title: Head lifting strength is associated with dysphagia and malnutrition in frail older adults.
abstract: OBJECTIVE
  The purpose of the present study was to assess the association between head lifting strength, dysphagia and malnutrition in frail older adults.
  
  
  METHODS
  A cross-sectional study was carried out in 386 frail older adults aged 65 years and older with dysphagia or suspected dysphagia. Head lifting strength was assessed by the Medical Research Council score. The severity of swallowing and nutritional status was evaluated using the Dysphagia Severity Scale and the Mini-Nutritional Assessment Short Form, respectively. Univariate and logistic regression analyses were applied to examine the associations between head lifting strength, dysphagia and malnutrition.
  
  
  RESULTS
  There were 129 men and 257 women. The mean age was 83 years. The median Barthel Index score was 30 (interquartile range 5-65). A total of 189 (49%) older adults could independently lift their head. Based on the Dysphagia Severity Scale, 79 participants had no dysphagia, 138 had dysphagia without aspiration and 169 had dysphagia with aspiration. The Mini-Nutritional Assessment Short Form showed that 175 older adults were malnourished, 171 were at risk for malnutrition and 40 had a normal nutritional status. The Medical Research Council score in men was higher compared with women. Head lifting strength was significantly correlated with age (r = -0.256), the Barthel Index (r = 0.540), the Dysphagia Severity Scale (r = 0.458) and the Mini-Nutritional Assessment Short Form (r = 0.331). In logistic regression analysis, the Medical Research Council score was independently associated with both dysphagia with aspiration and malnutrition.
  
  
  CONCLUSIONS
  Head lifting strength is associated with dysphagia with aspiration and malnutrition in frail older adults.
authors.affiliation: Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Japan; Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Wakabayashi
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sashika
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D017770:Lifting; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D053580:Muscle Strength / Q000502:physiology*; D015596:Nutrition Assessment; D053120:Respiratory Aspiration / Q000209:etiology*; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: deglutition disorders; frailty; malnutrition; presbyphagia; sarcopenia