Oral health-related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City, India

The Association of Oral Processing Factors and Nutrient Intake in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

Oral health and food oral-processing issues emerge with functional decline in the older adult population, potentially increasing the risk of malnutrition. Impairment of oral health is associated with poorer nutrition status; however, the relationship between oral factors and the intake of each nutrient remains poorly understood.

OBJECTIVE

The associations between different oral factors and nutrient intakes among community-dwelling older adults were investigated.

DATA SOURCES

A literature search from 5 databases (Web of Science, Scopus, Cochrane Library, Ovid [MEDLINE and Embase], and CINAHL) was completed on February 1, 2022. The search was limited to peer-reviewed articles published between the years 2012 and 2022.

DATA EXTRACTION

Six cross-sectional studies were included in the meta-analysis. Two authors independently completed the data extraction and summarized the study characteristics, factors adjusted for in the statistical analysis, the outcome, and summary statistics of the results.

DATA ANALYSIS

Meta-analyses showed evidence of a significant association between compromised oral factors (namely, denture status, chewing ability, and the number of teeth) with lower energy (weighted mean difference [WMD], -107 kcal d-1 (95% CI, -132 to -81), protein (WMD, -5.2 g d-1; 95% CI, -6.6 to -3.8), fat (WMD, -4.6 g d-1; 95% CI, -6.7 to -2.6), carbohydrate (WMD, -8.8 g d-1; 95% CI, -13.9 to -3.7), and vitamin C intakes (WMD, -12.9 mg d-1; 95% CI, -16.6 to -9.2) in older adults.

CONCLUSION

Oral health can be an indicator of compromised daily energy, protein, fat, carbohydrate, and vitamin C intakes in older adults. However, the small sample size of the studies included in this review and the heterogeneity among macronutrient studies should be considered. Because of the lack of studies covering all aspects of food oral processing (eg, salivary flow rate, tongue pressure), the associations between oral processing and nutrient intake were not thoroughly explored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022308823.

Oral-Health-Related Self-Efficacy among the Elderly Population in Riyadh, Saudi Arabia

Oral health self-efficacy is a fundamental determinant of behavioral changes among elderly patients. Objective: To assess the oral self-efficacy among the Saudi population aged 65 years old and above in Riyadh, Saudi Arabia. Methodology: This was a cross-sectional survey conducted on elderly individuals in Riyadh. An Arabic version of the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) was administered to all participants. The dependent variables included oral function, oral hygiene habits, and dental visits. For the statistical analysis, two independent sample t-tests and a one-way ANOVA test were used. Significance was judged at a p-value less than 0.05. Results: Of 400 participants recruited, 53% were males. About 58% had retained teeth, and 72% had visited a dentist in the past 12 months. Overall, 31.6%, 34.64%, 22.65%, and 11.14% of the participants rated their oral health as good, fairly good, rather poor, and poor, respectively. Age (p < 0.001), educational level (p < 0.001), and working status (p < 0.001) were significantly associated with GSEOH scores. Other sociodemographic characteristics were not found to affect the GSEOH scores. Conclusions: The overall self-efficacy of oral health among Saudi elderly individuals is fairly good. Age, educational level, and occupational status are the main determinants of oral health self-efficacy scores.

Exploring the Association between Vitamin D and Changes in Cognitive Function in Chilean Older Adults: Evidence from the ALEXANDROS Cohort Study

Background: The increasing aging of the population with the consequent increase of age-associated cognitive disorders pose the challenge of controlling its preventable risk factors, among which vitamin D deficit is a putative factor. Thus, our objective is to explore the association between vitamin D and cognitive performance in a cohort study of community-dwelling Chilean older people. Material and Methods: Cohort study of 955 (69.7% female), community-dwelling older Chileans free of cognitive impairment from the Alexandros cohorts, with 25(OH)D measurement at baseline. Cognitive Function was evaluated with the Mini Mental State Examination (MMSE) short-form questionnaire. Plasma levels of 25(OH)D were classified as Normal > 30 ng/mL Insufficiency 20−29 ng/mL, Deficiency 20−12 ng/mL and Severe Deficiency < 12 ng/mL. Penalized regressions models were made to assess associations. Results: Mean age of the sample was 66.6 + 4.5 years, with 8.5 + 4.7 years of education. After a mean follow-up of 9.6 years, 54 new cases of Mild Cognitive Impairment (MCI)were identified (Incidence density rate = 5.9 per 1000 person/years). Mean vitamin D plasma levels were lower in people with MCI than in the normal cognitive ones (23.0 + 12.75 vs. 28.35 + 15.17 ng/mL, p < 0.01). In the fully adjusted model only severe deficiency of vitamin D was associated with MCI (RR = 2.33; 95% CI: (1.03−5.26). Conclusions: In this longitudinal study, our results confirm that low Vitamin D is a risk factor for MCI, and that people with severe deficiency have more than double the risk of MCI people with normal Vitamin D levels. Considering the high frequency of vitamin D deficiency in older people, and its preventability, these results are very valuable for future public health programmes.

Designing food for the elderly: the critical impact of food structure

Ageing is an unavoidable progressive process causing many changes of the individual life. However, if faced in an efficient way, living longer in a healthy status could be an opportunity for all. In this context, food consumption and dietary patterns are pivotal factors in promoting active and healthy ageing. The development of food products tailored for the specific needs of the elderly might favour the fulfilment of nutritionally balanced diets, while reducing the consequences of malnutrition. To this aim, the application of a food structure design approach could be particularly profitable, being food structure responsible to the final functionalities of food products. In this narrative review, the physiological changes associated to food consumption occurring during ageing were firstly discussed. Then, the focus shifted to the possible role of food structure in delivering target functionalities, considering food acceptability, digestion of the nutrients, bioactive molecules and probiotic bacteria.

Quality of life and associations with health-related behaviours among older adults with increased cardiovascular risk

BACKGROUND AND AIMS

A better understanding of the relationship between cardiovascular disease risk factors and quality of life (QoL) in older age is needed to inform development of risk reduction strategies. This cross-sectional study investigated the association of QoL with health-related behaviours in older adults at risk of heart failure.

METHODS AND RESULTS

Older adults (N = 328) at risk of heart failure residing in Melbourne, Australia, provided data on QoL and health-related behaviours including physical activity, diet, smoking and alcohol consumption. Multiple linear regression modelling was used to examine associations between health-related behaviours, QoL and its constituent domains. After adjustment for age, gender, body mass index and comorbidities, current smoking was found to have a negative association with the mental component score (MCS) of QoL (β = -0.174, p ≤ 0.01), with a positive association seen between MCS and physical activity (β = 0.130, p = 0.01). Current alcohol use had a positive association with the physical component score (PCS) (β = 0.120, p = 0.02) and saturated fat intake consumption had a negative association with the physical functioning domain of QoL (β = -0.105, p = 0.03) but was not associated with either PCS or MCS.

CONCLUSION

Engagement of older adults at increased cardiovascular risk with behavioural risk factor modification using QoL as a driver of change may offer new opportunities to promote healthy ageing. Development of such strategies should consider that for some behaviours which are cardiovascular risk factors (alcohol intake, in particular), the positive association to QoL is complicated and needs further deliberation.

Anticholinergic burden and poor oral health are associated with frailty in geriatric patients undergoing inpatient rehabilitation: A cross-sectional study

BACKGROUND

Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty.

METHODS

We studied 115 geriatric inpatients (aged >65 years and recruited over a 3-month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non-English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale.

RESULTS

The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two-thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one-third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05-4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02-1.49).

CONCLUSION

High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty.

Effect of Morbidities, Depression, Anxiety, and Stress on Oral Health-Related Quality of Life among Migrant Elderly Following Children in Weifang, China

This study explored the relationship between depression, anxiety, stress, morbidity, and oral health-related quality of life (OHRQoL) in the migrant elderly following children (MEFC) in Weifang, China. A total of 613 MEFC were selected using multistage cluster random sampling. The GOHAI scale was used to evaluate oral health-related quality of life. The DASS-21 scale was used to assess levels of depression, anxiety, and stress. Univariate analysis and binary logistic regression were used to analyze the correlation between these indicators and oral health-related quality of life, of which 43.9% were classified as having poor oral health. Logistic regression analysis showed that the MEFC who were of older age (OR = 0.965, p = 0.039), with hypertension (OR = 0.567, p = 0.004), with gastroenteropathy (OR = 0.263, p = 0.007), had received an outpatient service in the past year (OR = 0.669, p = 0.048), were depressed (OR = 0.338, p = 0.012), and anxious (OR = 0.414, p = 0.026) were less likely to report good oral health status. On the other hand, the MEFC with a high school education or above (OR = 1.872, p = 0.020) were more likely to report good oral health than those with primary school education and below. In conclusion, with regard to depression, anxiety, and stress: the results indicated that the fewer morbidities, the lower the level of depression and anxiety and the better the OHRQoL of MEFC. Targeted measures for government, communities, and family members were given to improve the OHRQoL of MEFC.

The Association between Malnutrition and Oral Health in Older People: A Systematic Review

The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.

Oral Health and Related Quality of Life in Older People: A Systematic Review and Meta-Analysis

Background

Of the most important implications and complaints in the elderly group of the population, is oral and dental health problems. This study aimed to assess oral health- related quality of life in older people.

Methods

To data collection, databases were searched including PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Central Register of Controlled Trials and scholar google The keywords were "older adults", "Geriatric" Elderly", "Older", "Aged", "Ageing", "Oral health", "Oral hygiene" and "Quality of life", "QOL. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Studies from 1st Jan 2000 to 30^th Jan 2017 were included. Studies were subjected to meta-analysis to calculate indexes, using CMA:2 (Comprehensive Meta-Analysis) software.

Results

Totally, 3707 articles were searched that 48 of them were subjected to the oral and dental health-related quality of life in 59 groups of the elderly population with the mean age of 73.57+6.62 in the 26 countries. The obtained percentage values of dental and oral health were 80.2% (0-60), 14.8% (0-12), 16.4% (0-70), 22% (0-14 or 0-59) and 19.2% (0-196) for GOHAI with the additive method, GOHAI with Simple Count Method, OHIP-14 with the additive method, OHIP-14 with Simple Count method and OHIP-49 with additive method indexes, respectively.

Conclusion

The elderly group of the population had no proper oral health-related quality of life. Regarding the importance and necessity of oral and dental health and its effect on general health care in the target group, it is recommended to improve dental hygiene in the mentioned group of population.

Bosnian Version of Oral Health of Edentulous Patients (OHIP-EDENT-B&H) Questionnaire: Assessment of Reliability and Validity

Background/Aim: The aim of this study was to assess of the internal coherence of Bosnian translated version of the Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT-B&H), and evaluated the validity of this version.

Material and Methods: OHIP-EDENT-B&H questionnaires were completed by 117 edentulous patients and specialists of prosthodontics in health institutions of central Bosnia.

Results: Test-retesting analysis showed strong correlations, r ranging from 0.46 to 0.58, respecting complete dentures, with Kappa= 0.68, that indicated reliability of the questionnaire. The lowest reliability was obtained for Psychological disability (n= 117, α= 0.636) and the highest was obtained for Social disability (α= 0.859). The reliability of the summary scores for OHIP-EDENT-B&H was good (α= 0.907). Content validity for the test group-retest group did not expose significant differences between the groups tested.

Conclusions: The OHIPEDENT-B&H instrument for verifying of oral-health–related quality of life in edentulous patients demonstrated good reliability and validity in Bosnian patients.

Oral Health Status and the Impact on Oral Health-Related Quality of Life among the Institutionalized Elderly Population: A Cross-Sectional Study in an Area of Southern Italy

Background: The objectives of this study were to describe the oral health status in the institutionalized geriatric population in an area of southern Italy and to identify the impact of oral health on the Oral Health Related Quality of Life (OHRQoL). Methods: Data were collected from individuals aged ≥60 years in randomly selected Calabrian long-term care facilities. The dental health status was assessed recording the decayed, missing, or filled dental elements due to the carious lesions (DMFT) index, the presence of visible dental plaque, and the gingival condition. The influence of the dental health status on the self-perceived value of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI). Results: Among the 344 elderly individuals included, 18.4% reported frequent tooth-brushing, and only 39.9% reported the need of dental care. The DMFT index was 26.4. Less than a third of the participants had a GOHAI score of ≤50 which is suggestive of highly compromised OHRQoL. The GOHAI score was significantly better for elderly individuals with no self-perceived need of dental care and with a lower DMFT index. Conclusions: The burden of oral conditions among residents in long-term care facilities was considerable, with a high prevalence of missing teeth and dentures. Strategies targeting care providers are needed.

Impact of oral health on nutritional status, self-perception of oral health and quality of life of institutionalized elderly

Background

This study aimed to investigate the influence of oral health on nutritional status, self-perception of oral health and health related quality of life of institutionalized elders.

Material and Methods

A cross-sectional study was conducted with 193 institutionalized elders living in the metropolitan region of João Pessoa (Brazil). The independent variables included were: 1) caries experience (DMFT index and its components); 2) use and need of dental prostheses; and 3) type of edentulism. The dependent variables included were related to nutritional status, self-perception of oral health and health-related quality of life. Data were submitted to a descriptive and comparative analysis, through correlation, association and difference tests, considering a significance level of 5% (p<0.05).

Results

No statistical significant correlations or associations between the oral health status and nutritional status and quality of life were found (p>0.05). Individuals who did not need prosthesis had higher scores for nutritional status. Self-perception of oral health and health-related quality of life did not vary significantly according to the studied variables.

Conclusions

The oral health status has a limited impact on the nutritional status, and does not impact the self-perception of oral health and quality of life of the institutionalized elders. Key words:Nursing homes, oral health, quality of life.

Association of sociodemographic factors and self-perception of health status on oral health-related quality of life among the older persons in Malaysia

AIM

This study aimed to evaluate the oral health-related quality of life (OHRQoL) among older persons in Malaysia and its associations with sociodemographic and self-perception towards general health as well as oral health.

METHODS

A cross-sectional survey among community dwelling older persons utilizing stratified cluster sampling was conducted in 2018. Well-trained interviewers conducted a face-to-face interview with older persons aged ≥60 years to collect information on participants' sociodemographic characteristics, self-perception on general as well as oral health using the Geriatric Oral Health Assessment Index (GOHAI). Multivariate analysis of the data collected was performed using SPSS version 23.

RESULTS

Overall, the GOHAI mean ± SD score for older persons in Malaysia was 51.83 ± 7.98, which was an average of fair mean (P < 0.001). Those with poor self-rated oral health (48.34 ± 8.96) or poor self-rated general health (47.13 ± 8.93) had poor mean OHRQoL (P < 0.001). Logistic regression analysis shows older persons who stay with spouse/partner (adjusted odds ratio [aOR]: 1.96 [1.66, 2.31]), no formal education (aOR: 1.84 [1.29, 2.61]) and self-perceived unhealthy oral health (aOR: 3.83 [3.19, 4.59]) were significantly associated with higher odds of having poor OHRQoL.

CONCLUSIONS

The estimated OHRQoL of older persons in Malaysia is rated as fair, with minimum association contributed by the sociodemographic factors, but with a significant influence by self-rated oral and general health. Self-perception of health can be used as a good indicator to estimate the OHRQoL. Geriatr Gerontol Int 2020; 20: 57-62.

Oral care practices of long-term care home residents and caregivers: Secondary analysis of observational video recordings

AIMS AND OBJECTIVES

To describe the proportion of toothbrushing task steps, long-term care residents had an opportunity to complete; the duration and quality of toothbrushing by both residents and caregivers; and the feedback caregivers provided.

BACKGROUND

Poor oral health is widespread among older adults in long-term care homes; however, little is known about their actual oral health practices.

DESIGN

Secondary analysis of video recordings.

METHODS

A total of 58 video-recorded sessions were analysed from two long-term care homes in Canada. Eligible residents had at least one natural tooth, required oral care assistance, had Alzheimer's disease and understood English. Eligible caregivers spoke English and had worked for at least 1 year with people with dementia. Toothbrushing success was identified by the resident's participation in, and completion of, nine toothbrushing steps. Total time spent brushing teeth was calculated by summing the duration of time spent brushing teeth. Quality was described by time spent brushing the facial versus the lingual or occlusal surfaces. Caregiver verbal feedback was pulled from transcripts and analysed using content analysis. STROBE guidelines were used in reporting this study.

RESULTS

The two step residents most frequently completed or attempted were brushing their teeth (77% complete, 7% attempt) and rinsing their mouth (86% complete, 2% attempt). The average time spent brushing teeth was 60.33 s (SD = 35.15). In 66% of observed videos, toothbrushing occurred only on the facial tooth surfaces, with no time spent brushing the lingual or occlusal surfaces.

CONCLUSION

Caregivers are supporting residents to independently complete toothbrushing; however, the duration and quality of toothbrushing are not sufficient to ensure optimal oral health.

RELEVANCE TO CLINICAL PRACTICE

Clear, detailed guidelines are required to ensure adequate oral care for long-term care residents. Staff need to be aware that all surfaces should be brushed to ensure proper oral health.

Oral Health and Its Associated Factors Among Older Institutionalized Residents-A Systematic Review

The oral health of an ageing population, especially that of the institutionalized elderly population, constitutes a significant concern because it is closely linked to general health and the quality of life. Shared common risk factors drive the development and worsening of poor oral health and non-communicable diseases, which eventually lead to self-care inability. Several studies have reported on the poor oral health of the institutionalized elderly population. However, few comprehensive reports exist regarding the relationship between poor oral health, the oral health-related quality of life (OHRQoL) and the associated factors in this specific population. Objective: The objective is to describe recently reported oral health levels, the OHRQoL and the associated factors among older institutional residents. Methods: Studies published between July 2009 and June 2019 in MEDLINE, EMBASE and CINAHL were searched. The population, intervention, comparison and outcome (PICO) strategy was used as a guide. The reported factors related to poor oral health were identified (i.e., age, gender, educational level, acquired systemic conditions or dementia/cognitive impairment). Results: Twenty-five surveys (or study series) from 19 countries were included. The level of evidence reported by these studies was generally moderate to strong. The reported oral cleanliness and health of the surveyed institutionalized elderly were poor (>50% of residents had calculus; denture hygiene index > 80%). Gum (approximately 30% of dentate residents had moderate to severe periodontitis), teeth (decayed, missing or filled teeth >20), mucosa (>10% had mucosal lesions) and denture problems (up to 40%) were prevalent and were associated with a poor OHRQoL, especially in females, socially deprived residents or those with mild or above cognitive impairment. Those with a poor OHRQoL might show signs of poor nutrition. Conclusions: This report reviewed evidence-based knowledge on oral health, the OHRQoL and the associated factors among elderly institutional residents. Further research is needed to confirm these observations. For improved oral health, a better OHRQoL and the general well-being of older residents, clinical trials are needed, targeting modifiable factors, such as social inequality, oral healthcare accessibility, and/or nursing home service quality. The relationship between oral health, the OHRQoL and nutrition in this at-risk population also warrants exploration.

Association between oral health-related quality of life and nutritional status among older adults in district of Kuala Pilah, Malaysia

Background

Poor oral health has an impact on food choices and intake of important nutrients among older population. The use of oral health-related quality of life instruments along with the clinical dental indicators can help to assess the oral problems that lead to nutritional problems in this group. This study aims to determine the association between oral health-related quality of life (OHRQoL) and nutritional status among a group of older adults in Kuala Pilah district, Malaysia.

Methods

A cross-sectional study was carried out on 446 older adults aged 50 years and above from 20 randomly selected villages. Respondents were interviewed to collect information on their demographic characteristics and oral health perception, followed by physical examination to measure height, weight and body mass index (BMI) of respondents. The validated Malay version of General Oral Health Assessment Index (GOHAI) was used to measure OHRQoL.

Results

About one-third (35.8%) of the respondents had normal BMI. Majority of the respondents were overweight (40.4%) and obese (19.9%), while only a small proportion was underweight (3.9%). Mean GOHAI score was 53.3 (SD = 4.7), indicating low perception of oral health. About 81.6% respondents had moderate to low perception of oral health. Logistic regression analysis showed a statistically significant association between the GOHAI and BMI scores (OR = 2.3; p < 0.01).

Conclusions

Oral health-related quality of life was significantly associated with nutritional condition of respondents. Older adults with poor perception of their oral health were more likely to have unsatisfactory BMI compared to those who perceived their oral health to be good.

Frailty, oral health and nutrition in geriatrics inpatients: A cross-sectional study

BACKGROUND

Poor nutritional status is a risk factor for the development of frailty. Likewise, oral health is independently associated with nutrition. The potential association between oral health and frailty in hospitalised elderly adults has, however, not previously been investigated.

OBJECTIVE

To investigate the relationship between oral health and frailty in hospitalised elderly adults and to identify the predictors of frailty.

METHOD

A cross-sectional study of 168 geriatric inpatients >65 years old was performed from August to December 2016. Patients of non-English speaking background, with impaired cognition (MMSE <24), severe hearing or visual impairment or active delirium were excluded. Oral health, nutrition and frailty were assessed using previously validated tools, namely the Geriatric Oral Health Assessment Index (GOHAI), Mini Nutrition Assessment (MNA) and Reported Edmonton Frailty Scale (REFS). Other data collected included demographics, co-morbidities, level of education and smoking/alcohol history.

RESULTS

On univariate analysis, the REFS score decreased with better nutritional status/higher MNA (P < 0.001) and better self-reported oral health/higher GOHAI (P = 0.023). Nutritional status accounted for 17% of variability in frailty assessment. On multivariate analysis, co-morbidities (P < 0.001), MNA (P < 0.001) and living in residential care (P < 0.001) were independent predictors of frailty. After adjusting for nutrition and co-morbidities, self-reported oral health was found to have an independent negative association with frailty (P = 0.019).

CONCLUSION

Poor self-reported oral health was found to be independently associated with frailty. Further research should be directed at whether interventions to maintain good oral health can prevent or slow the progression of frailty.

Burden of Oral Symptoms and Health-Related Quality of Life in Long-Term Care Settings in Helsinki, Finland

OBJECTIVES

Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL.

DESIGN

A cross-sectional study in 2017.

SETTING

All long-term care wards in Helsinki, Finland.

PARTICIPANTS

2401 older residents (74% females, mean age 83.9).

MEASUREMENTS

Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D).

RESULTS

Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL.

CONCLUSION

Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.

Fewer teeth are a risk factor for being underweight in community-dwelling Japanese aged 40 years and older: The Yamagata (Takahata) Study

OBJECTIVE

The aim of the present study was to investigate comprehensively, the risk factors for underweight in cross-sectional study in the general population of Japan.

METHODS

The survey population was the general population of individuals aged >40 years in Takahata town, Japan in 2005. A postal survey in the form of a self-administered questionnaire was distributed, and 6084 individuals were entered into the final statistical analysis. The self-administered questionnaire contained items regarding lifestyle, oral health status, socio-economic status and dietary intake. To examine the independent relationships between an underweight status and several parameters, a multivariate logistic regression analysis was used to estimate adjusted odds ratios (ORs).

RESULTS

The number of teeth, age, alcohol consumption, hypertension, spousal status, smoking habit, appetite, body weight at 20 years of age, habit of going out and physical activity were independently associated with an underweight status compared with the normal weight group. Individuals with fewer than 10 teeth were especially more likely to be underweight than individuals with more than 20 teeth (OR = 1.956, 95% CI = 1.261-3.035).

CONCLUSION

This study showed an independent association between the number of teeth and an underweight status, indicating that fewer teeth can increase the risk of being underweight.

Relationship between the Necessary Support Level for Oral Hygiene and Performance of Physical, Daily Activity, and Cognitive Functions

To maintain good oral hygiene on their own, elderly adults need comprehensive abilities, such as physical, daily activity, and cognitive functions. In the long-term care certification, care support specialists conduct surveys that include a total of 74 items about physical function, daily activity function, living functions, cognitive function, mental/behavioral disorders, and adaption to social life. The data of the long-term care certification survey contain three items related to oral health: the necessary support level for oral hygiene, ability to swallow, and assistance with food intake. The aims of this study were to identify which functions are absent in elderly individuals who cannot maintain proper oral hygiene and to clarify at which stage it is necessary to assist elderly individuals with their oral hygiene and provide professional oral care. In this study, an analysis was conducted to identify the relationship between the necessary support level for oral hygiene and the performance of physical, daily activity, and cognitive functions. The results of the long-term care certification surveys were analyzed for 23,423 cases that involved 9,571 individuals who submitted a claim using long-term care statements between January 2009 and March 2018. The results of a multivariable logistic regression analysis showed that the following items had high odds ratios: “walk” and “stand up” in the physical and daily activity functions and the ability to “understand the everyday routine” and “make daily decisions” in the cognitive functions. The results of a decision tree analysis revealed that in order for elderly individuals to maintain good oral hygiene on their own, they must have adequate physical functioning as well as adequate performance of cognitive functions. Our study's findings suggest that comprehensive ability in both physical and cognitive functions is required for elderly adults to maintain their oral hygiene.

Assessing a conceptual model with both oral health and health related quality of life in community-dwelling elders

PURPOSE

The objective of this study was to test a hypothesized conceptual model for both the clinical and non-clinical status of oral health and health related quality of life (OHRQoL & HRQoL) among community-dwelling elders.

MATERIALS AND METHODS

Study participants (n = 517), who were recruited as part of a Taiwanese elderly community survey, were collected via dental examinations and questionnaires. We collected measures of clinical variables, self-reported symptom status, OHRQoL, nutritional status and HRQoL. The 517 participants were randomly assigned to one of two samples, to provide one training sample for estimation and one testing sample for validation. The path analysis with all observed variables was conducted based on the proposed theoretical model delineating pathways.

RESULTS

All of the direct pathways hypothesized by the model were significant. Functional status (OHRQoL measured by OHIP-14T) mediated clinical occlusion, and symptom status mediated nutritional status (MNA) and HRQoL (WHOQOL-BREF). The model accounted for 29% of the variance in HRQoL and demonstrated a good fit with the data.

CONCLUSIONS

This conceptual model suggests that OHRQoL, as an important mediator, links clinical conditions, symptom status, nutritional status, and overall HRQoL. Therefore, when therapeutic efforts are made to improve the outcomes for patients with oral diseases, not only can the OHRQoL be enhanced, but also the HRQoL can be improved as a result.

Consumption of green tea but not coffee is associated with the oral health-related quality of life among an older Japanese population: Kyoto-Kameoka cross-sectional study

BACKGROUND/OBJECTIVES

The consumption of both green tea and coffee is known to induce positive health effects; however, it remains unclear whether there is an association between the consumption of these beverages and oral health-related quality of life (OHRQoL). Thus, the present study investigated the relationship between the consumption of green tea and coffee and OHRQoL.

SUBJECTS/METHODS

We analyzed cross-sectional baseline data in 2012. The subjects were 7514 Japanese participants (3563 men, 3951 women; ≥65 years of age). Each subject completed a validated self-administered questionnaire that included items on the frequency of the consumption of green tea and coffee. OHRQoL was evaluated using the self-reported General Oral Health Assessment Index (GOHAI), which assesses oral health problems in older adults. A GOHAI score <50 points was defined as a poor OHRQoL.

RESULTS

Following adjustment for age, body mass index, total energy intake, alcohol, smoking, medication use, coffee, and fruit and vegetable consumption, increased consumption of green tea showed a strong positive association with the GOHAI score in both men and women (P_trend < 0.001 in both). In contrast, after adjusting for all factors, no statistically significant association was observed between coffee consumption and the GOHAI score in men (P_trend = 0.538) or women (P_trend = 0.607). The respective multivariate-odds ratios (95% confidence intervals) for a poor OHRQoL associated with green tea consumption frequencies of none, <1 cup/day, 1-2 cups/day, and ≥3 cups/day were 1.00, 1.01 (0.80-1.27), 0.95 (0.74-1.21), and 0.78 (0.61-0.99) (P_trend = 0.024) in men, and 1.00, 1.19 (0.90-1.57), 0.98 (0.74-1.29), and 0.86 (0.67-1.12) (P_trend = 0.014) in women.

CONCLUSIONS

Regardless of sex, green tea consumption was positively associated with the GOHAI score. Therefore, ≥3 cups/day of green tea may reduce the risk of a poor OHRQoL, especially in men.

Oral Health-related Quality of Life among Patients after Complete Denture Rehabilitation: A 12-month Follow-up Study

Introduction:

Complete edentulism is an eventual oral health outcome and results from the combined pathology of dental caries, periodontal disease, or faulty method of rehabilitation due to reduced cost. Complete edentulism has a significant concern and leads to reduced quality of life (QoL) along with impact on general health. However, it has been observed that due to wider and better oral health services globally, edentulism rate is decreasing every decade. Edentulism is directly related to masticatory and nutritional problems, and some authors regard it as a good mortality indicator.

Methodology:

The sample population consisted of 100 individuals comprising 63 males and 37 females who fulfilled the inclusion criteria. Geriatric oral health assessment index (GOHAI) was administered by a single investigator at baseline (preinsertion) and also 6 and 12 months postdenture insertion. Sociodemographic data, including age and gender, were also collected.

Results:

It was observed that the overall oral health-related QoL (OHRQoL) scores of the sample improved significantly at 6 and 12 months postinsertion (P < 0.001) when compared to baseline scores. When GOHAI scores were compared individually for males and females (pre- and post-insertion), it was observed that there was statistically significant improvement in OHRQoL (male – pre = 25.02 ± 1.34 and post-12 months = 8.84 ± 1.26, P < 0.001, female – pre = 25.19 ± 0.88 and post-12 months = 9.05 ± 1.20, P < 0.001) postinsertion of denture in both the groups.

Conclusion:

OHRQoL in patients improved after complete denture rehabilitation. There was an upward shift in score for each item in GOHAI from preinsertion to 6 and 12 months postinsertion of dentures, reflecting improvement in OHRQoL of the sample.

Oral Health Indicators for Risk of Malnutrition in Elders

OBJECTIVES

Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders.

DESIGN

Cross-sectional study.

SETTING

Five community centers run by non-government organizations (NGOs).

PARTICIPANTS

195 community dwelling elders (65 or above).

MEASUREMENTS

An interviewer-administered questionnaire was completed to collect information on elders' socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders' nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA).

RESULTS

The mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL.

CONCLUSION

Elders' tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition.

Frequency of Fruit and Vegetable Consumption and the Oral Health-Related Quality of Life among Japanese Elderly: A Cross-Sectional Study from the Kyoto-Kameoka Study

OBJECTIVE

Many previous studies have reported that fruit and vegetable consumption is associated with a reduced risk of various disease, but whether or not their consumption is associated with the oral health-related quality of life (OHRQoL) is unclear. The objective of this study was to examine the association between the frequency of fruit and vegetable consumption and the OHRQoL in elderly subjects by sex.

METHODS

We analyzed cross-sectional data from a population-based Kyoto-Kameoka Study in 2012 of 3112 men and 3439 women (age ≥ 65 years). The frequencies of fruit and vegetable consumption were assessed using a validated food frequency questionnaire. We evaluated the OHRQoL using the General Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems in old adults.

RESULTS

After adjusting for age, body mass index, alcohol, smoking, education, socioeconomic status, history of disease, medication use, mobility disability, and total energy intake, a higher frequency of combined fruit and vegetable consumption showed a significant positive association with the GOHAI score in both men and women (p-trend < 0.001 in both sexes). These associations remained significant after adjustment for poor mastication and denture use (p-trend all < 0.05 in both sexes). We observed a significant positive association even when the frequencies of fruit or vegetable consumption were analyzed separately (all p-trend < 0.05 in both sexes).

CONCLUSIONS

A higher frequency of fruit and/or vegetable consumption independently showed a strong positive association with the OHRQoL in both men and women. Further prospective studies are needed to confirm these findings.

Tooth loss and its relationship with protein intake by elderly Brazilians-A structural equation modelling approach

OBJECTIVE

This study aimed at assessing the relationship between self-perceived tooth loss and wearing dentures, on the one hand, and the consumption of protein, on the other hand, among the elderly population of Botucatu, SP. Food consumption tends to decrease with ageing, especially protein intake, and one of the causes could be the precariousness of oral health. Several risk factors associated with deficient dietary protein intake have been identified, namely greater physical dependence, reduced caloric intake and food insecurity, but no studies have analysed whether tooth loss and prostheses interfere with protein intake.

METHODS

An interview was conducted among 365 elderly individuals, in which we examined oral health-related quality of life (OHRQoL) as the only latent variable, in a 24-hour nutritional assessment dietary recall repeated 3 times, conducted in person by a trained nutritionist and also performed an analysis of nutritional needs using the Nutrition Data System Research (NDSR) Program.

RESULTS

The structural equation model, performed using Stata v.14, showed that lack of teeth (standardised coefficient [SC] = 0.21, P < .001), and prosthesis use (SC = -0.21, P < .001) was associated with OHRQoL. Lack of teeth had a direct effect on the consumption of animal protein (SC = 0.08, P = .02), a strong total effect on animal protein intake (SC = 0.51, P = .04) and a medium effect on total protein intake (SC = 0.20, P = .03), adjusted for confounders (depression and medical problems).

CONCLUSION

Tooth loss had a strong and significant total effect on animal protein intake and a medium effect on total protein intake among elderly Brazilians.

Quality of life and oral health in elderly

Background

We want to assess quality of life in elderly patients in relation to the number of remaining teeth, the number of ingested drugs and xerostomía and to determine the correlation between an increased intake of drugs and a greater feeling of dry mouth and to know the most commonly used measures to control xerostomia.

Material and Methods

30 subjects aged between 65 and 95 years (14 males, 16 females) completed the OHIP questionnaire to determine quality of life. For oral status, the number of remaining teeth according to WHO criteria and xerostomia using the xerostomia index (XI) were studied. In cases of dry mouth sensation, the measures to alleviate it were asked.

Results

The average quality of life according to the OHIP rate is 19.23 (Dt = 10.58), being 56 the worst quality of life. The Pearson correlation coefficient indicates that quality of life is not related to the number of remaining teeth (r = -0.046; p = 0.810) nor the number of ingested drugs (r = 0.226; p = 0.23) but a greater sensation of dry mouth is related to a poorer quality of life (r = 0.678; p = 0.230). There is no association between the number of ingested drugs and the xerostomia index (r = 0.144; p = 0.447). The most frequently measures used against dry mouth were drinking water (21 subjects) and sugarless candies (15 subjects).

Conclusions

Quality of life is not related to the number of remaining teeth nor the number of ingested drugs. However, a higher level of xerostomia was significantly associated with a poorer quality of life. There is no association between the number of drugs ingested and xerostomia index. Sugarless candies and drinking water are the more frequently used measures to alleviate dry mouth.

Key words:Quality of life, oral health, elderly.

Association between dental prosthesis need, nutritional status and quality of life of elderly subjects

PURPOSE

To determine the effect of prosthesis need on nutritional status and oral health-related quality of life (OHrQoL) in elderly and to check the disparity between prosthesis need and prosthesis want in the Indian elderly.

METHODS

A total of 946 geriatric participants reporting to a geriatric medicine clinic were recruited in the study. Mini-nutritional assessment (MNA), geriatric oral health assessment (GOHAI) indices, prosthesis need according to WHO criteria, and prosthesis want was recorded along with age, gender, socioeconomic status and posterior occluding pair.

RESULTS

Significant associations exist between prosthesis need and age (p = 0.005), MNA (p = 0.006) and GOHAI (p = 0.000). Prosthesis demand too was influenced by age (p = 0.004), posterior occluding pairs (p = 0.000), MNA (p = 0.012) and GOHAI (p = 0.000). GOHAI was negatively correlated with upper (r = -0.445) and lower prosthesis need (r = -0.460). Participants with some prosthesis need had significantly lower MNA and GOHAI scores as compared to those with no prosthesis need. Though prosthesis need was high (79.7 %), demand was low (39.3 %).

CONCLUSION

Prosthesis need affects nutritional status and OHrQoL in elderly, and a wide gap exists between need and want of prosthesis.

High prevalence of undernutrition and low dietary diversity in institutionalised elderly living in Sri Lanka

Objective

The present study aimed to assess nutritional status, dietary diversity and lifestyle risk factors associated with undernutrition in an institutionalised Sri Lankan elderly population.

Design

The study was of cross-sectional design followed by a stratified sampling method.

Setting

Twelve homes for the elderly recruited from six provinces in Sri Lanka.

Subjects

A total of 311 institutionalised elderly aged ≥60 years.

Results

The mean age of the study population was 75 (sd 8) years. Prevalence of undernutrition was 30 %. Mean food variety score, dietary diversity score and dietary serving score of the study population were 8·7 (sd 1·5), 7·3 (sd 1·2) and 10·9 (sd 2·0), respectively. Mean daily intakes of fruit, vegetables, meat, fish, eggs and pulses and dairy portions were below the national recommendations, whereas the mean consumption of sugar exceeded the national recommendation. Only the mean intake of starch was within the recommendation. Food allergies (OR=8·0; 95 % CI 3·9, 16·2), skipping meals (OR=3·8; 95 % CI 2·0, 7·5) and lack of leisure activities (OR=3·1; 95 % CI 1·5, 6·7) significantly increased the risk of undernutrition, whereas the use of dentures decreased the risk (OR=0·20; 95 % CI 0·06, 0·69).

Conclusions

High prevalence of undernutrition and low dietary diversity were observed in an institutionalised elderly Sri Lankan population. Therefore, there is an urgent need to implement nutrition interventions as part of geriatric care to reduce undernutrition and improve the diets of the institutionalised elderly population in Sri Lanka.

Impact of tooth replacement on the nutritional status of partially dentate elders

OBJECTIVES

The aim of this study was to compare the impact of two different tooth replacement strategies on the nutritional status of partially dentate older patients. Nutritional status was measured using the full version of the Mini Nutritional Assessment (MNA) and the short form of the Mini Nutritional Assessment (MNA-SF).

MATERIALS AND METHODS

A randomised controlled clinical trial was conducted (Trial Registration no. ISRCTN26302774). Partially dentate patients aged 65 years and older were recruited and randomly allocated to the two different treatment groups: the removable partial dentures (RPD) group and the shortened dental arch (SDA) group. Nutritional status was measured using the MNA and MNA-SF administered at baseline and 1, 6 and 12 months after treatment intervention by a research nurse blinded to the treatment group allocation of all participants.

RESULTS

Data collected using the full version of the MNA showed significant improvements in mean MNA scores over the length of the study (p < 0.05). For the entire patient group, there was a mean increase of 0.15 points at 6 months and a further increase of 0.19 points at 12 months. These increases were similar within the treatment groups (p > 0.05). For MNA-SF, the analysis showed that there were no significant differences recorded over the data collection points after treatment intervention (p < 0.05).

CONCLUSION

Tooth replacement using conventional and functionally orientated treatment for the partially dentate elderly showed significant improvements in MNA score 12 months after intervention.

CLINICAL RELEVANCE

Prosthodontic rehabilitation may play an important role in the nutritional status of partially dentate elders.

Assessment of Oral Health Related Quality of Life Among Completely Edentulous Patients in Western India by Using GOHAI

BACKGROUND

Quality of life in elderly is a very sensitive issue. It is important to know if the dental problems, general health and dental treatment have an impact on the quality of life in elderly. The elderly population has a typical set of mind regarding their oral health. This study examines the trends in patients' behavioral patterns due to tooth loss, suggestive of some change in quality of life.

AIMS

The purpose of this study was to identify and acknowledge the problems of completely edentulous patients and their relationship to the Quality of Life (QOL). Also, the study was aimed at exploring the changes in global self-rated general health between the pre and post-treatment scores.

SETTINGS AND DESIGN

This is a randomized controlled clinical trial study which is done to evaluate the problems in the elderly and quality of life as long as their oral health is concerned. It is conducted on a group of people representing the elderly population with complete edentulism.

MATERIAL AND METHODS

Sixty three patients with mean age 69.41 who needed dentures were investigated before and after 6 months of their treatment by administration of GOHAI (Geriatric Oral Health Assessment Index) scale. Comparison between Pre & Post-treatment values of various scores were done with McNemar-Bowker Test. Quantitative data was represented using Mean ± SD and Median, IQR (Interquartile range). Analysis of Pre & Post-treatment quantitative data was done using Wilcoxon Signed Rank Test.

RESULTS

The results of the present study showed GOHAI scores increased from 28.90 + 7.28 to 42.19 + 7.60 (p=highly significant). There was a significant change in the quality of life in elderly after their prosthodontic rehabilitation, though the self rated general health did not show any significant improvement.

CONCLUSION

It is the responsibility of the entire dental fraternity to understand the needs of elderly associated to their oral health. It is important to evaluate and assess the psychological effects of tooth loss on their quality of life. A thorough investigation is necessary before and after the dental/prosthodontic care.