Persistent oral health problems associated with comorbidity and impaired diet quality in older adults

Using Standardised International Oral Health-Related Datasets in 6 Countries

INTRODUCTION

Oral diseases affect a significant proportion of the world's population, yet international comparisons involving oral health outcomes have often been limited due to differences in the way country-level primary data are collected. In response to this, the World Dental Federation (FDI) Oral Health Observatory project was launched with the goal of collecting and producing standardised international data on oral health across countries. The aim of this descriptive cross-sectional study was to examine associations between self-reported general health and a range of factors (sociodemographics, oral health-related behaviours, oral impacts, clinical variables) using these standardised international datasets.

METHODS

Dentists within FDI member National Dental Associations who chose to take part in the project were selected using a multistage sampling method. The number of dentists in each cluster was set according to the proportion of the national population living in the area, and 50 patients per dentist were systematically approached to take part. Patients and dentists completed 2 separate questionnaires on a mobile app. Ordinal logistic regression (conducted in December 2022) was used to analyse the linked patient and dentist data from 6 countries: China (n = 2242); Colombia (n = 1029); India (n = 999); Italy (n = 711); Japan (n = 1271); and Lebanon (n = 798). Self-reported general health was the dependent variable, with age, sex, education, self-reported oral health-related behaviours, self-reported oral impacts, and clinical variables acting as the independent variables.

RESULTS

The results demonstrated a different pattern of associations in the different countries. Better self-reported general health was associated with degree-level education in all 6 countries and with reporting no oral impact and no sensitive teeth in 4 countries. Several country-specific patterns were also found, including the importance of tooth brushing in Colombia, periodontal health in Italy, and differing associations with sugary drinks consumption in India and Japan.

CONCLUSIONS

These descriptive findings provide a basis for further research and, importantly, for advocacy in identifying patient oral health care needs according to both person-reported and clinical aspects. This can facilitate optimisation of service provision and potentially influence policy and investments.

Sociodemographic and Health Indicators of Diet Quality in Pre-Frail Older Adults in New Zealand

This study aimed to identify sociodemographic and health indicators of diet quality in pre-frail community-dwelling older adults. Pre-frail older adults are those at risk of progression to clinical manifestations of frailty and are targets for preventative intervention. We previously reported that pre-frail older adults have reasonably good overall diet quality. However, further analyses found a low intake of energy, protein and several micronutrients.

METHODS

We collected detailed dietary intake from pre-frail (FRAIL scale 1-2) older adults using NZ Intake24, an online version of 24 h multiple pass dietary recall. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). We used regression generalized linear models to determine predictors of diet quality as well as classification and regression tree (CART) analysis to examine the complex relationships between predictors and identified profiles of sub-groups of older adults that predict diet quality.

RESULTS

The median age in this sample (n = 468) was 80.0 years (77.0-84.0). Living with others, a high deprivation index and a higher BMI were independent predictors of poorer diet quality. With CART analysis, we found that those with a BMI > 29 kg/m2, living with others and younger than 80 years were likely to have a lower diet quality.

CONCLUSIONS

We found that BMI, living arrangement and socioeconomic status were independent predictors of diet quality in pre-frail older adults, with BMI being the most important variable in this sample when the interaction of these variables was considered. Future research is needed to determine the similarities and/or differences in the profile of subgroups of older adults with poorer diet quality.

Demographics and Oral Health Care Utilization for Older Adults

The population of older adults is projected to increase dramatically as Baby Boomers continue to reach age 65 into 2029. This article discusses key shifts in this demographic, including changes in overall health status and living arrangements, that can aid in defining older adults and their medical needs. It also highlights the changes in dental use patterns and the increase in demand for comprehensive dental services for older adults in recent years. The article focuses on the fact that oral health contributes to overall health and the dental workforce must be prepared to treat older adults in their practices.

The Prevention, Diagnosis, and Treatment of Rapid Oral Health Deterioration (ROHD) among Older Adults

The world’s population is aging. Older adults are at risk for multiple chronic medical problems as they age. The management of these diseases requires these people to take a variety of medications, which may have undesired side effects. These medical issues can impact oral healthcare and result in a precipitous decline in oral health. A standardized teaching model has been developed to help novice dental practitioners learn how to access and treat oral health problems in older adults. This model is called rapid oral health deterioration (ROHD) risk assessment. The model has four steps for assessment and four categories of risk. This paper describes the components of the ROHD risk assessment, and how it can be used to prevent, diagnose and treat ROHD among older adults.

Correlation between geriatric nutritional risk index and oral condition in gastric cancer patients

OBJECTIVES

Nutritional status is a useful prognostic factor in gastric cancer patients. Since oral hypofunction may cause undernutrition, we cross-sectionally investigated whether the Geriatric Nutritional Risk Index (GNRI) is affected by the number of remaining teeth, occlusal support status and denture use.

MATERIALS AND METHODS

The participants were 114 patients diagnosed with gastric cancer between April 2017 and March 2020. The stage of gastric cancer, body mass index, albumin level, total lymphocyte count, C-reactive protein level and GNRI were evaluated. The number of remaining teeth was also evaluated, and the occlusion state was determined based on the Eichner classification. The patients were divided into three main groups representing different occlusal states based on the Eichner index and were also categorised based on denture use.

RESULTS

The mean age ± standard deviation of the patients was 75.2 ± 5.5 years. The Eichner classification had a significant positive correlation with GNRI. Low GNRI was associated with a poor occlusal state in group C, while a higher GNRI was associated with a stable occlusal state in group A. However, the denture-related groups showed no significant differences in GNRI.

CONCLUSION

The GNRI was associated with the occlusal support level but not with denture use.

Factors Associated With Dietary Risks in Older Korean Americans

Given the importance of healthy eating in the later years of life, the present study examined factors associated with dietary risks in older Korean Americans. We hypothesized that dietary risks would be associated with sociodemographic disadvantages, adverse health conditions, and limited sociocultural resources. Dietary risks were assessed with a scale covering five behavioral and situational risk factors (eating alone, skipping meals, functional challenges, oral health problems, and financial difficulties). Analyses of the data from the Study of Older Korean Americans (N = 2,150) showed that the sample on average had 1.13 risks (SD = 1.31), eating alone having the highest frequency (35.6%). Supporting the hypothesis, higher levels of dietary risks were found in individuals with sociodemographic disadvantages, poorer physical and mental health status, smaller social networks, and lower acculturation. Findings suggest concerted efforts to promote dietary behaviors and call attention to older immigrants who are socially and culturally isolated.

Patterns and predictors of dental hospitalizations in patients with acquired brain injury from pre-injury to acute and post-acute injury

BACKGROUND

Acquired brain injury (ABI) can cause long-term disability and functional impairment.

OBJECTIVE

This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations.

METHODS

The cohort comprises patients with ABI (n = 683), traumatic (n = 282) and non-traumatic (n = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated using multilevel mixed-effects logistic regression.

RESULTS

Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ+299.3) and remained elevated in the post-acute phase (23.98, Δ+20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization.

CONCLUSION

Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients.

Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults

The prevalence of nutrition-related chronic diseases, such as obesity, cardiovascular disease, and type 2 diabetes, among adults in the U.S. is of increasing importance. These conditions adversely affect the overall public health, health care systems, and economy. Marginalized minority groups have been disproportionally affected by these conditions. Lack of or inadequate health insurance limits access to health care, which contributes to poor health outcomes among individuals with these conditions. South Florida is home to diverse racial/ethnic minority groups, many of whom are uninsured and do not have access to expert-delivered nutrition education services. It is imperative to thoroughly study the health needs of these underserved patient populations and examine the rate of nutrition-related conditions among them in order to develop medically and culturally tailored nutrition education programs for them. Therefore, the aim of this study was to assess the prevalence of nutrition-related diseases among multi-racial/ethnic uninsured individuals living in South Florida. A four-week electronic health record of adult patients (N=272) from a free clinic in South Florida was analyzed. Spearman`s correlation and binary regression models were used to assess the relationship between the variables. The sample included females (65%) and males (35%). The mean age was 49.08±14.56 years. Overall, 87% had at least one nutrition-related condition, with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). BMI was a significant predictor of the prevalence of hypertension among Whites (p=0.008) and Blacks (p=0.002) but not Asians (p=0.536). Overall, a high rate of nutrition-related chronic diseases was found among uninsured adults in this study. This supports the need for increased medically, culturally, and economically tailored nutrition education programs in free clinic settings.

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

BACKGROUND

Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults.

METHODS

We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71-80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability.

RESULTS

In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27-3.42; OR = 1.73, 95% CI 1.03-2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13-3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04-1.94).

CONCLUSIONS

Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.

The Effect of Professional Oral Care on the Oral Health Status of Critical Trauma Patients Using Ventilators

Background: Oral care reduces the incidence of ventilator-associated pneumonia. In addition, it is important that critically ill patients to maintain their oral health in order to restore their quality of life and to receive adequate nutrition after recovery. Objective: The purpose of this study was to evaluate the effect of professional oral hygiene care (POHC) on the oral health status of patients using a ventilator. Methods: Fifty-seven ventilated trauma patients were admitted to a tertiary medical institution. For 5 days, the dental hygienist performed POHC every 24 h along with routine oral hygiene care (ROHC) every 8 h for the experimental group (Exp.) (n = 29), whereas only ROHC was provided the control group (Cont.) (n = 28). Oral health status was evaluated using a modified bedside oral exam (MBOE). Results: There was no significant difference between the two groups in the total MBOE score up to 48 h after admission. However, the difference between the two groups was significant for MBOE (F = 16.10, p = 0.000), gingiva (F = 6.02, p = 0.018), buccal mucosa (F = 4.21, p = 0.046), and dental plaque score after 72 h (F = 13.15, p = 0.000). Conclusion: This study confirms the importance of POHC in improving the oral health.

Effectiveness of Standard Oral Care Plan During Hospital Stay in Individuals With Brain Injury

Objective: To investigate the effectiveness of an existing standard oral care program (SOCP) and factors associated with it during hospitalization in individuals with acquired brain injury (ABI).

Material and Methods: A total of 61 individuals underwent a SOCP for 4 weeks in a longitudinal observational study. Rapidly noticeable changes in oral health were evaluated by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at weeks 1 and 5. Individuals' brushing habits, eating difficulties, and the onset of pneumonia were retrieved from their medical records. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.

Results: Dental plaque (P = 0.01) and total BOE score (P &lt; 0.05) decreased over time but not the proportion of dental calculus (P = 0.30), BOP (P = 0.06), and tooth brushing frequency (P = 0.06). Reduction in plaque and BOE over time were negatively associated with higher periodontitis scores at baseline (coef. −6.8; −1.0), respectively, which in turn were associated with an increased proportion of BOP (coef. ≈ 15.0). An increased proportion of calculus was associated with eating difficulties (coef. 2.3) and the onset of pneumonia (coef. 6.2).

Conclusions: Nursing care has been fundamental in improving oral health, especially reducing dental plaque and BOE scores. However, our findings indicate a need for improving the existing SOCP through academic-clinical partnerships.

Clinical Relevance: Early introduction of oral care program to brain-injured individuals is beneficial in reducing plaque accumulation and improving oral health.

Neighbourhoods and oral health: Agent-based modelling of tooth decay

This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models.

Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study

Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.

Oral health in patients with dementia: A meta-analysis of comparative and observational studies

OBJECTIVE

Poor oral health is common in dementia, but findings of epidemiological studies have been inconsistent. This meta-analysis examined oral health in patients with dementia diagnosed according to standardized diagnostic criteria.

METHODS

Six international databases (PubMed, EMBASE, PsycINFO, Medline, Cochrane Library, and Web of Science) were searched from their commencement date until 8 November 2018. Oral health was measured by the Remaining Teeth (RT) and Decayed, Missing, and Filled Teeth (DMFT) Index. The mean differences (MD) and 95% confidence intervals (CI) of DMFT Index total and component scores were calculated using a random-effect model.

RESULTS

Twenty-four studies were included for analyses. The pooled DMFT Index was 23.48 (95% CI: 22.34, 24.62), while the pooled score for each component was 2.38 (95% CI: 1.56, 3.20) in decayed teeth (DT), 18.39 (95% CI: 15.92, 20.87) in missing teeth (MT), 2.29 (95% CI: 0.62, 3.95) in filled teeth (FT), and 11.59 (95% CI: 9.14, 14.05) in RT. Compared to controls, people with dementia had significantly a higher DMFT Index total score (MD = 3.80, 95% CI: 2.21, 5.39, p < 0.00,001), and significantly lower number of RT (MD = -3.15, 95% CI: -4.23, -2.06, p < 0.00,001). Subgroup analyses revealed that higher DMFT Index score was significantly associated with year of survey (>2010), study design (case-control study), percentage of females (≤54.3), and the Mini Mental State Examination score (≤18.2). Higher MT score was significantly associated with study design (cross-sectional study), and lower FT score was significantly associated with year of survey (>2010).

CONCLUSIONS

Oral health was significantly poorer in people with dementia compared with controls. Regular screening and effective treatment should be implemented for this population.

Demographics and Oral Health Care Utilization for Older Adults

The population of older adults is projected to increase dramatically as Baby Boomers continue to reach age 65 into 2029. This article discusses key shifts in this demographic, including changes in overall health status and living arrangements, that can aid in defining older adults and their medical needs. It also highlights the changes in dental use patterns and the increase in demand for comprehensive dental services for older adults in recent years. The article focuses on the fact that oral health contributes to overall health and the dental workforce must be prepared to treat older adults in their practices.

Impact of Poor Oral Health on Community-Dwelling Seniors: A Scoping Review

The aim of this scoping review was to determine health-related impacts of poor oral health among community-dwelling seniors. Using MeSH terms and keywords such as elderly, general health, geriatrics, 3 electronic databases-Medline, CINAHL, and Age Line were searched. Title and abstracts were independently screened by 3 reviewers, followed by full-texts review. A total of 131 articles met our inclusion criteria, the majority of these studies were prospective cohort (77%, n = 103), and conducted in Japan (42 %, n = 55). These studies were categorized into 16 general health outcomes, with mortality (24%, n = 34), and mental health disorders (21%, n = 30) being the most common outcomes linked with poor oral health. 90% (n = 120) of the included studies reported that poor oral health in seniors can subsequently lead to a higher risk of poor general health outcomes among this population. Improving access to oral healthcare services for elderly can help not only reduce the burden of oral diseases in this population group but also address the morbidity and mortality associated with other general health diseases and conditions caused due to poor oral health. Findings from this study can help identify shortcomings in existing oral healthcare programs for elderly and develop future programs and services to improve access and utilization of oral care services by elderly.

Application of Ohmic-Vacuum Combination Heating for the Processing of Senior-Friendly Food (Multiphase Food): Experimental Studies and Numerical Simulation

The popularity of senior-friendly food has been increasing as the world enters the age of an aging society. It is required that senior-friendly food products are processed with the new concept of processing techniques that do not destroy the nutritional and sensory values. Ohmic heating can be an alternative to conventional heating methods for processing senior-friendly food with retaining excellent taste and quality because of less destruction of nutrients in the food. In this study, the ohmic–vacuum combination heating system was developed to process a multiphase type of senior-friendly food. Changes in physical and electrical properties of senior-friendly model foods were investigated depending on the experimental conditions such as vacuum pressure intensity and vacuum pretreatment time. Numerical simulations based on the experimental conditions were performed using COMSOL multiphysics. The ohmic–vacuum combination heating method with agitation reduced the heating time of the model food, and non-uniform temperature distribution in model food was successfully resolved due to the effect of vacuum and agitation. Furthermore, the difference was found in the hardness of solid particles depending on the vacuum treatment time and intensity after the heating treatment. The ohmic–vacuum combination heating system appeared effective when applying for the senior-friendly foods in multiphase form. The simulation results matched reasonably well with the experimental data, and the data predicted through simulation could save the cost and time of experimentation.

Interventions for improving oral health in people after stroke

BACKGROUND

For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group.

OBJECTIVES

To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke-specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts and full-text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta-analyses. We used GRADE to assess the quality of evidence for each outcome.

MAIN RESULTS

Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria. OHC interventions compared with usual care Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care. Multi-component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS -0.66, 95% CI -1.40 to 0.09; 2 trials, 83 participants; I² = 83%; P = 0.08; very low-quality evidence). Stroke survivors had less plaque on their dentures when staff had access to the multi-component OHC intervention (DMS -1.31, 95% CI -1.96 to -0.66; 1 trial, 38 participants; P < 0.0001; low-quality evidence). There was no evidence of a difference in gingivitis (DMS -0.60, 95% CI -1.66 to 0.45; 2 trials, 83 participants; I² = 93%; P = 0.26: very low-quality evidence) or denture-induced stomatitis (DMS -0.33, 95% CI -0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low-quality evidence) among participants receiving the multi-component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi-component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low-quality evidence). OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I² = 94%; P = 0.03; very low-quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I² = 65%; P = 0.06; very low-quality evidence). OHC interventions compared with placebo Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I² = 42%; P = 0.07; low-quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone-iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77). One OHC intervention compared with another OHC intervention Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi-component OHC intervention compared with conventional OHC interventions at three months (MD -0.04, 95% CI -0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low-quality evidence). There were no data for denture plaque.

AUTHORS' CONCLUSIONS

We found low- to very low-quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low-quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta-analyses to be low or very low quality, and this limits our confidence in the results. We still lack high-quality evidence of the optimal approach to providing OHC to people after stroke.

Diet Quality and Risk of Parkinson's Disease: A Prospective Study and Meta-Analysis

BACKGROUND

Several dietary components have been shown to be neuroprotective against risk of neurodegeneration. However, limited observational studies have examined the role of overall diet quality on risk of Parkinson's disease.

OBJECTIVES

We examined the associations between diet quality and risk of Parkinson's disease in a prospective cohort study and meta-analysis.

METHODS

Included in the cohort study were 3,653 participants (1,519 men and 2,134 women; mean age: 81.5 years) in the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Diet quality was assessed using a validated dietary screening tool containing 25 food- and behavior-specific questions in 2009. Potential Parkinson's cases were identified using electronic health records based on ICD9 (332.*), ICD10 (G20), and Parkinson-related treatments. Hazard ratios (HRs) and 95% confidence intervals (CIs) across diet quality tertiles were calculated using Cox proportional hazards models after adjusting for potential confounders. We further performed a meta-analysis by pooling our study with four published papers on this topic. Random-effects model was utilized to calculate the pooled risk ratios and 95% CIs.

RESULTS

During a mean of 6.94 years of follow-up, 47 incident Parkinson's cases were documented. Having high diet quality at baseline was associated with lower Parkinson's disease risk (adjusted HR for the highest vs the lowest diet quality tertile = 0.39; 95% CI: 0.17, 0.89; p-trend = 0.02). The meta-analysis including 140,617 individuals also showed that adherence to high diet quality or a healthy dietary pattern was associated with lower risk of Parkinson's disease (pooled risk ratio = 0.64; 95% CI: 0.49, 0.83).

CONCLUSION

Having high diet quality or a healthy dietary pattern was associated with lower future risk of Parkinson's disease.

Associations of social, physical, and financial factors with diet quality among older, community-dwelling women

OBJECTIVE

This analysis examined whether specific social, physical, and financial factors were associated with diet quality among older, community-dwelling women.

METHODS

This cross-sectional analysis was conducted in a subset of 6,094 community-dwelling Women's Health Initiative participants who completed a food frequency questionnaire, administered from 2012 to 2013, and a self-administered supplemental questionnaire, administered approximately 1 year later. The supplemental questionnaire included five questions assessing social, physical, and financial factors related to eating. Diet quality was assessed with the Healthy Eating Index-2010 (HEI-2010; range of 0-100; higher score indicates a higher quality diet). The total HEI-2010 score was calculated by summing individual scores representing the intake of nine adequacy components (beneficial food groups) and three moderation components (food groups to limit). Associations of responses to the five questions on the supplemental questionnaire with HEI-2010 scores were examined with multiple linear regression, adjusting for relevant covariates.

RESULTS

Mean ± standard deviation age of participants was 78.8 ± 6.7 years. Reporting eating fewer than two meals per day, having dental or other mouth problems causing problems with eating, and not always being able to shop, cook, or feed oneself were associated with statistically significantly lower HEI-2010 scores, compared with those not reporting these issues, after multivariable adjustment: 5.37, 2.98, and 2.39 lower scores, respectively (all P values <0.0001). Reporting eating alone most of the time and not always having enough money to buy food were not associated with HEI-2010 scores.

CONCLUSIONS

Among older, community-dwelling women, eating fewer than two meals per day, dental and other mouth problems, and diminished ability to shop for food, prepare meals, and feed oneself were associated with lower diet quality. These are potential targets for interventions to improve diet quality in older women. : Video Summary:http://links.lww.com/MENO/A561.

Self-Reported Oral Health Status Among Adults Aged 40+ Years With and Without Vision Impairment: National Health Interview Study, 2008

PURPOSE

To examine self-reported oral health among adults aged 40 years and older with and without vision impairment.

DESIGN

Cross-sectional, with a nationally representative sample.

METHODS

We used publicly available data from the Oral Health Module, last administered in 2008, of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath, and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked, or stained teeth; and/or bleeding gums), and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (P < .05) between vision impairment and oral health outcomes by age group, sociodemographics, and other explanatory variables.

RESULTS

Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged ≥65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status and 57.3% reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90%-150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment.

CONCLUSIONS

Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population.

Personalized Dental Caries Management for Frail Older Adults and Persons with Special Needs

Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.

Prosthetic treatment in the adult French population: Prevalence and relation with demographic, socioeconomic and medical characteristics

BACKGROUND

The aim of this study was to estimate the prevalence of dental prosthetic treatment and to investigate the demographic, social, economic and medical factors associated with the use of fixed and removable dentures in a representative sample of adults living in France.

METHODS

The data were obtained from the 2002-2003 Decennial Health Survey, a cross-sectional study of a representative sample of the population living in France, which included 29,679 adults. Information was collected by interview. The variables collected were fixed denture, removable denture, age, gender, number of children, area of residence, nationality, educational attainment, family social status, employment status, annual household income per capita, supplementary insurance, chronic disease, eyesight problems/glasses, hearing problems/hearing aids. Multinomial logistic regression models were used to study the relationship between prosthetic treatment and demographic, socioeconomic and medical characteristics unadjusted, adjusted for age and adjusted for all the characteristics.

RESULTS

The prevalence of prosthetic treatment was 34.6% (95% confidence interval (CI): [34.1; 35.2]) for fixed prosthetic dentures and 13.8% (95% CI: [13.4; 14.2]) for removable prosthetic dentures. We showed a gradient between educational attainment and removable dentures; the odds ratio adjusted for all the variables (aOR) associated with no or primary education compared to post-secondary education was 2.56; 95% CI: [2.09; 3.13]. When annual household income per capita was low, subjects were less likely to report fixed dentures (aOR=0.68; 95% CI: [0.62; 0.75]) than those with high annual household income per capita. Individuals without insurance less often reported fixed dentures than those with private insurance. Those reporting chronic disease were less likely to report fixed dentures (aOR=0.87; 95% CI: [0.79; 0.95]) but more likely to report removable dentures (aOR=1.29; 95% CI: [1.17; 1.43]) than those without chronic disease.

CONCLUSION

This study reveals social, economic and medical inequalities in fixed and removable prosthetic treatment among adults in France.

Tooth loss among older adults according to poverty status in the United States from 1999 through 2004 and 2009 through 2014

BACKGROUND

As tooth loss decreases in an aging United States, retaining enough natural teeth for function is important for quality of life.

METHODS

The authors used data from the 1999 through 2004 and the 2009 through 2014 National Health and Nutrition Examination Surveys to assess changes in tooth loss in adults 50 years or older. The authors evaluated changes in edentulism, retaining all teeth, and having a functional dentition (21 or more natural teeth) according to poverty status.

RESULTS

Edentulism was lower in 2009 through 2014 than in 1999 through 2004 (11% versus 17%) for adults 50 years or older, but this decrease was not significant among the poor (people at < 100% of the federal poverty guideline; P > .05). Complete tooth retention improved from 14% to 21% between 1999 through 2004 and 2009 through 2014 for people 50 years or older (P < .05). Gains were attributable mostly to adults who were nonpoor (≥ 200% federal poverty guideline). More older adults had a functional dentition in 2009 through 2014 than in 1999 through 2004 (67% versus 55%; P < .05), although the increases generally were significant only for those not living in poverty.

CONCLUSIONS

Complete tooth loss has decreased by more than 75% for those aged 65 through 74 years over the past 5 decades in the United States. Improvements in tooth loss measures, such as edentulism and complete tooth retention, have been most significant among the nonpoor, whereas those who are poor have experienced fewer improvements.

PRACTICE IMPLICATIONS

An aging population is experiencing less edentulism and greater tooth retention, so older adults may need more regular oral health care and prevention services to address concerns such as root caries and periodontal disease.

Hidden Hunger: Solutions for America's Aging Populations

The global population, including the United States, is experiencing a demographic shift with the proportion of older adults (aged ≥ 65 years) growing faster than any other age group. This demographic group is at higher risk for developing nutrition-related chronic conditions such as heart disease and diabetes as well as infections such as influenza and pneumonia. As a result, an emphasis on nutrition is instrumental for disease risk reduction. Unfortunately, inadequate nutrient status or deficiency, often termed hidden hunger, disproportionately affects older adults because of systematic healthcare, environmental, and biological challenges. This report summarizes the unique nutrition challenges facing the aging population and identifies strategies, interventions, and policies to address hidden hunger among the older adults, discussed at the scientific symposium "Hidden Hunger: Solutions for America's Aging Population", on March 23, 2018.

Does Oral Health Predict Functional Status in Late Life? Findings From a National Sample

OBJECTIVE

This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States.

METHOD

Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study ( N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS

Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health.

DISCUSSION

Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.

Correlation between dental conditions and comorbidities in an elderly Japanese population: A cross-sectional study

The purpose of this study was to investigate the correlation between dental conditions and comorbidities in an elderly population in Japan.A database constructed using data obtained from 12 nursing homes in Japan was used in this study. The study period ranged from January 2014 to December 2015, and elderly individuals with dental and other medical records were included in the analysis. Linear regression models were used to analyze univariate and multivariate correlation between dental conditions, comorbidities, and other sociodemographic/clinical backgrounds.After excluding individuals with missing data, 289 elderly individuals (107 men and 182 women; mean age, 85 years) were included in the analysis. These individuals had an average of 11.6 teeth, and the number decreased with older age (P < .001). The average number of decayed teeth was 1.4. A total of 116 subjects (40.1%) had dementia. In terms of comorbidities, dementia was not significantly associated with the number of present teeth (P = .56), but it was associated with the number of decayed teeth (P = .018). This association was also observed after adjusting for confounding variables in the multivariate regression analysis (P = .030).The number of decayed teeth was associated with dementia. While causality cannot be inferred from these observational results, the findings indicate that dental health could represent a marker of impending dementia, and probably represent a marker of general health status in the elderly population. Additional longitudinal studies are highly desirable to understand the causal relationships between dental conditions and comorbidities.

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.

Difference in food and nutrient intakes in Korean elderly people according to chewing difficulty: using data from the Korea National Health and Nutrition Examination Survey 2013 (6th)

BACKGROUND/OBJECTIVES

Chewing difficulty is a factor contributing to a poor nutritional status in the elderly. The aim of this study was to examine disparities in food and nutrition intakes among Korean elderly people with and without chewing difficulty.

SUBJECTS/METHODS

This study utilized data from the sixth Korea National Health and Nutrition Examination Survey conducted in 2013. The study subjects included males and females over 65 years of age who were not required to adhere to a special diet due to disease or sickness. They were divided into groups according to their chewing ability. Those who found chewing “very difficult” or “difficult”, were combined to form the chewing difficulty group. Similarly, those who found chewing “moderately difficult”, “easy”, and “very easy” were combined to form the normal chewing group.

RESULTS

Of the 999 subjects, 47.7% had chewing difficulties and the prevalence of chewing difficulty was higher in females than in males (P = 0.03) and higher in those 75 years of age and over than in younger individuals (P < 0.001). The chewing difficulty group had a significantly lower intake of fruits and vegetables (P < 0.05) and lower vitamin C and potassium intake than those in the normal group. Comparison of the percentages of Dietary Reference Intakes for Koreans (KDRIs) in the two groups indicated that the intake of most nutrients (energy, vitamin C, thiamin, riboflavin, niacin, calcium, phosphorus, sodium, potassium, and iron) were significantly lower in the chewing difficulty group than in the normal group. In particular, calcium intake was inadequate (51% of KDRIs) in the chewing difficulty group.

CONCLUSIONS

The results indicate that chewing difficulty is closely related to food and nutrient intake in the elderly and can result in vitamin and mineral intake deficiencies. It is evident that the care of elderly subjects with chewing difficulty is essential for maintaining a healthy lifestyle.

Living situations associated with poor dietary intake among healthy Japanese elderly: the Ohasama Study

BACKGROUND

Rapid increases in life expectancy have led to concurrent increases in the number of elderly people living alone or those forced to change living situations. Previous studies have found that poor dietary intake was common in elderly people living alone. However, there have been few studies about the dietary intake in elderly people living in other situations, particularly those living with family other than a spouse (nonspouse family), which is common in Japan.

OBJECTIVE

To examine the differences in dietary intake by different living situations in elderly Japanese people. We analyzed the data of 1542 healthy residents in the town of Ohasama aged 60 years and over who had completed self-administered questionnaires.

METHODS

The dietary intake was measured using a validated 141-item food frequency questionnaire. Multiple regression models with robust (White-corrected) standard errors were individually fitted for nutrients and foods by living situation.

RESULTS

In men, although the presence of other family was correlated with significantly lower intake of protein-related foods, e.g., legumes, fish and shellfish, and dairy products, these declines were more serious in men living with nonspouse family. Conversely, in men living alone the intake of fruits and vegetables was significantly lower. In women, lower intakes of fruit and protein-related foods were significantly more common in participants living with nonspouse family than those living with only a spouse.

CONCLUSION

These findings revealed that elderly people living alone as well as those living with family other than a spouse had poor dietary intake, suggesting that strategies to improve food choices and skills for food preparation could promote of healthy eating in elderly Japanese people.

[Seniors and orthodontics: from denial to a reasonable choice]

When patients older than 60 decide to undergo orthodontic treatment, their motivation is not merely for esthetic purposes; it is also intended to preserve their biological capital. Their treatment is often complicated. The orthodontist has to take into account any particularities related to their past dental or even orthodontic history. Their treatment are freed, sometimes due to necessary compromises, from constraints that are determined by the occlusion, the periodontium or by prosthetic devices which are sometimes implant borne. For some patients, the original shape of their teeth that make up their smile are an integral part of their personality. By preserving the integrity of these teeth with an orthodontic treatment they avoid the sudden and jarring transformation of their smile and maintain their identity. Therapeutic choices that combine orthodontics and prosthetics and sometimes surgery can preserve the senescence of a face.

Tooth loss strongly associates with malnutrition in chronic kidney disease

BACKGROUND

In chronic kidney disease (CKD), inadequate nutritional intake, inflammation, and increased oxidative stress have been the major contributing factors in malnutrition pathogenesis. However, there is still a paucity of evidence assessing the magnitude of the effect of tooth loss on malnutrition in CKD populations. The authors hypothesize that among patients with CKD, tooth loss may affect nutritional status, using the National Health and Nutrition Examination Survey 1988 to 1994 (NHANES III).

METHODS

Glomerular filtration rate (GFR) was estimated based on cystatin C levels using the relevant equation. Urinary albumin-to-creatinine ratio (albuminuria) was calculated in milligrams per gram with a cutoff point of 30 mg/g. CKD was defined based on estimated GFR <60 mL/minute/1.73m(2) and albuminuria ≥30 mg/g. The cutoff point for serum albumin was set at 3.7 g/dL. Tooth loss categories were based on the number of missing and replaced teeth.

RESULTS

A total of 2,749 patients was included and stratified based on their oral health status. There was a statistically significant correlation between tooth loss and the proportion of patients with low protein and caloric intake (P = 0.02 and 0.01, respectively). Serum albumin reached a frequency peak in the fully edentulous group without dentures (group 4, 19.2%). In the same group, individuals had lower protein (30.1%) and caloric intake (30.2%) (P = 0.01 and 0.02, respectively). Furthermore, logistic regression analysis confirmed the significant role of tooth loss on serum albumin and protein and energy intake in this population even after adjusting for confounding variables.

CONCLUSION

Tooth loss independently predicts low energy and protein intake, as well as serum albumin levels, biomarkers of malnutrition in CKD.

Relative validity of the Geisinger Rural Aging Study food frequency questionnaire

OBJECTIVE

To determine the relative validity of a population specific food frequency questionnaire (FFQ) and evaluate the effectiveness of the instrument for assessing nutritional risk in older adults.

DESIGN

A cross-over design with participants completing two different dietary assessment instruments in random order.

SETTING

The Geisinger Rural Aging Study (GRAS), a longitudinal study of over 20,000 adults living in the central, northern and eastern counties of Pennsylvania.

PARTICIPANTS

A subset of GRAS consisting of 245 older adults (60% women) ranging in age from 70 to 95 years.

MEASUREMENTS

Energy and nutrient intakes were assessed from two instruments: a population specific food frequency questionnaire (FFQ) and four 24-hour dietary recalls conducted over a two week period.

RESULTS

Pearson correlation coefficients between the FFQ and dietary recalls for most nutrients were 0.5 or higher which suggests that the FFQ provided relatively valid estimates of macro and micronutrient intakes examined. Bland-Altman plots were generated to examine the agreement between instruments. Data are shown for energy, folate and zinc with close agreement at lower intakes indicative of risk for folate and zinc. Sensitivity results also showed that the FFQ was able to correctly classify individuals adequately at risk for most nutrients examined.

CONCLUSION

This population specific FFQ appears to be a valid instrument for use in in evaluating risk for many nutrients that are of particular concern in older adults residing throughout many predominately rural counties in Pennsylvania.

A critical review of diabetes, glycemic control, and dental implant therapy

OBJECTIVES

To systematically examine the evidence guiding the use of implant therapy relative to glycemic control for patients with diabetes and to consider the potential for both implant therapy to support diabetes management and hyperglycemia to compromise implant integration.

MATERIAL AND METHODS

A systematic approach was used to identify and review clinical investigations directly assessing implant survival or failure for patients with diabetes. A MEDLINE (PubMED) database search identified potential articles for inclusion using the search strategy: (dental implants OR oral implants) AND (diabetes OR diabetic). Inclusion in this review required longitudinal assessments including at least 10 patients, with included articles assessed relative to documentation of glycemic status for patients.

RESULTS

Although the initial search identified 129 publications, this was reduced to 16, for inclusion. Reported implant failure rates for diabetic patients ranged from 0% to 14.3%. The identification and reporting of glycemic control was insufficient or lacking in 13 of the 16 studies with 11 of these enrolling only patients deemed as having acceptable glycemic control, limiting interpretation of findings relative to glycemic control. Three of the 16 studies having interpretable information on glycemic control failed to demonstrate a significant relationship between glycemic control and implant failure, with failure rates ranging from 0% to 2.9%.

CONCLUSIONS

Clinical evidence is lacking for the association of glycemic control with implant failure while support is emerging for implant therapy in diabetes patients with appropriate accommodations for delays in implant integration based on glycemic control. The role for implants to improve oral function in diabetes management and the effects of hyperglycemia on implant integration remain to be determined.

Severe tooth loss in older adults as a key indicator of compromised dietary quality

OBJECTIVE

Poor oral health influences the dietary quality of older individuals. The objective of the present study was to relate the number of teeth to adherence to the 2005 Dietary Guidelines for Americans among an ethnically diverse sample of older adults.

DESIGN

A block cluster design was used to obtain a sample of older adults. Data were weighted to census data for ethnicity and gender. Dietary intakes were assessed using an FFQ and converted into Healthy Eating Index-2005 (HEI-2005) scores.

SETTING

Two counties in North Carolina, USA, with large African-American and American Indian populations.

SUBJECTS

Community-dwelling older adults (N 635).

RESULTS

Three hundred and twenty-six participants had severe tooth loss (0-10 teeth remaining), compared with 305 participants with 11+ teeth. After controlling for socio-economic factors, those with 0-10 teeth had lower total HEI-2005 scores and consumed less Total Fruit, Meat and Beans, and Oils, and more energy from Solid Fat, Alcohol and Added Sugar, compared with those with 11+ teeth. Less than 1 % of those with 0-10 teeth and 4 % of those with 11+ teeth met overall HEI-2005 recommendations. Those with 0-10 teeth were less likely to eat recommended amounts of Total Vegetables, Dark Green and Orange Vegetables, and energy from Solid Fat, Alcohol and Added Sugar.

CONCLUSIONS

Older adults with severe tooth loss are less likely than those with moderate to low tooth loss to meet current dietary recommendations. Nutrition interventions for older adults should take oral health status into consideration and include strategies that specifically address this as a barrier to healthful eating.

Documenting the need for nutrition and health intervention for middle-aged and older adults in the Lower Mississippi Delta region

Multiple demographic, health, and environmental factors may influence the overall quality of diets among rural middle-aged and older adults. This project compared the diet quality of participants in Foods of Our Delta Survey (FOODS 2000) who were aged 55 years and older with national data. The data were assessed using 24-hour dietary recall methodology and a modified version of the United States Department of Agriculture Healthy Eating Index (HEI) that excluded the sodium component. The mean total Modified Healthy Eating Index (MHEI) study score was significantly lower than their counterparts from the national survey (61.0 +/- 0.68 vs. 65.6 +/- 3.65, P < 0.0001). Race and educational attainment were associated with higher MHEI scores. This study emphasized a critical need for implementing nutrition and health interventions in rural communities with special attention to subpopulations at risk.

Oral health issues in the nutrition of institutionalized elders

Oral health is critical to systemic health and quality of life for the elderly, especially the institutionalized elderly, who are at high risk for oral and nutritional problems. Oral health is an integral component of overall nutritional health, just as nutrition plays a vital role in overall oral health. This article reviews the critical factors in the relationship among oral, nutritional, and systemic health and urges ongoing collaboration of providers of health care to reduce the rate of morbidity and mortality in institutionalized elders.

Research on persistent pain in late life: current topics and challenges

Older women often experience pain in their daily lives. This article provides an overview of topics addressed in the geriatric pain research published between 1999 and 2004. New areas of emphasis of research have emerged such as the recognition of body mass and weight as a factor in persistent pain, while other areas have expanded, including the focus on pain among elders with cognitive impairments and the use of alternative treatment approaches. Understanding of pain in late life is hindered by study samples that lack diversity, treatment approaches that are narrowly focused, and a lack of attention to quality of life issues.

General health of elderly institutionalised and community-dwelling Brazilians

OBJECTIVE

To evaluate the heart rate, blood pressure, blood glucose and other important indicators of the general health of an elderly population of São José dos Campos, Brazil.

MATERIALS AND METHODS

A cross-sectional study was conducted among 150 institutionalised and 150 community-dwelling individuals aged 60 years or more. The parameters evaluated were heart rate, blood pressure and blood glucose. The elderly also answered a questionnaire about osteoporosis, falls, physical exercising, participation in social events, type of foods ingested, Alzheimer and Parkinson's diseases and medication.

RESULTS

The institutionalised elderly showed an average heart rate of 75.1, while that of the community-dwelling elderly was 76.7. The percentage of systolic hypertension in the institutionalised and community-dwelling groups was 36% and 30% respectively, while diastolic hypertension showed a percentage of 40% and 57%, and diabetes was 32% and 30%. Among the institutionalised and community-dwelling groups, 13.3% and 21.3% respectively, reported osteoporosis, 31.3% and 42.7% falls, 7.3% and 24% exercised regularly, 4% and 69.3% participated regularly in social events, 58.7% and 51.3% reported eating solid foods, and 13.3% and 2%, respectively, suffered from Alzheimer's disease. Parkinson's disease was reported by 2% in both groups. The institutionalised elderly reported taking an average of 3.2 medications, while among community-dwelling elderly this number was 1.8.

CONCLUSION

The entire sample presented a high prevalence of hypertension, diabetes and osteoporosis. No significant differences were found in the systemic health of the elderly institutionalised and community-dwelling groups. However, the latter group reported more frequent falls, participation in social events and exercised regularly.

Position of the American Dietetic Association: Oral Health and Nutrition

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.