AIM:The relationship between oral health and gut microbiota diversity remains unclear, especially in vulnerable populations. We aimed to explore the association between oral health status and gut microbiota diversity in older inpatients recovering from stroke. METHODS:This cross-sectional study was conducted in a convalescent rehabilitation ward. Participants were older post-stroke inpatients. Oral health was assessed using the Revised Oral Assessment Guide (ROAG), with scores ≥ 9 indicating oral problems. Gut microbiota diversity was analyzed by 16S rRNA gene sequencing of fecal samples, and measured using the Shannon index (prespecified primary outcome), richness (observed features/OTUs), and Faith's phylogenetic diversity (PD). Multivariable linear regression analysis was performed to examine the association between ROAG scores and diversity indices, adjusting for potential confounders. RESULTS:Participants were 156 older patients after stroke (mean age 78.6 years). Oral problems were present in 121 patients (77.6%). After adjusting for confounders including age, sex, stroke type, comorbidities, and nutritional intake, the total ROAG score was associated with the Shannon index (B = -0.044, 95% CI: -0.082 to -0.005). In exploratory analyses, no clear associations were found between ROAG scores and richness (B = -3.774, 95% CI: -7.844 to 0.296) or Faith's PD (B = -0.087, 95% CI: -0.451 to 0.277). CONCLUSION:In this registry-based cross-sectional study, poorer oral health (higher ROAG score) was associated with lower gut microbiota α-diversity (Shannon index). Given multiple outcomes and no preregistered analysis plan, these findings are exploratory/hypothesis-generating and require confirmation in independent cohorts and longitudinal studies.

ABSTRACT Background: Digital health interventions have gained attention as potential strategies for frailty prevention. However, their effectiveness in nonfrail older adults remains unclear. Objectives: This systematic review and meta-analysis evaluated the effectiveness of digital health interventions in preventing frailty and improving surrogate markers in healthy older adults. Methods: A comprehensive search of the MEDLINE, Cochrane Library, and Web of Science databases was conducted for studies published between 2000 and 2023. Eligible studies included randomized controlled trials (RCTs) or cohort studies assessing the impact of digital health interventions on frailty incidence or surrogate markers in nonfrail older adults (≥60 years). Pooled effect estimates for each outcome were calculated using a random-effects meta-analysis. Methodological quality was assessed using the Cochrane Risk of Bias (RoB) 2.0. GRADE criteria were used to assess evidence certainty. Results: Three RCTs met the inclusion criteria and included 257 participants. Meta-analysis showed no significant reduction in frailty incidence (odds ratio [OR] = 0.58; 95% confidence interval [CI]: 0.14–2.43; P = 0.46). No significant improvements were observed in chair stand performance (mean difference [MD] = −0.18; 95% CI: −1.24–0.88; P = 0.74) or physical activity levels (MD = 40.46; 95% CI: −1052.31–1133.23; P = 0.94). All studies had a high RoB, short intervention durations, and considerable heterogeneity in intervention types. Conclusion: The current evidence remains insufficient to confirm the effectiveness of digital health interventions in preventing frailty or improving surrogate markers in healthy older adults.

Background and AimOlder adults are susceptible to hospitalization-associated disability (HAD), particularly when nutritional status is impaired. This study aimed to examine the association between GLIM-defined malnutrition and HAD in hospitalized older adults and to descriptively compare HAD-related clinical characteristics according to HAD status within GLIM malnutrition and non-malnutrition groups.MethodsThis prospective observational cohort study used a multicenter database to identify 166 patients aged ≥70 years who were admitted to acute care wards between February 2023 and March 2025 and were independent in ADL before hospitalization. GLIM-defined malnutrition was assessed at admission and treated as the exposure. Patients were categorized into GLIM malnutrition and non-malnutrition groups and followed until discharge to determine the occurrence of HAD. Logistic regression analysis was used to identify the independent HAD predictors.ResultsThe mean age of the patients was 80 years; 103 were men and 63 were women. GLIM malnutrition was present in 67 (40%) patients. The occurrence of HAD during hospitalization was higher in patients with GLIM malnutrition than in those without GLIM malnutrition (48% vs. 16%, p < 0.001). Patients with malnutrition were older, frailer, and had lower body mass index. Multivariable logistic regression analysis showed that GLIM malnutrition was independently associated with HAD (odds ratio, 2.732; 95% confidence interval, 1.190-6.271; p = 0.018).SummaryGLIM-defined malnutrition is independently associated with HAD in older patients. Early nutritional assessment, targeted frailty prevention, and integrated prehospital care may help reduce the risk of HAD and improve recovery after discharge.

To compare the prognostic performance of the Asian Working Group for Sarcopenia (AWGS) 2025 diagnostic constructs—specifically height- versus body mass index (BMI)-indexed muscle mass—for discriminating functional outcomes in patients with stroke. From a cohort of 1246 consecutive post-acute stroke admissions, we analyzed 864 inpatients (median age 76 years; 47.2

Background:Psychotropic medications may impair recovery in older inpatients, but their effect on previously independent patients is unknown. We examined whether admission psychotropic medication use is associated with activities of daily living (ADL) decline at discharge. Methods:This multicenter prospective cohort study used data from a nine-center hospital-associated disability database collected from February 1, 2023, to March 31, 2025. Patients aged ≥70 years admitted to general medical wards who underwent rehabilitation and were independent of ADL before admission (Katz Index=6) were enrolled. The primary and secondary outcomes were the Katz Index and Food Intake Level Scale (FILS) score at discharge, respectively. One primary multivariable analysis and two sensitivity analyses were performed. Pharmacist-led instruction sessions were also evaluated, and FILS scores were compared by session status. Results:Among 202 patients (mean age, 80.3 years; 39.6% female), 32 (15.8%) used psychotropic medications at admission. In the primary analysis, psychotropic use was independently associated with a lower discharge Katz Index (B = -0.333, p = 0.046). The association was consistent in both sensitivity analyses (Model 1: B = -0.386, p = 0.019; Model 2: B = -0.345, p = 0.020), but not FILS score at discharge (p = 0.970). Any pharmacist-led session was linked to higher FILS scores, without a dose-response pattern. Conclusion:Use of psychotropic medications at admission may be a risk factor for ADL decline at discharge in previously independent older inpatients. The patients receiving any instruction session had higher FILS scores than those receiving none.

[This retracts the article DOI: 10.2490/prm.20240019.].

This study aimed to investigate the prevalence of sarcopenic obesity defined by the Asia–Oceania consensus and its association with ADL in post-stroke patients. The prevalence of sarcopenic obesity according to the Asia–Oceania consensus was 3.3

This article is an official position paper that summarizes current evidence and offers recommendations for spiritual care in rehabilitation nutrition. Spirituality is defined as pertaining to the fundamental questions and desires of human existence, encompassing meaning, purpose, dignity, and connection. Spiritual pain is a state of lost meaning related to temporality, relationship, autonomy, and independence, manifesting due to end-of-life, permanent disability, and loss. Rehabilitation nutrition plays a vital role in alleviating this pain by supporting functions, nutritional status, and the patient's sense of meaning and hope. Practice involves interdisciplinary collaboration utilizing specific approaches related to the four dimensions, such as active listening and empathy, presence, maintaining hope, and fostering gratitude and forgiveness. To implement this holistic care effectively, education and training for healthcare workers are required, emphasizing respect for both the patient's and their own spiritual aspects. Ultimately, incorporating spiritual care into rehabilitation nutrition is crucial for improving patient well-being.

ABSTRACT Background: Sarcopenic dysphagia (SD) is a swallowing disorder due to sarcopenia involving the whole-body skeletal muscles and the swallowing muscles. Objectives: The aim of this study was to investigate the effects of comorbid dementia on rehabilitation outcomes in patients with SD. Methods: This retrospective cohort study used data from the Japanese SD Database. Patients with dysphagia aged 20 years or older with a food intake level scale (FILS) of 8 or less diagnosed with SD were included. Baseline data were collected for all patients. Follow-up data were collected after 3 months. For patients who had been in hospital for <3 months, follow-up data were collected at discharge. The effect of comorbid dementia with SD on improvement in activities of daily living (ADL) and swallowing function was examined using multivariate analysis. Results: Of 285 participants with SD, 98 (34.4%) had dementia and 187 (65.6%) did not. Ordered logistic regression revealed dementia as a significant predictor of lower FILS scores at follow-up (odds ratio: 1.89, 95% CI: 1.15–3.10, P = 0.012). Multiple regression analysis indicated dementia significantly predicted lower Barthel Index (BI) scores at follow-up (β = −0.106, P = 0.024), after adjusting for baseline characteristics including age, sex, hospital type, and baseline BI. Conclusion: In patients with SD, comorbid dementia was associated with poorer rehabilitation outcomes in swallowing function and ADL. These findings highlight the necessity of personalized rehabilitation strategies that account for individual cognitive impairments.

Background Hospital Associated Disability (HAD) refers to a condition in which Activities of Daily Living (ADL) decline during hospitalization and is associated with longer hospital stays as well as increased mortality and readmission prevalence among older adults. Many existing registry databases do not adequately capture preadmission ADL information, complicating the accurate identification of HAD. The purpose of this study was to develop and evaluate the quality of a multicenter registry database on HAD that includes detailed information on nutrition, medication use, swallowing, and walking ability. Method The research was carried out as a prospective multicenter study involving nine institutions across Japan, with Mie University Hospital designated as the leading institution. The participants were patients aged ≥70 years old who were admitted to a general ward for rehabilitation and were independent in ADL (Katz Index: 6 points) before admission. Data were collected using the REDCap system on admission and discharge. Assessment items included age, gender, Katz Index, Functional Comorbidity Index, Clinical Frailty Scale, malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria, Food Intake LEVEL Scale (FILS), Functional Ambulation Categories, etc. A decrease in the Katz Index during hospitalization was defined as HAD, and a decrease in the FILS was defined as hospital associated dysphagia. Results A total of 209 patients with a mean age of 80.1 years were enrolled, and 60.8% were male. The leading causes of hospitalization included malignancies (39.7%), cardiovascular diseases (29.7%), and respiratory diseases (15.3%). HAD occurred in 29.1% of patients, hospital associated dysphagia was observed in 16.7%, and weight loss during hospitalization occurred in 75.4%. Walking ability declined in 15.9% of patients during their hospital stay. The median length of stay was 19 days; 82.3% were discharged home, and 2.9% died during hospitalization. Moderate or severe malnutrition on admission according to the GLIM criteria was present in 40.4% of patients. Missing data were few, <5%, except for items such as cancer stage and preadmission weight, and the quality of the data was high. All facilities had a weekend and holiday rehabilitation system, with more than half of the facilities having a dedicated ward dietitian and dental specialist. Discussion In this study, we established a multicenter database on HAD in older hospitalized patients and were able to collect high quality data, including nutritional status, swallowing ability, and rehabilitation information. The incidence of HAD was generally consistent with that reported in previous studies. In the future, this registry is expected to contribute to the identification of risk factors, the development of predictive models for HAD, and the design of early intervention programs for high-risk patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement JSPS KAKENHI (grant number 22K19669). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Ethics Committee of Mie University Hospital (No. H2023-015) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets generated in this study are available from the corresponding authors upon request.

OBJECTIVE:This study aimed to clarify the association between oral health status and cachexia among the patients with dysphagia. MATERIAL AND METHODS:The registry data of the Japanese Sarcopenic Dysphagia Database were used. Oral health screening was performed with the Revised Oral Assessment Guide (ROAG) or the Oral Health Assessment Tool (OHAT). ROAG score ≥ 13 or OHAT score ≥ 3 was defined as poor oral health status. Activities of Daily Living (ADL) was evaluated with the Barthel index (BI) and swallowing function was evaluated with the Food Intake Level Scale (FILS). The relationship between oral status and the presence of cachexia and other evaluation criteria was evaluated in univariate and multivariate analyses. RESULTS:The study included 401 older patients with dysphagia (mean age 81 years; 49% women, and 209 cases (52%) had poor oral health. In univariate analysis, poor oral health had significantly more malnutrition and cachexia (p = 0.003 and p = 0.001, respectively) and significantly lower BI and FILS (both p < 0.001). Multivariate analysis showed that oral care status was detected as a factor affecting the presence of cachexia (odds ratio: 1.881, 95% confidence interval, 1.156 to 3.060, p = 0.011). CONCLUSION:The risk of cachexia is higher in the case of poor oral health status. Rehabilitation, nutritional support and oral health care may contribute to the management of cachexia.

Background/Aims Malnutrition is a common clinical problem causing poor outcomes, including longer hospital stays, complications, functional decline, and mortality. Oral nutritional supplements (ONS) are a key component of medical nutrition therapy for patients who cannot meet their nutritional needs through diet alone. Despite their proven effectiveness, ONS use in practice remains inconsistent due to the lack of comprehensive, practice-based, and internationally validated guidelines. In 2023, the Turkish Clinical Enteral and Parenteral Nutrition Society (KEPAN) developed a national consensus report to address this gap. To enhance international validity and applicability, this study aimed to validate and refine those recommendations through a global Delphi process involving multidisciplinary experts. Methods A two-round modified Delphi study was conducted between February 2023 and March 2024. Twenty-two experts from 13 countries and various disciplines (internal medicine, gastroenterology, geriatrics, surgery, family medicine, physiatry, clinical nutrition, dietetics, etc.) rated 22 predefined recommendations using a 5-point Likert scale. Consensus was defined as a median score ≥4 with a 25th percentile ≥4. Expert comments were reviewed and incorporated, and recent international guidelines were used to update the supporting commentaries as well. Results Seventeen recommendations achieved consensus in round 1, and the remaining five in round 2. The final internationally validated set of recommendations covers practical aspects of ONS use including: (1) indications for initiation, dose, timing, and product selection; (2) monitoring strategies, adherence, and management of taste, tolerance, and other common problems; and (3) condition-specific considerations across diabetes, chronic kidney disease, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease, neurological diseases, pressure injuries, surgery, cancer, geriatrics and multimorbidity, as well as guidance on continuation and discontinuation of ONS. The refined recommendations emphasize the food-first principle, individualized decision-making, and multidisciplinary collaboration to optimize person-centered nutritional care. Conclusions This study delivers the first internationally validated, expert-informed recommendations on ONS use, providing a standardized and adaptable framework for global implementation. Familiarity with and application of these recommendations in clinical practice should lead to improved nutritional care, better adherence, enhanced patient outcomes, and more efficient, person-centered use of ONS across several healthcare settings.