Relationship between tongue pressure and back muscle strength in healthy elderly individuals

Factors associated with the oral health status of patients with schizophrenia: A cross-sectional study

BACKGROUND

Oral function deterioration attributed to ageing and medications is one of the main contributory factors of dysphagia. Therefore, oral health management is essential in older patients with schizophrenia. However, no previous studies have evaluated the oral function in patients with schizophrenia.

OBJECTIVE

We surveyed patients with schizophrenia to identify factors associated with ageing-related variations in oral function.

METHODS

This cross-sectional study included 34 male patients diagnosed with schizophrenia who were hospitalised at a psychiatric hospital between July and September 2021 and underwent a screening examination during dental care. The survey items included basic information, oral hygiene information, oral (oral diadochokinesis [ODK] and tongue pressure), physical function, and nutritional status. Thirty-six male community-dwelling older individuals were included as controls, and their outcomes were compared with those of patients with schizophrenia.

RESULTS

Compared with healthy older adults, patients with schizophrenia demonstrated significantly lower teeth numbers, ODK, and calf circumference (CC) (p < .05). Multiple regression analysis revealed that ODK was associated with age and schizophrenia (p < .05). Conversely, tongue pressure was associated with CC (p < .05), suggesting different factors' association with the parameters indicating decreased oral function.

CONCLUSIONS

Our study findings suggest that older patients with schizophrenia have decreased tongue pressure and generalised muscle mass, highlighting the need to manage oral function. Interventions for tongue pressure were more strongly associated with muscle mass and could be easier to manage than those with disease-dependent changes in ODK.

TRIAL REGISTRATION

Retrospectively registered.

Effects of oral function and depressive tendencies on nutritional status in older adults requiring support or low-level care: An investigation using path analysis

AIM

This study investigated the effects of differences in oral function and depressive tendencies on nutritional status in older adults requiring support or low-level care.

METHODS

In 106 older adult participants residing in nursing/care homes or participating in community-level preventive care activities, the Mini Nutritional Assessment-Short Form (MNA®-SF) for nutritional status and oral diadochokinesis (ODK), tongue pressure, and repetitive saliva swallowing test (RSST) for oral function, 15-item Geriatric Depression Scale (GDS), Diet-Related Quality of Life Scale-Short Form (DRQOL-SF), and Functional Independence Measure (FIM) were administered. Basic information, including cognitive function, was evaluated. Hierarchical MNA (dependent variable)-based multiple regression analysis was performed, followed by path analysis using factors with significant associations with MNA scores.

RESULTS

RSST, ODK, tongue pressure, FIM, and DRQOL were positively correlated with MNA scores and GDS was negatively correlated. Hierarchical multiple regression demonstrated associations with tongue pressure, GDS, FIM, DRQOL scores, and gender. Path analysis confirmed significant paths from tongue pressure to MNA, tongue pressure to FIM, and FIM to MNA (P < .001). Significant paths were confirmed from GDS to MNA (P < .01), from DRQOL to MNA (P < .05), and from gender to MNA (P < .01).

CONCLUSIONS

Tongue pressure, GDS, FIM, DRQOL scores, and gender were identified as factors that directly affect MNA. Tongue pressure showed the greatest effect and indirectly affected MNA via FIM. These findings emphasize the importance of early detection of low nutritional risk for preventing depression and oral function deterioration, and of evaluation of dietary satisfaction and improvement of quality of life in diets.

Improving physical performance reduces dysphagia via improvement of tongue strength in patients with acute heart failure: a two-wave cross-lagged mediation model analysis

BACKGROUND

Physical performance improvement through whole-body exercise may have a positive impact on dysphagia via improvement of maximum tongue pressure (MTP).

AIMS

The present study aimed to quantitatively analyze whether improvement in physical performance reduces dysphagia by improving MTP in patients with acute heart failure (AHF).

METHODS

A total of 146 patients with AHF and dysphagia were included. Dysphagia was defined as a functional oral intake scale (FOIS) score < 6. The short physical performance battery (SPPB) indexed physical performance. A two-wave cross-lagged mediation model was used to examine whether an improvement in SPPB results improves the FOIS score via an improvement in MTP. The SPPB, MTP, and FOIS scores (T1: baseline, T2: hospital discharge) were included in the model.

RESULTS

A total of 146 patients were included in the final analysis. The SPPB result at T1 positively affected MTP (β = 0.150, P = 0.030) and the FOIS score (β = 0.249, P = 0.002) at T2. MTP at T1 also positively affected the FOIS score at T2 (β = 0.189, P = 0.026). Furthermore, the SPPB result indirectly affected the FOIS score by affecting the MTP (indirect effect = 0.028; 95% CI = 0.010, 0.078).

DISCUSSION

This study contributes to the knowledge base regarding the potential of exercise therapy as a new treatment strategy for dysphagia in patients with AHF.

CONCLUSION

An improvement in SPPB results improved the FOIS score by improving the MTP in patients with AHF.

Association between characteristics of swallowing-related muscles and trunk muscle mass

Swallowing function is associated with systemic factors. Whether trunk or appendicular skeletal muscle mass is a better indicator of swallowing-related muscle characteristics in community-dwelling older adults is not clear. Hence, we investigated the association between the characteristics of swallowing-related muscles (e.g., mass and quality) and trunk muscle mass. Community-dwelling older adults aged ≥ 65 years (n = 141; men: n = 45, women: n = 96) were recruited for this cross-sectional observational study via a health survey conducted in 2018. Trunk muscle mass index (TMI) and appendicular skeletal muscle mass index (SMI) were measured using bioelectrical impedance analysis. Cross-sectional areas (CSAs) and echo intensity (EI) of the geniohyoid muscle (GHM) and tongue were evaluated using an ultrasonic diagnostic apparatus. Multiple regression analysis was used to examine the relationship of the characteristics of swallowing-related muscle with TMI and SMI. Multiple regression analysis showed that CSA of the GHM was positively associated with both TMI (B = 24.9, p < 0.001) and SMI (B = 13.7, p = 0.002). EIs of swallowing-related muscles were not associated with TMI and SMI. Trunk muscle mass was associated with swallowing-related muscle mass and not muscle quality. The results of this study shed light on the elucidation of association of dysphagia with TMI and SMI.

Associations of swallowing-related muscle quantity and quality with sarcopenic parameters

PURPOSE

To examine the associations between swallowing-related muscle characteristics and sarcopenic parameters.

METHODS

We included 147 community-dwelling older adults (age: 71.6 ± 4.7 years, body mass index: 23.0 ± 2.7 kg/m² (mean ± standard deviation), men: 50; women: 97) and categorized them into robust (n = 125), low-function (n = 17), and sarcopenia (n = 5) groups based on the diagnostic criteria of the Asia Working Group for Sarcopenia 2019. We evaluated the geniohyoid muscle (GHM) and tongue characteristics (muscle quantity and quality). The cross-sectional area (CSA) indicated the muscle quantity, and echo intensity (EI) values indicated the muscle quality. A multiple regression analysis was performed to clarify the relationship of swallowing-related muscle characteristics and strength with sarcopenic parameters.

RESULTS

The grip strength (CSA of GHM: β = 1.64, p = 0.03) and skeletal muscle mass index (CSA of tongue: β = 74.81, p = 0.003, EI of tongue: β = 1.92, p = 0.009) were better indicators of swallowing-related muscle characteristics.

CONCLUSION

These findings may facilitate the early detection of aging-related deterioration in swallowing-related musculature through the diagnostic process of sarcopenia and increase our understanding of muscle physiology.

Usefulness and Validity of a Jaw-Closing Force Meter in Older Adults

We prototyped a new device with a soft and flexible pressure sensor to measure the force to close the mandible with or without occlusal support (jaw-closing force, JCF). This study aimed to clarify the practicality of this instrument. Healthy young and older adults with occlusal support were recruited. Intra- and inter-rater reliability of the JCF meter was examined using data from younger participants. Data regarding age, sex, body mass index, remaining teeth, and dentures of the older adults were obtained. Furthermore, the right and left JCFs were measured using a JCF meter; occlusal force was measured using an existing occlusal force-measuring device. Intra- and inter-rater correlation coefficients were significantly reproducible (0.691−0.811, p < 0.05). JCF was correlated with occlusal force (p < 0.05). Multiple regression analysis revealed that factors significantly associated with JCF included denture status (p < 0.001), age (p = 0.038), and occlusal force (p = 0.043). The prototyped JCF meter can measure JCF with high reproducibility, reliability, and validity. Further, association with occlusal force, which is an existing index, was observed. This device could be used to measure the JCF with or without occlusal support as a new method of evaluating oral function in older adults.

Factors Predicting Tongue Pressure Decline among Community-Dwelling Older Adults: The Takashimadaira Study

A limited number of longitudinal studies have explored factors contributing to decreases in tongue pressure (TP). This longitudinal study aimed to clarify the factors affecting TP decline among community-dwelling older adults. We followed the Takashimadaira Study participants with a baseline TP ≥ 30 kPa for 2 years. A TP of <30 kPa at follow-up was defined as TP decline. We used Poisson regression with robust standard errors to explore the factors related to TP decline. The studied baseline variables were dental status, sociodemographic characteristics, health behaviors, appetite, medical conditions, physical function, cognitive status, and anthropometric and body composition characteristics. Inverse probability weighting (IPW) was used to adjust for selection bias. Overall, 357 individuals (159 men and 198 women) with a mean (standard deviation) age of 75.9 (4.1) years were included in the analyses. Of these, 59 study participants (16.5%) exhibited TP decline. After adjusting for baseline TP and applying IPW, poor appetite (incident rate ratio [95% confidence interval] = 1.58 [1.01−2.48]), low skeletal muscle mass index (1.66 [1.02−2.70]), and cognitive impairment (1.93 [1.12−3.33]) were associated with TP decline. In conclusion, we demonstrated that baseline appetite, body composition, and cognitive status could predict future TP decline among community-dwelling older adults.

Higher extracellular water/total body water ratio is associated with lower tongue and grip strength: a cross-sectional study

PURPOSE

This study aimed to investigate the relationship between tongue factors (tongue strength and tongue volume), systemic factors (grip strength and walking speed), and the extracellular water/total body water ratio.

METHODS

This cross-sectional study included community-dwelling adults. Body water composition and skeletal muscle mass index were measured using bioelectrical impedance analysis. Moreover, tongue grip strength, tongue volume, occlusal support condition (Eichner classification), and walking speed were measured. Multiple linear regression analysis was performed to investigate the relationship between the tongue and systemic factors as dependent variables and body water composition.

RESULTS

We included 171 community-dwelling adults (62 men and 109 women) aged 70.0 years (interquartile range: 8). Tongue strength (r=-0.22, p=0.004) and grip strength (r=-0.39, p<0.001) were correlated with the extracellular water/total body water ratio. In multiple linear regression analysis, tongue strength was associated with the extracellular water/total body water ratio (β=-0.20, p=0.034), and grip strength was associated with the extracellular water/total body water ratio (β=-0.12, p=0.047), sex, body mass index, skeletal muscle mass index, and occlusal support condition.

CONCLUSIONS

A higher extracellular water/total body water ratio indicates lower tongue and grip strength. Dentists and dental hygienists should be aware of systemic factors present in patients with lower tongue and grip strength. These findings may lead to further medical investigations and diagnosis of other systemic diseases.

Oral Health of Elderly People in Institutionalized Care and Three-Month Rehabilitation Programme in Southern Poland: A Case-Control Study

Demographic ageing is a global growing process and the quality of ageing is an important parameter in this process. The aim of the study was to analyse the distribution of remaining dentition in relation to oral hygiene indicators among elderly people remaining in institutional care and those who participated in a 3-month rehabilitation program, aimed at increasing time of independent functioning, in southern Poland. The patients underwent a questionnaire and clinical examination. An analysis of missing teeth was performed, plaque index, and gingival index were measured. Residents of the Municipal Health Centre for Older and Dependent People (n = 50) had a higher incidence of missing teeth in the maxilla (88.4%), mandible (77.6%), as well as in the maxilla and mandible combined (83%) than residents of the Daily Medical Care House (n = 30). The distribution of the remaining teeth, in both groups, corresponds to the outlets of the large salivary glands. The group of 53.8% of patients with dry mouth had PI scored 3. Residents with dry mouth were more likely to have plaque deposits and gingival inflammation. It is necessary to develop and implement an oral care program for patients with reduced saliva secretion, with a particular focus on dependents.

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.

Effect of Isometric Tongue Lifting Exercise on Oral Function, Physical Function, and Body Composition in Community-Dwelling Older Individuals: A Pilot Study

INTRODUCTION

It is known that oral frailty is one of the risk factors for physical frailty. Therefore, early detection, appropriate treatment, and prevention of oral frailty are really important. Tongue lifting exercise has been identified as a well-known method for improving decreased tongue pressure, one of the factors for oral frailty. However, few reports have investigated how tongue-strengthening exercises affect physical function and body composition. The aim of this study was to investigate the effects of isometric tongue lifting exercises on oral function, physical function, and body composition.

METHODS

Participants were 49 elderly people aged 68-79 years, who had previously participated in the "Itoshima Frail Study." Participants performed isometric tongue lift exercises for 3 months. Oral function (tongue pressure and oral diadocokinesis), physical function (grip strength, open-eyed one-leg standing, sit-to-stand motion time, 5-m gait speed, and 3-m Timed up and go [TUG]), and body composition were measured at baseline and post-intervention, and the extent of changes in each item was statistically analyzed. Furthermore, participants were divided into physical frailty/pre-frailty and robust groups based on the Japanese version of the frail scale proposed by [BMC Geriatr. 2015 Apr;15:36] and were compared in terms of the extent of changes in each item baseline and the post-intervention.

RESULTS

After the intervention, oral function increased significantly together with a significant improvement in physical function, open-eyed one-leg standing time, sit-to-stand motion, and 3-m TUG. For body composition, visceral fat level and basal metabolic rate decreased significantly. Although no significant change in body composition was observed in the physical frailty/pre-frailty group after the intervention, significant improvements in several items were observed in the robust group.

CONCLUSION

Isometric tongue lifting exercise can effectively improve oral function. Furthermore, it might affect physical function and body composition.

Effects of Oral Management on Elderly Patients with Pneumonia

OBJECTIVES

In this study, we examined the factors influencing the presence or absence of dental intervention in patients with pneumonia in an acute-care hospital, focusing on oral intake and its status.

DESIGN

Observational study.

SETTING

Teikyo University School of Medicine, Mizonokuchi Hospital.

PARTICIPANTS

Patients ≥65 years of age who were admitted to the Teikyo University School of Medicine, Mizonokuchi Hospital between January 1, 2018 and December 31, 2019 with pneumonia who were referred to the Department of Rehabilitation with suspected dysphagia were included in the study. Fifty patients who underwent dental intervention were compared with 50 controls who had received no dental interventions prior to the opening of the dental department.

MEASUREMENTS

Time series matching was retrospectively performed using the Oral Health Assessment Tool (OHAT). From the medical records, age at admission, sex, pneumonia severity classification (age, dehydration, respiratory failure, orientation disturbance, and blood pressure [A-DROP] score), body mass index, Charlson's Comorbidity Index, OHAT, functional oral intake scale (FOIS) score at admission and discharge, and the length of hospital stay were retrieved; FOIS level ≥4 was defined as established oral intake.

RESULTS

The number of patients in the control group before matching was 179. Twelve patients with missing information and seven patients who died in the hospital were excluded from this study. Multivariable logistic regression analysis showed that dental intervention (odds ratio 3.0, p = 0.014) was associated with the establishment of oral intake at discharge. Multiple logistic regression analysis showed that dental intervention was a significant factor for FOIS at discharge (p = 0.002) and the length of hospital stay (p = 0.039).

CONCLUSION

Oral management with dental intervention was associated with establishing oral intake and reducing hospital stay in patients with pneumonia, regardless of pneumonia severity or comorbidities.

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.