was 0.87 with specificity of 0.89. Of these 204 patients, 107 were also administered the MWST. Fifty-five were evaluated as normal by the screening system, 49 of whom were evaluated as normal by VF or VE. Sixteen were evaluated as "SA suspected" by the screening system; seven of them were normal, and seven were evaluated as having SA by VF or VE. Nineteen were evaluated as aspirating with cough, 14 of whom had aspiration with cough as shown by VF or VE. Seventeen were evaluated as having SA, 15 of whom had SA shown by VF or VE. The cough test was useful in screening for SA. Moreover, a screening system that included MWST and a cough test could accurately distinguish between the healthy who were safe in swallowing and SA patients who were unsafe.