Search

Background For residents of long-term care facilities (LTCFs), antimicrobial-resistant bacteria (ARB) are a risk factor, yet their oral colonisation, potentially leading to aspiration pneumonia, remains unclear. This study was undertaken to survey the prevalence, phenotypic characteristics, and molecular epidemiology of antimicrobial-resistant Gram-negative bacteria in the oral cavity of LTCF residents, and to analyse the risk factors for such carriers. Methods This study involved 98 residents of a LTCF in Hiroshima City, Japan, aged between 55 and 101 years. Oropharyngeal swabs were collected and plated on screening media for ESBL-producing and carbapenem-resistant bacteria; isolates were identified and tested for antibiotic susceptibility; biofilm formation was tested in vitro; identification of epidemic clones were pre-determined by PCR; resistance genes, sequence types, and whole-genome comparison of strains were conducted using draft genome sequences. Demographic data and clinical characterisations were collected and risk factors analysed. Results Fifty-four strains from 38% of the residents grew on screening media and comprised predominantly of Acinetobacter spp. (35%), Enterobacteriaceae spp. (22%), and Pseudomonas spp. (19%). All Escherichia coli isolates carried CTX-M-9 group and belonged to the phylogroup B2, O25:H4 ST131 fimH30 lineage. Six Acinetobacter baumannii isolates presented identical molecular characteristics and revealed more biofilm production than the others, strongly suggesting their clonal lineage. One Acinetobacter ursingii isolate displayed extensive resistance to various ß-lactams due to multiple acquired resistance genes. One Pseudomonas aeruginosa isolate showed exceptional resistance to all ß-lactams including carbapenems, aminoglycosides, and a new quinolone, showing a multidrug-resistant Pseudomonas aeruginosa (MDRP) phenotype and remarkable biofilm formation. Genome sequence analysis revealed this isolate was the blaIMP-1-positive clone ST235 in Japan. Strokes (cerebral infarction or cerebral haemorrhage) and percutaneous endoscopic gastrostomy tubes were recognised as risk factors for oral colonisation by ARB in the LTCF residents. Conclusions ARB, as defined by growth on screening agar plates, which carried mobile resistance genes or elements or conferred high biofilm formation, were already prevalent in the oral cavity of LTCF residents. Health-care workers involved in oral care should be aware of antimicrobial resistance and pay special attention to transmission prevention and infection control measures to diminish ARB or mobile resistance elements dissemination in LTCFs.

Objective The purpose of this study was to examine the frequency of oral hypofunction in community-dwelling older people and determine its relationship with frailty and sarcopenia. Background Previous studies have shown that frailty and sarcopenia are associated with decreased oral function. However, these studies have only evaluated frailty or sarcopenia alone and have not evaluated their relationship with each other. Materials and methods The participants were community-dwelling independent older people in Kyoto. Their oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function). Oral hypofunction was defined as abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre-frail and frail) according to the frailty phenotype and deficit-accumulation models. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) Consensus. The relationships between oral function and frailty were analysed using logistic regression analyses, after adjusting for sarcopenia. Results Among the 340 participants that were analysed (69 men, 271 women; average age: 75.0 years), 182 (53.5%) had oral hypofunction (40 men, 142 women; average age: 76.8 years). There was a significant relationship between oral hypofunction and deficit-accumulation model-assessed frailty, after adjusting for sarcopenia. Conclusion Almost half of the community-dwelling older people have oral hypofunction, which is significantly related to comprehensive frailty and sarcopenia.

Objective This study aimed to assess the relationship between oral hygiene/stomatognathic function and residual intraoral medication in older adults and to identify the oral factors associated with residual oral medication. Methods The study included 309 older adults (77 men, 232 women, mean age: 74.1 ± 7.4 years) who were prescribed medications at regular intervals. The following survey items were assessed: overall physical condition, intraoral condition and oral function. Participants prescribed oral medication were classified into groups with and without residual medication in the oral cavity. Statistical analysis was performed using univariate analysis for each of the factors contributing to the presence of residual medication. Results Only 1.9% of all patients had residual medication, which suggests that older adults in this survey had a low risk of residual intraoral medication. However, greater attention should be given to residual intraoral medication in older adults receiving long-term care. Powdered-form oral medications were more likely to remain in the oral cavity. Older adults with residual medication had a tendency to have less occlusal support, poor tongue hygiene and poor tongue movement. Oral function, particularly functions that are closely related to swallowing, was significantly lower in the residual intraoral medication group when compared to those of the group without residual intraoral medication. Conclusions Reduced oral function and powered medication were associated with greater residual intraoral medication in this sample of older Japanese adults.

We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25–17.84, p

To develop and assess a dysphagia training method involving lollipop sucking training in older adults with dementia, clarify its effectiveness for improving oral function.Twenty-five older adults with dementia (5 males and 20 females, mean age 90.8 ± 6.7 years) were participated in this study. Participants were trained in lollipop sucking once a day, 3 times a week for 6 months. Mini-Mental State Examination (MMSE), Barthel Index (BI), Candy Sucking Test (CST), and BMI values were measured before and after the training. Participants were grouped into those who achieved0.1 g/min increase in CTS value after the training (increase group) and those who did not (nonincrease group).No significant change was observed after the training. The increase group contained 4 patients and the non-increase group contained 21 patients. There were no significant differences in MMSE, BI, or BMI between the two groups before and after the training. However, the CST values of the increase group before the training (0.31 ± 0.13 g/min) were significantly lower than non-increase group (0.69 ± 0.27 g/min) (p 0.01). Respective changes in BMI before and after training were 1.13 ± 0.85 kg/m² and -0.53 ± 1.76 kg/m² in the increase and non-increase, and the difference in these changes was statistically significant (p = 0.04).Our new rehabilitation method was well accepted by older adults with dementia, and there was an improvement in oral function as a result of the rehabilitation, which had some good influence on weight gain.

To maintain oral intake in elderly patients with dementia, it is important to evaluate their oral function. However, these patients often have difficulties following instructions during oral function tests, especially with the progression of dementia. The task of sucking a lollipop candy is simple for elderly patients with mild or severe dementia. The present study aimed to develop a new oral function test - the "candy sucking test" (CST) - for elderly patients with dementia.We recruited 23 female elderly patients with dementia (mean age 89.0 ± 6.7 years). First, we determined the number of participants who were able to carry out this new oral function test, compared with other existing tests. Then, swallowing function was evaluated using videofluoroscopy for those who could carry out the CST.More participants were able to perform carry out CST than other function tests (P0.05). A significant correlation was observed between the CST value, evaluated as the difference in candy weight, and oral transit time (ρ = -0.62, P0.01).The CST could be useful as a new method for evaluating the oral function of elderly patients with dementia. Geriatr Gerontol Int 2017; 17: 1977-1981.

Maximum tongue pressure (MTP) measurement is a convenient, less invasive assessment that has been developed to quantify tongue strength; however, it is unclear whether MTP is useful for the detection of swallowing disorders in amyotrophic lateral sclerosis (ALS) patients. The purpose of this study was to clarify the relationship between MTP and the characteristics of swallowing disorders on videofluorography and to determine the usefulness of tongue pressure measurement for the assessment of swallowing function in ALS patients. Twenty-five ALS patients were evaluated according to the ALS functional rating scale-revised (ALSFRS-R), and their ability to swallow yogurt was observed via videofluorography. MTP was measured using a device (TPM-01, JMS, Hiroshima) equipped with a balloon probe. Then, the relationships between the ALSFRS-R score, swallowing function, and MTP were analyzed. MTP was significantly lower in the subjects with reduced tongue function (p = 0.002) or with pharyngeal residue (p = 0.006) than in the subjects with normal characteristics. Bolus formation and oral transit time and pharyngeal transit time were significantly prolonged among those with reduced MTP. MTP at a cut-off value of 21.0 kPa was associated with a full score on the bulbar-related items of the ALSFRS-R. MTP may serve as a new diagnostic tool for the early detection of swallowing dysfunction in ALS patients, because of its good relationship with their swallowing characteristics.

Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period) and after team organization (post period). Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01). Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19-0.84, p = 0.02). The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.

Objective Dysphagia is a critical issue in amyotrophic lateral sclerosis (ALS) patients. An evaluation of swallowing function is important for assessing the risk of aspiration. We investigated the validity of tongue sonography compared with videofluoroscopic examination for ALS patients. Methods We investigated 18 ALS patients. Nine subjects underwent repeated investigations. All of the subjects underwent tongue sonography and videofluoroscopic examination. Additionally, tongue sonography was evaluated in 18 age- and sex-matched healthy volunteers. To determine tongue thickness, we measured the vertical distance from the surface of the mylohyoid muscle to the tongue dorsum using ultrasonography. Results In the ALS patients, the tongue was significantly thinner than in healthy subjects. Tongue thickness was associated with body mass index and onset type in the ALS patients ( p =0.006). Temporal analyses of videofluoroscopy revealed that tongue thickness was associated with oral preparatory and transit time ( p =0.032) but not with pharyngeal transit time. Repeated measurement data revealed a decrease in tongue thickness over the course of the measurements ( p =0.002). Conclusions In ALS patients, reduced tongue thickness suggests disease progression and tongue dysfunction. Significance Tongue sonography is a useful modality for the non-invasive and quantitative evaluation of tongue thickness and dysphagia in ALS patients.

Background. Although age-related changes resulting in slowing of the swallowing reflex and a decline in the neuromuscular control system have been reported, there have been few reports on swallowing function in dentate elderly persons. The purpose of this study was to clarify the primary influence of aging on swallowing in healthy dentate elderly persons older than 80 years who have more than 20 teeth. Methods. Dentate elderly persons (12 male, 7 female; mean age: 81.2 years) and dentate young participants (9 male, 5 female; mean age: 26.8 years) as a control group participated voluntarily. Participants reported no clinical symptoms relating to dysphagia, neurologic impairments, or degenerative diseases, and were asked to swallow 10 ml of barium sulfate solution (10% w/v) three times. Functional swallowing was recorded on 35 mm cinefilm at 30 frames per second with a digital subtraction angiography system. Lateral images of cinefluorography of seated participants’ mouth, pharynx, and larynx were obtained. Visual image analysis for qualitative and quantitative evaluation was made with a cine projector. Results. No participants exhibited aspiration during three trials. Occurrence and frequencies of piecemeal deglutition, premature loss of liquid, oral and pharyngeal residues, and laryngeal penetration were significantly greater in dentate elderly persons (p , .05) than in the dentate young participants. Oral transit time, pharyngeal delay time, and pharyngeal transit time in dentate elderly persons were prolonged significantly compared with those in dentate young participants (p , .01). Conclusion. Physiological swallowing functions deteriorate even in healthy dentate elderly persons. This deterioration may be explained primarily by the influence of aging on swallowing.

Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for evaluating swallowing dysfunction. We have hypothesized that low tongue pressure may be able to predict pneumonia occurrence in acute stroke patients. Tongue pressure was measured using balloon-type equipment in 220 acute stroke patients. The modified Mann Assessment of Swallowing Ability (MASA) score was evaluated independently on the same day. Tongue pressure was measured every week thereafter. An improvement in tongue pressure was observed within the first 2 weeks. Receiver operating curve analysis was performed to determine the ability of tongue pressure to predict modified MASA score

To quantitatively estimate tongue function, we developed a handy device for intraoral pressure measurement. The objective of this study was to assess maximum voluntary tongue pressure (MVTP) in Japanese frail elderly persons receiving nursing care services.The study included 42 men and 87 women, aged 58-100 years. To record MVTP, the participants were asked to compress the balloon (diameter: 18 mm) of the disposable intraoral pressure probe onto their palates for 7 s using the maximum voluntary effort of the tongue. Pressures were recorded three times at 1 min intervals.Maximum voluntary tongue pressure was successfully measured in 111 persons. Mean (standard deviation) MVTP was 18 (12) kPa, with a range of 0-63 kPa. The remaining 18 persons could not accurately follow our instructions and MVTP could not be measured.In comparison with the reported standard value using the same device, the frail elderly persons included in our study were found to exert less MVTP than healthy dentate individuals. These results suggest the need for proper quantitative evaluation of oral function, including tongue capacity, at nursing care facilities.

The purpose of this study was to clarify the correlation between dental and nutritional status among community-dwelling elderly Japanese people.The subjects were 182 elderly individuals, aged 65-85 years, who voluntarily participated in a health seminar at Kyoto Prefectural University of Medicine. These subjects were divided into two groups according to the occlusion. The subjects in the retained contact group were those who had retained molar occlusion with natural teeth. The lost contact group were those who retained molar occlusion with removable partial dentures. Anthropometric variables such as body mass index (BMI) were collected and dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ).No statistical difference in BMI or intake of macronutrients was found between these two occlusal groups. The lost contact group reported significantly lower consumption of vegetables and higher consumption of confectionaries (foods rich in sugar) than did the retained contact group (P0.05), and therefore had significantly lower intake of vitamin C and dietary fiber (P0.05).It can be concluded that natural tooth contact loss in the posterior region affect the intake of vitamins and dietary fiber. .

The purpose of this study was to clarify quantitatively the differences in tongue-tip motion among the dentulous elderly people and also among the elderly edentulous, both with and without their dentures and, to identify the influence of tooth loss and denture wear on tongue-tip motion. Fourteen young dentulous people, 12 elderly dentulous people and 13 elderly edentulous people participated in this study. Subjects were asked to swallow a 10 mL barium sulfate solution three times. The elderly edentulous people were asked to swallow the solution while wearing dentures and with dentures removed. Functional swallowing was recorded on cine-film with a digital subtraction angiography system. Lateral cinefluorography images were obtained from seated subjects. Using a cine-projector, the movements of the tongue surface were traced as dots and lines frame by frame on a single tracing sheet within a definite period of time from the beginning of the oral phase to the end of the pharyngeal phase. With counting the number of 'trajectories' of tongue-tip motion, tongue movements were classified as 'stable' and 'hyperactive' types. The results was that significantly more 'hyperactive' type subjects were found among the elderly edentulous who were not wearing dentures (12 of 13) compared with the dentulous young (1 of 14), the elderly dentulous (1 of 13) or the elderly edentulous wearing dentures (1 of 13) (P < 0.001). The tongue-tip motion for the 'hyperactive' type was very complex and the tongue-tip anchoring against the palate was always instable.

A new tongue pressure device consisting of a simple and safe disposable probe and manometer has been developed. This report describes a study that examined the validity of the new device, comparing it to a widely used tongue pressure manometer, the Iowa Oral Performance Instrument (IOPI), and to the stable adhered three air-filled bulbs manometry system. The first test compared maximum tongue pressure measured with the new device and the IOPI (13 male, 9 female, 25.0 years). The second test compared maximum tongue pressure and swallowing tongue pressure measured with the new device and the three-bulb device (13 male, 9 female, 31.0 years). Significant correlations of maximum tongue pressure were found between the new device and the IOPI in the first test (p

It is clinically important to evaluate tongue function in terms of rehabilitation of swallowing and eating ability. We have developed a disposable tongue pressure measurement device designed for clinical use. In this study we used this device to determine standard values of maximum tongue pressure in adult Japanese. Eight hundred fifty-three subjects (408 male, 445 female; 20-79 years) were selected for this study. All participants had no history of dysphagia and maintained occlusal contact in the premolar and molar regions with their own teeth. A balloon-type disposable oral probe was used to measure tongue pressure by asking subjects to compress it onto the palate for 7 s with maximum voluntary effort. Values were recorded three times for each subject, and the mean values were defined as maximum tongue pressure. Although maximum tongue pressure was higher for males than for females in the 20-49-year age groups, there was no significant difference between males and females in the 50-79-year age groups. The maximum tongue pressure of the seventies age group was significantly lower than that of the twenties to fifties age groups. It may be concluded that maximum tongue pressures were reduced with primary aging. Males may become weaker with age at a faster rate than females; however, further decreases in strength were in parallel for male and female subjects.

To clarify the influence of aging and denture use on swallowing in healthy edentulous people aged 75 and older.A cross-sectional research design was used with participants from Hiroshima University Hospital, Hiroshima University, and Hiroshima City.Participants were examined in Hiroshima University Hospital, Hiroshima, Japan.Thirteen edentulous elderly volunteers (7 male, 6 female; aged 75-86, mean age 81.2) and 19 dentulous elderly volunteers (12 male, 7 female; aged 80-87, mean age 81.2) as a control group participated in this study. Participants reported no clinical symptoms relating to dysphagia, neurological impairments, or degenerative diseases.Participants were asked to swallow a 10-mL barium sulfate solution three times. Edentulous older people were asked to swallow the solution while wearing dentures and with dentures removed. Functional swallowing was recorded on cine-film with a digital subtraction angiography system. Lateral cinefluorography images were obtained from seated subjects. Using a cine-projector, visual images were evaluated qualitatively and quantitatively.No participants exhibited aspiration. The occurrence of laryngeal penetration in the edentulous older people not wearing dentures was the only significant difference (P.05).Only laryngeal penetration differed significantly between edentulous older people not wearing their dentures and dentulous older people.

To evaluate the influence of dental occlusion, with or without the use of dentures, on mortality in community-dwelling elderly persons.A total of 1030 randomly selected healthy independent elderly aged 65 and over were surveyed in 1995. For the study reported here, subjects were classified into three groups according to the presence or absence of maxillo-mandibular tooth contacts. Subjects with no maxillo-mandibular tooth contacts were further subdivided into those with and without dentures.Data on mortality were obtained from Kure City Council in September 2003. Cox regression models were used in analysing the risk for death with gender and age as covariates.Individuals whose teeth had contact in at least the bilateral premolar regions at baseline had 0.78 times (95% CI: 0.60-0.99) smaller risk for death during the succeeding 8 years than those who had no occlusion. Among those who had no occlusion with their own teeth, the risk for mortality among denture non-users was 1.52 times (95% CI: 1.25-1.83) higher than the risk for denture users.These results may support the view that, in the elderly; poor dental occlusion is associated with an increased risk for mortality and that, in the edentulous, the use of dentures is associated with a decreased risk for mortality.