Gender differences in the association between transitions in depressive symptoms and oral health among older adults with chronic conditions

BACKGROUND

Oral health influences the quality of life of older adults. Further, depression is negatively associated with oral health. However, little is known about this relationship among older adults with chronic health conditions. Additionally, since oral health and depression differ between genders, this study aimed to investigate the effect of transitions in depressive symptoms on oral health among older adults with chronic health conditions by gender.

METHODS

We used data from the Korean Longitudinal Study of Aging (2020-2022). The study sample comprised 2836 older adults (1104 men; 1732 women). We adopted multiple linear regression to examine the association between depressive symptom transitions and oral health by gender.

RESULTS

The new onset depression symptoms were significantly associated with the deterioration of oral health in men (β = -5.4308) and women (β = -4.8328). Our study showed a gender-specific association between new onset depressive symptoms and particular domains of oral health. For men, the association was slightly more negative in psychosocial function (β = -2.1177) while women presented lower GOHAI scores in both the physical function domain (β = -1.8800) and the psychosocial function domain (β = -1.8801).

LIMITATIONS

The data used in this study were self-reported via a survey; thus, self-report bias may be a relevant concern.

CONCLUSION

To prevent deterioration in oral health, depressive symptoms must be detected and addressed early among older adults with chronic conditions. This study underscores the importance of interventions that consider gender differences in the association between depressive symptoms and psychosocial and physical functioning.

Determining the relationship between oral health and physical function in elderly people

BACKGROUND

Poor oral conditions in the elderly may have numerous effects on general health, including physical fitness and performance.

OBJECTIVES

This study aimed to determine the relationship between oral health and physical function in elderly people.

METHODS

Physical function and oral health parameters were compared using parametric comparison tests and Pearson correlation analyses. In addition, principal components analysis, hierarchical clustering and multidimensional scaling analysis clustered the patients' physical and oral health scores. The relationship between the groups was also determined using decision tree analysis.

RESULTS

A total of 112 elderly patients participated in the study. Grip strength (GS) was higher in patients with high chewing ability, and Timed Up and Go (TUG) scores were lower in the high oral health group (p < .05). GS was correlated with Decay, Missing, and Filled Teeth Index (DMFT) and the number of remaining and functional teeth (p < .05). According to principal component analysis, it was seen that there were three components (oral, functional and quality of life (QoL) parameters), and the features that were related to each other were gathered together. TUG and GS showed the highest relative importance among physical function criteria in the classification based on chewing ability. They were GS and physical activity for oral health-related QoL.

CONCLUSION

In the elderly, higher physical function parameters, especially GS may be an indicator of a better oral health and oral health-related QoL. Preventive physical rehabilitation practices, in addition to oral treatments, may be effective in improving oral health in the elderly.

Effects of various prosthetic methods for patients with Kennedy Class I partial edentulism on oral hypofunction, subjective symptoms, and oral health-related quality of life

PURPOSE

This propensity score matching, multicenter, cross-sectional study was performed to examine the effects of various prosthetic methods for dental clinic outpatients with Kennedy Class I partial edentulism (KCIPE) on oral hypofunction, subjective frailty symptoms, and oral health-related quality of life (QOL).

METHODS

Patients (n = 348) were classified into the following three groups for analysis: NT, patients with natural dentition providing intermaxillary contact in four occlusal supporting zones; RPD, patients with KCIPE who received removable partial dentures; and ISFP, patients with KCIPE who received implant-supported fixed prostheses. Participants' basic characteristics were recorded, and oral function tests were conducted. Subjective symptoms of physical and oral frailty were investigated via questionnaire. Oral health-related QOL was assessed using the Japanese short version of the Oral Health Impact Profile (OHIP-JP16). Propensity score matching was performed to adjust for patient background factors that could influence oral hypofunction in each group.

RESULTS

Compared with the ISFP group, the RPD group had significantly higher rates of poor oral hygiene, reduced occlusal force, decreased masticatory function, and declines in swallowing function and oral hypofunction; the odds ratio for oral hypofunction was 4.67. Compared with the ISFP group, the RPD group had significantly greater subjective symptoms of physical frailty and oral frailty, as well as higher OHIP scores.

CONCLUSIONS

Prosthetic treatment of KCIPE affected oral hypofunction, subjective frailty symptoms, and oral health-related QOL in dental clinic outpatients.

Dry Mouth Dilemma: A Comprehensive Review of Xerostomia in Complete Denture Wearers

Xerostomia, commonly known as dry mouth, presents a significant challenge for individuals wearing complete dentures, affecting their oral health and quality of life. This review explores the relationship between saliva and complete dentures, highlighting the varied management strategies for xerostomia. Saliva plays a critical role in denture retention, lubrication, and oral environment buffering. Complete denture wearers often experience reduced salivary flow, aggravating symptoms of xerostomia. Various management approaches are discussed, including general measures such as hydration and salivary stimulation techniques which aim to boost saliva production naturally. The use of salivary substitutes provides artificial lubrication and moisture to alleviate dry mouth discomfort. Oral lubricating devices, such as sprays, gels, and lozenges, offer relief by mimicking saliva's lubricating properties, thereby improving denture stability and comfort. This review addresses the etiology of xerostomia in complete denture wearers and explores preventive measures to reduce its impact. A comprehensive approach has been discussed for the management of xerostomia which will help to improve the oral health and well-being of complete denture wearers experiencing dry mouth.

Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review

There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

BACKGROUND

Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample.

METHODS

Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: "Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say 'no difficulty', 'some difficulty', 'a lot of difficulty' or 'cannot do at all/ unable to do'?" Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors.

RESULTS

The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5-2.1), low socioeconomic status (PR 2.0, 95% CI 1.7-2.5), limitations to usual activities due to health problems (PR 1.9, 1.6-2.2), depressive symptoms (PR 1.7, 1.5-2.1), daily smoking (PR 1.6, 95% CI 1.3-1.8), low dental utilization (PR 1.6, 95% CI 1.4-1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5-2.1).

CONCLUSIONS

One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.

Lip and tongue strength associated with chewing patterns in aging population

BACKGROUND

Improving chewing function of older adults increases the health-related quality of life. Few studies indicated the correlation between tongue, lip strength on masticatory performance in older people. The study aimed to investigate the association between lip, tongue strength on chewing pattern in aging population.

METHODS

The older adults had independent daily intake without assistance were enrolled. They had intact dentition and no periodontitis. To estimate the number of chewing strokes and chewing time by consuming a cornstarch cookie were used to represent chewing pattern. Lip and tongue pressure were evaluated with an Iowa Oral Performance Instrument. Linear regression analysis was used to analyze the lip and tongue pressure associated with the chewing time and strokes. Spearman's correlation analysis was utilized to evaluate the associations among chewing time and chewing strokes or lip and tongue pressure.

RESULTS

35 women and 35 men with an average age of 73.2 years were investigated. Tongue pressure was significantly related to the chewing time and the number of chewing strokes (p = 0.01 and 0.03). There was a close association between chewing time and the number of chewing strokes (p < 0.0001). The correlation between lip and tongue pressure was significant (p < 0.0001).

CONCLUSION

The tongue strength significantly related to chewing ability in aging population. Increasing the tongue strength greatly reduced the number of chewing strokes and chewing time. Good masticatory ability could increase the motor function of tongue; raising the tongue strength might be able to improve mastication in older adults.

Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States

INTRODUCTION

Edentulism affects health and quality of life.

OBJECTIVES

Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model.

METHODS

The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set (n = 4,288) was split into selection (70%, n = 3,002) and test data (30%, n = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training (n = 1,716) and validation (n = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples.

RESULTS

From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate (P = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.

CONCLUSION

Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.

KNOWLEDGE TRANSFER STATEMENT

This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.

Antecedents of Subjective Health among Korean Senior Citizens Using Archival Data

This study aimed to investigate the determinants of subjective health among South Korean senior citizens. Secondary data for the year 2018 was used from the Senior Citizen Research Panel data collected by the Korea Employment Information Service. A total of 3822 valid observations were analyzed. The dependent variable was subjective health, and the independent variables were religion participation, social gathering participation, economic activity, food expenditure, leisure expenditure, travel frequency, and art watching frequency. Descriptive analysis, correlation matrix, and independent t-test were carried out for data analysis. Multiple linear regression analysis was employed using assets, age, and gender as control variables to test the research hypotheses. The results indicate that all the proposed attributes have a significant positive impact on the subjective health of Korean senior citizens, with implications for policy making.

The effects of oral health and social support on health-related quality of life of migrant older with children in Weifang, China

Background

With the accelerated urbanization and aging population in China, more and more migrant older with children (MOC) moved to new cities. Previous studies mainly explored the acculturation of MOC, yet few focused on the health conditions of this vulnerable group. This study aimed to investigate the effects of oral health and social support on health-related quality of life (HRQOL) of MOC in Weifang, China.

Method

This study was a cross-sectional study and participants were selected by multi-stage cluster random sampling in Weifang, China. The HRQOL was assessed via the 12-item Short-Form Health Survey (SF-12) which included the mental component summary (MCS) and the physical component summary (PCS). The oral health was evaluated by the Geriatric Oral Health Assessment Index (GOHAI). The social support was administered using the Social Support Rating Scale (SSRS). Descriptive analysis was used to describe participants’ sociodemographic variables, oral health and social support. Univariate analysis and binary logistic regression analysis was used to investigate the association between the social support, oral health and HRQOL.

Results and discussion

It was found that 25.0% of MOC were defined as MCS poor and PCS poor, respectively. Those participants with average and low monthly household income compared to those around them, average and poor oral health, and low levels of social support were more likely to have poor PCS. Those with temporary residence permits, fair and poor oral health, and medium and low levels of social support were more likely to report poor MCS.

Conclusion

Results indicated that better social support and oral health led to higher HRQOL of MOC. Implications for the government, communities and families of MOC were given to improve their HRQOL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13843-0.

Tooth retention, health, and quality of life in older adults: a scoping review

OBJECTIVE

This scoping review describes the relationship between tooth retention, health, and quality of life in older adults.

METHODS

Seven databases were searched for English language articles for subjects ≥ 65 y from 1981 to 2021. Exposure was tooth retention (≥ 20), and outcomes were general/systemic health and quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool.

RESULTS

140 articles were included, only four were randomized trials. Inter-rater agreement (κ) regarding study inclusion was 0.924. Most were assessed with low risk of bias (n = 103) and of good quality (n = 96). Most studies were conducted in Japan (n = 60) and Europe (n = 51) and only nine in the US. Tooth retention was referred to as "functional dentition" in 132 studies and "shortened dental arch" in 19 studies. Study outcomes were broadly synthesized as (1) cognitive decline/functional dependence, (2) health status/chronic diseases, (3) nutrition, and (4) quality of life.

DISCUSSION

There is a positive relationship between tooth retention, overall health, and quality of life. Older adults retaining ≥ 20 teeth are less likely to experience poorer health. Having < 20 teeth increases the likelihood for functional dependence and onset of disability, and may affect successful ageing. This review supports the general finding that the more teeth older adults retain as they age, the less likely they are to have adverse health outcomes. However, significant knowledge gaps remain which can limit decision-making affecting successful ageing for many older adults. This review highlights the need to consider, as an important marker of oral health and function, the retention of a functional minimum of a natural dentition, rather than a simple numeric score of missing teeth.

Relationship between skeletal bone mineral density and subjective masticatory difficulty

Background

Masticatory ability is an essential factor for sustaining quality of life and social and systemic well-being, particularly in elderly. This study aimed to reveal the association between subjective masticatory difficulty and skeletal bone mineral density (BMD).

Methods

Data from the Korean National Health and Nutrition Examination Survey, which was conducted from 2008 to 2011 were analyzed. This study included 13,092 Koreans (5656 males, 7436 females) over 50 years of age. Masticatory difficulty was evaluated based on a self-reported questionnaire. Areal BMD of the total hip, femoral neck, and lumbar spine as well as lean body mass were determined using dual-energy X-ray absorptiometry. Data about the sociodemographic characteristics, physical activity, number of teeth present, sum of decayed, missing, and filled permanent teeth (DMFT) index and Community Periodontal Index (CPI) were collected. Multivariate logistic regression analysis was conducted to analyze associations between subjective masticatory difficulty and BMD, adjusting for the confounding covariates.

Results

Significant differences were observed in the areal BMD of the total hip, femoral neck, and lumbar spine as well as lean body mass accordance with the presence of subjective masticatory difficulty in both males and females. The number of teeth, DMFT, and CPI score did not show significant differences based on the presence of self-reported satisfaction of chewing performance in both males and females. Results from multivariate logistic regression demonstrated that the subjective masticatory difficulty showed significant interactions with skeletal BMD and the associations between masticatory satisfaction and BMD of the total hip and femoral neck were more prominent in females compared to those in males.

Conclusions

The skeletal BMD, particularly areal BMD of the femoral neck was significantly associated with subjective masticatory difficulty in elderly, especially in elder females.

Duração da mastigação e da fase oral da deglutição em idosos com diferentes condições dentárias: análise clínica

RESUMO Objetivo: mensurar o tempo total da mastigação e da fase oral da deglutição em idosos saudáveis, considerando diferentes consistências alimentares, a presença de dentes naturais e o tipo de reabilitação oral protética, bem como realizar comparação entre as condições dentárias e as consistências. Métodos: estudo transversal com 57 idosos saudáveis, entre 60 e 82 anos, distribuídos em grupo dentado (D) (n=15) e grupos reabilitados: próteses parciais fixas ou removíveis em uma ou ambas as arcadas (PP) (n=15); prótese total removível maxilar e mandibular (PTR) (n=15); prótese total - prótese removível superior e prótese implanto-suportada inferior (PTIS) (n=12). O tempo de duração (segundos) da mastigação e da fase oral da deglutição foi medido nas consistências: sólida (pão francês), pudim (10 ml) e líquida (10 ml). Resultados: idosos dentados saudáveis apresentaram os intervalos: líquido=1,07±0,35 s; pudim=3,48±1,76 s; e sólido=27,88±7,11 s. Foram observadas diferenças estatisticamente significativas entre os grupos D e PTIS (p=0,0056) e entre D e PTR (p=0,0056) para líquido. Para todos os grupos, houve aumento estatisticamente significante entre as consistências líquida e sólida e entre pastosa e sólida (p<0,001). Conclusões: idosos dentados apresentaram menor tempo de fase oral da deglutição para líquidos do que idosos edêntulos totais reabilitados, mas não diferente dos idosos com prótese parcial. O tempo de mastigação e deglutição do alimento sólido foi maior que o das demais consistências, independente da condição dentária.

Duration of mastication and oral phase of swallowing in the elderly with different dental conditions: a clinical analysis

ABSTRACT Purpose: to measure the total time of mastication and oral phase of swallowing in healthy elderly people, considering different food consistency, the presence of natural teeth, and the type of prosthetic oral rehabilitation, as well to compare dental conditions and consistencies. Methods: a cross-sectional study with 57 healthy elderly people, aged between 60 and 82 years, divided into: dentate group (D) (n=15); and rehabilitated groups; PD: fixed or removable partial dentures in one or both arches (n=15); CRD: maxillary and mandibular complete removable dentures (n=15); ISCD: complete dentures - maxillary removable denture and mandibular implant-supported dentures (n=12). The duration time (seconds) of chewing and of the oral phase of swallowing was measured in the consistencies: solid (a roll slice), pudding (10 ml) and liquid (10 ml). Results: healthy dentate elderly subjects had the following intervals: liquid=1.07±0.35 s; pudding=3.48±1.76 s; and solid=27.88±7.11 s. Statistically significant differences were observed between the D and ISCD groups (p=0.0056) and between D and CRD (p=0.0056) for liquid. For all groups, there was a statistically significant increase between liquid and solid consistencies and between pasty and solid ones (p<0.001). Conclusions: the dentate elderly had shorter oral phase time of swallowing for liquids than the rehabilitated edentulous elderly, but not different from the elderly with partial dentures. Chewing and swallowing time for solid food was longer than that for the other consistencies, regardless of dental condition.

Factors Related to Oral Intake of Food by Hospitalized Patients with Malnutrition under the Care of a Nutrition Support Team

This study aimed to evaluate the role of the general condition and oral health status in determining the primary nutritional route and suitable food form for oral ingestion among malnourished inpatients. This cross-sectional study included 255 inpatients referred to a nutrition support team (NST), which included dental professionals, at an acute care hospital. We assessed the participants’ basic information, and Dysphagia Severity Scale (DSS) and Oral Health Assessment Tool (OHAT) scores. The nutritional intake mode was evaluated based on the Functional Oral Intake Scale scores at the initial NST consultation (FOIS-I), and then revised by the NST based on the participants’ general condition and oral health (FOIS-R). There was a divergence between FOIS-I and FOIS-R, with FOIS-R being significantly higher than FOIS-I (p < 0.001). Logistic regression analysis of FOIS-R identified that consciousness level (odds ratio (OR): 0.448; 95% confidence interval (CI): 0.214–0.935) and DSS (OR: 3.521; 95% CI: 2.574–4.815) significantly affected the oral nutrition intake. Among participants who could ingest orally (FOIS-R ≥ 3; n = 126), FOIS score had significant negative and positive associations with the OHAT and DSS scores, respectively. These findings suggest that appropriate assessment of oral health status, including swallowing function, might contribute to high-quality nutrition management.

Longitudinal impact of oral health on geriatric syndromes and clinical outcomes in community-dwelling older adults

Background

Oral health is essential for daily living and plays a pivotal role in overall health conditions and well-being. This study evaluated the impact of self-reported oral health on geriatric conditions, institutionalization, and mortality.

Methods

This study analyzed the population of the Aging Study of Pyeongchang Rural Area that had undergone geriatric assessments between 2016 and 2017. The oral health status of the participants was determined using three items from the General Oral Health Assessment Index, and the participants were classified into three groups according to the total sum of the scores as good (3), fair (4–7), or poor (8–15). The outcomes were the incidence of geriatric syndromes at 2 years and the composite outcome of mortality and institutionalization.

Results

Among the 1189 participants, 44.1 % were women, and the mean age of the study population was 75.0 years. Good, fair, and poor oral health were observed in 597 (50.2 %), 406 (34.1 %), and 186 (15.6 %) individuals, respectively. Worsening oral health status was associated with the incidences of various geriatric syndromes at follow-up, and these associations were attenuated after adjusting for baseline demographic and geriatric parameters. Similarly, the significant association between baseline oral health status and the incidence of the composite outcome was attenuated after adjusting for demographic and geriatric parameters.

Conclusions

Oral health affected the geriatric health conditions in this prospective, longitudinal cohort of community-dwelling older adults. The correlations and interactions of oral health status with other functional parameters may deserve consideration as a geriatric domain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02416-2.

Analysis of the relevant factors associated with oral health-related quality of life in elderly denture wearers

PURPOSE

The purpose of the present study was to explore the factors related to oral health-related quality of life (OHRQoL) in elderly patients who underwent prosthetic treatment with removable dentures through several objective and subjective examinations and to analyze their interrelationships.

METHODS

The current study involved 78 denture wearers, aged 65 years or above, who underwent treatment at the clinic of prosthodontics and undertook routine checkups. The present study used eight age-matched patients with healthy dentition as controls. The following items were evaluated: OHRQoL (Oral Health Impact Profile), main occluding area, maximal occlusal force, masticatory performance, and masticatory ability. Spearman's rank correlation coefficient was used to assess the correlation between the OHIP score and each item and multiple linear regression analysis with the backward elimination method was used to analyze the factors affecting the OHIP score (α = 0.05).

RESULTS

The OHIP summary score was significantly correlated with the number of occlusal supports, number of remaining teeth, maximal occlusal force, and the masticatory ability score. The multiple regression analysis revealed that the number of occlusal supports, the number of remaining upper teeth, whether the upper main occluding area was the remaining tooth or not, and the masticatory ability score were the significant independent variables that affected the OHIP summary scores.

CONCLUSIONS

The present study verified the relationship between the OHRQoL and the occlusion of remaining teeth or the items derived from the main occluding areas. The current results suggest that retaining the maxillary first molar is a key factor in the OHRQoL.

Association of Oral Hypofunction with Frailty, Sarcopenia, and Mild Cognitive Impairment: A Cross-Sectional Study of Community-Dwelling Japanese Older Adults

Oral hypofunction is a new concept that addresses the oral function of older adults. Few studies have investigated the relationship between oral hypofunction and general health conditions such as frailty, sarcopenia, and mild cognitive impairment. This paper explores these relationships in a large-scale, cross-sectional cohort study. The relationships of oral hypofunction with frailty, sarcopenia, and mild cognitive impairment were examined using data from 832 individuals who participated in the 2018 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan. Individuals with frailty, sarcopenia, and mild cognitive impairment had significantly higher rates of oral hypofunction. Frailty was independently associated with deterioration of the swallowing function (odds ratio 2.56; 95% confidence interval, 1.26-5.20), and mild cognitive impairment was independently associated with reduced occlusal force (odds ratio 1.48; 95% confidence interval, 1.05-2.08) and decreased tongue pressure (odds ratio 1.77; 95% confidence interval, 1.28-2.43). There was no independent association found between sarcopenia and oral function. In conclusion, early intervention for related factors such as deterioration of the swallowing function in frailty, reduced occlusal force, and decreased tongue pressure in mild cognitive impairment could lead to the prevention of general hypofunction in older adults.

Oral Health-Related Quality of Life in Anticoagulated Patients with Warfarin Treatment: A Cross-Sectional Study

To evaluate factors associated with oral health-related quality of life (OHRQoL) in patients under oral anticoagulant therapy with warfarin, a cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL using the short version of the Oral Health Impact Profile (OHIP-14) instrument. After calibration (Kappa > 0.60), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (worse OHRQoL) was associated with ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Demographic and clinical factors can negatively influence the perception of anticoagulated patients on OHRQoL.

Oral health is essential for quality of life in older adults: A Swedish National Quality Register Study

OBJECTIVE

To examine the relationship between QoL and oral health from two Swedish national quality registries (NQRs).

BACKGROUND

Oral health plays an important part in general health, which might also affect QoL. No studies have examined the relationships between QoL and oral health in late adulthood based on aggregated data from Swedish NQRs.

MATERIAL AND METHODS

Four NQRs incorporated the EQ-5D, which assesses 5 aspects of QoL: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Items from the Revised Oral Assessment Guide, obtained from the NQR Senior Alert, were used to identify older adults at risk for oral health issues.

RESULTS

A total of 510 individuals had data on all relevant variables. Analyses indicated significantly higher QoL for individuals without risk of oral health problems (M = -0.15 (SD = 1.01)), compared to those with risk (M = -0.75 (SD = 1.52)). Logistic regression analysis showed that lower QoL (OR = 0.69 (0.49, 0.97)), mental status (OR = 0.37 (0.19, 0.71)), lower self-rated health (OR = 0.59 (0.42, 0.85)) and higher age (OR = 1.07 (1.01, 1.13)) were significantly related to risk of oral health problems. Higher BMI (OR = 1.13 (0.99, 1.30)), living alone (OR = 2.37 (0.93, 6.06)) and more years of education (OR = 1.15 (1.01, 1.31)) were associated with higher risk of oral health problems.

CONCLUSIONS

Oral health is a significant component of quality of life in late adulthood. NQRs are of value for healthy ageing research in populations that may be underrepresented in research studies.

The Influence of Oral Health Factors on the Quality of Life in Older People: A Systematic Review

BACKGROUND AND OBJECTIVES

The number of people aged 65 years or older is growing substantially. As a result of increased health burden and tooth retention, more oral health problems are expected in this age group. A poor oral health-related quality of life (OHQoL) can compromise a person's psychological state, social relationships, personal beliefs, and physical health. The aim of this systematic review was to identify oral health factors associated with OHQoL in people aged 65 years or older and to give a comprehensive overview of the body of literature for each oral health factor separately.

RESEARCH DESIGN AND METHODS

A comprehensive search was performed in five databases. The following terms were used as index terms or free-text words: "Oral Health," "Quality of Life," "Older People." Two researchers independently assessed studies for eligibility based on predefined criteria.

RESULTS

Of 3,702 references retrieved from the databases, 68 studies were eligible and included (9 randomized clinical trials, 6 cohort studies, and 53 cross-sectional studies). All results were reported descriptively. OHQoL in people aged 65 years or older is positively associated with higher number of teeth, higher number of occluding pairs, implant-retained overdentures, and the shortened dental arch concept and negatively associated with xerostomia, orofacial pain, and poor chewing ability. In the current literature, there is no consensus on the association between edentulism, caries, and periodontal conditions and OHQoL.

DISCUSSION AND IMPLICATIONS

Having a functional dentition (either natural or prosthetic) is important for a good OHQoL, whereas painful or functional complaints are associated with impaired OHQoL.

The impact of occluding pairs on the chewing patterns among the elderly

OBJECTIVES

This study aims to investigate the impact of occluding pairs (OPs) on chewing strokes, chewing time, mealtime duration, and bite force in an aging population.

METHODS

The 100 participants included 52 women and 48 men with average age of 71.2 years. The subjects were restricted to those who can eat what they wanted and had no temporomandibular joint disorder (TMD) and dysphagia history; their OPs were counted in the posterior occlusal support zone in accordance with the Eichner classification. Free habitual mastication of a cornstarch cookie was analyzed by recording the number of chewing strokes and the amount of time needed for complete mastication. Strokes were counted by considering the opening and closing mandibular movements. Mealtime was defined as the time spent to finish a lunchbox and accomplish swallowing. Bite force was estimated with a T-Scan III®. A linear regression analysis was used to evaluate the impact of the OPs on the chewing strokes, chewing time, mealtime duration, and bite force.

RESULTS

In this study, 76% of the participants had 4 OPs and 12% participants had 3 OPs. Increasing the OPs significantly shortened the chewing time and mealtime duration (P = 0.02). The mealtime duration did not notably affect the chewing time (P = 0.237). There was significant association between OPs and bite force (P < 0.0001).

CONCLUSIONS

In elderly, increasing OPs significantly raised the bite force and shortened the chewing time and strokes. More OPs might be the key to maintain good chewing function.

CLINICAL SIGNIFICANCE

Among the elderly, increasing OPs significantly raised the bite force and shortened the chewing time and mealtime duration. To provide better chewing function, good oral hygiene is important to maintain as many OPs as possible; how to gain more OPs is essential concern in the prosthodontic treatment plan making.

Relationship between Subjective Oral Discomfort and Health-Related Quality of Life in the South Korean Elderly Population

This study examined the relationship between oral discomfort and health-related quality of life (HRQOL) in the Korean elderly, using the datasets provided by the Korea National Health and Nutrition Examination Survey (KHNANES) over 6 consecutive years (2010-2015). A total of 13,618 participants aged 65 years and over were included in the final analysis. A complex sample logistic regression was performed to determine the impact of oral discomfort on HRQOL. The results revealed that toothache, masticatory discomfort, and pronunciation problems caused by oral health conditions were all risk factors for decreased HRQOL. In particular, masticatory discomfort (adjusted odds ratio (AOR) 1.63, Model III (adjusted for all covariates)) and pronunciation problems (AOR 1.64, Model III) negatively impacted the HRQOL of the elderly to a great extent. Masticatory discomfort had a stronger negative impact on HRQOL in the domains of "self-care" (AOR 1.83) and "usual activities" (AOR 1.66), while pronunciation problems had a similar impact on all five domains of the EuroQol 5-Dimension (EQ-5D). These findings could serve as baseline data for setting up early intervention programs for the timely prevention of oral health-related discomfort problems that greatly affect the QOL of the elderly population, and for the development of comprehensive and efficient dental insurance policies.

A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population

Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.