Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey

Impact of edentulism on community-dwelling adults in low-income, middle-income and high-income countries: a systematic review

OBJECTIVES

This study aims to comprehensively explore the consequences of edentulism on community-dwelling adults in low-income, middle-income and high-income countries.

DESIGN

Systematic review and Synthesis Without Meta-Analysis (SWiM).

DATA SOURCES

MEDLINE, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 21 March 2023, in addition to grey literature searches, reference cross-checking and study recommendations.

ELIGIBILITY CRITERIA

Interventional and observational epidemiological studies of community-dwelling completely edentulous adults aged 18 years and above, residing in low-income, middle-income and high-income countries were included. Animal studies, studies of children and adolescents, studies of exclusively non-community-dwelling individuals and studies exclusive to partially dentate, dentate and treated edentulous individuals were excluded. There were no language restrictions. Search terms were designed to identify relevant articles, which examined the impact of edentulism on oral health-related quality of life, frailty, general health, physical health, mental health, nutritional status, employability, education, socioeconomic status and mortality.

DATA EXTRACTION AND SYNTHESIS

Data were extracted manually by two authors. Risk of bias was assessed using the QualSyst Tool. Articles were synthesised and reported using SWiM guidelines.

RESULTS

The seven broad outcome areas included mortality, frailty, mental health, general health, quality of life, health behaviour and nutrition. We identified no studies assessing the impact of edentulism on productivity or other economic outcomes, and no randomised trials of treatment for edentulism with any of these outcomes. Among 364 articles identified from database searches and 38 additional articles from reference cross-checks and professional recommendations, title and abstract screening resulted in a full text review of 58. Among these, 32 were subsequently included for narrative synthesis, with sample sizes ranging from 539 to 237 023 participants. All studies (n=32) contributing to the synthesis reported negative impact of edentulism on outcomes including mortality, frailty, mental health, general health, cognition and nutrition.

CONCLUSIONS

Edentulism has a consistently negative impact on the health outcomes examined in this review. Randomised trials are needed to evaluate interventions reducing the burden of edentulism, specifically with regard to economic and productivity outcomes.

PROSPERO REGISTRATION NUMBER

CRD42022320049.

Identifying and predicting physical limitation and cognitive decline trajectory group of older adults in China: A data-driven machine learning analysis

OBJECTIVE

This study aimed to utilize data-driven machine learning methods to identify and predict potential physical and cognitive function trajectory groups of older adults and determine their crucial factors for promoting active ageing in China.

METHODS

Longitudinal data on 3026 older adults from the Chinese Longitudinal Healthy Longevity and Happy Family Survey was used to identify potential physical and cognitive function trajectory groups using a group-based multi-trajectory model (GBMTM). Predictors were selected from sociodemographic characteristics, lifestyle factors, and physical and mental conditions. The trajectory groups were predicted using data-driven machine learning models and dynamic nomogram. Model performance was evaluated by area under the receiver operating characteristics curve (AUROC), area under the precision-recall curve (PRAUC), and confusion matrix.

RESULTS

Two physical and cognitive function trajectory groups were determined, including a trajectory group with physical limitation and cognitive decline (14.18 %) and a normal trajectory group (85.82 %). Logistic regression performed well in predicting trajectory groups (AUROC = 0.881, PRAUC = 0.649). Older adults with lower baseline score of activities of daily living, older age, less frequent housework, and fewer actual teeth were more likely to experience physical limitation and cognitive decline trajectory group.

LIMITATION

This study didn't carry out external validation.

CONCLUSIONS

This study shows that GBMTM and machine learning models effectively identify and predict physical limitation and cognitive decline trajectory group. The identified predictors might be essential for developing targeted interventions to promote healthy ageing.

Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults

BACKGROUND

Although tooth loss appears to be related to functional limitations, the mechanisms that underpin this relationship are unknown. We sought to address this knowledge gap by examining a multiple mediation hypothesis whereby tooth loss is predicted to indirectly affect functional limitations through social participation, subjective well-being, and cognitive function.

METHODS

This study included 7,629 Chinese adults from the 2017/2018 Chinese Longitudinal Healthy Longevity Survey wave. The serial mediation effects were examined using Model 6 in the Hayes' PROCESS macro for SPSS.

RESULTS

Tooth loss was significantly related to functional limitations. There was a direct (β = - 0.0308; 95% CI, - 0.0131 to - 0.0036) and indirect (β = - 0.0068; 95% CI, - 0.0096 to - 0.0041) association between tooth loss and instrumental activities of daily living (IADL) limitations, but only an indirect correlation with activities of daily living (ADL) limitations (β = - 0.0188; 95% CI, - 0.0259 to - 0.0121). Social participation, subjective well-being, and cognitive function serially mediated the relationship between tooth loss and ADL/IADL limitations.

CONCLUSION

The association between tooth loss and functional limitations is serially mediated by social participation, subjective well-being, and cognitive function. Our findings underscore the necessity of considering psychological and social factors as integrated healthcare approaches for the functional health of older adults.

A New Landscape of Human Dental Aging: Causes, Consequences, and Intervention Avenues

Aging is accompanied by physical dysfunction and physiologic degeneration that occurs over an individual's lifetime. Human teeth, like many other organs, inevitably undergo chronological aging and age-related changes throughout the lifespan, resulting in a substantial need for preventive, restorative as well as periodontal dental care. This is particularly the case for seniors at 65 years of age and those older but economically disadvantaged. Dental aging not only interferes with normal chewing and digestion, but also affects daily appearance and interpersonal communications. Further dental aging can incur the case of multiple disorders such as oral cancer, encephalitis, and other systemic diseases. In the next decades or even hundreds of years, the proportion of the elderly in the global population will continue to rise, a tendency that attracts increasing attention across multiple scientific and medical disciplines. Dental aging will bring a variety of problems to the elderly themselves and poses serious challenges to the medical profession and social system. A reduced, but functional dentition comprising 20 teeth in occlusion has been proposed as a measurement index of successful dental aging. Healthy dental aging is critical to healthy aging, from both medical and social perspectives. To date, biomedical research on the causes, processes and regulatory mechanisms of dental aging is still in its infancy. In this article, updated insights into typical manifestations, associated pathologies, preventive strategies and molecular changes of dental aging are provided, with future research directions largely projected.

A longitudinal study of self-report tooth loss impacting functional status among Chinese older adults: moderated mediation of social relationships and psychological resilience

OBJECTIVES

This study aimed to discern the longitudinal association between tooth loss and subsequent functional status, specifically investigating the moderated mediation effects of social relationships and psychological resilience.

METHODS

Data from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed, we included 2,834 older adults aged 65 and over in the study. The longitudinal relationship between tooth loss and functional status was analyzed using the generalized estimating equation. Hayes' PROCESS macro for SPSS was utilized to study the mediating and moderating effects.

RESULTS

In the fully adjusted model, the number of natural teeth at T1 was positively associated with instrumental activities of daily living (IADL) score at T3, but not activities of daily living (ADL) score. Compared with 20+ teeth, participants with complete tooth loss at T1 had a higher risk of developing ADL and IADL disability. Participants with 1-9 teeth at T1 had a 38% risk of developing IADL disability at T3 (OR = 1.38, 95% CI = 1.07-1.76, p = 0.012). Social relationships mediated the association between tooth loss and IADL only among participants whose psychological resilience was average (B = 0.0006, 95% CI = 0.0001-0.0014) or high (B = 0.0013, 95% CI = 0.0003-0.0026).

CONCLUSION

Psychological resilience moderated the mediating effects of social relationships on the association between tooth loss and functional ability.

CLINICAL SIGNIFICANCE

This longitudinal study contributes to elucidating parts of social-psychological mechanisms underlying tooth loss and functional disability. It suggests that by cultivating positive social relationships and enhancing psychological resilience, the adverse impacts of tooth loss on functional disability may be mitigated.