Introduction: Aspiration pneumonia is a common problem among older adults; it has a high mortality rate and the prevalence is increasing. Reports on the risk factors for mortality in patients with aspiration pneumonia are limited. This study aimed to evaluate the risk factors for 90‐day survival in patients with aspiration pneumonia.Methods: This retrospective observational study was conducted at Seirei Mikatahara General Hospital between 1 April 2015 and 31 March 2016. Patients with aspiration pneumonia who had dysphagia or aspiration confirmed by modified water swallow test or VideoEndoscopic examination of swallowing were included. The primary endpoint was 90‐day survival. We performed univariate and multivariate logistic regression analyses with survival and non‐survival at 90 days as the independent variables.Results: A total of 276 patients were recruited for this study. The A‐DROP score (odds ratio [OR] = 2.440; 95% confidence interval [CI], 1.400–4.270; p < 0.01), Geriatric Nutritional Risk Index score (OR = 0.383; 95% CI, 0.178–0.824; p < 0.05) and sex (OR = 0.365; 95% CI, 0.153–0.869; p < 0.05) were independent early predictors of mortality.Conclusion: The results suggest that nutritional status and the severity of pneumonia are important factors that predict life expectancy in patients with aspiration pneumonia.

Background: Hospital-acquired disability (HAD), defined as a decline in activities of daily living (ADL) during hospitalization, is a significant component of post-intensive care syndrome (PICS) and may influence long-term outcomes in critically ill patients. Its impact on post-discharge functional recovery, especially among patients who appear ADL-independent at discharge, remains unclear. Methods: This analysis of the multicenter prospective J-RELIFE cohort included 357 ICU patients aged ≥ 40 years who required mechanical ventilation for ≥48 h. The primary outcome was global functional decline, defined as a Kihon Checklist (KCL) score ≥ 8 at 3 months after hospital discharge. Multivariable logistic regression and Cox proportional hazards models were used to identify independent predictors of functional decline, including HAD (Δ Barthel Index ≥ 5), age ≥ 65 years, and psychological distress at discharge (Hospital Anxiety and Depression Scale ≥ 8). Results: Global functional decline at three months was observed in 45% of patients. In logistic regression analysis, HAD (OR = 1.80, 95% CI: 1.00–3.24, p = 0.049), psychological distress (OR = 2.11, 95% CI: 1.27–3.49, p = 0.004), and older age (OR = 1.03 per year, p = 0.027) were independently associated with the outcome. Relative risk analysis confirmed similar associations: HAD (RR = 1.99, 95% CI: 1.71–2.31), psychological distress (RR = 1.35), and their combination significantly increased the risk of functional decline. Among patients who were ADL-independent at discharge (Barthel Index ≥ 85), those with all three risk factors had a markedly elevated risk (RR = 10.17, 95% CI: 6.46–16.00, p < 0.001). Conclusions: HAD, older age, and psychological distress at discharge are robust predictors of functional decline after ICU discharge, even in patients who appear functionally independent at discharge. These findings support comprehensive discharge planning that incorporates both physical and psychological assessments to identify high-risk individuals and improve long-term outcomes.

Background and Objective: The International Primary Airways Group (IPAG) questionnaire is a useful tool for screening for chronic obstructive pulmonary disease. The cut-off score of the IPAG questionnaire is investigated in Japan. However, its validity has not been examined according to sex, which was the aim of this study. Methods: We included 4364 participants aged 40 years or older, all current and ex-smokers and never-smokers, who completed the IPAG questionnaire and underwent spirometry. The IPAG questionnaire consists of eight items and the cut-off score is set to 17. We calculated the odds ratios of airflow limitation for each of the eight questions, by sex. We performed receiver operating characteristic analysis, calculating the area under the curve, sensitivity, and specificity for each sex. Results: For both men (n=2784) and women (n=1580), only three questions were independent risk factors of airflow limitation. The odds ratios for age (≥ 70 years), wheezing, and smoking history (≥ 50 pack-years) were 10.61, 3.50, and 2.40, respectively, for men (all p< 0.001), and 4.30 (p< 0.001), 2.32 (p=0.026), and 5.69 (p=0.014), respectively, for women. For men and women, the areas under the curve were 0.741 and 0.670, respectively. The sensitivity and specificity values, respectively, were as follows: 83.6% and 47.1% for men with a cut-off score of 17; 80.0% and 53.7% for men with a cut-off score of 18; 56.7%, and 65.9% for women with a cut-off score of 17; and 76.7% and 43.9% for women with a cut-off score of 15. Conclusion: Regardless of sex, only three IPAG questions were deemed useful as screening for airflow limitation. The cut-off scores for men and women may be appropriately set at 18 and 15, respectively, in the Japanese population.

Objective: To evaluate the factors that influence walking ability in patients hospitalized due to aspiration pneumonia. Methods: This retrospective observational study evaluated patients hospitalized with aspiration pneumonia. The primary endpoint was preservation of walking ability. Univariate and multivariate logistic regression analyses were performed with the preservation of walking ability as the dependent variable. Results: A total of 143 patients were enrolled in this study. The patients were divided into two groups: those whose walking ability decreased after hospitalization ( n = 61) and those whose walking ability was maintained after hospitalization ( n = 82). Multivariate logistic regression analyses showed that A-DROP (odds ratio [OR] 3.006; 95% confidence interval [CI] 1.452, 6.541; P < 0.01), the Geriatric Nutritional Risk Index (OR 0.919; 95% CI 0.875, 0.960; P < 0.001) and days to initial mobilization (OR 1.221; 95% CI 1.036, 1.531; P < 0.05) were the independent early predictors for preservation of walking ability. Conclusion: Nutritional status and early mobilization were important risk factors affecting the maintenance of walking ability in patients hospitalized due to aspiration pneumonia. Thus, a combination of nutrition and early rehabilitation is needed for these patients. Registry of Research Studies involving Human Subjects: This study was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN 000046923).

Purpose: Assessment for frailty is important as it enables timely intervention to prevent or delay poor prognosis in chronic obstructive pulmonary disease (COPD). The aims of this study, in a sample of outpatients with COPD, were to (i) assess the prevalence of physical frailty using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria and the Short Physical Performance Battery (SPPB) and the degree of agreement between the findings of the two assessments and (ii) identify factors associated with the disparity in the results obtained with these instruments. Patients and Methods: This was a multicenter cross-sectional study of individuals with stable COPD enrolled in four institutions. Frailty was assessed using the J-CHS criteria and the SPPB. Weighted Cohen’s kappa (k) statistic was performed to investigate the magnitude of agreement between the instruments. We divided participants into two groups depending on whether there was agreement or non-agreement between the results of the two frailty assessments. The two groups were then compared with respect to their clinical data. Results: A total of 103 participants (81 male) were included in the analysis. The median age and FEV₁ (%predicted) were 77 years and 62%, respectively. The prevalence of frailty and pre-frail was 21% and 56% with the J-CHS criteria and 10% and 17% with the SPPB. The degree of agreement was fair (k = 0.36 [95% CI: 0.22– 0.50], P< 0.001). There were no significant differences in the clinical characteristics between the agreement group (n = 44) and the non-agreement group (n = 59). Conclusion: We showed that the degree of agreement was fair with the J-CHS criteria detecting a higher prevalence than the SPPB. Our findings suggest that the J-CHS criteria may be useful in people with COPD with the aim of providing interventions to reverse frailty in the early stages.