Wakabayashi Hidetaka
Department of Rehabilitation Medicine, Yokohama City University Medical Center, Japan.
Clin Calcium. 2018;28(9):1229-1234.
Frailty and sarcopenia occur not only in whole-body but also oral and swallowing function. Presbyphagia is age-related decline of swallowing function in older adults. Oral frailty is age-related decline of oral function in older adults. Presbyphagia and oral frailty are not dysphagia but frailty of oral and swallowing function. Oral sarcopenia is defined as sarcopenia in muscles of the oral cavity. Sarcopenic dysphagia is characterized by swallowing difficulty resulting from a loss of mass and function in whole-body skeletal and swallowing muscles. Sarcopenic dysphagia is diagnosed using a 5-step algorithm for sarcopenic dysphagia. Iatrogenic sarcopenia can be one of the causes of sarcopenic dysphagia. Iatrogenic sarcopenia is defined as sarcopenia caused by the activities of medical staff including doctors, nurses, or other health care professionals in healthcare facilities. Iatrogenic sarcopenia has three categories:1)activity-related:caused by unnecessary inactivity or unnecessary nil per os, 2)nutrition-related:caused by inappropriate nutritional care management, and 3)disease-related:in case of iatrogenic diseases. Rehabilitation nutrition is recommended for preventing and treating sarcopenic dysphagia. Rehabilitation nutrition is defined as that which 1)evaluates holistically by the International Classification of Functioning, Disability and Health, and the presence and cause of nutritional disorders, sarcopenia, and excess or deficiency of nutritional intake;2)conducts rehabilitation nutrition diagnosis and rehabilitation nutrition goal setting;and 3)elicits the highest body functions, activities, participations, and quality of life by improving nutritional status, sarcopenia, and frailty using 'nutrition care management in consideration of rehabilitation' and 'rehabilitation in consideration of nutrition' in people with a disability and frail older people. Rehabilitation nutrition can be practiced by using the rehabilitation nutrition care process, which is a systematic problem-solving method. It consists of five steps:rehabilitation nutrition assessment and diagnostic reasoning, rehabilitation nutrition diagnosis, rehabilitation nutrition goal setting, rehabilitation nutrition intervention, and rehabilitation nutrition monitoring.
衰弱和肌肉减少症不仅发生在全身，也出现在口腔和吞咽功能方面。老年吞咽困难是指老年人吞咽功能随年龄增长而下降。口腔衰弱是指老年人口腔功能随年龄增长而下降。老年吞咽困难和口腔衰弱并非吞咽障碍，而是口腔和吞咽功能的衰弱。口腔肌肉减少症被定义为口腔肌肉中的肌肉减少症。肌肉减少性吞咽障碍的特征是全身骨骼肌和吞咽肌肉质量和功能丧失导致吞咽困难。肌肉减少性吞咽障碍通过肌肉减少性吞咽障碍的五步算法进行诊断。医源性肌肉减少症可能是肌肉减少性吞咽障碍的原因之一。医源性肌肉减少症被定义为由医护人员（包括医生、护士或其他医疗保健专业人员）在医疗机构中的活动所导致的肌肉减少症。医源性肌肉减少症有三类：1）活动相关：由不必要的不活动或不必要的禁食引起；2）营养相关：由不适当的营养护理管理引起；3）疾病相关：在医源性疾病的情况下。推荐采用康复营养来预防和治疗肌肉减少性吞咽障碍。康复营养被定义为：1）通过国际功能、残疾和健康分类全面评估营养障碍、肌肉减少症以及营养摄入过多或不足的存在情况和原因；2）进行康复营养诊断和设定康复营养目标；3）通过对残疾人和衰弱老年人采用“考虑康复的营养护理管理”和“考虑营养的康复”来改善营养状况、肌肉减少症和衰弱，从而激发最高的身体功能、活动、参与度和生活质量。康复营养可通过康复营养护理流程来实施，这是一种系统的问题解决方法。它包括五个步骤：康复营养评估和诊断推理、康复营养诊断、康复营养目标设定、康复营养干预和康复营养监测。
