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Aim: The present study examined the relationship between body mass index and the ability to perform the activities of daily living in patients with vertebral compression fractures. Methods: A retrospective cohort analysis of patients aged >65 years hospitalized with a vertebral compression fracture was carried out using a nationwide database in Japan. Body mass index was categorized as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–27.4 kg/m2) and obese (≥27.5 kg/m2) according to the World Health Organization criteria for the Asia–Pacific region. The primary outcome was Barthel Index gain, namely, the change in the Barthel Index score at discharge from that at admission. Secondary outcomes were the length of hospital stay and readmission within 30 days of discharge. Results: Among 41 423 participants, 24.5% were classified as underweight, excluding those with missing body mass index data. The underweight group had a significantly lower Barthel Index gain than the normal, overweight and obese groups (median 20 vs 25 vs 30 vs 30, respectively, P < 0.001). The underweight group also had longer hospital stays and higher 30‐day readmission rates than the other groups. A multivariable analysis showed that being underweight was independently associated with a Barthel Index gain −3.63 points (95% confidence interval −4.58 to −2.68) lower than normal weight. Furthermore, being underweight was an independent variable affecting the length of hospital stay and readmission within 30 days (P < 0.001). Conclusions: In patients with vertebral compression fractures, being underweight leads to lower Barthel Index scores, longer hospital stays and increased readmissions within 30 days of discharge. Geriatr Gerontol Int 2023; 23: 788–794. [ABSTRACT FROM AUTHOR]

Background: Frailty is a significant predictor of prognosis in older patients with community-acquired pneumonia (CAP). No effective therapy has been reported in frail patients with CAP, with frailty determined using the Hospital Frailty Risk Score (HFRS). Aims: To investigate whether early physical rehabilitation intervention would effectively minimize adverse outcomes in frail older patients (determined using the HFRS) hospitalized for CAP. Methods: This retrospective cohort analysis involved patients with CAP aged ≥ 65 years enrolled in the Japanese Diagnostic Procedure Combination Database between 2014 and 2020 and assessed as being frail. We compared 30-day mortality and readmission rates for patients who did and who did not receive physical rehabilitation within three days of admission and evaluated the association between outcomes and receiving early physical rehabilitation using Cox regression models and inverse probability weighting (IPW) for sensitivity analysis. Results: The analysis involved 31,133 frail older patients hospitalized for CAP (mean age 84.3 ± 6.3 years; females, 49.1%), including 11,515 (37.0%) who received early physical rehabilitation. Cox regression analysis showed that early physical rehabilitation intervention was inversely associated with 30-day mortality and readmission rates. The IPW model also showed similar results. Discussion: Early physical rehabilitation was associated with reduced risks of 30-day mortality, overall in-hospital mortality, and 30-day readmission rates in frail older patients with CAP. Conclusions: Early physical rehabilitation in frail older patients hospitalized for CAP may improve outcomes. This finding highlights the importance of simultaneously introducing the HFRS and early physical rehabilitation intervention into clinical practice for frail older patients with CAP. [ABSTRACT FROM AUTHOR]

Background: This study examined the association between parenteral energy/amino acid doses and in-hospital mortality among inpatients on long-term nil per os (NPO) status, using a medical claims database in Japan.Methods: Hospitalized patients with aspiration pneumonia, aged 65 and older, and on more than 7-day NPO status were identified in a medical claims database between January 2013 and December 2018. Using multivariate logistic regression and regression analyses, we examined the association between mean parenteral energy/amino acid doses and in-hospital mortality, and secondarily, the association between prognosis (in-hospital mortality, inability to receive full oral intake, readmission, and hospital stay length) and 4 groups of mean amino acid doses (no dose: 0 g/kg/day; very low dose: >0, ≤0.3 g/kg/day; low dose: >0.3, ≤0.6 g/kg/day; moderate dose: >0.6 g/kg/day).Results: The analysis population included 20 457 inpatients (≥80 years: 78.3%). In total, 5 920 mortalities were recorded. Increased amino acid doses were significantly associated with reduced in-hospital mortality (p < .001). With a no dose reference level, the odds ratios (95% confidence interval) of in-hospital mortality adjusted for potential confounders were 0.78 (0.72-0.85), 0.74 (0.67-0.82), and 0.69 (0.59-0.81) for very low, low, and moderate amino acid doses, respectively. Additionally, patients prescribed amino acid dose levels more than 0.6 g/kg/day had shorter hospitalization periods than those prescribed none.Conclusions: Increased amino acid doses were associated with reduced in-hospital mortality. Sufficient amino acid administration is recommended for patients with aspiration pneumonia requiring NPO status. [ABSTRACT FROM AUTHOR]

Purpose: A high score determined by SARC-F, a simple screening questionnaire for sarcopenia, has been reportedly associated with worse medical outcomes. However, information regarding whether high SARC-F scores are associated with a poor prognosis in patients with advanced cancer remains limited. We clarified whether a SARC-F score ≥ 4 predicts poor prognosis in patients with cancer receiving palliative care.Methods: We conducted a retrospective cohort study of patients with cancer who received palliative care at a university hospital between May 2019 and April 2020. Patient characteristics including age, sex, height, weight, cancer type, serum albumin level, C-reactive protein level, presence of edema, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), SARC-F score, history of anticancer therapy, and clinical outcomes were collected from electronic medical records.Results: Of 304 patients, 188 had a SARC-F score < 4, and 116 patients had a SARC-F score ≥ 4. The overall survival of patients with a SARC-F score ≥ 4 was 40 days (95% CI 29-47), which was significantly worse than 121 days (95% CI 95-156) for patients with a SARC-F score < 4 (p < 0.001). SARC-F score ≥ 4 (hazard ratio: HR 1.56), edema (HR 1.94), head and neck cancer (HR 0.51), C-reactive protein (HR 1.05), ECOG-PS ≥ 3 (HR 1.47), and radiotherapy (HR 0.52) were associated with overall survival. The ability to climb stairs was a SARC-F sub-item significantly associated with mortality (HR 1.59).Conclusion: The SARC-F questionnaire is a useful predictor of prognosis for patients with cancer receiving palliative care because a SARC-F ≥ 4 score predicts worse overall survival. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the usefulness of frailty for predicting adverse events in patients with vertebral compression fractures (VCFs) during hospitalization using data obtained from the Japanese health insurance system. Methods: This retrospective cohort study of patients with VCFs aged ≥65 years was conducted using a nationwide database in Japan. We examined the relationships between frailty risk, classified using the Hospital Frailty Risk Score (HFRS), in‐hospital mortality, and complications such as pressure ulcers and pneumonia. Multivariate logistic regression analysis was used to estimate the association between the HFRS and the outcomes of patients with VCFs. Results: In this study, the data of 30 980 in‐patients with VCFs were analyzed. Of these patients, 76.8%, 21.3%, and 1.9% had low, intermediate, and high risks of frailty, respectively. The higher the risk of frailty, the higher the rate of in‐hospital mortality and the occurrence of all complications (P < 0.001 for trend). An intermediate risk of frailty was independently associated with in‐hospital mortality (odds ratio [OR], 1.421; P < 0.001), whereas a high risk of frailty did not show statistical significance (OR, 1.385; P = 0.150). Each frailty risk was independently associated with the occurrence of all complications during hospitalization. Conclusions: The HFRS, which can assess the risk of frailty based on routinely collected medical records, was predictive of adverse events in older patients with VCFs based on a nationwide database in Japan. Future studies need to assess approaches to preventing adverse events in frail VCF patients. Geriatr Gerontol Int 2022; 22: 233–239. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. Design: Single-center retrospective study. Setting: A university hospital. Participants: All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. Measurements: Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. Results: We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). Conclusion: The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: Community-dwelling older adults with sarcopenia are likely to fall. However, few studies have investigated whether sarcopenia is associated with falls during hospitalization in older adults. The purpose of this study was to determine whether the SARC-F when used as a simple screening tool for sarcopenia at the time of admission, predicts in-hospital falls. Design: A retrospective, observational study. Setting: A 900-bed university hospital. Participants: A total of 9,927 patients aged 65 years and older were hospitalized at the hospital between April 2019 and March 2020. Measurements: The SARC-F contains five items: strength, assistance in walking, rise from a chair, climb stairs, and falls were evaluated at hospital admission. To investigate the relationship between the SARC-F score and falls, a ROC curve analysis was performed. Multivariate analysis adjusted for fall-related confounding factors such as age, gender, ADL, and disease were performed. Results: Mean age: 75.9±6.7 years; male: 56.2% were analyzed, and 159 patients (1.6%) fell during hospitalization. SARC-F scores at admission were significantly higher in the fall group than in the control group (3 [1–6] points vs. 0 [¬0–2] point, p<0.001). Statistical association was observed between the SARC-F and in-hospital fall (area under the curve = 0.721 [0.678–0.764], p < 0.001). The cut-off value for the highest sensitivity and specificity of the SARC-F score for in-hospital falls was two (sensitivity = 0.679, specificity = 0.715). Among the subitem of the SARC-F, the hazard ratios for climbing stairs were significantly higher (HR = 1.52 [1.10–2.09], p = 0.011) and for a history of fall was significantly higher (HR = 1.41 [1.02–1.95], p = 0.036). A SARC-F score ≥ 2 had a significantly higher incidence of in-hospital falls compared to a SARC-F score <2 (3.7% vs. 0.7%, p < 0.001). Also, a SARC-F score ≥ 2 had a significantly higher hazard ratio for falls (2.11 [1.37–3.26], p < 0.001). Conclusion: SARC-F can help predict falls among hospitalized older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Functional Assessment for Control of Trunk (FACT) was developed to evaluate trunk function after stroke. However, only a few studies used FACT to show functional outcome. OBJECTIVE: This study aimed to validate the FACT predictive ability for functional outcome following stroke and create an English version of the FACT. METHODS: This retrospective, observational study was conducted with patients aged≥65 years with stroke. Patients were divided into two groups according to the median FACT score at admission: trunk impairment or high trunk function group. Multiple regression analysis was performed for Functional Independence Measure (FIM) gain and FIM efficiency to examine the relationship between trunk function assessed by FACT at admission and functional prognosis. RESULTS: 105 participants (mean age, 80.2±7.6, 57.1%were men) were included. Of these, 48 (45.7%) and 57 (54.3%) were categorized to the trunk impairment group and high trunk function group, respectively. FACT score at admission was associated with FIM gain (coefficient = 0.875, P = 0.001) and FIM efficiency (coefficient = 0.015, P = 0.016) after adjusting for confounders. CONCLUSIONS: Trunk impairment at admission assessed by FACT could predict functional prognosis. The English version of FACT was created and further demonstrated the validity of FACT. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop appendicular skeletal muscle mass (ASM) estimating formulas that also consider the presence of paralysis for older adults and people with disabilities. Methods: This retrospective study analyzed 315 consecutive patients, post‐stroke, aged ≥65 years, in a rehabilitation hospital. Six different ASM estimating formulas were developed using a five‐fold cross‐validation method and compared with the measured ASM obtained from bioelectrical impedance analysis. These formulas included age, gender, height, weight, arm circumference, triceps skinfold, calf circumference and presence of paralysis. Using Pearson's correlation coefficients (r) and intraclass correlation coefficient (ICC), we examined the correlation between the formulas and the measured ASM. The accuracy of the ASM estimating formula for detecting decreased muscle mass was evaluated using the F‐value and Matthew's correlation coefficient. Results: Patients' mean ± SD age was 79.0 ± 8.1 years, and 51.4% of them were men. The mean ± SD bioelectrical impedance analysis‐measured ASM was 13.7 ± 4.3 kg. Furthermore, 241 (76.5%) patients had decreased measured ASM. The mean adjusted R2 of the developed six formulas was 0.861–0.871. In all formulas, the r and ICC of the estimated ASM for the measured ASM were strong (r = 0.936–0.930 and ICC = 0.928–0.934). These formulas revealed excellent sensitivity (86.0–88.2%), specificity (72.5–81.1%), accuracy (0.838–0.870), F‐value (0.899–0.918) and Matthew's correlation coefficient (0.509–0.612) for measured ASM depletion. Conclusions: We successfully developed ASM estimating formulas using anthropometric measurements considering the presence of paralysis. Thus, these formulas are beneficial for diagnosing sarcopenia in older adults, without requiring any special equipment. Geriatr Gerontol Int 2020; 20: 1145–1150. [ABSTRACT FROM AUTHOR]

Object: The SARC-F questionnaire is a sarcopenia screening tool. However, the validity of the SARC-F score ≥4 (SARC-F≥4) for the evaluation of sarcopenia in the hospital setting has not been investigated. This study investigated the validity of SARC-F≥4 as a screening tool for sarcopenia among hospitalized older adults. Design: Cross-sectional retrospective study. Setting: A university hospital. Participants: This study included older adult patients (age ≥65 years) who were hospitalized at, and subsequently discharged from, the hospital between April and September 2019 and underwent a nutritional assessment by the nutrition support team during their hospitalization. Measurements: SARC-F was recorded at the time of admission, and the criteria specified by the Asia Working Group for Sarcopenia in 2019 (AWGS 2019) were applied to diagnose sarcopenia and possible sarcopenia. Appendicular muscle mass was estimated through validated equations, and three different models were developed for sarcopenia diagnosis. The sensitivity, specificity, and positive/negative likelihood ratios were calculated to analyze the accuracy of the SARC-F≥4 for sarcopenia and possible sarcopenia. Receiver-operating characteristic analyses were conducted to calculate the area under the curve (AUC). Results: In total, 1,689 patients (mean age: 77.2±13 years; male: 54.4%) were analyzed, and 636 patients (37.7%) had SARC-F≥4. Patients with SARC-F≥4 had a statistically significant higher prevalence of AWGS 2019-defined sarcopenia than patients with SARC-F <4 in the models (65.4–78.9% vs 40.9–15.2%, p<0.001). The sensitivity, specificity, and positive/negative likelihood ratios of SARC-F≥4 for sarcopenia and possible sarcopenia were 49.1–51.3%, 73.9–81.2%, and 1.88–2.72/0.60–0.69 and 48.0%, 84.5%, and 3.11/0.62, respectively. The AUC for sarcopenia and possible sarcopenia were 0.644–0.695 and 0.708, respectively. The AUC of SARC-F for possible sarcopenia was equivalent to or larger than that for sarcopenia (DeLong test p=0.438, 0.088, and <0.001 vs the three models). Conclusions: SARC-F≥4 is suitable as a screening tool for sarcopenia in hospitalized older adults. SARC-F assessment could facilitate the detection and exclusion of sarcopenia at hospitalization and may lead to early adoption of a therapeutic and preventive approach. [ABSTRACT FROM AUTHOR]

Aim: The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut‐off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. Methods: This retrospective cross‐sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut‐off value of GNRI, and the results were compared against the Mini Nutritional Assessment – Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut‐off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. Results: The mean age of the patients was 76.0 ± 7.0 years. The optimal cut‐off value of GNRI for Mini Nutritional Assessment – Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817–0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776–0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut‐off in the European Society of Clinical Nutrition and Metabolism‐defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment – Short Form‐based and MUST‐based diagnosis, respectively. Conclusions: The study showed GNRI <96 points as the optimal cut‐off value for nutritional screening. GNRI might be one of the easy‐to‐use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811–816. [ABSTRACT FROM AUTHOR]

Background: Poor oral health at hospital admission is a potential higher mortality risk predictor. We aimed to determine in-hospital mortality by assessing poor oral health using a validated tool.Methods: A retrospective observational study was conducted in an acute care hospital, and 624 consecutive geriatric patients were included. Patients were divided into three groups according to oral health, stratified by the Oral Health Assessment Tool (OHAT) scores. Nutritional status, daily living activities, cognitive impairment, and comorbidities were collected as covariates. Univariate and multivariate analyses were performed to identify the relationship between oral health and survival.Results: The mean age was 83.8 ± 7.9 years, and 41% were males. Groups with an OHAT score equivalent to 0, 1-2, and ≥ 3 comprised 213, 206, and 205 patients, and 11 (5.2%), 13 (6.3%), and 37 (18.0%) of those patients died in the hospital, respectively. Patients in the OHAT score ≥ 3 group had higher mortality than those in the other groups (log-rank test: p = 0.012 for the OHAT = 0 group; p = 0.010 for the OHAT = 1-2 group after Bonferroni corrections). Patients in the OHAT score ≥ 3 group continued to have poor survival even after adjusting for confounders in the Cox's regression analysis (hazard ratio: 2.514, 95% confidence interval: 1.220-5.183, p = 0.012).Conclusion: In geriatric patients, poor oral health at hospital admission was an independent in-hospital mortality predictor. Future studies on oral care intervention stratified by oral health conditions are warranted. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the association between malnutrition and improvement of swallowing ability during rehabilitation of stroke patients. This was a retrospective cohort study. One hundred eighty-eight older adults with oropharyngeal dysphagia after stroke who were admitted to a rehabilitation hospital. The International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) was used to assess swallowing ability. The Global Leadership Initiative on Malnutrition (GLIM) definition was used to diagnose malnutrition. The primary outcome was IDDSI-FDS score at discharge. The mean age of the patients was 78.9 ± 7.7 years, and 36.7% were women. A total of 122 (64.8%) patients were diagnosed with malnutrition. Compared with those without malnutrition, malnourished patients had more severe dysphagia on admission. After adjusting for confounders, malnutrition was an independent contributor to the IDDSI-FDS scores at discharge (standardized coefficient: −0.165, P =.011). In patients with oropharyngeal dysphagia after stroke, malnutrition at admission inversely affected their swallowing ability at discharge. Dysphagia rehabilitation, including early nutritional intervention, may be effective in the recovery of swallowing ability. [ABSTRACT FROM AUTHOR]

Objectives: Due to the water-rich cooking process required to soften texture modified diets (TMDs), TMDs may have poorer nutrition. The aim of this study was to investigate the associations between daily premorbid TMD consumption and nutritional status at the time of hospitalization, and its burden on hospitalization outcomes. Design: Retrospective observational study. Setting: An academic hospital. Participants: The cohort comprised 3,594 older adult patients aged ≥65 years admitted to the hospital. Measurements: Patients were interviewed on admission using a premorbid daily consumption meal form to determine whether the patient ate a TMD. Nutritional status was examined using nutritional screening tools (Mini-Nutritional Assessment Short Form [MNA-SF], Malnutrition Universal Screening Tool [MUST], Geriatric Nutritional Risk Index [GNRI]) and the European Society of Clinical Nutrition and Metabolism (ESPEN)-defined criteria of malnutrition at admission. Length of hospital stay (LOS) and in-hospital mortality were considered outcomes of hospitalization. Multivariate analyses were performed to detect associations between premorbid TMD consumption and nutritional status and outcomes. Results: The mean age of the subjects was 75.9±7.0 years, including 58% males. Overall, 110 (3.1%) patients consuming a premorbid TMD were identified. They were older (p<0.001), had poor nutritional status (lower MNA-SF score [p<0.001] and GNRI value [p<0.001], higher MUST score [p<0.001], and more prevalent ESPEN-defined malnutrition [61.8% vs. 14.0%, p<0.001] than did patients without a TMD. The mortality rate and LOS of patients with TMD was higher (7.3% vs. 2.9%, p=0.017) and longer (19 days vs. 8 days, p<0.001) than those without TMD. Multivariate analyses showed that TMD consumption was independently associated with poor nutritional status and prolonged LOS after adjusting confounders. Conclusion: Daily consumption of a TMD during the premorbid period affects nutritional status at the time of hospitalization and outcomes. Further studies are necessary to investigate whether nutritional intervention can improve outcomes for people on a TMD. [ABSTRACT FROM AUTHOR]

Aim: Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. Methods: This retrospective cross‐sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. Results: In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1–2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6–2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1–2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5–2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema‐related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%–38.7% for men. Conclusions: Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993–998. [ABSTRACT FROM AUTHOR]

The article presents the Thoracic Paravertebral Neurolysis for the Treatment of Intractable Chest Wall Pain Caused by Neoplasms. Topics discussed include Cancer-associated chest wall pain is caused by primary and metastatic neoplasms invading the chest wall and pleura and can be controlled by conventionally recommended systemic analgesics; and describe the effect of thoracic paravertebral neurolysis on intractable chest wall pain caused by neoplasms invading the chest wall and pleura.

Aim: There is no consensus on energy intake in the acute stage and how it relates to improvement in activities of daily living (ADL) in geriatric stroke patients. We examined whether energy intake after admission is related to improvement in ADL and complications. Methods: This retrospective cohort study evaluated the data from stroke inpatients at five acute care hospitals, including the mean daily energy intake during the first week after admission. Patients were categorized into two groups based on their daily energy intake; cases where the energy intake per day reached the basal energy expenditure calculated by the Harris–Benedict equation were designated as the intake energy sufficiency group. Patient characteristics were compared between groups. We assessed ADL using the Functional Independence Measure; a secondary outcome was the presence of complications. Results: Of the 192 participants (mean age 79.6 ± 7.6 years) included in the study, 131 patients were admitted for cerebral infarction, 58 for intracerebral hemorrhage and three for subarachnoid hemorrhage. Of the two groups, that with an energy sufficiency had a greater gain in total Functional Independence Measure (median 27 and 9, respectively; P = 0.001) and a lower complication rate (6.7% and 26.5%, respectively; P ≤ 0.001). Multivariate analyses showed that energy sufficiency was independently associated with the total Functional Independence Measure gain and complication rate. Conclusions: Energy intake during the first week after admission affected improvement of ADL and onset of complications during hospitalization in geriatric stroke inpatients. Geriatr Gerontol Int 2018; 18: 1334–1339. [ABSTRACT FROM AUTHOR]

• Association between frailty risk and adverse events in patients with hip fractures. • Patients at frailty risk had a higher incidence of adverse events. • Patients at frailty risk had a poor functional outcomes. Background: Frailty may predict adverse events in patients with hip fractures. This study aimed to investigate the association between frailty and adverse events in patients with hip fractures after surgery using information from Japanese health insurance. Methods: This retrospective cohort study included patients with hip fractures aged ≥ 65 years using a nationwide database in Japan. We examined the relationship of the frailty risk, which was defined using the Hospital Frailty Risk Score (HFRS), with in-hospital mortality, complications such as delirium and pneumonia, and functional outcomes. We used descriptive analysis, logistic regression, and linear regression analysis to estimate the association between the HFRS and outcomes in patients with hip fracture. Results: We analysed data from 36,192 patients with hip fractures after surgery (mean age: 83.6 ± 6.7 years, female: 79.5%). The proportions of low, intermediate, and high risk of frailty were 68.4%, 28.1%, and 3.5%, respectively. The frailty risk was independently associated with in-hospital mortality (intermediate risk: odds ratio [OR] 1.385, P < 0.001; high risk: OR 1.572; P < 0.001) and the occurrence of complications. Furthermore, each frailty risk was negatively associated with the Barthel Index score at discharge (intermediate risk: coefficient –11.919, P < 0.001; high risk: coefficient –18.044; P < 0.001). Conclusions: The HFRS could predict adverse events, including in-hospital mortality, in Japanese older patients with hip fractures. This finding supports the validity of using the HFRS in clinical practice for patients with hip fractures. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Hospital‐associated dysphagia, characterized by deconditioning of swallowing as a result of hospitalization, is sometimes observed in patients with aspiration pneumonia (AP). Cognitive impairment is known as a negative factor in dysphagia rehabilitation. The present study aimed to examine the association between cognitive impairment and hospital‐associated dysphagia in patients with AP receiving dysphagia rehabilitation. Methods: A retrospective observational study was carried out in an acute geriatric hospital. A total of 249 AP patients receiving multidisciplinary individualized dysphagia rehabilitation were included. Patients were divided into four groups according to their Mini‐Mental State Examination scores. The Functional Oral Intake Scale (FOIS) was used to assess swallowing ability, and hospital‐associated dysphagia was defined as a FOIS decline of ≥1 or ≥2 levels. Body mass index and Barthel Index were obtained to assess nutritional status and activities of daily living. Results: The mean age was 85.6 ± 7.3 years, and 47% were men. Frequencies of hospital‐associated dysphagia observed in lowest to highest Mini‐Mental State Examination groups were 43.0%, 36.2%, 47.4% and 27.3% (P = 0.133), and 13.9%, 20.7%, 17.5% and 5.5% (P = 0.117) based on FOIS decline ≥1 or ≥2 levels, respectively. Multivariable regression model showed that the Mini‐Mental State Examination score was not an independent determinant of FOIS at discharge (beta = 0.063, P = 0.378) after adjusting for age, sex, body mass index, Barthel Index, pneumonia severity, speech‐language pathologist intervention, comorbidities, length of hospital stay and premorbid FOIS. Conclusions: The severity of cognitive impairment has no impact on hospital‐associated dysphagia in AP patients receiving dysphagia rehabilitation. A future interventional study will be expected to further validate our findings. Geriatr Gerontol Int 2018; 18: 233–239. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to research on the hospitalization of elderly individuals with pneumonia.

• Effects of BMI on ADL in older Asian patients with femoral fracture were examined. • Underweight was associated with poor recovery of ADL after femoral fracture. • Underweight patients had more complications and a lower rate of return to home. • Overweight/obesity may positively affect functional recovery after femoral fracture. To evaluate the effects of body mass index (BMI) on recovery of activities of daily living (ADL) in older Asian patients with femoral fracture registered in a nationwide inpatient database in Japan. We retrospectively analyzed data of patients aged ≥65 years with acute femoral fracture between April 2014 and November 2017 in the Diagnosis Procedure Combination database. Patients were classified into the following categories based on BMI (kg/m2): underweight (<18.5); normal weight (18.5–22.9); overweight (23–27.4); obese (≥27.5); and missing data. Demographic data included age, sex, type of fracture, comorbidities, and Barthel Index (BI). The primary outcome was BI at discharge and secondary outcomes were the overall complication rate and discharge to home. In total, data for 13,348 patients were extracted from the database, of whom 80.3 % were female. At discharge, underweight patients had lower BI than overweight or obese patients. In multivariable analysis, underweight and missing BMI data were associated with lower BI at discharge (partial regression coefficients −2.324 and −5.763, respectively). In contrast, overweight and obese were correlated with higher BI (3.080 and 5.732, respectively). Underweight was independently associated with a higher overall complication rate (odds ratio 1.195) and a lower rate of discharge to home (odds ratio 0.865). Underweight was associated with poorer performance in ADL, higher risk of complications, and lower rate of discharge to home in older Asian patients with femoral fracture. Overweight and obese had positive effects on ADL. [ABSTRACT FROM AUTHOR]