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Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445-450.

Background: Although patients with idiopathic pulmonary fibrosis (IPF) often receive treatment with antifibrotic drugs (AFDs) and pulmonary rehabilitation (PR) concurrently, there are no reports on the effect of PR on patients with IPF receiving AFDs. Therefore, we investigated the effect of PR on patients with IPF receiving AFDs. Methods: Eighty-seven eligible patients with IPF (61 male; 72.0 ± 8.1 years; GAP severity stage I/II/III: 26/32/12) were recruited for the study. Patients who completed a 3-month outpatient PR program and those who did not participate were classified into four groups according to use of AFDs: PR group (n = 29), PR+AFD group (n = 11), treatment-free observational group (control group; n = 26), and AFD group (n = 21). There was no significant difference in age, sex, or severity among the groups. Patients were evaluated for physical functions such as 6-min walk distance (6MWD) and muscle strength, dyspnea, and health-related quality of life (HRQOL) at baseline and at 3 months. Results: In the PR group, dyspnea and 6MWD showed significant improvement after the 3-month PR program (p < 0.05 and p < 0.01, respectively). HRQOL was significantly worse at 3 months (p < 0.05) in the AFD group, but not in the other groups. The change in 6MWD from baseline to the 3-month time point was significantly higher in the PR+AFD group than in the AFD groups (p < 0.01). Conclusions: It was suggested that AFD treatment reduced exercise tolerance and HRQOL at 3 months; however, the concurrent use of PR may prevent or mitigate these effects.

Background: Dysphagia is one of the most serious complications of occipitocervical fusion (OCF). The previous studies have shown that postoperative cervical alignment, documented with occipito (O)-C2 angles, C2-C6 angles, and pharyngeal inlet angles (PIA), impacted the incidence of postoperative dysphagia in patients undergoing OCF. Here, we investigated the relationship of preoperative versus postoperative cervical alignment on the incidence of postoperative dysphagia after OCF. Methods: We retrospectively reviewed the clinical data/medical charts for 22 patients following OCF (2006– 2019). The O-C2 angles, C2-C6 angles, PIA, and narrowest pharyngeal airway spaces (nPAS) were assessed using plain lateral radiographs of the cervical spine before and after the surgery. The severity of dysphagia was assessed with the functional oral intake scale (FOIS) levels as documented in medical charts; based on this, patients were classified into the nondysphagia (FOIS: 7) versus dysphagia (FOIS: 1–6) groups. Results: Seven patients (35%) experienced dysphagia after OCF surgery. Preoperative PIA and nPAS were smaller in the dysphagia group. Spearman rank correlation showed a positive correlation between preoperative PIA and FOIS and between preoperative nPAS and FOIS. Conclusion: This study suggests that preoperative cervical alignment may best predict the incidence of postoperative dysphagia after OCF.

Introduction/Background The halo-vest brace has been a common mode for immobilization of the cervical spine. The incidence of complications such as pin loosing and infection are known in patients with halo-vest fixation. Dysphagia is one of the most serious complications seen with the use of a halo-vest brace. The aim of this study was to elucidate factors associated with the incidence of dysphagia in patients treated using a halo-vest brace in terms of not only demographic data, but also radiological findings of the cervical spine. Material and method We retrospectively reviewed medical records and radiological measurements using lateral plain X-rays of the cervical spine in patients who had undergone halo-vest fixation in our institute between January 2006 and August 2016. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS) from medical records. Patients were classified into non-dysphagia (FILS level: 10) and dysphagia (FILS level: 1–9) groups. Results Forty-three patients were attributed for analysis. Twenty-eight patients were classified into non-dysphagia group, 15 patients were classified into dysphagia group. Mean age was grater (P = 0.041), length of ICU stay was longer (P = 0.002), and frequency of tracheostomy was larger (P = 0.043) in the dysphagia group. Mean O-C2 angle was smaller in the dysphagia group (P = 0.027). Body mass index [odds ratio (OR) = 0.522, 95% confidence interval (CI) = 0.377–0.934, P = 0.024], ICU stay (OR = 1.302, 95% CI = 1.272–10.624, P = 0.016), and O-C2 angle (OR = 0.911, 95% CI = 0.833–0.996, P = 0.041) remained independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative linear correlation between ICU stay and FILS level (r = 0.476, P = 0.001) and a positive linear correlation between O-C2 angle and FILS level (r = 0.385, P = 0.011). Conclusion This study suggested the significance of O-C2 angle as well as ICU stay for incidence and severity of dysphagia in patients with halo-vest fixation.

BACKGROUND AND AIMS Chronic foot and ankle joint pain is one of the most frequent complaints which is regularly seen in the out-patient clinic of our medical institute. In previous studies we have reported on the benefits of low level laser therapy (LLLT) for chronic pain in the elbow, hand, finger and the lower back. The present study examined the effects of LLLT on chronic foot and ankle joint pain. MATERIALS AND METHODS Over the past 5 years, 17 subjects visited the out-patient clinic with complaints of chronic foot and ankle joint pain of a variety of aetiologies. The patients received LLLT using a 1000 mW semi-conductor laser device, delivering 20.1 J/cm2 per point at 830 nm in continuous wave. Each patient was given four shots per session per foot twice a week for 4 weeks. RESULTS A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p < 0.01). All but 2 of the patients showed improvement: excellent (2) and good (13). After treatment, no significant differences were observed in the ankle joint range of motion, however. Discussions with the patients revealed that it was important for them to learn how to avoid overuse of the ankle when walking, poor walking posture and a poor pacing technique that would caused them foot and ankle pain in everyday life. Following these postural guidelines could ensure continuous benefits from the treatment. CONCLUSION The present study demonstrated that LLLT was an effective form of treatment for chronic foot and ankle joint pain, in conjunction with postural education during all activities of daily living.

Despite the development and wide distribution of guidelines for pneumonia, death from pneumonia is increasing due to population aging. Conventionally, aspiration pneumonia was mainly thought to be one of the infectious diseases. However, we have proven that chronic repeated aspiration of a small amount of sterile material can cause the usual type of aspiration pneumonia in mouse lung. Moreover, chronic repeated aspiration of small amounts induced chronic inflammation in both frail elderly people and mouse lung. These observations suggest the need for a paradigm shift of the treatment for pneumonia in the elderly. Since aspiration pneumonia is fundamentally based on dysphagia, we should shift the therapy for aspiration pneumonia from pathogen-oriented therapy to function-oriented therapy. Function-oriented therapy in aspiration pneumonia means therapy focusing on slowing or reversing the functional decline that occurs as part of the aging process, such as “dementia → dysphagia → dystussia → atussia → silent aspiration”. Atussia is ultimate dysfunction of cough physiology, and aspiration with atussia is called silent aspiration, which leads to the development of life-threatening aspiration pneumonia. Research pursuing effective strategies to restore function in the elderly is warranted in order to decrease pneumonia deaths in elderly people.

In the elderly, even though many antibiotics were developed, pneumonia has still been one of the major causes of mortality. Especially aspiration pneumonia which is the main problem. Aspiration pneumonia whose onset mechanism is not only dysphagia but also the depression of the cough reflex. There are six main causes of dysphagia, one of them is discordance between respiration and swallowing. It is important problem in aspiration pneumonia. Respiration and swallowing have common points in anatomy and function. By the common points, if swallowing was detached from respiration, discordance between respiration and swallowing would occur, and then dysphagia would be caused immediately. Moreover swallowing and cough reflexes are recognized as airway protective reflexes and these are related with various brain functions. Brain functions are depressed by aging. Therefore in the elderly, swallowing and cough reflexes are depressed. When we think about the reactivation of swallowing and cough reflexes, it is important to think about the relationship between these reflex and brain functions. These days, anti-aspiration drugs are found by research focusing on the relationship between brain function and airway protective reflexes.

Background Dysfunction of swallowing and coughing leads to life-threatening aspiration pneumonia, especially in the elderly. In order to induce the cough and swallowing reflexes efficiently, sensory inputs to trigger the reflexes are essential. Methods Both the cough and swallowing reflexes respond to mechanical and chemical stimuli. However, the mechanisms of action of the two reflexes are not homogeneous. Some substances stimulate both reflexes, but others stimulate one of the reflexes and inhibit the other one. Results Capsaicin, a TRPV1 agonist, stimulates both the cough and swallowing reflexes. Menthol, a TRPM8 agonist, stimulates the swallowing reflex, but it inhibits the cough reflex, especially if applied to the nose. Acid stimulates the cough reflex but its effect on the swallowing reflex is complicated. Theophylline inhibits the cough reflex by decreasing the excitability of sensory nerves, whereas it stimulates the swallowing reflex by antagonizing adenosine receptors. In smoking, cigarette smoke and nicotine have different effects. Cigarette smoke stimulates the cough reflex, while it inhibits the swallowing reflex. Nicotine inhibits the cough reflex but does not affect the swallowing reflex. Conclusion Whenever you prescribe for an abnormality of one of the reflexes, you should think about the effect of the prescription on the other reflex.