Correlation between phase angle and the number of medications in older inpatients: A cross-sectional study.

Background: Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in geriatric care, could influence PhA. This investigates whether the number of medications and polypharmacy with PhA as a biomarker of muscle quality in older inpatients aged ≧ 65 and determines the extent to which multiple medications contribute to the risk of reduced muscle quality. Methods: This retrospective cross-sectional study analyzed data from older inpatients requiring rehabilitation. PhA was measured using bioelectrical impedance analysis. The number of medications taken by each patient was recorded at admission. Polypharmacy was defined as the concurrent use of five or more medications at admission. Results: In this study of 517 hospitalized older adults (median age: 75 years; 47.4% men), 178 patients (34.4%) were diagnosed with sarcopenia. Polypharmacy was present in 66% of patients. The median PhA was 4.9° in men and 4.3° in women. Multivariate linear regression analysis was performed separately for men and women. In men, PhA was negatively correlated with the number of medications (ß = -0.104, p=0.041) and polypharmacy (ß = -0.045, p=0.383). In women, PhA was negatively correlated with the number of medications (ß = -0.119, p=0.026) and polypharmacy (ß = -0.098, p=0.063). Analyses were adjusted for age, BMI, sarcopenia, CRP, and hemoglobin levels. Conclusions: The number of medications at admission negatively impacted PhA in older inpatients, highlighting the importance of reviewing prescribed drugs and their interactions.

Low phase angle is associated with swallowing outcomes in patients with acute stroke.

BACKGROUND AND PURPOSE: Stroke-induced dysphagia is a critical complication that can lead to severe secondary worldwide health issues. This retrospective cohort study investigated the association between phase angle (PhA) and swallowing function in the acute phase of stroke. We aim to establish whether nutritional and muscular interventions associated with PhA could enhance swallowing recovery and reduce related risks post-stroke. METHODS: Stroke patients requiring rehabilitation were assessed for the association between low PhA-with cutoff values for low PhA defined as less than 5.28 for men and 4.32 for women-and swallowing function using a functional oral intake scale (FOIS) on Day 7 after admission and after the completion of acute stroke treatment. RESULTS: In this study of 140 acute stroke patients (median age 74[69-81], and 85 men and 55 women), 76 patients with low PhA significantly exhibited older age, lower body mass index, more decline in skeletal muscle mass index, and lower premorbid modified Rankin Scale scores compared to 64 patients with high PhA. Multivariate linear regression revealed that low PhA was independently associated with FOIS scores on Day 7 after admission (ß=-0.143 and p=0.036) and after the completion of acute stroke treatment (ß=-0.513 and p=0.024), even when adjusting for confounding factors. CONCLUSIONS: Low PhA is associated with swallowing function in patients with acute stroke. Nutritional and physical interventions improving PhA may lead to a reduction of the risk associated with stroke sequelae.

Probable Respiratory Sarcopenia Decreases Activities of Daily Living in Older Patients Hospitalized with Respiratory Diseases: A Cross-sectional Study.

Objectives: Respiratory sarcopenia is characterized by low respiratory muscle mass and respiratory muscle strength, but its impact on activities of daily living (ADL) remains unknown. We aimed to investigate the association between respiratory sarcopenia and decreased ADL. Methods: This retrospective cross-sectional study included older inpatients (≥65 years old) with respiratory diseases who underwent rehabilitation. Because the evaluation of respiratory muscle mass is challenging, probable respiratory sarcopenia was defined according to low appendicular skeletal muscle index (<7 kg/m2 for men, <5.7 kg/m2 for women) and peak expiratory flow rate (<4.4 L/s for men, <3.21 L/s for women). ADL was assessed on the first day of rehabilitation using the baseline Barthel Index (BI). Results: Of 111 inpatients (median age 75 years; 57 women), 13 (11.7%) had probable respiratory sarcopenia. Forty-five patients (40.5%) had sarcopenia and 12 of these had probable respiratory sarcopenia. Pulmonary functions (Forced Vital Capacity and expiratory volume in 1 s) were significantly lower in patients with probable respiratory sarcopenia than those without. Spearman's rank coefficient analysis showed probable respiratory sarcopenia did not significantly correlate with age, phase angle, Charlson Comorbidity Index (CCI), or hemoglobin (Hb). Multivariate linear regression analysis with baseline BI revealed probable respiratory sarcopenia (ß -0.279 and P=0.004) was the significant factor after adjusting for age, sex, body mass index, chronic obstructive pulmonary disease, CCI, and Hb. Conclusions: Probable respiratory sarcopenia was independently associated with decreased ADL in patients aged 65 years and older who were hospitalized with respiratory diseases.

Impact of Presarcopenic Dysphagia on 1-Year Mortality After Videofluoroscopic Swallowing Study in Patients with Cancer.

Sarcopenic dysphagia is the term for swallowing difficulty associated with loss of mass, strength, and physical performance, which leads to increased pharyngeal residues. Unlike sarcopenia, presarcopenia is characterized by low muscle mass without decreased muscle strength or physical performance and can develop into dysphagia due to low skeletal muscle mass. This retrospective study investigated the impact of presarcopenic dysphagia (PSD) on 1-year mortality in patients with cancer and dysphagia who underwent a videofluoroscopic swallowing study (VFSS). An operational definition of PSD based on presarcopenia and pharyngeal residues was adopted. The psoas muscle mass index (cm2/height [m2]), calculated by the psoas muscle area at the third lumber vertebra via abdominal computed tomography (CT) and related to height, was used to assess presarcopenia with cutoff values of 4.62 for men and 2.66 for women. Pharyngeal residues were assessed using a VFSS to evaluate dysphagia. Patients' medical charts were analyzed to investigate 1-year mortality after a VFSS. Out of 111 consecutive patients with cancer, 53 (47.7%) were defined as having PSD. In a forward-stepwise Cox proportional regression analysis, PSD (HR 2.599; 95% CI 1.158-5.834; p = 0.021) was significantly associated with 1-year mortality after a VFSS, even after adjusting for the factors of operation, Functional Oral Intake Scale (FOIS) scores at discharge, and modified Barthel Index (BI) scores at discharge. PSD, defined as CT-based presarcopenia and pharyngeal residues observed during a VFSS, is associated with increased 1-year mortality in patients with cancer and dysphagia.

Negative impact of computed tomography-based low skeletal muscle mass on swallowing recovery in patients with post-stroke dysphagia.

OBJECTIVES: Dysphagia due to stroke has a high prevalence, and evaluating the swallowing function of dysphagia and promoting oral intake is essential in patients with stroke. The psoas muscle mass index（cm2/height2（m2））, calculated by the psoas muscle area at the L3 level via abdominal computed tomography （CT）, can predict the development of dysphagia. However, knowledge about the impact of CT-based skeletal muscle mass on swallowing recovery, remains unknown. Therefore, we investigated whether CT-based low skeletal muscle mass impacted swallowing recovery. METHODS: A retrospective cohort study was conducted on patients with post-stroke dysphagia who underwent acute treatments along with a videofluoroscopic swallowing study（VFSS）. Swallowing recovery was identified as the improvement of the Functional Oral Intake Scale （FOIS） from the time of VFSS to discharge（observational period: ObPd）. The psoas muscle mass index's cut-off values for low skeletal muscle mass were 3.74 cm2/m2 and 2.29 cm2/m2 for men and women respectively. RESULTS: There were 53 subjects （36 male, median age 73.9）. The median during the ObPd was 26 days, and the median days from onset to admission and admission to VFSS were 0 and 18, respectively. Sixteen patients had low skeletal muscle mass. The median improvement of FOIS during the ObPd was 2, and the median length of hospital stay was 51 days. In the stepwise multiple linear regression analysis for the improvement of FOIS during the ObPd, low skeletal muscle mass （ߠ- 0.245; 95% confidence interval - 2.248 to - 0.127; p = 0.029） was a significant factor, even adjusted for serum albumin at admission, disturbance of consciousness at VFSS, FOIS at VFSS, and aspiration during VFSS. CONCLUSION: CT-based low skeletal muscle mass negatively impacted swallowing recovery during the ObPd in patients with post-stroke dysphagia.

Comprehensive flood control involving citizens in a Japanese watershed.

In July 2009, the city of Fukuoka, Japan experienced a flood disaster along the Hii River, which runs through densely populated, concrete-covered areas of the city. The drainage system was overwhelmed and the river overflowed due to heavy rainfall and rapid runoff. The event led citizens in its watershed to plan and implement comprehensive flood control. The plan aims not only to mitigate floods but also to revitalize the river environment and populated communities in urban areas. This study reports the activities led by the citizens. They organized and carried out civic forums, workshops, and fieldwork to share views as to how the flood disaster was caused, how floods in the watershed should be controlled, and how the river environment should be rehabilitated. This study illuminates how people, including the flood victims and municipal engineers, can change drastically and communicate effectively in the course of discussing and implementing the comprehensive flood control measures.