Regular dental visits may prevent severe functional disability: A community-based prospective study

Differences in Cumulative Long-Term Care Costs by Dental Visit Pattern Among Japanese Older Adults: The JAGES Cohort Study

BACKGROUND

Long-term care (LTC) costs create burdens on aging societies. Maintaining oral health through dental visits may result in shorter LTC periods, thereby decreasing LTC costs; however, this remains unverified. We examined whether dental visits in the past 6 months were associated with cumulative LTC insurance (LTCI) costs.

METHODS

This cohort study of the Japan Gerontological Evaluation Study targeted independent adults aged≥65 years in 2010 over an 8-year follow-up. We used data from a self-reported questionnaire and LTCI records from the municipalities. The outcome was cumulative LTCI costs, and exposure was dental visits within 6 months for prevention, treatment, and prevention or treatment. A 2-part model was used to estimate the differences in the predicted cumulative LTCI costs and 95% confidence intervals (CIs) for each dental visit.

RESULTS

The mean age of the 8 429 participants was 73.7 years (standard deviation [SD] = 6.0), and 46.1% were men. During the follow-up period, 17.6% started using LTCI services. The mean cumulative LTCI cost was USD 4 877.0 (SD = 19 082.1). The predicted cumulative LTCI costs were lower among those had dental visits than among those who did not. The differences in predicted cumulative LTCI cost were -USD 1 089.9 (95% CI = -1 888.5 to -291.2) for dental preventive visits, -USD 806.7 (95% CI = -1 647.4 to 34.0) for treatment visits, and -USD 980.6 (95% CI = -1 835.7 to -125.5) for preventive or treatment visits.

CONCLUSIONS

Dental visits, particularly preventive visits, were associated with lower cumulative LTCI costs. Maintaining oral health through dental visits may effectively reduce LTCI costs.

Self-care ability and associated factors in community-dwelling older adults living with oral frailty using the COM-B model

BACKGROUND

Self-care can improve overall oral health. However, few studies have investigated this in community-dwelling older adults with oral frailty. The Capability, Opportunity, Motivation and Behaviour (COM-B) model may be an appropriate framework to identify factors that affect self-care ability.

OBJECTIVES

The purpose of this study was to investigate the current status of and factors influencing self-care ability in community-dwelling older adults living with oral frailty, and to analyse the risk factors of low self-care ability.

METHODS

Two hundred seventy-five community-dwelling older adults with oral frailty participated in this cross-sectional study from October 2022 to March 2023. Participants underwent evaluations of oral health knowledge and behaviour, oral health literacy, nutritional condition, social support, oral health-related quality of life, self-efficacy and self-care ability using questionnaires. The self-care ability of older adults was assessed using the Chinese version of self-care ability scale for the elderly (SASE). The influencing factors were evaluated by single-factor analysis, correlation analysis and multi-factor analysis. Furthermore, we conducted additional analysis, wherein self-care ability was analysed as a categorical variable.

RESULTS

Of the participants, the SASE score was 62.43 ± 7.33, and 73.09% were inadequate at self-care ability. There was a positive correlation between the level of self-care ability and each variable (p < .001). Multiple linear regression showed that health literacy (p < .001), age (p < .001), nutritional condition (p = .001), gender (p = .003), quality of life (p = .014) and self-efficacy (p = .040) were significantly associated with decreased self-care ability (R2 = 0.444, F = 19.241). Binomial logistic regression analysis showed that gender, educational level, nutritional condition, oral health literacy and quality of life (all P<0.05) were risk factors for developing low levels of self-care ability.

CONCLUSION

This study suggests that health literacy, age, nutritional condition, quality of life, gender and self-efficacy are important factors that influence self-care ability in community-dwelling older adults living with oral frailty.

Professional dental care and survival rates in long-term care recipients: A cohort study of 1 459 163 individuals in South Korea

OBJECTIVES

To determine the dental care pattern and survival rates of participants who received long-term care (LTC) and a matched control cohort in South Korea.

BACKGROUND

Global ageing trends and the development of superaged societies pose healthcare challenges. South Korea's LTC system aids those with chronic illnesses and disabilities. Despite the link between oral health and systemic diseases, providing dental care in LTC facilities often reflects social neglect.

METHODS

We identified 1 459 163 individuals eligible for LTC insurance in the Korean National Health Insurance Service database from July 2008 to 2015 (LTC cohort) and 1 459 544 individuals matched through propensity-score matching (matched cohort). The LTC recipients were further categorised into subgroups based on their care type (institutional, home or mixed care). Population of utilising dental services and the average number of dental visits were counted in each cohort, and the survival rate of the LTC cohort was determined according to dental utilisation.

RESULTS

Population of utilising dental services increased steadily in all cohorts except for institutional care, with the highest utilisation (around 30%) observed in the matched cohort. Lower independence in LTC cohorts was associated with lower dental utilisation: 18-27% for home care, 12-18% for mixed care, and 10% for institutional care. The survival rates in the LTC cohort were significantly lower than in the matched cohort (P < .0001), with 28.1% survival in LTC vs 59.3% in the matched cohort.

CONCLUSION

Long-term care recipients experience social neglect for oral care, while higher survival rates were observed in those utilised dental services.

Number of teeth and functional disability in community-dwelling older adults

INTRODUCTION

This study determined whether tooth loss was associated with the development of functional disability and estimated the population attributable fraction (PAF) of functional disability due to tooth loss, along with risk factors for functional disability such as physical function and cognitive impairment.

METHODS

The participants were 838 community-dwelling older adults aged ≥70 years living in the Tsurugaya district in Japan in 2003. The exposure variable was the number of remaining teeth (counted by trained dentists). Other variables were age, sex, depressive symptoms, cognitive impairment, educational attainment, physical function and social support. The Cox proportional hazards model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the incidence of functional disability for each risk factor, such as tooth loss. The functional disability PAF due to tooth loss was estimated, and risk factors for functional disability were identified.

RESULTS

In total, 619 (73.9%) participants developed functional disability during follow-up. A multivariable model showed that those with <20 teeth (HR, 1.28; 95% CI, 1.08-1.53) were more likely to develop functional disability than those with 20 teeth or more. PAF estimation for functional disability was shown to have decreasing values in the following order: age, female sex, tooth loss and reduced physical function.

CONCLUSIONS

Tooth loss was associated with the development of functional disability in community-dwelling older Japanese adults. While retaining teeth may be a potential strategy for avoiding functional disability, clinical studies on the effect of dental treatment on preventing functional disability are warranted.

Utilization of Japanese long-term care-related data including Kaigo-DB: An analysis of current trends and future directions

Despite high expectations from the government and researchers regarding data utilization, comprehensive analysis of long-term care (LTC)-related data use has been limited. This study reviewed the use of LTC-related data, including Kaigo-DB, in Japan after 2020. There was an increase in studies using LTC-related data in Japan between 2020 and 2021, followed by a stabilization period. The national government provided 13.5% of this data (6.5% from Kaigo-DB), while prefectures and municipalities contributed 85.2%, and facilities provided 1.3%. The linked data used in 90.4% of the studies primarily consisted of original questionnaire or interview surveys (34.6%) and medical claims (34.0%). None of the studies based on Kaigo-DB utilized linked data. In terms of study design, cohort studies were the most common (84.6%), followed by descriptive (5.1%), cross-sectional (3.2%), and case-control studies (1.3%). Among the 138 individual-based analytical descriptive studies, the most frequently used LTC-related data as an exposure was LTC services (26.8%), and the most common data used as an outcome was LTC certification or care need level (43.5%), followed by the independence degree of daily living for the older adults with dementia (18.1%). To enhance the use of LTC-related data, especially the valuable national Kaigo-DB, insights can be gleaned from how researchers effectively utilize municipal and prefectural data. Streamlining access to Kaigo-DB and enabling its linkage with other datasets are promising for future research in this field.

Disparity in access for people with disabilities to outpatient dental care services: a retrospective cohort study

BACKGROUND

People with disabilities face difficulties in oral health management and gaining access to dental care. The availability of a regular source of dental care (RSDC) is an important factor that influences the access to health services and care management. The purpose of this study was to determine the effect of the availability of RSDC on the number of annual dental visits and dental expenses per visit among people with disabilities.

METHODS

Data of 7,896,251 patients with dental problems in South Korea were analyzed using the 2002-2018 National Health Insurance claims data. A generalized estimating equation was applied to analyze the repeated-measurement data, and the interaction effect between RSDC and the disability severity was evaluated.

RESULTS

The number of annual dental visits was higher among people with (2.62) than among those without (2.23) disabilities. Despite their increased dental needs, both annual dental visits and dental expenses per visit were low among older individuals (p < 0.001). The proportion and frequency of annual dental visits was lower among women than among men with disabilities. RSDC had differential effects on the severity of disability. Compared to people without disabilities, RSDC increased the number of annual dental visits (p = 0.067) and the dental expenses per visit (p < 0.05) among those with severe disabilities, but the effect on the number of annual dental visits was not significant among those with mild disabilities (p = 0.698).

CONCLUSIONS

Our results suggest a need for a special dental care system for people with disabilities, to ensure an RSDC, particularly for women and for older people with disabilities.

Relationship between maintenance of occlusal support achieved by home-visit dental treatment and prognosis in home-care patients-a preliminary study

AIM

To determine whether occlusal maintenance and reconstruction by dental intervention is associated with the prognosis of older home-care patients.

METHODS

The study participants were 289 older home-care patients (101 males, mean age 82.2 ± 7.7 years) who received visiting dental treatment from dental clinics in the region between 2012 and 2018. The participants were followed up for 1000 days after receiving the necessary dental treatment in a home-visit setting. The participants were divided into three groups: those with natural tooth occlusion, those whose molar occlusion was maintained or reconstructed by dentures, and those whose occlusion was not reconstructed. Factors associated with prognosis were determined using the Cox proportional hazard model, with occlusal status, comorbidities, the activity of daily living, and residence status as explanatory variables.

RESULTS

In the overall population, occlusal status (hazard ratio [HR] of those with occlusal disintegration versus those with natural tooth occlusion: 2.1, confidence interval [95% CI]: 1.18-3.82) and age (HR: 2.28, 95% CI: 1.44-3.61) were identified as significant factors. In the group of participants aged <85 years, only occlusal status (HR of those with occlusal disintegration versus those with natural tooth occlusion: 3.4, 95% CI: 1.34-8.68) was a significant factor. In the group of participants aged ≥85 years, occlusal status was not significantly associated with prognosis.

CONCLUSIONS

The maintenance and acquisition of occlusal support achieved by dental treatment contribute to improved prognosis in older patients younger than 85 years requiring home nursing care. Geriatr Gerontol Int 2022; 22: 976-981.

The impact pathways of environmental, social, and behavioural factors on healthy ageing for urban dwellers aged 85+: Longitudinal study of the Tokyo Oldest Old Survey on Total Health (TOOTH)

In the context of global population ageing and concentration in cities, the population aged 80 and over (80+) is growing rapidly. Japan has the fastest ageing population and longest healthy average life expectancy, while health decline becomes pronounced and care needs increase in the 85+ age group post the ‘average life expectancy’. The healthy ageing of older urban community dwellers is a pressing issue in world initiatives for sustainable urbanisation. However, for the 85+ age group, less is known about how promoting/inhibiting factors and their pathways influence healthy ageing, and related longitudinal studies remain insufficient. Using data from a longitudinal cohort study conducted from 2008–2009 to 2014–2015 among independent dwellers aged 85+ in central Tokyo (men = 203, women = 232), this study analysed the impact pathways of environmental, social, and behavioural factors on health and survival to explore promoters and potential risks on healthy ageing by gender, with multi-group structural equation modelling (SEM) and Bayesian SEM. For both genders, there was a positive chained pathway starting from friends as facilitators through positive interactions between 'social participation’ and 'active behaviour' to 'ageing-related health'. Additionally, their personal networks were small, suggesting that men with family-centred networks and women with non-family-centred networks require different approaches and supports. Implications of the results are discussed, and an organised social watch and support system, which becomes more important in the ‘new normal’ for urban dwellers aged 85+, is recommended.

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A 6-year longitudinal cohort study for independent urban dwellers aged 85+.

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SEM analysis among environmental, social, and behavioural factors on health.

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Friends can facilitate positive chained path through activities to health.

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Gender-differences in nature of personal networks affect healthy ageing.

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Social watching, support are necessary for this group in sustainable urbanisation.

Age differences in the association of physical leisure activities with incident disability among community-dwelling older adults

Background

The relationship between leisure activities (LA) in old age and prevention of disability has not been fully investigated, and age and gender differences of these relationships are unknown. This study aimed to investigate whether physical and cognitive LA predicted incident disability among community-dwelling older adults by age and gender.

Methods

We prospectively observed 8,275 residents aged 65 or above without disability at baseline for 3 years. Incident disability was defined as a new certification of the public long-term care insurance system. LA were classified into two types: physical LA and cognitive LA. The frequency of LA was categorized into frequent (i.e., once a week or more), moderate (i.e., monthly or yearly), and non-engagement. Covariates included age, gender, family number, education, perceived economic situation, body mass index, chronic medical conditions, alcohol consumption, smoking status, regular dental visits, depression, cognitive functioning, and social participation. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for incident disability. We performed stratified analyses by age groups (i.e., the young-old aged 65–74 and the old-old aged 75–97) and gender (i.e., men and women).

Results

The 3-year cumulative incidence of disability was 7.5%. After adjustment for covariates and mutual adjustment for both types of LA, a significant dose-response relationship between more frequent LA and lower risk of incident disability was found in young-old physical LA (P-trend < 0.001), in old-old cognitive LA (P-trend = 0.012), in male cognitive LA (P-trend = 0.006), and in female physical LA (P-trend = 0.030). Compared with people without LA, adjusted CIR (95% CI) of frequent LA was 0.47 (0.30–0.74) in young-old physical, 0.75 (0.58–0.96) in old-old cognitive, 0.65 (0.46–0.89) in male cognitive, and 0.70 (0.52–0.95) in female physical. Regarding the effect modification according to age and gender, only interaction between age and physical LA significantly prevented incident disability (P for interaction = 0.019).

Conclusion

We found age differences in the association of physical LA with incident disability among community-dwelling older adults. An effective measure to prevent long-term care in the community would be to recommend frequent physical LA for the young-old.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.21-00018.