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Posture and firmness changes in a pressure-relieving air mattress affect cough strength in elderly people with dysphagia.

ABSTRACT: Dysphagia is the major pathophysiologic mechanism leading to aspiration pneumonia in the elderly. Elderly people with dysphagia who show low levels of the cough peak flow (CPF) are at greater risk for aspiration pneumonia. It has been reported that CPF values were significantly lower in the "soft" versus "hard" mode of a pressure-relieving air mattress in healthy volunteers in a supine position. Parameters such as spinal curvature, however, were not evaluated in detail. In this study, we clarified whether the changes in posture associated with two different firmness levels of a pressure-relieving air mattress were associated with cough production and related factors in the elderly with dysphagia. The body sinking distance, pelvic tilt angle, and immersion of the lumbar spine were measured to evaluate changes in posture. Forty subjects met the study criteria for dysphagia. The "soft" mode showed significantly lower CPF values than the "hard" mode (soft 274.9 ± 107.2 L/min vs. hard 325.0 ± 99.5 L/min, MD 50.0 95%CI 33.1-66.9 P < 0.001). Values of forced vital capacity (FVC) and maximal inspiratory pressure (PImax) were significantly lower in the "soft" mode than in the "hard" mode (MD 0.10 95%CI 0.04-0.17, P = 0.002, MD 3.2 95%CI 0.9-5.5, P = 0.007, respectively). Although there was no significant difference between the two firmness levels, maximal expiratory pressure (PEmax) values also tended to be lower in the "soft" than in the "hard" mode, (MD 2.9 95%CI -0.6-6.3 P = 0.1). At both firmness levels, CPF values were significantly correlated with FVC, PImax, and PEmax. The difference in sinking distance in the anterior superior iliac spine was significantly larger than that in the lesser tubercle of the humerus and patella. Additionally, in the soft mode, the pelvic tilt angle and contact area around the lumbar spine were significantly larger than those observed in the "hard" mode. Parameters associated with the production of cough, including inspiratory muscle strength, lung volume, and ultimately CPF, may be affected by immersion of the lumbar spine and curvature of the spine that results from the "soft" mode in elderly patients with dysphagia.

SUBMITTER: Kamikawa N

PROVIDER: S-EPMC6289577 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Posture and firmness changes in a pressure-relieving air mattress affect cough strength in elderly people with dysphagia.

Kamikawa Norimichi N Hamada Hironobu H Sekikawa Kiyokazu K Yamamoto Hikaru H Fujika Yoshiya Y Kajiwara Teruki T Aizawa Fumiya F Otoyama Ippo I

PloS one 20181211 12

Dysphagia is the major pathophysiologic mechanism leading to aspiration pneumonia in the elderly. Elderly people with dysphagia who show low levels of the cough peak flow (CPF) are at greater risk for aspiration pneumonia. It has been reported that CPF values were significantly lower in the "soft" versus "hard" mode of a pressure-relieving air mattress in healthy volunteers in a supine position. Parameters such as spinal curvature, however, were not evaluated in detail. In this study, we clarifi ...[more]

PMID: 30533019

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Project description:Background and objectives: This study aimed to determine the cut-off values of the following three respiratory pressure meters; the voluntary peak cough flow (PCF), maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP); associated with post-stroke dysphagia and assess which of these parameters show good diagnostic properties associated with post-stroke dysphagia. Materials and Methods: Retrospective analysis of a prospectively maintained database. Records of patients with first-ever diagnosed dysphagia attributable to cerebrovascular disease, who had performed spirometry measurements for the PCF, MIP and MEP. Results: From a total of 237 stroke patients, 163 patients were diagnosed with dysphagia. Those with dysphagia had significantly lower PCF values than those without dysphagia (116.3 ± 75.3 vs. 219.4 ± 91.8 L/min, p < 0.001). In addition, the former group also had lower MIP (30.5 ± 24.7 vs. 41.6 ± 25.7 cmH2O, p = 0.0002) and MEP (41.0 ± 27.9 vs. 62.8 ± 32.3 cmH2O, p < 0.001) values than the latter group. The receiver operating characteristic curve analysis showed that the PCF cut-off value of 151 L/min (area under the receiver operating characteristic curve [AUC] 0.81; sensitivity 72%; specificity 78.8%) was associated with post-stroke dysphagia. The optimum MEP and MIP cut-off were 38 cmH2O (AUC 0.70, sensitivity 58%; specificity 77.7%) and 20 cmH2O (AUC 0.65, sensitivity 49%; specificity 84%). PCF showed the highest AUC results. Results from the univariate analysis indicated that PCF values of ≤151 L/min increased risk of dysphagia by 9.51-fold (4.96-18.23). Multivariable analysis showed that after controlling of other clinical factor, the PCFs at this cut-off value still showed increased risk of by 4.19 (2.02-83.69) but this was not observed with the MIPs or MEPs. Conclusions: Our study has provided cut-off values that are associated with increased risk of dysphagia. Among the three parameters, PCF showed increased association with post-stroke dysphagia.

Project description:BackgroundMost household air pollution (HAP) interventions in developing countries of sub-Saharan Africa have focused on a single source, such as replacing polluting cooking sources with cleaner burning cooking stoves. Such interventions, however, have resulted in insufficient reductions in HAP levels and respiratory health risks in children. In this study we determined how multiple HAP combustion sources and exposure-mitigation factors in the home environment influence child respiratory health alone and in combination.MethodsWe carried out a case-control study to determine associations between multiple indicators of HAP and persistent cough among children (<15 years of age) seeking care at three primary-care clinics in Kampala, Uganda. HAP indicators included self-report of combustion sources inside the home (e.g., stove type, fuel type, and smoking); housing characteristics and cooking practices that mitigate HAP exposure (e.g., use of windows, location of cooking, location of children during cooking) and perceptions of neighborhood air quality. To explore joint associations between indicators of HAP, we applied a Bayesian clustering technique (Bayesian profile regression) to identify HAP indicator profiles most strongly associated with persistent cough in children.ResultsMost HAP indicators demonstrated significant positive bivariate associations with persistent cough among children, including fuel-type (kerosene), the number of hours burning solid fuels, use of polluting fuels (kerosene or candles) for lighting the home, tobacco smoking indoors, cooking indoors, cooking with children indoors, lack of windows in the cooking area, and not opening windows while cooking. Bayesian cluster analysis revealed 11 clusters of HAP indicator profiles. Compared to a reference cluster that was representative of the underlying study population cough prevalence, three clusters with profiles characterized by highly adverse HAP indicators resulted in ORs of 1.72 (95% credible interval: 1.15, 2.60), 4.74 (2.88, 8.0), and 8.6 (3.9, 23.9). Conversely, at least two clusters of HAP indicator-profiles were protective compared to the reference cluster, despite the fact that these protective HAP indicator profiles used solid fuels for cooking in combination with an unimproved stove (cooking was performed predominantly outdoors in these protective clusters).ConclusionsIn addition to cooking fuel and type of cook stove, multiple HAP indicators were strongly associated with persistent cough in children. Bayesian profile regression revealed that the combination of HAP sources and HAP exposure-mitigating factors was driving risk of adverse cough associations in children, rather than any single HAP source at the home.

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Project description:Sarcopenic dysphagia is defined as difficulty in swallowing due to sarcopenia, which may be related to weakness of the tongue muscles. This meta-analysis aimed to explore the association between tongue strength and sarcopenia and to determine whether tongue strength measurement could be a specific indicator of sarcopenic dysphagia. We conducted a systematic search of electronic databases from their inception to February 2021 for clinical studies that investigated tongue strength in participants with and without sarcopenia. The primary outcome was the weighted mean difference (WMD) and standardized mean difference (SMD) of tongue pressure between the different groups. The secondary outcome was the correlation of tongue pressure with the subcomponents that defined sarcopenia. Ten studies that involved 1,513 participants were included in the meta-analysis. Compared with those without sarcopenia, patients with sarcopenia had significantly less tongue pressure, with a WMD of -4.353 kPa (95% CI, -7.257 to -1.450) and an SMD of -0.581 (95% CI, -0.715 to -0.446). There was no significant difference in tongue pressure between patients with sarcopenic dysphagia and those with non-sarcopenic dysphagia, with a WMD of -1.262 kPa (95% CI, -8.442 to 5.918) and an SMD of -0.187 (95% CI, -1.059 to 0.686). Significant positive associations were identified between tongue pressure and grip strength and between tongue pressure and gait speed, with correlation coefficients of 0.396 (95% CI, 0.191 to 0.567) and 0.269 (95% CI, 0.015 to 0.490), respectively. Reduced tongue strength is associated with sarcopenia but is not an exclusive marker for sarcopenic dysphagia. Tongue strength correlates with the values of subcomponents that define sarcopenia. In patients with low performance of sarcopenia subcomponent, tongue pressure must be examined to diagnose subclinical dysphagia. Protocol registration: This meta-analysis was registered on INPLASY (registration number INPLASY202120060).

Dataset Information

Posture and firmness changes in a pressure-relieving air mattress affect cough strength in elderly people with dysphagia.

Publications

Posture and firmness changes in a pressure-relieving air mattress affect cough strength in elderly people with dysphagia.

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