Relationship between chewing ability and sarcopenia in Japanese community-dwelling older adults

The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement was to search the literature to determine if there is a relationship between patient specific factors and occlusal force.

MATERIALS AND METHODS

A literature review was conducted in the following databases: Evidence-Based Medicine Reviews (EBMR), Cochrane Database of Systematic Reviews, Embase, and Ovid MEDLINE(R) and Epub Ahead of Print. Articles on patient factors and occlusal force were compiled by using a combination of the key words: "bite force," "occlusal force," "partial and complete edentulism," "bruxism," and "orthognathic class." Inclusion criteria included meta-analyses, systematic reviews, randomized controlled trials, case series, and journal articles. Exclusion criteria were case reports, studies in children, animals, and bench studies.

RESULTS

Of the 1502 articles that met the initial search criteria, 97 related to patient-specific factors affecting occlusal forces. These articles were evaluated, rated, and organized into appropriate categories addressing questions of foci.

CONCLUSIONS

The range of occlusal force is highly variable among subjects correlated to patient specific factors such as age, gender, partial and complete edentulism, the presence of a maxillofacial defect, location of edentulous area, orthognathic profile, and magnitude of occlusal vertical dimension. Tooth replacement therapies targeted at increasing occlusal contact seem to have a positive effect on increasing occlusal force. Bruxism does not necessarily demonstrate higher occlusal powering but may have greater tooth contact time. Occlusal force is not clearly affected by the type of dental restoration or restorative material used. The clinical significance of the changes in occlusal forces is yet to be determined.

Relationship between two pressure-sensitive films for testing reduced occlusal force in diagnostic criteria for oral hypofunction

OBJECTIVE

To measure the occlusal force in the same group of patients with the Dental Prescale 50H type R and the Dental Prescale II, examine the association between them, and determine the reference value for Dental Prescale II that corresponds to the 50H type R 200 N reference value used to make a diagnosis of oral hypofunction.

BACKGROUND

Reduced occlusal force, a measure of frailty in older persons, was previously determined with Prescale 50H type R pressure-sensitive film, but it has been replaced by the Prescale II.

MATERIALS AND METHODS

The study participants were 441 men and women aged ≥ 65 (mean, 71.8 ± 5.3) years. The occlusal force was measured with the two different types of pressure-sensitive film, and their association was examined. Receiver operating characteristic curves for the Prescale II measured values were created with the 200 N reference value used for the 50H type R film as the cut-off value.

RESULTS

The analysis set included 391 participants for whom measurements were obtained using both the 50H type R and the Prescale II. Linear regression analysis produced regression equations, and a ROC curve analysis provided reference values of 500 N for the Prescale II (without pressure filter) and 350 N for the Prescale II (with pressure filter).

CONCLUSION

In occlusal force tests for making a diagnosis of oral hypofunction, reference values for the Prescale II (without pressure filter) and for the Prescale II (with pressure filter) were determined. The findings suggested that the Prescale II can be used as a diagnostic examination for oral hypofunction.

Poor Appetite and Eating Difficulties Can Predict the Long-Term Risk of Falling: A Longitudinal Study in Middle-Aged and Older Adults

OBJECTIVES

This study investigates whether self-reported nutritional status affects falling among middle-aged and older adults.

METHOD

We used 8-year follow-up data from the Taiwan Longitudinal Study on Aging. At baseline, respondents' appetite, changes in amount of food intake, and eating difficulties were assessed in a questionnaire-based survey in addition to anthropometric measurements (body mass index, mid-arm circumferences, and involuntary body weight loss). Their associations with falls in the follow-up were examined using multivariable log-binomial regression.

RESULTS

The study included 2,519 respondents aged 50 years and older. Poor appetite (prevalence ratio [PR] = 1.25, 95% confidence interval [CI] = [1.07, 1.46]) and eating difficulties (PR = 1.16, 95% CI = [1.02, 1.32]) significantly predicted falling 8 years later with adjustments for sociodemographics, health behaviors, comorbidities, and anthropometric measures by taking into account probabilities of follow-up.

CONCLUSION

Poor appetite and eating difficulties can predict falling in the long-term independent of anthropometric measurements among middle-aged and older adults.

Oral dysfunctions and cognitive impairment/dementia

With global increases in the aging population, the number of patients with dementia is greatly increasing, which has become a big social problem. Many studies have shown strong associations between oral disorders and systemic disorders, such as diabetes, arthritis, sepsis, aspiration pneumonia, arteriosclerosis, bacterial endocarditis, and other cardiovascular diseases. Similarly, numerous cross-sectional studies showed that patients with dementia usually have poor oral conditions and tooth loss. These have long been considered as a result of difficulty with oral care due to impaired cognitive function, memory, and physical ability in patients with dementia. Indeed, even in patients with mild cognitive impairment, oral care becomes insufficient owing to decreases in spontaneity of grooming and finger dexterity. However, recent studies have shown that tooth loss and occlusal dysfunction may affect brain function and trigger the onset of dementia found in neurodegenerative diseases including Alzheimer's disease. In this review, we highlight the relationships among aging, oral dysfunction, and the development of dementia. Increasing evidence suggests that oral dysfunction is not only a result of dementia in the elderly people, but could also be a causative factor for the onset of dementia.

Prevalence and risk factors of sarcopenia in community-dwelling older adults visiting regional medical institutions from the Kadoma Sarcopenia Study

This study aimed to investigate risk factors for sarcopenia in community-dwelling older adults visiting regional medical institutions. We retrospectively analyzed medical records of 552 participants (mean age: 74.6 ± 6.7 years, males 31.3%) who underwent body composition evaluation between March 2017 and December 2018 at one of 24 medical institutions belonging to the Kadoma City Medical Association in Japan. We collected the participant's characteristics and laboratory data. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019. Sarcopenia, including severe sarcopenia, was detected in 22.3% of all participants, 17.3% of men, and 24.5% of women; rates increased with age. Multivariate logistic regression analysis revealed age (odds ratio [OR]: 2.12; 95% confidence interval [CI] 1.20-3.75), obesity (OR: 0.15; 95% CI 0.07-0.32), hypertension (OR: 0.44; 95% CI 0.25-0.76), certification of long term care (OR: 3.32; 95% CI 1.41-7.81), number of daily conversations (OR: 0.44; 95% CI 0.25-0.77), and malnutrition (OR: 2.42; 95% CI 1.04-5.60) as independent predictors of sarcopenia. Receiver operating characteristic curve analysis demonstrated that the cut-off for daily conversations defining sarcopenia was 4.8 persons. The prevalence of sarcopenia in this study was 22.3%. Besides traditional risk factors for sarcopenia, the number of daily conversations was an independent factor.

Association between oral health and sarcopenia: A literature review

PURPOSE

Sarcopenia has recently been attracting attention as an early sign of the need for nursing care in older adults. Some studies have reported that oral health is related to sarcopenia and its diagnostic factors (hand grip strength, walking speed, and skeletal muscle mass). However, the relationship between oral health and sarcopenia remains poorly investigated and no review to date has compiled the available research on this relationship. The aim of this review was to summarize the current evidence describing the association between oral health and sarcopenia.

STUDY SELECTION

The internet database PubMed was searched using various combinations of related and synonymous keywords for "oral" or "dental" or "oral health" or "oral function" and "sarcopenia" or "walking speed" or "hand grip strength" or "skeletal muscle mass." A total of 27 studies found to be eligible were critically evaluated and their key findings were summarized.

RESULTS

Most of the studies were cross-sectional and conducted in Japan. A wide range of oral factors, including number of teeth, occlusal support, periodontal state, occlusal force, mastication, tongue pressure, and swallowing, were covered. The overall findings were that oral health indices could be significantly associated with sarcopenia and its diagnostic factors.

CONCLUSIONS

Relationships may exist between aspects of oral health and sarcopenia or its diagnostic factors. However, reports showing associations between oral health and sarcopenia are scarce, and definitive conclusions could not be drawn. Further longitudinal studies are necessary to confirm these relationships.

A comparison of colorimetric and visual methods for the assessment of masticatory performance with color-changeable chewing gum in older persons

Background/purpose

Color-changeable chewing gum is used for the evaluation of masticatory performance. However, it is currently unclear whether colorimetric and visual assessment methods yield consistent results. This study aimed to clarify the consistency between colorimetric and visual methods used for the evaluation of color changes in color-changeable chewing gum.

Materials and methods

The sample comprised 644 older persons (mean age, 75.4 ± 6.4 years). The chewing gum was masticated 60 times at the participant's own chewing rate and then expectorated. The color of the chewing gum was evaluated with the ΔE values and a∗ values, measured using a colorimeter, and the 10 Color Shades (10CSh) and 5 Color Scales (5CSc), using visual evaluation. Spearman's correlation analysis was performed to examine the correlation between the results obtained by the four methods. The significance level was set at α = 0.05.

Results

The ΔE values, a∗ values, 10CSh scores, and 5CSc scores were all significantly correlated. The highest correlation coefficient (0.979) was between the ΔE values and a∗ values. The lowest correlation coefficient (0.847) was between the a∗ values and 5CSc scores. Decreased masticatory performance was observed with increased age.

Conclusion

Significant correlations were found for all four methods used in the assessment of masticatory performance with color-changeable chewing gum. While visually based assessments are valid, colorimetric methods are more sensitive to smaller changes in masticatory performance.

Semi-powered exoskeleton that regulates the muscular activity of jaw movement for oral functional rehabilitation/training

The sequential oral functions of mastication and swallowing are well tuned in humans. To prevent oral hypofunction as a risk factor for systemic frailty by oral motor training, semi-powered exoskeleton was developed and evaluated its loading/assist effects by monitoring electromyography signals and saliva secretion in healthy persons. The actuator of the driving unit combined mechanical and powered mechanics and was driven alternatively by an unpowered stainless-steel spring system for jaw-opening training by loading and a powered shape-memory alloy spring system to assist jaw closing. Sequential device movement was controlled by two electronic circuits with two magnetic switching systems to match human jaw movement. This exoskeleton realized a 25% increase of jaw-opening muscular activity for training, 15% saving of jaw-closing muscular activity for assistance, and 15% enhancement of saliva secretion, which could contribute to the prevention of oral frailty by maintenance and strengthening of oral function in the upcoming super-aging society.

Development of a simple method to measure masseter muscle mass

OBJECTIVE

To develop a simple method to estimate masseter muscle mass.

BACKGROUND

The masseter muscle is important for optimal oral function. A decrease in the masseter muscle mass may affect the oral and physical function of the whole body; therefore, it is an important entity to measure. However, to date, no easy measurement method has been developed for the same. Herein, we devised a simple method to estimate masseter muscle mass. In addition, we compared our method with magnetic resonance imaging (MRI) and skeletal muscle mass (SMM) to verify its validity.

MATERIALS AND METHODS

We recorded the age, sex, masseter muscle mass (by MRI), number of retained natural teeth, number of functional teeth, length and thickness of masseter muscle, and skeletal muscle mass in 53 community-dwelling elderly people (21 men and 32 women, average age 72.9 ± 4.5 years). The estimated masseter muscle mass was calculated by multiplying the length, width and thickness of the muscle.

RESULTS

The correlation coefficient between masseter muscle mass and estimated masseter muscle mass was r = .903; thus, a strong correlation was recognised. The correlation coefficient between the estimated masseter muscle mass and SMM was r = .279, considering age and sex.

CONCLUSION

We obtained substantial results using our method for estimating the masseter muscle mass and verified its validity by comparing it with masseter muscle mass measured by MRI and SMM. We believe that our proposed technique is simple and useful for estimating masseter muscle mass.

Association between Mixing Ability of Masticatory Functions Measured Using Color-Changing Chewing Gum and Frailty among Japanese Older Adults: The Kyoto-Kameoka Study

The relationship between mixing ability of masticatory functions and frailty has not been well evaluated. This study investigated the prevalence of physical and comprehensive frailty and its association with mixing ability in 1106 older adults aged ≥65 years who underwent physical examination as part of the Japanese Kyoto-Kameoka Study. Mixing ability was assessed using color-changing chewing gum (1-5 points, 5 representing the best mixing ability). Participants were divided into four groups (5 points, 4 points, 3 points, and 1 or 2 points). The modified Japanese versions of the Cardiovascular Health Study (mJ-CHS) criteria and the validated Kihon Checklist (KCL) were used to assess physical and comprehensive frailty, respectively. Multivariate logistic regression was used to evaluate the association between frailty and mixing ability. The prevalence of physical and comprehensive frailty was 11.8% and 27.9%, respectively. After adjusting for confounders, the odds ratios of physical and comprehensive frailty comparing the highest to the lowest chewing gum score groups were 3.64 (95% confidence interval (CI): 1.62 to 8.18; p for trend = 0.001) and 2.09 (95% CI: 1.09 to 4.03; p for trend = 0.009), respectively. Mixing-ability tests involving chewing gum may be an indicator associated with both physical and comprehensive frailty.

Association between oral, social, and physical frailty in community-dwelling older adults

OBJECTIVES

Oral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty.

METHODS

Oral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty.

RESULTS

Logistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF.

CONCLUSIONS

These findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.

Oral health for achieving longevity

Oral frailty is defined as a decrease in oral function accompanied by a decrease in mental and physical functions. Studies showing that people with oral frailty are at high risk of physical frailty, sarcopenia, severe conditions requiring nursing care and death have been reported in Japan. An increase in life expectancy and maintenance of teeth result in a decrease in the effect of the number of teeth. In contrast, a decrease in oral function as a result of aging has been suggested to have major effects on dysfunction and mortality risk. The present report is a narrative review of major clinical studies on the relationships of the number of teeth, dentures, occlusion and oral function with longevity, with the aim of providing information for future studies centered on oral function in Japan or overseas. This review clearly shows the relationships of the number of teeth, dentures, and occlusion with health and longevity. Recent studies have shown that, besides maintenance of the number of teeth, attempting to maintain or increase oral function, having a good diet and maintaining nutritional status are all linked to general health. Decreased oral function is a major risk factor for developing malnutrition and sarcopenia. Oral frailty, a new concept that has been recently introduced in Japan, is considered to have major effects on dental and oral health policies in Japan, in the old-age group, and is expected to be reflected in the dental and oral health policies of various countries, as they also predict increased life expectancies. Geriatr Gerontol Int 2020; ••: ••-••.

Association between oral health status and handgrip strength in older Korean adults

PURPOSE

Poor oral conditions in older adults are not limited to oral problems, which lead to physical problems. Prior research insufficiently has probed the relationship between oral health and physical function. This study investigated the relationship between oral health status and grip strength in older adults living in the community.

METHODS

This study used data from the 2014-2018 Korean National Health and Nutrition Survey. Oral health status was assessed by the type of dental prosthesis, the number of teeth. Grip strength was determined as the highest value among the three consecutive measurements of the dominant hand. The covariates included age, income, education, alcohol drinking, smoking, body mass index, sedentary time, comorbidity and number of caries teeth. Multiple logistic regression analysis was performed to examine the association between oral health status and grip strength.

RESULTS

Data on 6,437 older adults (men 2766; women 3671) were analyzed. The mean age was 72.9 ± 0.1 years. In the crude model of logistic regression analysis, both men and women had an association between full denture use and low grip strength compared to high grip strength. After controlling for covariates, the remaining 0-9 teeth was associated with low grip strength compared to high grip strength in men [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.03-1.88]. The use of full dentures was also associated with low grip strength compared to high grip strength in men (OR = 1.47, 95% CI = 1.09-1.98). No significant associations were found in women.

CONCLUSION

Low handgrip strength was associated with using full dentures and remaining 0-9 teeth in older men. Low grip strength, one of the key characteristics of sarcopenia and frailty, may serve as an important indicator of poor oral health, especially among men in late life.

Impact of Elderly Masticatory Performance on Nutritional Status: An Observational Study

Background and Objectives: Masticatory limitations on the dietary habits of edentulous subjects restrict their access to adequate nutrition, exposing them to a greater risk of protein energy malnutrition. The aim of this study is to verify the existence of an association between Masticatory Performance (MP) and nutritional changes in the elderly. Materials and Methods: 76 participants were enrolled. MP testing was performed using the two-color chewing gum mixing test. The system used reveals the extent to which the two differently colored chewing gums mix, and allows discrimination between different MPs. The assessment of the participants' nutritional statuses was carried out through a food interview. Anthropometric parameters were collected, and bioimpedance analysis was performed. Results: Mean MP was 0.448 ± 0.188. No statistically significant differences were detected between male and female subjects (p > 0.05). According to the Body Mass Index (BMI), obese patients had a lower MP than overweight and normal weight subjects (0.408 ± 0.225, 0.453 ± 0.169 and 0.486 ± 0.181, respectively). MP values were lower both in male and female subjects with a waist circumference above the threshold than those below it (0.455 ± 0.205 vs. 0.476 ± 0.110, respectively, in males and 0.447 ± 0.171 vs. 0.501 ± 0.138, respectively, in females). No relationship was noticed between MP and bioimpedance parameters (p > 0.05). Conclusions: A statistically significant relation was observed between MP and the number of missing teeth. A reduced MP could worsen nutritional parameters. A reduced MP did not seem to negatively affect bioimpedance parameters.

Combined effect of poor appetite and low masticatory function on sarcopenia in community-dwelling Japanese adults aged ≥ 75 years: A 3-year cohort study

OBJECTIVE

This study aimed to investigate the longitudinal association of the combination of poor appetite (PA) and low masticatory function (LMF) with sarcopenia in community-dwelling older adults.

METHODS

In total, 173 community-dwelling Japanese adults aged ≥ 75 years participated in the 3-year cohort study. Appetite assessment using the Simplified Nutritional Appetite Questionnaire (SNAQ) and masticatory function assessment using spectrophotometric measurement of differences in gum colour before and after masticating colour-changeable chewing gum (ΔE*ab) were performed at baseline. SNAQ score of ≤ 14 was defined as PA. The lowest tertile of ΔE*ab was defined as LMF. Follow-up examinations were administered annually over a 3-year period to determine sarcopenia incidence, which was defined by the criteria proposed by the Asian Working Group for Sarcopenia. Adjusted hazard ratios (HRs) of sarcopenia incidence according to the presence of PA and LMF were calculated using Cox proportional hazards regression models.

RESULTS

At baseline, 81 participants (46.8%) had neither PA nor LMF, 34 (19.7%) had PA alone, 35 (20.2%) had LMF alone, and 23 (13.3%) had both PA and LMF. On follow-up, 31 participants (17.9%) developed sarcopenia. After adjusting for covariates, the adjusted HR for sarcopenia in participants with both PA and LMF was 4.4 (95% confidence interval = 1.6-12.2) compared with those without PA or LMF. PA or LMF alone was not significantly associated with sarcopenia development.

CONCLUSIONS

Coexisting PA and LMF increase the risk of sarcopenia development among community-dwelling Japanese adults aged ≥ 75 years.

Oral Management in Rehabilitation Medicine: Oral Frailty, Oral Sarcopenia, and Hospital-Associated Oral Problems

Oral health is a crucial but often neglected aspect of rehabilitation medicine. Approximately 71% of hospitalized rehabilitation patients and 91% of hospitalized acute care patients have impaired oral health. Poor oral condition in hospitalized patients can be attributed to factors such as age, physical dependency, cognitive decline, malnutrition, low skeletal muscle mass and strength, and multimorbidity. Another major factor is a lack of knowledge and interest in oral problems among health care workers. Recently, new concepts have been proposed, such as oral frailty, oral sarcopenia, and hospital-associated oral problems. Oral frailty, the accumulation of a slightly poor status of oral conditions and function, strongly predicts physical frailty, dysphagia, malnutrition, need for long-term care, and mortality in community-dwelling older adults. Oral sarcopenia refers to sarcopenia associated with oral conditions and function, although its definition has not yet been fully discussed. Hospital-associated oral problems are caused by disease, disease treatment, surgery, endotracheal intubation, poor self-care abilities, lack of care by medical staff, drugs, and iatrogenic factors during hospitalization. Furthermore, oral problems have negative impacts on rehabilitation outcomes, which include functional recovery, length of hospital stay, discharge home, and in-hospital mortality. Oral health management provided by dental hygienists improves not only oral status and function, swallowing function, and nutritional status but also activities of daily living, discharge home, and in-hospital mortality in post-acute rehabilitation. Oral rehabilitation, promotion, education, and medical-dental collaboration can be effective interventions for oral problems and therefore are necessary to improve rehabilitation outcomes.

Development and Predictors of Sarcopenic Dysphagia during Hospitalization of Older Adults

The study aimed to investigate the impact of sarcopenia and sarcopenia-related conditions on the development of swallowing disorders during hospitalization. Older adult inpatients (n = 8768) without swallowing disorders in the premorbid period were studied. Sarcopenia-related conditions were evaluated in terms of nutritional status, physical status, and ambulatory conditions as well as hand-grip strength and muscle mass assessed by calf circumference. Development of swallowing disorders was defined based on food texture at discharge from the hospital. The patients’ mean age was 76.1 ± 6.9 years. A total of 374 (4.3%) patients developed swallowing disorders during hospitalization. They were older, with poorer nutritional status, and had more decline of physical performance than those without swallowing disorders. Performance Status score (odds ratio (OR) = 1.28 (1.12–1.46) p < 0.001), ambulatory dependency (OR = 1.72 (1.09–2.71), p = 0.020), malnutrition score (OR = 0.92 (0.87–0.97), p = 0.002), insufficient nutritional intake (OR = 2.33 (1.60–3.40), p < 0.001), and length of stay (OR = 1.01 (1.00–1.01), p = 0.001) were independent contributing factors for swallowing disorder development in the multivariate analysis. The presence of possible sarcopenia was also a contributor to swallowing disorder development. In conclusion, swallowing disorders could develop in patients with possible sarcopenia and sarcopenia-related conditions during hospitalization. Clinicians should be aware of this risk and provide appropriate interventions to prevent sarcopenic dysphagia.

The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea

Background

Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery.

Methods

In this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed.

Results

Dysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]).

Conclusions

Dysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.

Correlation between prognostic nutritional index and occlusal status in gastric cancer

OBJECTIVE

Systemic inflammatory responses in cancer patients are important factors for nutrition and prognosis. This study evaluates the association between tooth loss, occlusal status, and prognostic nutritional index (PNI).

METHODS

A total of 93 patients with gastric cancer were included. These parameters were investigated the following: stage, body mass index (BMI), total lymphocyte count, C-reactive protein (CRP), PNI, and albumin (ALB). Patients were divided into three groups by Eichner classification (group A had contact in four support zones; group B had in one to three zones or in anterior region; and group C had no contact). PNI assumed 40 or less undernutrition. Multiple regression analysis was performed (PNI, dependent variable; Eichner index, main independent variable), using four independent variables (sex, age, BMI, and CRP) as adjustment factors.

RESULTS

The mean ± SD PNI in groups A, B, and C was 43.0 ± 4.7, 41.7 ± 5.2, and 36.7 ± 7.7, respectively. A significant positive correlation was found between the number of teeth, both ALB, and PNI. ALB and PNI differed significantly between groups A and C (ALB, p = .0003; PNI, p = .005).

CONCLUSION

We recommend a preoperative dental evaluation for assessing the nutritional status of patients with gastric cancer.

The association between bilateral maximum occlusal force and all-cause mortality among community-dwelling older adults: The Tsurugaya project

PURPOSE

This study aimed to investigate the relationship between the bilateral maximum occlusal force (MOF) of full dental arches and all-cause mortality in a group of community-dwelling older males and females in Japan.

METHODS

This 13-year prospective cohort study was conducted among 815 older adults (395 male and 420 female) aged 70 years or over (mean age ± standard deviation: 75.1 ± 4.5 years). Bilateral MOF in the intercuspal position was recorded with horseshoe-shaped pressure-sensitive film. Participants were grouped by gender into tertiles according to MOF. Demographic variables, chronicity, comorbidity, physical status, cognitive and psychological status, social functioning, and blood chemistry data were also assessed. Information regarding all-cause mortality and migration was obtained from the Sendai Municipal Authority. Cox proportional hazard modeling was performed to assess all-cause mortality during the follow-up period.

RESULTS

In total, 159 male and 109 female participants died over a median 12.9-year follow-up period, and the cumulative mortality significantly increased with lower MOF in both males and females. The multivariate Cox proportional hazard model demonstrated a significant increase in the risk of all-cause mortality associated with lower tertiles of MOF, relative to the upper tertile in males (hazard ratio: 1.62; 95% confidence interval: 1.05-2.51) and females (hazard ratio: 1.94; 95% confidence interval: 1.10-3.56).

CONCLUSIONS

There was a significant and independent association of bilateral MOF with all-cause mortality in community-dwelling elderly males and females in Japan. These findings suggested that maintenance of oral functioning contributes to general health.

Screening for masticatory disorders in older adults (SMDOA): An epidemiological tool

PURPOSE

Masticatory changes in the older adult population may cause nutritional impairment, so epidemiological studies are important to allow specific public health interventions. Thus, this study aims at constructing and validating an instrument for screening for masticatory disorders in older adults (SMDOA).

METHODS

Validation study. First step: validity evidence based on test content. Defining the construct and elaborating the questions by a panel of experts and evaluating the representativeness and relevance of the items in relation to the construct by a committee of 28 experts. Analysis was performed through the Content Validity Index for Items (CVI-I) and the Content Validity Index (CVI). Second stage: validity evidence based on response processes. The questionnaire was applied to 40 older adults (≥60 years) using the cognitive interview strategy. Quantitative and qualitative analysis of the responses was carried out. Third stage: validity evidence based on the internal structure. The instrument was applied to 295 older adult patients and a confirmatory factorial analysis was performed to fit the model.

RESULTS

The first version of SMDOA consisted of 16 issues related to chewing. The CVI and CVI-I were satisfactory, and only one question was excluded. The instrument with 15 questions was well evaluated by the older adults, only requiring minor adjustments to the morphosyntax. After the confirmatory factorial analysis, adjustments were made in its internal structure resulting in the 9-question model in two factors regarding function and masticatory perception.

CONCLUSIONS

The SMDOA presented good evidence of validity in its content, response processes and internal structure.

Assessment of potential clinical cascade between oral hypofunction and physical frailty: Covariance structure analysis in a cross-sectional study

No report has yet examined the impact of oral hypofunction on physical frailty in relation to intra-relationships of physical frailty assessment items. The purpose of this study was to verify the potential of a clinical cascade between oral hypofunction and physical frailty, and especially to support the hypothesis that the influence of oral hypofunction on physical frailty is greater than the intra-relationships among elements of physical frailty and that sex differences significantly affect these relationships. The participants were 272 older adults (101 men and 171 women; mean age 75.1 ± 7.5 years). Maximum occlusal force (MOF) and oral dryness (OD), as indicators of oral hypofunction, and grip strength (GS) and walking speed (WS), as indicators of physical frailty, were measured. Mutual relationship of four variables was verified using covariance structure analysis. In men, three paths from MOF to WS and GS and from WS to GS were confirmed, and those from MOF to WS and from WS to GS were found to be significant (P < .01). In women, three paths from MOF to WS and GS and from WS to GS were also confirmed, as with the men, and those from MOF to WS and from MOF to GS were found to be significant (P < .01). Model adaptability was shown to be good for both men and women. The results suggest our hypothesis was verified, and it is expected that the early detection of oral hypofunction, that is MOF, may be important for assessing physical frailty, especially in women.

Elderly patients with lower-jaw mobility require careful food texture modification: A cohort study

BACKGROUND

Few studies have investigated the relationship between lower-jaw mobility and oral ingestible food texture choices in elderly patients. This study aimed to evaluate whether lower-jaw mobility affects levels of food texture modification.

METHODS

This prospective cohort study targeted inpatients aged ≥65 years with pneumonia or urinary tract infection from August 2014 through July 2015. We defined "lower-jaw mobility" as movement of the lower jaw (more than about 1 cm) when gently supported from both sides of the mandibular angle with index fingers. The primary outcome was food texture at discharge, which was evaluated using "Japanese Dysphagia Diet 2013": non per os, codes 0-4 (in the order of increasing swallowing difficulty), and normal meal.

RESULTS

We evaluated 38 patients in the mobility group (mean age: 86.5 years) and 251 patients in the nonmobility group (mean age: 83.2 years). Percentages of patients capable of ingesting each food texture were as follows (mobility vs nonmobility): normal meal, 5.3% vs 50.1%; code 4, 39.5% vs 31.9%; code 3, 5.3% vs 8.8%; code 2, 10.5% vs 4.4%; code 1, 2.6% vs 0.8%; code 0, 0.0% vs 0.4%; and non per os, 36.8% vs 2.8%. Food texture codes were lower in the mobility group (P < 0.001). These relationships remained significant even after adjusting for potential confounding factors in multivariate analysis (P < 0.001).

CONCLUSION

Elderly patients with lower-jaw mobility were restricted to texture-modified foods. Lower-jaw mobility can be assessed easily even by nonmedical personnel, and regular assessment could help identify elderly patients requiring dietary adjustment.

Risk factors associated with low handgrip strength in the older Korean population

Hand grip strength (HGS) is a means to assess health status and physical abilities indirectly. Various factors are known to be related to HGS, but data on the factors influencing HGS in the Korean population are lacking. Recently, the Korea National Health and Nutrition Examination Survey (KNHANES) conducted by the Korea Centers for Disease Control and Prevention surveyed social status, nutrition, physical status, and other medical history including HGS. This study aimed to investigate the social, physical, and individual health behavior factors associated with low HGS in the elderly Korean population. This population-based cross-sectional study was based on the 2014-2016 KNHANES. Community-dwelling Korean elderly (aged ≥65 years) were included in this survey. The relationship between HGS and socioeconomic status, nutrition, exercise, and other clinical characteristics were analyzed using multivariate logistic regression. The sample size was 3,634 (weighted: 6,006,406). Elderly men and women with low HGS showed lower body mass index, reduced physical activity and lower education level. Among elderly men, excessive carbohydrate and inadequate protein intake were observed in the low HGS group. Meanwhile, older women who did not drink alcohol and had diabetes were at higher risk of low HGS. In conclusion, various physical, nutritional, socioeconomic and comorbidity statuses were seemed to be the factors associated with HGS in Korean elderly. However, further cohort or case-control study will be necessary to determine the causal relationship of those factors and HGS.

The three-axial gyroscope sensor detects the turning point between opening and closing phases of chewing

Most devices measuring the kinematics of masticatory function are cumbersome to setup and not portable. Data collection would be facilitated, particularly in the elderly, if the device used for the objective measurement of mastication was easily transportable and simple to setup. Accelerometers and gyroscope sensors are lightweight and portable and may be useful alternatives. The definition of the turning point between the opening and closing phases of chewing is important for studies of associations between muscle activity and effects of perturbations. Measures of the mediolateral angle (specifically, the mandibular tilt from the lateral view) allow the detection of the turning point between the opening and closing phases. The aim was to determine whether a three-axial gyroscope sensor can detect the turning point between opening and closing phases of chewing. Fourteen asymptomatic participants chewed gum while the output was recorded from a three-axial gyroscope sensor (Seiko Epson, Japan) attached to the chin and a 6 degree-of-freedom electromagnetic jaw-tracking device (Pollhemus, USA). Bland-Altman plots were used to assess the matching of the recordings made by the three-axial gyroscope sensor and the jaw-tracking device. The turning points between the opening and closing phases of chewing matched closely when recorded by a jaw-tracking device and when using a three-axial gyroscope sensor. A three-axial gyroscope sensor can validly detect the turning point between the opening and closing phases during chewing of gum.

Association Between Sarcopenia and Tooth Loss

Background

The aim of this study was to determine whether the prevalence and extent of periodontal disease and tooth loss are increased in participants with sarcopenia.

Methods

This cross-sectional study included 8,053 males (sarcopenia, 2,772; nonsarcopenia, 5,281) and 10,729 females (sarcopenia, 3,085; nonsarcopenia, 7,644) ≥18 years of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011 and underwent assessments of oral health and appendicular skeletal muscle mass. Muscle mass index was calculated as appendicular muscle mass divided by height squared. The cutoff values for sarcopenia were 7.0 kg/m² for males and 5.4 kg/m² for females.

Results

The group with sarcopenia brushed their teeth less frequently. The presence of periodontitis was significantly higher in participants with sarcopenia (males, 30.3%; females, 45.9%) than in participants without sarcopenia (males, 18.3%; females, 17.4%) (p<0.001). The number of natural teeth was significantly lower in participants with sarcopenia. The adjusted odds ratio for sarcopenia in participants with <20 natural teeth compared to those with full dentition was 1.96 (95% confidence interval [CI], 1.58–2.48) in males and 2.86 (95% CI, 2.31–3.56) in females. Subgroup analysis of the adjusted odds ratio for sarcopenia in older (≥65 years) individuals with <20 natural teeth was 1.92 (95% CI, 1.49–2.66) in males and 2.63 (95% CI, 2.25–3.64) in females.

Conclusion

Loss of the natural teeth wass significantly associated with sarcopenia.

Relationship between masticatory function and frailty in community-dwelling Japanese elderly

BACKGROUND

Frailty likely results in impaired functioning, and frail individuals requiring long-term care have recently attracted the attention of researchers. In the oral health field, the number of elderly individuals who require intervention for retaining occlusion has been increasing, as has the number of remaining teeth and required prosthetic treatment. Additionally, the number of elderly with reduced masticatory function has also been increasing, and frailty is a suspected factor.

AIMS

The aim of this study is to clarify the relationship between frailty and masticatory function decline.

DESIGN

A cross-sectional study.

METHODS

A total of 747 participants (total mean age 73.6 ± 5.8 years old) underwent a comprehensive examination at the Tokyo Metropolitan Institute of Gerontology. Three masticatory functions were evaluated: maximum occlusal force, mixing ability, and self-reported chewing ability. Frailty was determined using all 25 questions of the Basic checklist developed by the Japanese Ministry of Health, Labour and Welfare, following the method reported by Satake et al. RESULTS: Binomial logistic analysis clarified the relationship between frailty and evaluation of each of the three masticatory functions. Significant correlations of pre-frailty or frailty with maximum occlusal force, mixing ability, and subjective chewing ability were observed.

CONCLUSION

All three masticatory functions (maximum occlusal force, mixing ability, and self-reported chewing ability) were associated with pre-frailty or frailty in community-dwelling Japanese elderly.

A 2-year longitudinal study of the relationship between masticatory function and progression to frailty or pre-frailty among community-dwelling Japanese aged 65 and older

BACKGROUND

An association has recently been reported between frailty and reduced masticatory function; however, the causal relationship remains unclear.

OBJECTIVE

The aim of this study was to clarify the relationship between masticatory function and frailty progression.

METHODS

Among 6699 individuals aged 65 and older (mean age 72.8 ± 5.2 years) who were invited to participate in comprehensive medical check-ups, 418 who underwent examinations at the Tokyo Metropolitan Institute of Gerontology in both 2013 and 2015 and who met inclusion criteria were included in this study. Frailty was determined with the Kihon Checklist developed by the Japanese Ministry of Health, Labour and Welfare. The following three masticatory functions were evaluated: occlusal force, mixing ability and subjective chewing ability. The following confounding factors were investigated: age, sex, grip strength, comfortable walking speed, Mini-Mental State Examination (MMSE) score, Self-Rating Depression Scale (SDS) score, skeletal mass index (SMI), number of medications taken and number of remaining teeth. Statistical analysis was performed with binomial logistic regression analysis.

RESULTS

Logistic regression analysis revealed that comfortable walking speed, SDS score, MMSE score and masticatory function were significantly related to progression to frailty or pre-frailty. Of the three masticatory function items evaluated, mixing ability and subjective chewing ability were related to frailty progression.

CONCLUSION

Our results confirm that masticatory function was associated with the progression to pre-frailty or frailty among community-dwelling individuals 65 years and older over the 2-year period of this longitudinal study. Of the masticatory function items evaluated, mixing ability and subjective chewing ability were associated with frailty progression.

Factors related to dissociation between objective and subjective masticatory function in Japanese community-dwelling elderly adults

Clinicians' evaluations of older adults sometimes reveal inconsistencies between objective and subjective dental status. This study investigated which factors contribute both to good objective masticatory function (OMF) and the poor subjective masticatory function (SMF) that often becomes a clinical issue. Study participants included 635 elderly community-dwelling Japanese adults who underwent a comprehensive geriatric health examination in 2012. SMF was assessed with a question from the Kihon Checklist on eating difficulties (poor or good). OMF was assessed by a colour-changing gum (poor or good). Also investigated were age, sex, depressive symptoms, instrumental activities of daily living (I-ADLs), number of people who joined the participant at dinner, grip strength, usual walking speed, number of remaining teeth, number of functional teeth and their occlusal force. The group with good OMF and good SMF, defined as group 1, and the group with good OMF but poor SMF, group 2, were compared. Logistic regression analyses confirmed that the number of remaining and functional teeth participants had was statistically unrelated to differences between OMF and SMF. Instead, differences were related to stronger depressive symptoms (OR = 1.67, CI = 1.14-2.44), less ability to conduct I-ADL activities (OR = 0.73, CI = 0.59-0.91), slower usual walking speeds (OR = 0.18, CI = 0.06-0.58) and less occlusal force (OR = 0.99, CI = 0.99-1.00). Depressive symptoms, I-ADLs, and physical function are shown to be significantly related to divergence between objective and subjective masticatory function in elderly Japanese. This suggests that dissociations between objective and subjective dental evaluations of elderly adults indicate need for assessment of their mental and physical function.

The relationship between masseter muscle thickness and appendicular skeletal muscle mass in Japanese community-dwelling elders: A cross-sectional study

PURPOSE OF THE STUDY

Sarcopenia has been identified as a health hazard in elderly people. Although the association between sarcopenia and a decrease in masticatory function has been reported, the mechanism underlying this association has not been widely reported. Therefore, in order to elucidate the relationship between sarcopenia and masticatory function, we examined whether the masseter muscle thickness (MMT), which is a factor influencing masticatory function, in community-dwelling elders is associated with the appendicular skeletal muscle index (SMI), a diagnostic criterion for sarcopenia.

MATERIALS AND METHODS

MMT was measured in 774 community-dwelling elders aged 65 years or older at resting state via ultrasonography, and SMI was measured with the bioelectrical impedance method. The relationships were investigated by calculating Pearson's correlation coefficients. Multiple regression analyses adjusted for age and sex, SMI, and oral-related items were performed to determine the association between these factors.

RESULTS

There was a significant correlation between the MMT and the SMI. The multiple regression analysis indicated that SMI was significantly associated with a decrease in MMT.

CONCLUSIONS

The reduction in whole-body skeletal muscle mass in sarcopenia may be involved in the reduction in MMT. Prevention of sarcopenia may be an important factor for maintaining masticatory function in the elderly.

Association of handgrip strength with various oral functions in 82- to 84-year-old community-dwelling Japanese

OBJECTIVE

The purpose of this study was to elucidate the associations between muscle strength and several oral functions in a large cohort of community-dwelling, 82- to 84-year-old community-dwelling Japanese people.

BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD

Several studies have examined the relationships between physical performance and oral functions. However, no studies have investigated the associations of muscle strength with various objectively evaluated oral functional parameters in a large cohort of very old adults.

MATERIALS AND METHODS

This study included 809 community-dwelling Japanese people (407 men and 402 women) aged 82-84 years. The oral functions examined were the maximal occlusal force, masticatory performance, stimulated salivary flow rate, repetitive saliva-swallowing test (RSST) score, tongue pressure and mouth-opening distance. Handgrip strength was measured, and its correlations with oral functions were assessed. Multiple linear and logistic regression analyses were performed to investigate the relationships between oral functions and handgrip strength.

RESULTS

Multivariate analysis revealed that handgrip strength was correlated with not only the maximal occlusal force, masticatory performance and tongue pressure but also the RSST score and mouth-opening distance after adjustment for sex, number of teeth, use of removable denture, periodontal condition, instrumental activities of daily living, body mass index. When we examine the elderly people whose handgrip strength is declining, we should predict that their various oral functions may be declining.

CONCLUSION

Handgrip strength was related to various oral functions after adjustment for the number of teeth in this population of community-dwelling 82- to 84-year-old Japanese.

Assessment of sarcopenia in virally suppressed HIV-infected Asians receiving treatment

OBJECTIVES

In a clinic-based, treated HIV-infected cohort, we identified individuals with sarcopenia and compared with age, sex and ethnically matched controls; and investigated associated risk factors and health outcomes.

DESIGN

Sarcopenia (age-related muscle loss) causes significant morbidity to the elderly, leading to frequent hospitalizations, disability and death. Few have characterized sarcopenia in the HIV-infected who experience accelerated aging.

METHODS

Sarcopenia was defined as low muscle mass with weak grip strength and/or slow gait speed using lower 20th percentiles of controls. Multivariate logistic and linear regression analyses were used to explore risk factors and health-related outcomes associated with sarcopenia among HIV-infected individuals.

RESULTS

We recruited 315 HIV-infected individuals aged at least 25 years with at least 1-year history of undetectable viral load on treatment (HIV RNA <50 copies/ml). Percentage of sarcopenia in 315 HIV-infected was 8%. Subsequently, 153 of the 315 were paired with age, sex and ethnically matched HIV-uninfected. The percentage of sarcopenia in the HIV-infected (n = 153) compared with uninfected (n = 153) were 10 vs. 6% (P = 0.193) respectively, whereas of those at least 50 years of age among them were 17% vs. 4% (P = 0.049), respectively. Associated risk factors among the HIV-infected include education level, employment status, BMI, baseline CD4 cell count, duration on NRTIs and GGT levels. Identified negative outcomes include mortality risk scores [5.42; 95% CI 1.46-9.37; P = 0.007) and functional disability (3.95; 95% CI 1.57-9.97; P = 0.004).

CONCLUSION

Sarcopenia is more prevalent in HIV-infected at least 50 years old compared with matched controls. Our findings highlight associations between sarcopenia with loss of independence and greater healthcare burden among treated HIV-infected individuals necessitating early recognition and intervention.

Sarcopenic Dysphagia. A Narrative Review

Sarcopenic dysphagia is described as difficulty swallowing due to generalized sarcopenia of skeletal muscles and thus swallowing muscles. It is a recently recognized condition. It draws attention due to its important complications. The risk factors of dysphagia include age, history of clinical disease, and physical frailty, including reduced activities of daily living. It is a common syndrome among the elderly and demands multidisciplinary therapeutic interventions, including nutritional support and rehabilitation programs, which are non-invasive but effective methods, mandatory for the best outcome. The prevention, assessment, and intervention methods for sarcopenic dysphagia are very important. Recent studies demonstrate that new concepts in rehabilitation and nutritional support render promising results.

Functional determinants of dietary intake in community-dwelling older adults: a DEDIPAC (DEterminants of DIet and Physical ACtivity) systematic literature review

Objective

The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults.

Design

A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant.

Setting

Community.

Subjects

Older adults at least 65 years old without acute or specific chronic diseases.

Results

From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived.

Conclusions

Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.

A 5-year longitudinal study of association of maximum bite force with development of frailty in community-dwelling older adults

To determine whether maximum bite force (MBF), an objective measure of oral function, is associated with development of frailty in community-dwelling older adults. This prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Baseline MBF was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up examinations, including physical fitness and anthropometric evaluation and structured questionnaires, were administered annually over a 5-year period to determine the incidence of frailty, which was defined by the presence of 3 or more of the following 5 components derived from the Cardiovascular Health Study: low level of mobility, low physical activity level, weakness, shrinking and poor endurance and energy. Adjusted hazard ratios (HRs) of incidence of frailty according to sex-stratified tertiles of baseline MBF were calculated using Cox proportional hazards regression models. During the follow-up, 49 participants (15.2%) developed frailty. Participants in the lower tertile of MBF exhibited a significantly greater risk of frailty than those in the upper tertile. After adjustment for sex, depression, diabetes and Eichner index, the adjusted HRs for frailty in the upper through lower tertiles of MBF were 1.00 (reference), 1.27 (95% confidence interval [CI]: 0.50-3.20) and 2.78 (95% CI: 1.15-6.72), respectively (P for trend = .01). Poor oral function, as indicated by low MBF, increases the risk of development of frailty among elderly men and women.

Indicators of Dysphagia in Aged Care Facilities

PURPOSE

The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities.

METHOD

A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating Assessment Tool score, oral motor assessment score, Mini-Mental State Examination, medical history, and various functional status ratings. Binomial logistic regression was used to identify independent variables associated with dysphagia in this cohort.

RESULTS

Two statistical models were constructed. Model 1 used variables from case files without the need for hands-on assessment, and Model 2 used variables that could be obtained from hands-on assessment. Variables positively associated with dysphagia identified in Model 1 were male gender, total dependence for activities of daily living, need for feeding assistance, mobility, requiring assistance walking or using a wheelchair, and history of pneumonia. Variables positively associated with dysphagia identified in Model 2 were Mini-Mental State Examination score, edentulousness, and oral motor assessments score.

CONCLUSIONS

Cognitive function, dentition, and oral motor function are significant indicators associated with the presence of swallowing in the elderly. When assessing the frail elderly, case file information can help clinicians identify frail elderly individuals who may be suffering from dysphagia.

Effects of a Community-Based Program for Oral Health and Nutrition on Cost-Effectiveness by Preventing Disability in Japanese Frail Elderly: A Quasi-Experimental Study Using Propensity Score Matching

OBJECTIVE

In the Japanese Long-Term Care Insurance (LTCI) system, a community-based program for oral health and nutrition (OHN program) has been implemented with the aim of reducing incident disability and care costs. However, the effectiveness of this program has not been confirmed epidemiologically. The purpose of the present study was to test the hypothesis that the OHN program does reduce incident disability and care costs.

DESIGN

A prospective study with a 28-month follow-up period was conducted using data from administrative databases at Tagajo City, Japan. Among frail elderly persons (aged 65 years or more) who were enrolled in the LTCI program in Tagajo, 64 participants in the OHN program and 128 controls (nonparticipants) were selected by propensity score matching.

MEASUREMENTS

We used 2 types of outcome measure: composite outcome (incident disability and death) and care cost. Data on incident disability were retrieved from the public LTCI database. Care cost was defined as the total amount of LTCI service cost added to medical care cost.

RESULTS

The hazard ratio of composite outcome was significantly lower for the intervention group than for the control group (hazard ratio = 0.32, 95% confidence interval 0.12-0.82). Even when we set incident disability as an outcome, the hazard ratio for the intervention group did not change (hazard ratio = 0.33, 95% confidence interval 0.11-0.97). The mean cumulative care cost during the 28 months tended to be lower for the intervention group ($4893) than that for the control group ($5770), but this was not statistically significant by the gamma regression model (cost ratio = 0.85, P = .513). The mean care cost per unit follow-up period (1 month) for the intervention group was significantly lower (cost ratio = 0.54, P = .027).

CONCLUSIONS

The results of this study suggest that the OHN program is effective for preventing incident disability and, consequently, for saving care costs per unit survival period.

Factors affecting masticatory function of community-dwelling older people: Investigation of the differences in the relevant factors for subjective and objective assessment

OBJECTIVE

This study aimed to examine relevant factors for subjective and objective assessment of masticatory functions and elucidate any differences between the two methods.

BACKGROUND

Previous studies have reported that the results of subjective and objective assessment of masticatory function in older people do not necessarily agree.

MATERIALS AND METHODS

This study included 487 community-dwelling Japanese older people (205 male and 282 female; mean age 74.1±6.3 years) who participated in a comprehensive geriatric health examination. Basic information (gender and age), higher level of competence in daily living, depression, subjective masticatory function (SMF) and objective masticatory function (OMF) assessments, cognitive function, skeletal muscle mass, handgrip strength, gait speed and oral status (number of remaining and functional teeth, mouth dryness and occlusal force) were recorded.

RESULTS

Multiple logistic regression analysis showed that depression (odds ratio [OR]: 1.181, 95% confidence interval [CI]: 1.094-1.275), mouth dryness (OR: 2.037, CI: 1.212-3.423) and occlusal force (OR: 0.997, CI: 0.996-0.999) were significantly associated with SMF, whereas higher level of competence in daily living (OR: 0.730 CI: 0.586-0.910), skeletal muscle mass (OR: 0.521 CI: 0.283-0.960), number of functional teeth (OR: 0.862 CI: 0.775-0.959), number of remaining teeth (OR: 0.868 CI: 0.810-0.930) and occlusal force (OR: 0.994, CI: 0.991-0.998) were associated with OMF.

CONCLUSION

Subjective masticatory functionSMF and OMF were associated with different factors, suggesting that both mental and physical factors should be taken into consideration when treating decreased masticatory function.