Sarcopenic Dysphagia,Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.     

Possible Rehabilitation Procedures to Treat Sarcopenic Dysphagia

Sarcopenic dysphagia requires the presence of both dysphagia and generalized sarcopenia. The causes of dysphagia, except for sarcopenia, are excluded. The treatment for sarcopenic dysphagia includes resistance training along with nutritional support; however, whether rehabilitation procedures are useful remains unclear. In this narrative review, we present possible rehabilitation procedures as a resistance training for managing sarcopenic dysphagia, including Shaker exercise, Mendelsohn maneuver, tongue-hold swallow exercise, jaw-opening exercise, swallow resistance exercise, lingual exercise, expiratory muscle strength training, neuromuscular electrical stimulation, and repetitive peripheral magnetic stimulation. We hope that some procedures mentioned in this article or new methods will be effective to treat sarcopenic dysphagia.     

A Machine Learning-Based Screening Test for Sarcopenic Dysphagia Using Image Recognition

Background: Sarcopenic dysphagia, a swallowing disorder caused by sarcopenia, is prevalent in older patients and can cause malnutrition and aspiration pneumonia. This study aimed to develop a simple screening test using image recognition with a low risk of droplet transmission for sarcopenic dysphagia. Methods: Older patients admitted to a post-acute care hospital were enrolled in this cross-sectional study. As a main variable for the development of a screening test, we photographed the anterior neck to analyze the image features of sarcopenic dysphagia. The studied image features included the pixel values and the number of feature points. We constructed screening models using the image features, age, sex, and body mass index. The prediction performance of each model was investigated. Results: A total of 308 patients participated, including 175 (56.82%) patients without dysphagia and 133 (43.18%) with sarcopenic dysphagia. The area under the receiver operating characteristic curve (ROC-AUC), sensitivity, specificity, positive predictive value, negative predictive value, and area under the precision-recall curve (PR-AUC) values of the best model were 0.877, 87.50%, 76.67%, 66.67%, 92.00%, and 0.838, respectively. The model with image features alone showed an ROC-AUC of 0.814 and PR-AUC of 0.726. Conclusions: The screening test for sarcopenic dysphagia using image recognition of neck appearance had high prediction performance.     

Nutritional Management Enhances the Recovery of Swallowing Ability in Older Patients with Sarcopenic Dysphagia

This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group (p = 0.004 and p < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.     

卒中后吞咽障碍临床治疗效果分析

目的分析经颅直流电刺激结合吞咽训练治疗卒中后吞咽障碍的疗效。方法选取本院卒中后吞咽障碍患者50例(2017年12月—2018年12月),随机分为吞咽训练治疗的对照组(25例)与经颅直流电刺激结合吞咽训练治疗的观察组(25例),观察患者治疗效果、洼田饮水试验评分、VFSS(电视透视吞咽功能检查)评分。结果观察组治疗有效率96.00%,对照组76.00%,χ2=4.1528,P=0.0415,差异有统计学意义。治疗后,观察组洼田饮水试验评分(1.40±0.53)分,低于对照组,t=8.8522,P=0.0000,差异有统计学意义。治疗后,观察组VFSS评分(7.98±0.37)分,高于对照组,t=21.2033,P=0.0000,差异有统计学意义。结论给予卒中后吞咽障碍患者经颅直流电刺激结合吞咽训练治疗,能有效提高患者治疗效果,改善患者吞咽功能。     

Sarcopenic Dysphagia Is Associated With Mortality in Institutionalized Older Adults

ObjectiveTo estimate mortality associated with sarcopenic dysphagia.DesignA 3-year follow-up cohort.Setting and ParticipantsNinety-five nursing home residents were evaluated to determine the baseline presence or absence of oropharyngeal dysphagia and followed up for 3 years.MethodsThe primary outcome was the risk of death. Dysphagia was assessed using a volume-viscosity swallow test. We used an algorithm to determine sarcopenic dysphagia based on grip strength, walking speed, calf circumference, and exclusion of neurologic or structural causes of dysphagia. We constructed 3 subgroups: without dysphagia, nonsarcopenic dysphagia, and sarcopenic dysphagia. Cox proportional regression analyses were used to predict the risk of death.ResultsThirty-five percent of participants had no dysphagia, 20% nonsarcopenic dysphagia, and 45% sarcopenic dysphagia. Sarcopenic dysphagia was independently associated with a higher risk of death [hazard ratio (HR) 2.44, 95% CI 1.02-5.80, P = .043] than without dysphagia. In addition, a higher Charlson Comorbidity Index score was associated with a higher risk of death (HR 1.33, 95% CI 1.01-1.75, P = .040).Conclusions and ImplicationsThis study shows that sarcopenic dysphagia was associated with increased mortality among institutionalized older adults. These deaths could be potentially preventable.     

Ultrasonography to Measure Swallowing Muscle Mass and Quality in Older Patients With Sarcopenic Dysphagia

Background

Sarcopenic dysphagia is characterized by difficulty swallowing due to a loss of whole-body skeletal and swallowing muscle mass and function. However, no study has reported on swallowing muscle mass and quality in patients with sarcopenic dysphagia.

Sarcopenic Dysphagia: A Narrative Review from Diagnosis to Intervention

Sarcopenia, defined as a decline in muscle mass and function related to aging, affects both limb and swallowing-related muscles. Sarcopenic dysphagia is characterized by decreased swallowing function; therefore, early detection of subclinical dysphagia and subsequent intervention appear to be crucial in the elderly. Numerous tools have been employed to measure the function, strength, and mass of swallowing-related muscles in sarcopenic elderly. The swallowing function can be evaluated by questionnaires like Eating Assessment Tool, Functional Oral Intake Scale, and Food Intake Level Scale, and tests such as the modified water swallowing test and videofluoroscopic swallowing study. Surface electromyography and high-resolution manometry can be applied for quantifying swallowing-related muscle strength. Modalities such as ultrasonography and magnetic resonance imaging are capable of estimating the swallowing muscle mass. In patients with sarcopenic dysphagia, a thorough assessment should be given followed by an integrated intervention combining swallowing muscle strengthening, nutrition support, food texture modification, physical, and occupational therapies. This article aimed to comprehensively summarize the diagnostic criteria/tools as well as their associations/performance in sarcopenic dysphagia. The intervention strategy will also be narrated in this review.     

Inflammation in Relation to Sarcopenia and Sarcopenic Obesity among Older Adults Living with Chronic Comorbidities: Results from the National Health and Nutrition Examination Survey 1999–2006

Loss of muscle mass and waning in muscle strength are common in older adults, and inflammation may play a key role in pathogenesis. This study aimed to examine associations of C-reactive protein (CRP) and systemic immune-inflammation index (SII) with sarcopenia and sarcopenic obesity in older adults with chronic comorbidities. Cross-sectional data from the National Health and Nutrition Examination Survey (1999–2006) were obtained for participants aged ≥60 years. Sarcopenia was defined by a lean mass and body height (males < 7.26 kg/m², females < 5.45 kg/m²). Sarcopenic obesity was defined by the concurrent presence of sarcopenia and obesity (defined by relative fat mass). Logistic regression was used to assess the associations of CRP and SII with sarcopenia and sarcopenic obesity. The dose–response relationship was examined via restricted cubic splines. Of the participants (n = 2483), 23.1% (n = 574) and 7.7% (n = 190) had sarcopenia and sarcopenic obesity, respectively. The multivariable logistic regression models suggested a positive association of SII with sarcopenia and sarcopenic obesity, but a positive statistically significant association was not consistently observed for CRP. Dose–response curves suggested similar association patterns for these biomarkers. In clinical practice, measures to prevent sarcopenia and sarcopenic obesity are needed for older vulnerable people with high systemic inflammation.     

急性脑卒中吞咽障碍患者早期康复护理的效果观察

目的 探讨早期康复护理对急性脑卒中吞咽障碍患者的护理效果.方法 选取2020年2月—2021年2月在我院进行治疗的急性脑卒中吞咽障碍患者为研究对象,随机分为对照组和试验组,每组患者40例,对照组实施常规护理,试验组在对照组基础上增加早期康复护理,对比两组患者吞咽障碍评分、吞咽障碍改善有效率及护理效果满意度.结果 试验组...     

脑卒中伴吞咽困难患者的早期康复护理

目的了解对脑卒中患者进行早期康复治疗对改善其吞咽功能障碍的临床效果。方法取本院2016年5月—2018年7月诊疗脑卒中吞咽功能障碍患者60例相关数据进行分析,分组并设为对照组(常规康复训练)、观察组(早期康复训练),各有患者30例。结果在疗效评价方面,观察组患者总有效率优于对照组(P<0.05);分别于康复治疗前后对患者神经功能缺损情况(NIHSS量表)、吞咽障碍情况(Burke量表)评价,患者干预后均有改善但观察组所得数据更具优越性(P<0.05)。结论对脑卒中后存在吞咽功能障碍后遗症患者进行早期康复治疗对于病情改善有积极意义。     

Sarcopenia,Obesity, Sarcopenic Obesity and Risk of Poor Nutritional Status in Polish Community-Dwelling Older People Aged 60 Years and Over

Poor nutritional status (PNS) is a modifiable factor determining abnormalities in body composition-sarcopenia, obesity, and sarcopenic obesity (SO). We aimed to assess the prevalence of these conditions and their association with PNS in 211 community-dwelling older adults. Sarcopenia was diagnosed based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recommendations. Obesity was diagnosed with the Percent Body Fat (>42% in women and >30% in men). Subjects fulfilling the criteria for obesity and concomitantly with reduced lower and/or upper limbs muscle strength and muscle mass (ALM/BMI < 0.512 in women and <0.789 in men) were classified as SO phenotype. Participants without obesity and sarcopenia were categorized as ‘normal’ phenotype. Nutritional status was estimated with the Mini Nutritional Assessment, and a score of <24 indicated PNS. In total, 49.8% participants had abnormal body composition (60.7% men and 42.5% women; p = 0.001). Sarcopenia, obesity, and SO were diagnosed in 10%, 32.7%, and 7.1% of subjects. PNS was found in 31.3% of the study sample. Its prevalence differed between phenotypes: 81% in sarcopenia, 60% in SO, 14.5% in obesity, and 28.3% in the ‘normal’ phenotype group (p = 0.000). Based on the results, abnormal body composition is prevalent in elderly subjects. Sarcopenia and SO are often associated with PNS.     

吞咽训练联合康复护理对脑卒中后吞咽障碍疗效

目的研究康复护理下的吞咽功能训练对脑卒中患者吞咽功能障碍的疗效分析。方法本次研究开展时间为2016年2月-2018年11月,期间选择入本院接受护理干预的脑卒中伴吞咽功能障碍患者共计136例。根据护理干预方式差异将患者分成组均68例的对照组以及试验组,对照组给予常规护理,试验组予以吞咽训练联合康复护理。比较干预后两组吞咽情况与满意度。结果经相关护理后,试验组吞咽功能恢复较对照组更优,P <0.05,差异有统计学意义,且两组满意度上亦属试验组患者为高,P <0.05,差异有统计学意义。结论对脑卒中并伴有吞咽障碍的患者,合理应用康复护理干预结合吞咽功能训练,能够获得较单一吞咽功能训练更显著的疗效,利于患者吞咽功能恢复,临床护理满意度高。     

The Prevalence and Prognosis of Sarcopenic Dysphagia in Patients Who Require Dysphagia Rehabilitation

The journal of nutrition, health & aging - The purpose of this study was to assess the prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation....     

脑卒中后吞咽障碍与肺炎的临床分析

目的：探讨脑卒中后吞咽障碍与卒中部位的关系，并分析吞咽障碍对卒中相关性肺炎的影响。方法：根据脑卒中部位将192例急性脑卒中患者分为左侧脑卒中组、右侧脑卒中组、双侧或脑干卒中组，比较三组患者吞咽障碍的发生率；根据吞咽障碍的发生情况将192例分为吞咽障碍组及无吞咽障碍组，比较两组患者卒中后肺炎的发生率。结果：左侧脑卒中组、右侧脑卒中组、双侧或脑干卒中组三组患者吞咽障碍的发生率有差别，X^2=6．07，P=0．048；吞咽障碍组及无吞咽障碍组卒中后肺炎的发生率有差别，P=0．000，吞咽障碍组的卒中后肺炎发生率高于无吞咽障碍组。结论：脑卒中后吞咽障碍的发生可能与卒中部位相关，吞咽障碍是卒中相关性肺炎的危险因素。     

脑卒中后吞咽障碍与医院获得性肺炎的关系

目的观察脑卒中后吞咽障碍与医院获得性肺炎发生的关系及对预后的影响。方法对356例脑卒中住院患者进行床边误吸试验,由此分为吞咽障碍组(A组)与无吞咽障碍组(B组),观察两组医院获得性肺炎发生与死亡情况。结果A组医院获得性肺炎发生率达23.5%,B组医院获得性肺炎发生率4.6%,两组差异有统计学意义(2χ=25.8,P<0.01),A组死亡率10.4%,B组死亡率4.0%,差异有统计学意义(χ2=5.3,P<0.05)。结论脑卒中后吞咽障碍是医院获得性肺炎的重要危险因素,显著影响预后,应予以高度重视。     

Impact of Premorbid Malnutrition and Dysphagia on Ischemic Stroke Outcome in Elderly Patients: A Community-Based Study

Objective: The present study was performed to assess nutritional status and its relationship with clinical outcomes in elderly stroke patients.

Method: In this cross-sectional study, 253 stroke patients were studied. Mini Nutritional Assessment (MNA) was used to assign patients to three groups: malnourished, at risk of malnutrition, and well nourished. Northwestern Dysphagia Patient Check Sheet was administered to all patients. Anthropometric measures, including body mass index (BMI), calf circumferences (CC), mid-arm circumferences (MAC), and triceps skinfold thickness were brought out. In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed.

Results: Of 253 patients, 34.4% were malnourished, 42.3% were at risk of malnutrition, and 23.3% were well nourished. The malnourished patients had significantly lower BMI, CC, and MAC (p?<?0.05). The levels of albumin and high-sensitivity C-reactive protein were significantly different among the groups (p?<?0.001). The admission and 3-month follow-up mRS scores, as well as dysphagia, were significantly higher in the malnourished patients and those at risk of malnutrition (p?<?0.001). In addition, mRS scores at admission and 3-month follow-up scores, as well as the length of hospital stay (LOS), were significantly correlated with MNA score, dysphagia, BMI, CC, MAC, albumin, and high-sensitivity C-reactive protein (p?<?0.05). Significant unadjusted associations were observed among MNA scores, BMI, CC, MAC, dysphagia scores, NIHSS scores, length of hospital stay (LOS), albumin, hs-C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR) with a poor outcome. With a multivariate logistic regression analysis, NIHSS scores and MNA scores remained significantly associated with the poor outcome in patients with ischemic stroke.

Conclusions: The findings of the present study underline the importance of nutritional status in elderly stroke patients.