Decreased oral function in older adults requiring long-term care and associated dietary restrictions are thought to increase the risk of developing fever and pneumonia through malnutrition and decreased immune function. We conducted a cohort survey for approximately 1.5 years using oral care assessment sheets for older adults who were capable of oral ingestion and who required nursing care in a facility. The purpose of this study was to clarify the factors related to the onset of fever.

　A statistical analysis was performed on 259 subjects for whom the presence or absence of fever could be confirmed for 1 year. Significant associations were found between the onset of fever and the staple food form, difficulty in mouth-opening, difficulty in protruding the tongue, difficulty in swallowing, lack of spontaneity in oral care, difficulty in keeping the mouth open, and difficulty in holding water in the mouth. Furthermore, without limiting the observation period, Cox hazard analysis was performed on the relationship between these items and the onset of fever in 279 subjects for whom data were available. It was found that there was a significant relationship between difficulty in mouth-opening, difficulty in protruding the tongue, difficulty in swallowing, lack of spontaneity in oral care, difficulty in keeping the mouth open, and difficulty in holding water in the mouth. Older age and lower body mass index were associated with a higher risk of the onset of fever, and the risk of the onset of fever was higher in men than in women.

　These results suggest that a marked decline in oral functions such as mouth-opening, tongue protrusion, swallowing, and holding water in the mouth could predict the onset of fever.

　Objective:　Oral myofunctional therapy (MFT) includes “popping exercises,” in which the patient raises the tongue and presses the peripheral areas of its dorsum closely against the palate while opening the mouth to produce a “pop” sound. However, the efficacy of popping exercises in increasing tongue pressure and improving related oral function has not been demonstrated. In this study, we evaluated the effectiveness of popping training and tongue-pressing training in improving oral function, such as increasing tongue pressure, in healthy adults volunteers.

　Methods:　Twenty-four healthy adult volunteers were randomly divided into two groups, one of which practiced popping exercises and the other an exercise involving pressing the tongue against the palate. They engaged in these exercises 30 times per day, five times a week for four weeks. The oral wetness, tongue pressure, masticatory ability, and oral diadochokinesis (ODK) using /pa/, /ta/, and /ka/ were evaluated before and after the exercises.

　Results:　In both groups, there were significant differences in tongue pressure, masticatory ability, and ODK using /pa/, /ta/, and /ka/ after the exercises compared with the baseline (p＜0.05). A comparison of the magnitudes of these differences after the exercises compared with the baseline found no significant differences between the two groups.

　Conclusion:　The present results suggest that popping exercises as a form of MFT not only increase tongue pressure, but also improve masticatory ability and ODK to the same degree as exercises involving pressing the tongue against the palate.

　Objective:　This study aimed to investigate the relationship between aspiration and pharyngeal residue from the differences in physical properties of jellies and thickened liquids administered to patients with neuromuscular diseases.

　Methods:　Patients with neuromuscular diseases who underwent videofluoroscopic examination of swallowing (VF) were retrospectively surveyed from medical records. Observing the lateral view of VF, we used four different jelly diets: jellies of 5,000 N/m² and 8,500 N/m² firmness respectively, a lightly thickened jelly (viscosity 116.6 mPa・s), and an intermediately thickened jelly (viscosity 276.8 mPa・s). The presence or absence of aspiration and pharyngeal residue was investigated. For statistical analysis, the chisquared (χ²) test and Fisher's exact test were used to compare aspiration and pharyngeal residue for each property. In addition, Student's t-test was used to compare age and BMI, with and without aspiration and pharyngeal residue.

　Results:　Sixty-five subjects (28 men and 37 women) who underwent VF during the study were included in the analysis. No significant differences were observed in aspiration between the physical properties. Residues in the epiglottic fossa were significantly less with the lightly thickened jelly than the 5,000 N/m² jelly (p＜0.05) compared to the 8,500 N/m² jelly, residues were significantly less with the intermediately and lightly thickened jellies (p＜0.05 and p＜0.01, respectively). The residues in the piriform fossa were significantly less with the lightly thickened jelly than the 5,000 N/m² jelly (p＜0.05); however, there were no differences among other properties.

　Conclusion:　We investigated the relationship between aspiration and pharyngeal residue in patients with neuromuscular diseases and suggest that a low-viscosity liquid may be appropriate due to the presence of less pharyngeal residue.

　The texture of gel cooked from high-amylose rice flour as dysphagia diet was investigated. By using both a cooker and a microwave oven, a smooth gel that had a suitable texture for dysphagia diet could be cooked from rice flour milled by jet-mill under the wet condition. The duration of cooling the rice flour paste, ranging from 1.5 h to overnight, did not affect the texture. The hardness of the rice gel was lowered by warming at 24℃ and 45℃, but retained a suitable texture for dysphagia diet for 3 h. High-amylose rice flour may be useful as a staple food ingredient for dysphagia diet.

　Objective:　Impaired eating and swallowing function in healthy elderly people is called presbyphagia. Because there are gender differences in age-related changes to the feeding and swallowing organs, the characteristics of presbyphagia are expected to differ between men and women. Therefore, we compared the symptoms―sarcopenia, sarcopenia of swallowing-related muscles, oral function, and nutritional status―of community-dwelling elderly with suspected presbyphagia and those with good swallowing function and examined the different characteristics of presbyphagia in men and women.

　Methods:　Sixty-four community-dwelling elderly were included in this study. The Eating Assessment Tool-10 (EAT-10) was used to assess eating and swallowing function, and the elderly were divided into two groups: one with good swallowing function and one with suspected presbyphagia. Skeletal muscle index, grip strength, and maximum walking speed were measured to assess sarcopenia, and muscle mass of the geniohyoid muscle and maximum tongue pressure were measured to assess sarcopenia of swallowing-related muscles. Oral function was assessed using a basic checklist, and nutritional status was determined using the MNA^®-SF. Sarcopenia, sarcopenia of swallowing-related muscles, oral function, and nutritional status were compared between men and women.

　Results:　Sixty-one subjects were analyzed (78.6±7.3 years old, 16 males, 45 females). Presbyphagia was suspected in 23.0% of the community-dwelling elderly. Compared to the group with good swallowing function, the male presbyphagia group showed significant differences in the EAT-10 measurement “coughing when eating,” the percentage of low skeletal muscle mass and low tongue pressure, maximum walking speed, and the muscle mass of the geniohyoid muscle. In contrast, compared to the group with good swallowing function, the female presbyphagia group showed significant differences in two EAT-10 measurements: “weight loss due to swallowing problems” and “coughing when eating.” This group also showed significant differences in oral function and xerostomia on the basic checklist and weight loss on the MNA^®-SF.

　Conclusion:　Presbyphagia was suspected in 23.0% of the elderly. Symptoms of suspected presbyphagia were “increased coughing while eating” in both men and women. However, the mechanism of the decline in feeding and swallowing function that causes the symptoms may differ between men and women.

　Objective:　In this practical study, researchers and practitioners collaborated to achieve good dietary support for a group home. The purpose was to clarify changes in the thoughts and actions of the entire team consisting of practitioners and researchers.

　Methods:　The study was conducted using a mutual action research approach. Three group home caregivers and the researcher formed a research team to exchange opinions and discuss the subject of how dietary support should be provided at care facilities. “Wishes” for better dietary support were clarified, and feasible actions were planned in order to implement dietary support in line with the preferences expressed. Information obtained from semi-structured interviews, verbatim transcripts of three discussions, “reflection records,” and participant observation was analyzed, with a focus on changes in the thoughts and actions of caregivers regarding dietary support.

　Results:　In the study, three phases of the process of changes in the thoughts and actions were identified as follows:

Phase 1: The researcher and research collaborators discussed and agreed on their individual thoughts and feelings about meals.

Phase 2: The researcher and the research collaborators shared a common understanding by clarifying their “wishes.”

Phase 3: The research collaborators thought for themselves and moved toward implementation.

　Conclusion:　Changes in the thoughts and actions of the research collaborators became evident as they worked together with group home caregivers to solve dietary support issues. Efforts using mutual action research have the potential to solve problems and bring about change.

　Introduction:　Sulpiride, an antipsychotic drug, is used in low doses as a stomachic and antidepressant and is sometimes prescribed to alleviate anorexia. However, there have been reports of dysphagia as an adverse effect of sulpiride, although the relationship between sulpiride dosage and dysphagia is not clear. In this study, we experienced a case of drug-induced dysphagia in an older patient, who was prescribed 150 mg/day of sulpiride to alleviate anorexia.

　Case:　An 88-year-old man was transferred to our hospital for rehabilitation after a cardiogenic stroke in his right occipital lobe. His swallowing function was judged to be normal by a repetitive saliva swallowing test (RSST) performed three times, and he had a modified water swallowing test (MWST) score of 5 (no thickening) on day 1 of hospital transfer. On day 21 after hospital transfer, the patient developed a fever and dysphagia. A cough test showed no cough, and a videoendoscopic examination of swallowing (VE) revealed saliva intrusion into the larynx. A videofluoroscopic examination of swallowing (VF) revealed decreased pharyngeal clearance and silent aspiration. After considering the advantages and disadvantages of sulpiride, the drug was discontinued. Two weeks later, a cough test showed coughing within 10 s, and the VE and VF showed improvement in swallowing function.

　Conclusions:　Sulpiride can cause drug-induced dysphagia, even at low doses, and may cause silent aspiration as an adverse effect, which should be diagnosed by a cough test, VE, and VF.

　The patient was an 85-year-old female who underwent mandible segmental resection of the right side, right-side neck dissection, and reconstruction with anterolateral thigh (ALT) flap and titanium plate to treat gingival carcinoma. The post-operative course was good, and she could take adequate general diets orally with the mandibular prosthesis we made. Eleven months later, plate infection occurred, so she underwent surgery to remove the plate. Because of high deviation of the mandible to the right side after removal of the plate, she could neither use the mandibular prosthesis nor chew, and was unable to take general diets.

　Food residue was lodged in the space enclosed by the right buccal mucosa, ALT flap, tongue and remaining jaw. The food residue made her oral hygiene poor and she felt fatigue after each meal. We considered that the texture of her foods needed to be adjusted, but she wanted to keep eating those with the same texture. Therefore, we repaired the prosthesis with the aim of improving oral hygiene and reducing meal-related fatigue. As a result, food residue remaining in the space, oral hygiene and meal-related fatigue improved. Thus, we treated this case of dysphagia caused by high deviation of the mandible both morphologically and functionally.