Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Geriatr Gerontol Int. 2024 Oct;24(10):1045-1052. doi: 10.1111/ggi.14971. Epub 2024 Aug 27.
Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post-stroke older patients.
A retrospective cohort study was conducted on 708 hospitalized post-stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure-motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure-cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest.
The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023-0.718), worse swallowing level (B = -0.878, 95% CI -1.280 to -0.476), and poorer cognitive status (B = -1.872, 95% CI -2.960 to -0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone.
The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 24: 1045-1052.
低体重指数（BMI）和口腔健康状况差在老年脑卒中患者中较为常见，且与不良预后相关。然而，它们对脑卒中后患者的功能恢复的综合影响尚不清楚。本研究旨在探讨低 BMI 和口腔健康状况差对老年脑卒中患者日常生活活动（ADL）独立性、吞咽功能和认知状态的协同影响。
对 708 例年龄≥70 岁的住院脑卒中后患者进行回顾性队列研究。低 BMI 定义为<20kg/m，口腔健康状况采用改良口腔评估指南（ROAG）进行评估，得分≥13 分表示存在口腔问题。主要结局为出院时 ADL 独立性（功能性独立测量-运动评分>78 分）。次要结局包括吞咽水平（食物摄入水平量表）和认知状态（功能性独立测量-认知评分）。采用多元回归分析探讨低 BMI、口腔健康状况差及其组合与感兴趣结局的关系。
低 BMI 和口腔健康状况差同时存在与 ADL 独立性降低的可能性较低独立相关（比值比 0.130，95%置信区间 [CI] 0.023-0.718），吞咽水平更差（B=-0.878，95%CI -1.280 至 -0.476），认知状态更差（B=-1.872，95%CI -2.960 至 -0.784），校正混杂因素后。联合作用比单一条件的作用更强。
低 BMI 和口腔健康状况差的同时存在对老年脑卒中住院患者的功能恢复产生协同的负面影响。综合干预措施包括营养支持、口腔管理和康复，对于优化这一脆弱人群的结局至关重要。老年医学与老年健康学 2024；24：1045-1052。
