Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study
Abstract
:1. Introduction
1.1. Dysphagia in Older Patients
1.2. Swallowing Mechanism
1.3. Relationship between Dysphagia and Health Outcomes
1.4. Difference in Rehabilitation between Urban and Rural Settings
1.5. Rationale and Purpose of This Study
2. Materials and Methods
2.1. Purpose
2.2. Design
2.3. Setting
2.4. Recovery Rehabilitation Unit
2.5. Participants
2.5.1. Inclusion Criteria
- -
- Aged over 65 years and discharged from the Unnan City Hospital after treatment of acute diseases and training in the rehabilitation unit
- -
- Discharged between 1 April 2016 and 31 March 2020
- -
- Consented to their data being used in this research
2.5.2. Exclusion Criteria
- -
- Lacked key outcomes and predictors: body mass index (BMI), blood albumin concentration, care level, duration of rehabilitation, dysphagia, and the discharge conditions.
- -
- Admitted to the rehabilitation unit and died or transferred to the acute unit in the hospital during the admission because of acute changes in their conditions.
2.6. Measurements
2.6.1. Primary Outcome
2.6.2. Independent Variable
2.6.3. Covariates
Polypharmacy
Charlson Comorbidity Index
Care Level Based on the Japanese Long-Term Care Insurance System
Functional Independence Measure
2.7. Statistical Analysis
2.8. Assessment of Ethical or Other Risks and Permissions
3. Results
3.1. Participant Selection
3.2. Demographics of the Participants
3.3. Reasons for Hospital Admission
3.4. Relationship between Dysphagia and Home Discharge
4. Discussion
4.1. Dysphagia Impinges on Home Discharge of Older Patients in Rural Areas
4.2. Medicines Affecting Dysphagia in Internal Medicine
4.3. ADL Affecting Discharge to Home
4.4. Factors Not Related to Home Discharge among Older Patients
4.5. Comprehensive Methods to Address Dysphagia among Older Patients
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Definitions |
---|---|
Primary outcome | Discharge destination (Home or long-term care facilities) |
Patient demographics | Age (years) |
Sex (male or female) | |
Body mass index (kg/m2) at admission | |
Serum albumin (g/dL) at admission | |
Number of medications at admission | |
Charlson Comorbidity Index score at admission | |
Care level based on the Japanese long-term insurance at admission | |
Cognitive and motor component scores of the Functional Independence Measure at admission Reasons for admission (orthopedic or medical condition) |
Standards | Explanation |
---|---|
7 | Complete independence (timely, safety) |
6 | Modified independence (with device) |
5 | Supervision (subject = 100%) |
4 | Minimal assistance (subject = 75% or more) |
3 | Moderate assistance (subject = 50% or more) |
2 | Maximal assistance (subject = 25% or more) |
1 | Total assistance or not testable (subject less than 25%) |
Dysphagia | ||||
---|---|---|---|---|
Factor | Total | Yes | No | p-Value |
N | 783 | 101 | 682 | |
Age (years), mean (SD) | 82.12 (10.77) | 81.71 (8.87) | 82.18 (11.03) | 0.684 |
Male sex (%) | 270 (34.5) | 53 (52.5) | 217 (31.8) | <0.001 |
Albumin (g/dL), mean (SD) | 3.76 (0.56) | 3.70 (0.58) | 3.77 (0.56) | 0.305 |
BMI (kg/m2), mean (SD) | 21.37 (4.91) | 20.75 (3.81) | 21.47 (5.04) | 0.181 |
Medicines taken, mean (SD) | 4.91 (3.00) | 5.45 (3.44) | 4.83 (2.93) | 0.055 |
Patients with polypharmacy, n (%) | 402 (51.3) | 57 (56.4) | 345 (50.6) | 0.288 |
Reasons for admission, n (%) | ||||
Medical | 314 (40.1) | 72 (71.3) | 242 (35.5) | <0.001 |
Orthopedic | 469 (59.9) | 29 (28.7) | 440 (64.5) | |
FIM score at admission | ||||
Total FIM score (median) | 109.00 (13.00, 126.00) | 86.00 (18.00, 126.00) | 111.00 (13.00, 126.00) | <0.001 |
Motor domain score (median) | 78.00 (2.00, 91.00) | 61.00 (13.00, 91.00) | 79.00 (2.00, 91.00) | <0.001 |
Cognitive domain score (median) | 32.00 (0.00, 35.00) | 28.00 (5.00, 35.00) | 32.00 (0.00, 35.00) | <0.001 |
Discharge to home (%) | 643 (82.1) | 54 (53.5) | 589 (86.4) | <0.001 |
Care level (%) | ||||
0 | 567 (72.4) | 68 (67.3) | 499 (73.2) | 0.024 |
1 | 39 (5.0) | 1 (1.0) | 38 (5.6) | |
2 | 72 (9.2) | 10 (9.9) | 62 (9.1) | |
3 | 48 (6.1) | 8 (7.9) | 40 (5.9) | |
4 | 29 (3.7) | 6 (5.9) | 23 (3.4) | |
5 | 28 (3.6) | 8 (7.9) | 20 (2.9) | |
Dependent condition (%) | 216 (27.6) | 33 (32.7) | 183 (26.8) | 0.234 |
CCI score (%) | ||||
2 | 40 (5.1) | 1 (1.0) | 47 (6.9) | <0.001 |
3 | 66 (8.4) | 7 (6.9) | 59 (8.7) | |
4 | 209 (26.7) | 20 (19.8) | 189 (27.7) | |
5 | 163 (20.8) | 24 (23.8) | 139 (20.4) | |
6 | 150 (19.2) | 24 (23.8) | 126 (18.5) | |
7 | 80 (10.2) | 14 (13.9) | 66 (9.7) | |
8 | 37 (4.7) | 4 (4.0) | 33 (4.8) | |
9 | 20 (2.6) | 5 (5.0) | 15 (2.2) | |
10 | 9 (1.1) | 2 (2.0) | 7 (1.0) | |
12 | 1 (0.1) | 0 (0.0) | 1 (0.1) | |
CCI score ≥ 5 (%) | 460 (58.7) | 73 (72.3) | 387 (56.7) | 0.003 |
Heart failure (%) | 100 (12.8) | 16 (15.8) | 84 (12.3) | 0.338 |
Myocardial infarction (%) | 38 (4.9) | 4 (4.0) | 35 (5.1) | 0.807 |
Asthma (%) | 36 (4.6) | 5 (5.0) | 31 (4.5) | 0.8 |
Kidney diseases (%) | 151 (19.3) | 17 (16.8) | 134 (19.6) | 0.589 |
Peptic ulcer (%) | 36 (4.6) | 2 (2.0) | 34 (5.0) | 0.303 |
Liver diseases (%) | 26 (3.3) | 8 (7.9) | 17 (2.5) | 0.016 |
COPD (%) | 24 (3.1) | 1 (1.0) | 23 (3.4) | 0.348 |
DM (%) | 143 (18.3) | 21 (20.8) | 122 (17.9) | 0.491 |
Brain hemorrhage (%) | 90 (11.5) | 8 (7.9) | 82 (12.0) | 0.314 |
Brain infarction (%) | 171 (21.8) | 24 (23.8) | 147 (21.6) | 0.607 |
Hemiplegia (%) | 28 (3.6) | 2 (2.0) | 26 (3.8) | 0.564 |
Dementia (%) | 65 (8.3) | 10 (9.9) | 55 (8.1) | 0.561 |
Connective tissue diseases (%) | 37 (4.7) | 5 (5.0) | 32 (4.7) | 0.805 |
Cancer (%) | 134 (17.0) | 13 (14.0) | 111 (17.4) | 0.226 |
Medical Condition | Orthopedic Condition | ||||
---|---|---|---|---|---|
Diagnosis | Number | Percentage | Diagnosis | Number | Percentage |
Brain stroke | 139 | 44.3% | Femoral fracture | 201 | 42.9% |
Brain hemorrhage | 75 | 23.9% | Compression fracture | 122 | 26.0% |
Pneumonia * | 21 | 6.7% | Knee osteoarthritis | 50 | 10.7% |
Pyelonephritis | 15 | 4.8% | Pelvic fracture | 34 | 7.2% |
Dehydration | 12 | 3.8% | Spinal canal stenosis | 15 | 3.2% |
Other infections * | 12 | 3.8% | Hip osteoarthritis | 11 | 2.3% |
Heart failure | 11 | 3.5% | Patella fracture | 11 | 2.3% |
Cancer * | 7 | 2.2% | Tibial fracture | 9 | 1.9% |
Intracranial hypertension | 4 | 1.3% | Spinal cord injury | 7 | 1.5% |
Guillain–Barre Syndrome | 4 | 1.3% | Radius fracture | 4 | 0.9% |
Aortic dissection | 3 | 1.0% | Neck fracture | 2 | 0.4% |
Hernia | 3 | 1.0% | Amputation | 1 | 0.2% |
Autoimmune diseases * | 3 | 1.0% | Brachial plexus injury | 1 | 0.2% |
Bowel obstruction | 2 | 0.6% | Clavicular fracture | 1 | 0.2% |
Epilepsy | 2 | 0.6% | |||
Pulmonary embolism | 1 | 0.3% |
Factor | Odds Ratio | 95% CI | p-Value |
---|---|---|---|
Presence of dysphagia | 0.38 | 0.20–0.73 | 0.0032 |
Age | 1 | 0.97–1.03 | 0.85 |
Males | 1.37 | 0.78–2.41 | 0.28 |
Albumin | 1.09 | 0.69–1.70 | 0.72 |
Polypharmacy | 0.53 | 0.32–0.90 | 0.018 |
Reasons for admission, internal medicine | 0.44 | 0.26–0.77 | 0.0041 |
FIM score at admission | |||
Motor domain score | 1.07 | 1.05–1.08 | <0.001 |
Cognitive domain score | 1.00 | 0.96–1.04 | 0.9 |
Dependent condition | 1.26 | 0.74–2.17 | 0.4 |
CCI score ≥ 5 (%) | 1.62 | 0.90–2.93 | 0.11 |
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Ohta, R.; Weiss, E.; Mekky, M.; Sano, C. Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study. Int. J. Environ. Res. Public Health 2022, 19, 10125. https://doi.org/10.3390/ijerph191610125
Ohta R, Weiss E, Mekky M, Sano C. Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study. International Journal of Environmental Research and Public Health. 2022; 19(16):10125. https://doi.org/10.3390/ijerph191610125
Chicago/Turabian StyleOhta, Ryuichi, Emily Weiss, Magda Mekky, and Chiaki Sano. 2022. "Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study" International Journal of Environmental Research and Public Health 19, no. 16: 10125. https://doi.org/10.3390/ijerph191610125