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Tongue Strength is Associated with Grip Strength and Nutritional Status in Older Adult Inpatients of a Rehabilitation Hospital

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Abstract

The aim of this cross-sectional study was to investigate whether tongue strength observed in older adult inpatients of a rehabilitation hospital is associated with muscle function, nutritional status, and dysphagia. A total of 174 older adult inpatients aged 65 years and older in rehabilitation (64 men, 110 women; median age, 84 years; interquartile range, 80–89 years) who were suspected of having reduced tongue strength due to sarcopenia were included in this study. Isometric tongue strength was measured using a device fitted with a disposable oral balloon probe. We evaluated age, muscle function as assessed by the Barthel index and grip strength, nutritional status as measured by the Mini Nutritional Assessment—short form (MNA-SF), body mass index, serum albumin, controlling nutritional status, and calf circumference and arm muscle area to assess muscle mass. In addition, the functional oral intake scale (FOIS) was used as an index of dysphagia. Multivariate linear regression analysis revealed that isometric tongue strength was independently associated with grip strength (coefficient = 0.33, 95 % confidence interval (CI) 0.12–0.54, p = 0.002), MNA-SF (coefficient = 0.74, 95 % CI 0.12–1.35, p = 0.019), and FOIS (coefficient = 0.02, 95 % CI 0.00–0.15, p = 0.047). To maintain and improve tongue strength in association with sarcopenic dysphagia, exercise therapy and nutritional therapy interventions, as well as direct interventions to address tongue strength, may be effective in dysphagia rehabilitation in older adult inpatients.

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References

  1. Cabre M, Serra-Prat M, Palomera E, et al. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2010;39(1):39–45. doi:10.1093/ageing/afp100.

    Article  PubMed  Google Scholar 

  2. Teramoto S, Fukuchi Y, Sasaki H, et al. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008;56(3):577–9. doi:10.1111/j.1532-5415.2008.01597.x.

    Article  PubMed  Google Scholar 

  3. Teramoto S, Yoshida K, Hizawa N. Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia. Respir Investig. 2015;53(5):178–84. doi:10.1016/j.resinv.2015.01.003.

    Article  PubMed  Google Scholar 

  4. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: european consensus on definition and diagnosis: report of the european working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–23. doi:10.1093/ageing/afq034.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Maeda K, Akagi J. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people. Geriatr Gerontol Int. 2015. doi:10.1111/ggi.12486.

    Google Scholar 

  6. Muhle P, Wirth R, Glahn J, et al. Age-related changes in swallowing physiology and pathophysiology. Nervenarzt. 2015;86(4):440–51. doi:10.1007/s00115-014-4183-7.

    Article  CAS  PubMed  Google Scholar 

  7. Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle. 2014;5(4):269–77. doi:10.1007/s13539-014-0162-x.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Buehring B, Hind J, Fidler E, et al. Tongue strength is associated with jumping mechanography performance and handgrip strength but not with classic functional tests in older adults. J Am Geriatr Soc. 2013;61(3):418–22. doi:10.1111/jgs.12124.

    Article  PubMed  Google Scholar 

  9. Kortebein P. Rehabilitation for hospital-associated deconditioning. Am J Phys Med Rehabil. 2009;88(1):66–77. doi:10.1097/PHM.0b013e3181838f70.

    Article  PubMed  Google Scholar 

  10. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure”. JAMA. 2011;306(16):1782–93. doi:10.1001/jama.2011.1556.

    Article  CAS  PubMed  Google Scholar 

  11. Muller EA. Influence of training and of inactivity on muscle strength. Arch Phys Med Rehabil. 1970;51(8):449–62.

    CAS  PubMed  Google Scholar 

  12. Kaiser MJ, Bauer JM, Ramsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734–8. doi:10.1111/j.1532-5415.2010.03016.x.

    Article  PubMed  Google Scholar 

  13. Folstein MF, Folsein SE, Fanjiang G. Mmse mini-mental state examination clinical guide. Odessa: PAR Inc; 2001.

    Google Scholar 

  14. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2015;30(1):80–7. doi:10.1007/s00455-014-9577-y.

    Article  PubMed  Google Scholar 

  15. Utanohara Y, Hayashi R, Yoshikawa M, et al. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23(3):286–90. doi:10.1007/s00455-007-9142-z.

    Article  PubMed  Google Scholar 

  16. Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61–5.

    CAS  PubMed  Google Scholar 

  17. Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21. doi:10.1016/S0261-5614(03)00098-0.

    Article  CAS  PubMed  Google Scholar 

  18. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. first validation in a hospital population. Nutr Hosp. 2005;20(1):38–45.

    CAS  PubMed  Google Scholar 

  19. Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition—an ESPEN consensus statement. Clin Nutr. 2015;34(3):335–40. doi:10.1016/j.clnu.2015.03.001.

    Article  CAS  PubMed  Google Scholar 

  20. Evans WJ, Morley JE, Argiles J, et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793–9. doi:10.1016/j.clnu.2008.06.013.

    Article  CAS  PubMed  Google Scholar 

  21. Butler SG, Stuart A, Leng X, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66(4):452–8. doi:10.1093/gerona/glq234.

    Article  PubMed  Google Scholar 

  22. Kawakami R, Murakami H, Sanada K, et al. Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women. Geriatr Gerontol Int. 2014. doi:10.1111/ggi.12377.

    PubMed  Google Scholar 

  23. Rolland Y, Lauwers-Cances V, Cournot M, et al. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc. 2003;51(8):1120–4. doi:10.1046/j.1532-5415.2003.51362.x.

    Article  PubMed  Google Scholar 

  24. Barbosa-Silva TG, Bielemann RM, Gonzalez MC, et al. Prevalence of sarcopenia among community-dwelling elderly of a medium-sized South American city: results of the COMO VAI? Study J Cachexia Sarcopenia Muscle. 2015;7(2):136–43. doi:10.1002/jcsm.12049.

    Article  PubMed  Google Scholar 

  25. Morandi A, Onder G, Fodri L, et al. The Association between the probability of sarcopenia and functional outcomes in older patients undergoing in-hospital rehabilitation. J Am Med Dir Assoc. 2015;16(11):951–6. doi:10.1016/j.jamda.2015.05.010.

    Article  PubMed  Google Scholar 

  26. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489–95. doi:10.1016/s1470-2045(10)70218-7.

    Article  PubMed  Google Scholar 

  27. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the asian working group for sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101. doi:10.1016/j.jamda.2013.11.025.

    Article  PubMed  Google Scholar 

  28. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516–20. doi:10.1016/j.apmr.2004.11.049.

    Article  PubMed  Google Scholar 

  29. Tohara H, Saitoh E, Mays KA, et al. Three tests for predicting aspiration without videofluorography. Dysphagia. 2003;18(2):126–34. doi:10.1007/s00455-002-0095-y.

    Article  PubMed  Google Scholar 

  30. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24.

    Article  PubMed  Google Scholar 

  31. Rofes L, Arreola V, Mukherjee R, et al. Sensitivity and specificity of the eating assessment tool and the volume-viscosity swallow test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil. 2014;26(9):1256–65. doi:10.1111/nmo.12382.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Tamura F, Mizukami M, Ayano R, et al. Analysis of feeding function and jaw stability in bedridden elderly. Dysphagia. 2002;17(3):235–41. doi:10.1007/s00455-002-0063-6.

    Article  PubMed  Google Scholar 

  33. Okamoto N, Tomioka K, Saeki K, et al. Relationship between swallowing problems and tooth loss in community-dwelling independent elderly adults: the Fujiwara-kyo study. J Am Geriatr Soc. 2012;60(5):849–53. doi:10.1111/j.1532-5415.2012.03935.x.

    Article  PubMed  Google Scholar 

  34. Eichner K. Über eine Gruppen-einteilung der Lücken-gebisse fr die Prothetik. Dtsch Zahnärztl Z. 1955;23:1831–4.

    Google Scholar 

  35. Bohannon RW. Dynamometer measurements of hand-grip strength predict multiple outcomes. Percept Mot Skills. 2001;93(2):323–8. doi:10.2466/pms.2001.93.2.323.

    Article  CAS  PubMed  Google Scholar 

  36. Hedlund JU, Hansson LO, Ortqvist AB. Hypoalbuminemia in hospitalized patients with community-acquired pneumonia. Arch Intern Med. 1995;155(13):1438–42.

    Article  CAS  PubMed  Google Scholar 

  37. Yoshimura Y, Uchida K, Jeong S, et al. Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: a randomized controlled trial. J Nutr Health Aging. 2015. doi:10.1007/s12603-015-0570-4.

    Google Scholar 

  38. Namasivayam AM, Steele CM, Keller H. The effect of tongue strength on meal consumption in long term care. Clin Nutr. 2015. doi:10.1016/j.clnu.2015.08.001.

    PubMed  Google Scholar 

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Acknowledgments

This study was supported by The Sumiko Okada International Fellowship Fund and the Grants-in-aid for scientific research (KAKENHI) (no. 16K19262).

Funding

This work was supported by The Sumiko Okada International Fellowship Fund and the Grants-in-aid for scientific research (KAKENHI) (no. 16K19262).

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Setagaya Memorial Hospital, Tokyo, Japan

    Kotomi Sakai

  2. Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, 1-8-13, Surugadai Kanda, Chiyoda, Tokyo, 101-8310, Japan

    Kotomi Sakai, Enri Nakayama & Koichiro Ueda

  3. Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Haruka Tohara

  4. Department of Internal Medicine, Setagaya Memorial Hospital, Tokyo, Japan

    Tomomi Maeda & Motonobu Sugimoto

  5. Department of Orthopaedic Surgery, Setagaya Memorial Hospital, Tokyo, Japan

    Takahiro Takehisa

  6. Department of Internal Medicine, Hakuai Memorial Hospital, Tokushima, Japan

    Yozo Takehisa

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  1. Kotomi Sakai
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Corresponding author

Correspondence to Enri Nakayama.

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The authors have no financial or any other kind of personal conflicts to disclose.

Ethical approval

The study protocol was approved by the Institutional Review Board of Setagaya Memorial Hospital (approval no. 2014-1). All enrolled patients provided their written informed consent.

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Sakai, K., Nakayama, E., Tohara, H. et al. Tongue Strength is Associated with Grip Strength and Nutritional Status in Older Adult Inpatients of a Rehabilitation Hospital. Dysphagia 32, 241–249 (2017). https://doi.org/10.1007/s00455-016-9751-5

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  • DOI: https://doi.org/10.1007/s00455-016-9751-5

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