Consciousness

(1) Clinical efficacy: Cure: the hiccup completely stopped 3 days after treatment. Remission: the attack times of hiccup were obviously reduced, which is more than 50% lower than that before treatment. Invalid: the above criteria are not met or the disease aggravates [12 (link)]. Total effective rate = (cured + relieved) cases/total cases × 100%. The patient’s median response time, the median cure time, and the one-time medication response rate were recorded. (2) Adverse reactions and recurrence: adverse reactions including fatigue (conscious fatigue and limb weakness), drowsiness (excessive daytime sleep or sleep onset), tremors (rhythmic and alternating swinging movements), and hiccup recurrence after drug discontinuation were recorded during the treatment.

This single-center, prospective, observational cohort study included patients treated at the CICW of National Center for Geriatrics and Gerontology in Japan between July 2015 and November 2020. This registry was completed in November 2020 because CICW was converted to a care ward for patients with COVID-19. Written informed consent was obtained from all patients or their family members, as appropriate. Ethical approval was obtained from the relevant Ethics Committee of Human Research of the National Center for Geriatrics and Gerontology, Japan (No. 830).
Participants registered in the CICW database sequentially during the study period were retrospectively screened. The database was developed for a registry study that focused to clarify the association between frailty and home admission. The database contained information of participants with informed consent and those who were not planned to be discharged from the CICW within 2 weeks, were not in the terminal stage of life, or did not have a pacemaker. The CICW database included the information regarding skeletal muscle mass by using bioelectrical impedance analysis (BIA). We excluded patients having a pacemaker because BIA can cause interference with the pacemakers.
The exclusion criteria of this research were visualized in Figure 1 and were as follows: (1) age under 65 years, (2) living in nursing homes before CICW admission, (3) length of hospitalization of less than 2 weeks, (4) Mini-Mental State Examination (MMSE) score not performed or of 9 or less, (14 (link)) and (5) missing measurements. Missing items of MMSE were replaced to 0, because these missing data represented the lacked ability to finish the item (e.g., fracture of the dominant hand, visual impairment or disturbance of consciousness). Of the screened 717 participants, 167 were excluded due to age under 65 years (n=10), living in a nursing home before CICW admission (n=38), CICW stay of less than 2 weeks (n=40), MMSE not performed or MMSE scores ≤9 (n=53), and missing data for Geriatric Depression Sacle 15 (GDS15) or the Mini Nutritional Assessment-Short Form (MNA-SF) or the Functional Independence Measure (FIM) completing all FRAIL-NH components (n=26). Finally, 550 older adults (258 with robust, 97 with prefrail, and 195 with frail status) were included in the analysis.
Figure 1

Flowchart of inclusion and exclusion for this study