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Sato S, Sasabuchi Y, Okada A, Yasunaga H. Association between self-reported difficulty in chewing or swallowing and frailty in older adults: A retrospective cohort study. GeroScience 2024:10.1007/s11357-024-01325-7. [PMID: 39212786 DOI: 10.1007/s11357-024-01325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Oral frailty can contribute to physical and mental health disorders. Previous research has shown an association between frailty and self-reported difficulty in chewing or swallowing. However, their combined assessment has obscured their specific impact on frailty-related outcomes. To investigate the independent associations between difficulty in chewing or swallowing and 1-year frailty outcomes, while also examining their interactions. This retrospective cohort study utilized the DeSC database to identify older adults aged ≥ 75 years who underwent health checkups between April 2014 and November 2022. Multivariate Cox regression analyses were conducted to assess the association between self-reported difficulty in chewing or swallowing and outcomes, including hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality within 1 year. Interactions between chewing and swallowing difficulties were also evaluated. Among 359,111 older adults, 39.0% reported oral function difficulties. Swallowing difficulty alone lacked significant outcome association. However, chewing difficulty alone was significantly associated with higher risks of hospitalization due to aspiration pneumonia (hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.15-1.58; P < 0.001), all-cause hospitalization (HR, 1.08; 95% CI, 1.05-1.11; P < 0.001), and all-cause mortality (HR, 1.28; 95% CI, 1.14-1.44; P < 0.001) compared with no self-reported difficulty. A significant positive interaction between self-reported difficulty in chewing and swallowing was observed for all-cause mortality (P = 0.009). Self-reported difficulty in chewing was significantly associated with higher risks of hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality among older adults. Chewing and swallowing difficulties showed a synergistic effect, significantly increasing all-cause mortality risk.
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Affiliation(s)
- So Sato
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.
| | - Yusuke Sasabuchi
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan
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Castrejón-Pérez RC, Borges-Yáñez SA, Ramírez-Aldana R, Nasu I, Saito Y. Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis. Community Dent Oral Epidemiol 2024; 52:572-580. [PMID: 38509032 DOI: 10.1111/cdoe.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people. METHODS The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence. RESULTS The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]). CONCLUSION Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.
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Affiliation(s)
- Roberto C Castrejón-Pérez
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
| | - S Aída Borges-Yáñez
- Division of Postgraduate and Research Studies, School of Dentistry, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja, Logroño, Spain
- Departamento de Matemáticas, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ikuo Nasu
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja, Logroño, Spain
| | - Yasuhiko Saito
- School of Dentistry at Matsudo, Nihon University, Chiba, Japan
- College of Economics, Nihon University, Tokyo, Japan
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Furuhashi H, Honda T, Furuta Y, Tomooka S, Tajimi T, Kimura Y, Yoshida D, Ninomiya T. Association between masticatory function, frailty, and functional disability: an observational study. BMC Geriatr 2024; 24:538. [PMID: 38907214 PMCID: PMC11193275 DOI: 10.1186/s12877-024-05131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Increase in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for functional disability, but the role of frailty in the association has not been clarified. METHODS Forty thousand five hundred sixty-two community-dwelling older adults aged 65 years and over who were insured by public health insurance as of April 2018 were followed up for a median of 3.0 years. Masticatory function was categorized as good, moderate, or poor based on a self-reported questionnaire. The development of functional disability was defined as a new certification of the need for long-term care. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs). RESULTS During the follow-up period, 1,397 individuals experienced functional disability. After adjusting for age, sex, comorbidities, medical history, and lifestyle behaviors, the HR for incident functional disability was significantly higher in the moderate and poor groups compared to the good group (moderate, HR 1.21 [95% CI, 1.07-1.37]; poor, HR 1.64 [95% CI, 1.03-2.62]). However, after additional adjustment for frailty-related factors-namely, underweight, regular exercise, and gait speed-the association was attenuated in both the moderate group (HR 1.06 [95% CI, 0.94-1.21]) and the poor group (HR 1.51 [95% CI, 0.94-2.41]). CONCLUSIONS Masticatory dysfunction was significantly associated with incident functional disability in a community-dwelling older Japanese population. Our findings suggest that masticatory dysfunction may be a surrogate of frailty rather than a direct cause of functional disability.
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Affiliation(s)
- Hiroko Furuhashi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoko Tomooka
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takahiro Tajimi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yasumi Kimura
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Department of Health Nutrition, Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan
- Division of Community Health Nursing and Home Care Nursing, Graduate School of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City, 812-8582, Japan.
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Kudo Y, Takeuchi K, Kusama T, Kojima T, Waguri-Nagaya Y, Nagayoshi M, Kondo K, Mizuta K, Osaka K, Kojima M. Differences in prevalence of self-reported oral hypofunction between older adult patients with rheumatoid arthritis and the general older population: A cross-sectional study using propensity score matching. J Oral Rehabil 2024; 51:924-930. [PMID: 38356183 DOI: 10.1111/joor.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/14/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To examine the association between rheumatoid arthritis (RA) and oral hypofunction (OHF) using propensity score matching (PSM) to adjust for differences between older adults with RA and the general older adult population. METHODS We conducted a cross-sectional survey among 189 older adults with RA in 2019 (mean age, 71.9 ± 3.6) and 47 178 independent older adult residents in 2016 (mean age, 71.6 ± 4.0), respectively. The questionnaire covered information on socio-demographic characteristics and OHF for both groups. Age, sex, educational level and smoking history were used to determine PSM. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of self-reported OHF (fewer remaining teeth, decreased masticatory function, deterioration of swallowing function and oral dryness) were estimated using Poisson regressions. RESULT OHF was observed in 44.4% of patients with RA and 27.5% of residents. Before PSM, the prevalence of OHF among patients with RA was higher than that of residents (PR, 1.75; 95% CI, 1.50-2.05). After PSM, there were 189 patients with RA and residents, and the prevalence of OHF among patients with RA was still higher (PR, 1.61; 95% CI, 1.22-2.13). Poisson regression showed that the prevalence of 19 or fewer teeth (PR, 1.06; 95% CI, 0.82-1.36), difficulties eating tough foods (PR, 1.18; 95% CI, 0.90-1.55), difficulties swallowing tea or soup (PR, 1.77; 95% CI, 1.19-2.63), and dry mouth (PR, 2.79; 95% CI, 1.90-4.07) was higher among patients with RA than residents. CONCLUSION Compared with the general older adult population, patients with RA have a higher prevalence of self-reported OHF.
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Affiliation(s)
- Yoko Kudo
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kenji Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Kusama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Hospital, Nagoya, Japan
- Department of Orthopedic Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsunori Kondo
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Social Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Kentaro Mizuta
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Masayo Kojima
- Nagoya City University, Nagoya, Japan
- Department of Frailty, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
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Smit MJD, Nijholt W, Bakker MH, Visser A. The predictive value of masticatory function for adverse health outcomes in older adults: a systematic review. J Nutr Health Aging 2024; 28:100210. [PMID: 38489994 DOI: 10.1016/j.jnha.2024.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/31/2023] [Indexed: 03/17/2024]
Abstract
Masticatory function is associated with a variety of health outcomes. The aim of this systematic review is to clarify the predictive value of masticatory function for adverse health outcomes, such as frailty, sarcopenia and malnutrition, in older adults. An online literature search covered articles published in English or Dutch in three databases (PubMed, Embase and CINAHL, last searched November 4th 2022). Inclusion criteria were: an observational study design, focus on adults aged ≥65 years and evaluation of the association between masticatory function and health outcomes. Reviews and articles published before the year 2000 were excluded. Methodological quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the U.S. National Institutes of Health. Study population demographics, methods for assessing masticatory function, and the association between masticatory function and adverse health outcomes were extracted. From the 34 included studies, 5 studies had a prospective design, 2 had a retrospective design, and the other 27 studies had cross-sectional design. The majority of the studies were conducted in Japan (74%, n = 26). Twenty studies (59%) used one indicator for masticatory function, the other 41% used two (n = 9) or more (n = 5) indicators. Masticatory function was most frequently assessed with the maximum occlusal force (MOF) (79%, n = 27). The identified health outcomes were clustered into 6 categories: physical parameters and sarcopenia, history of falling, nutritional status, frailty, cognitive function and mortality. Despite the complex and multidimensional character of both masticatory function and most identified adverse health outcomes, some significant associations were reported. Prospective studies showed that reduced masticatory function in older adults is associated with incidence of frailty and frailty progression, cognitive decline and all-cause mortality. Regarding the other identified adverse health outcomes, i.e., physical measures and sarcopenia, history of falling and nutritional status, only cross-sectional studies were available and results were less concordant. As all prospective studies showed that reduced masticatory function in older adults is associated with adverse health outcomes, prevention of decline of masticatory function by adequate oral care may contribute to healthy ageing.
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Affiliation(s)
- Menke J de Smit
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willemke Nijholt
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mieke H Bakker
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Anita Visser
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Gerodontology, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Hama Y, Sasaki Y, Soeda H, Yamaguchi K, Okada M, Komagamine Y, Sakanoshita N, Hirota Y, Emura K, Minakuchi S. Accuracy of newly developed color determination application for masticatory performance: Evaluating color-changeable chewing gum. J Prosthodont Res 2024:JPR_D_23_00140. [PMID: 38616128 DOI: 10.2186/jpr.jpr_d_23_00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE Color-changeable chewing gums are used to evaluate masticatory performance, as measured by a colorimeter or visually based on a color scale. Although anyone can use a color scale, the evaluation accuracy depends on the evaluator. We develop an application that can determine the degree of color change in chewing gum using smartphone images, making color evaluation accurate and easy to measure. METHODS For the application, 60 chewed gum samples were prepared. Two shots were captured using two smartphone models. To create the application algorithm, a formula was developed to approximately map the color value from the smartphone images to the true value using a colorimeter. A basic validation was performed on 60 new samples covering a range of colors, followed by a field validation on 100 healthy dentate participants aged 20-39 years. RESULTS The intraclass correlation coefficient for two repeated shots had a high value ≥ 0.97 in the basic and field validations, confirming reliability. No significant differences were observed in the paired t-test and Wilcoxon signed-rank test, and a significant and strong correlation (correlation coefficient ≥ 0.92) was observed between the evaluation values using the colorimeter and the basic and field validations. Bland-Altman plots further confirmed the validity of the application. CONCLUSIONS A software application was developed to enable easy, quick, and accurate determination of the masticatory performance of a chewing gum from images taken using a smartphone with highly reliable and validated results.
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Affiliation(s)
- Yohei Hama
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyuki Sasaki
- Clinical Dental Research Promotion Unit, Faculty of Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitomi Soeda
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuzumi Okada
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuriko Komagamine
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Yusuke Hirota
- Chewing gum R&D section, Central Laboratory, Lotte Co., Ltd., Saitama, Japan
| | - Koji Emura
- Chewing gum R&D section, Central Laboratory, Lotte Co., Ltd., Saitama, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Kashiwazaki K, Komagamine Y, Uehara Y, Yamamoto M, Nakai H, Bui NHT, Liu H, Namano S, Tonprasong W, Kanazawa M, Minakuchi S. Effect of gum-chewing exercise on maintaining and improving oral function in older adults: A pilot randomized controlled trial. J Dent Sci 2024; 19:1021-1027. [PMID: 38618096 PMCID: PMC11010614 DOI: 10.1016/j.jds.2023.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/28/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose Gum chewing has been found to improve oral function. Nevertheless, few randomized controlled trials have investigated the effects of gum-chewing exercises on oral function in older adults. This study aimed to examine the effect of gum-chewing exercises on oral function in older adults. Materials and methods This was a single-blind, randomized controlled trial, conducted from November 2021 to January 2022. A total of 130 participants were divided randomly into the intervention and control groups. The intervention group was told to chew experimental gums for one month, while the control group was instructed to chew experimental tablets for one month. Maximum bite force, occlusal contact areas, oral dryness, tongue pressure, tongue and lip functions (number of times each of the following syllables is pronounced per second:/pa/,/ta/, and/ka/), masticatory function, subjective masticatory function, and gum-chewing time were measured at baseline and one month following intervention to assess outcomes. Results One month following the intervention, tongue pressure was significantly higher in the intervention group than in the control group (P = 0.027). In the within-group comparisons, maximum bite force (P < 0.001), unstimulated saliva flow (P < 0.001), tongue and lip functions (/pa/: P < 0.001;/ta/: P < 0.001;/ka/: P < 0.001), color scale value (P = 0.019), and ΔE value (P = 0.024) were significantly increased in the intervention group. Conclusion The results suggest that gum-chewing exercises can improve oral functions in older adults, although additional increases in masticatory load may be necessary to establish a more effective oral function training method using gum-chewing exercises in older adults.
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Affiliation(s)
- Kenta Kashiwazaki
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuriko Komagamine
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Uehara
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mao Yamamoto
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroto Nakai
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ngoc Huyen Trang Bui
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hengyi Liu
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sahaprom Namano
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Watcharapong Tonprasong
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manabu Kanazawa
- Digital Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Okada M, Hama Y, Futatsuya R, Sasaki Y, Noritake K, Yamaguchi K, Matsuzaki M, Kubota C, Hosoda A, Minakuchi S. Association between Masticatory Performance, Nutritional Intake, and Frailty in Japanese Older Adults. Nutrients 2023; 15:5075. [PMID: 38140333 PMCID: PMC10746083 DOI: 10.3390/nu15245075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
The older adult population in Japan is expected to increase. Therefore, long-term care and frailty prevention are important. However, the relationship between masticatory performance, nutritional intake, and frailty remains unclear. This cross-sectional study aimed to examine energy, protein, and vitamin D intake and its association with frailty and masticatory performance in older adults. Patients between January 2022 and January 2023 were recruited and divided into robust and frail groups. Masticatory performance, nutrition, frailty, and other data, such as age and sex, were evaluated through onsite measurements and a questionnaire. Logistic regression analysis was conducted with frailty as a dependent variable and masticatory performance as an independent variable, adjusting for age, sex, skeletal muscle mass, living alone, energy intake, protein-energy ratio, and vitamin D intake. No significant differences were observed between the groups regarding age or sex. The robust group showed significantly better results for protein-energy ratio, vitamin D intake, and subjective and objective masticatory performance than the frail group. Logistic regression analysis revealed a significant correlation between skeletal muscle mass, protein-energy ratio, and objective masticatory performance with frailty. Masticatory performance was associated with frailty, independent of the intake of nutrients such as energy, protein, and vitamin D.
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Affiliation(s)
- Mitsuzumi Okada
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (M.O.); (R.F.); (K.Y.); (M.M.); (S.M.)
| | - Yohei Hama
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (M.O.); (R.F.); (K.Y.); (M.M.); (S.M.)
| | - Ryota Futatsuya
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (M.O.); (R.F.); (K.Y.); (M.M.); (S.M.)
| | - Yoshiyuki Sasaki
- Clinical Dental Research Promotion Unit, Faculty of Dentistry, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Kanako Noritake
- Oral Diagnosis and General Dentistry, Tokyo Medical and Dental University Hospital, Tokyo 113-8549, Japan;
| | - Kohei Yamaguchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (M.O.); (R.F.); (K.Y.); (M.M.); (S.M.)
| | - Mayuko Matsuzaki
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (M.O.); (R.F.); (K.Y.); (M.M.); (S.M.)
| | - Chieko Kubota
- Department of Oral Health Sciences, Meikai University, Chiba 279-8550, Japan;
| | - Akemi Hosoda
- Division of Medical Nutrition, Faculty of Healthcare, Tokyo Healthcare University, Tokyo 141-8648, Japan;
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (M.O.); (R.F.); (K.Y.); (M.M.); (S.M.)
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Aishima M, Ishikawa T, Ikuta K, Noguchi-Watanabe M, Nonaka S, Takahashi K, Anzai T, Fukui S. Unplanned Hospital Visits and Poor Oral Health With Undernutrition in Nursing Home Residents. J Am Med Dir Assoc 2023; 24:1855-1860.e1. [PMID: 37591488 DOI: 10.1016/j.jamda.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES In 2021, the Japanese government began operating a long-term care (LTC) database called the Long-Term Care Information System for Evidence (LIFE). However, its utility has not been verified. Regarding unplanned hospital visits of nursing home residents, one of the challenges in LTC is that poor oral health with undernutrition could indicate high-risk residents. Therefore, this study examined the association between poor oral health with undernutrition assessed using the LIFE data and unplanned hospital visits of nursing home residents. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS The participants were 237 residents aged ≥65 years in 4 nursing homes in Japan. The analyses included 1041 LIFE data entries repeatedly measured for the participants every month and unplanned hospital visit data during the observation period. METHODS The participants' LIFE and unplanned hospital visit data were obtained from the nursing home providers. Poor oral health was defined using oral items included in the LIFE data and body mass index. Using the LIFE data, the association between poor oral health and unplanned hospital visits within 1 month after LIFE assessment entries was analyzed. The odds ratios (ORs) and 95% CIs were calculated using a generalized linear mixed model. RESULTS In total, 59 of 1041 LIFE data (5.7%) entries were unplanned hospital visits within 1 month after LIFE assessment. Among patient characteristics, significant differences were noted in dementia diagnosis [OR (95% CI): 2.66 (1.26-5.63)], although no significant differences were observed in other characteristics. Multivariate analysis using participant identification as a random effect confirmed that poor oral health was associated with unplanned hospital visits within 1 month [adjusted OR (95% CI): 2.63 (1.05-6.61)]. CONCLUSIONS AND IMPLICATIONS Poor oral health assessed using the LIFE data could be used as an indicator to identify nursing home residents at high risk for unplanned hospital visits.
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Affiliation(s)
- Miya Aishima
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takako Ishikawa
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kasumi Ikuta
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Maiko Noguchi-Watanabe
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sayuri Nonaka
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sakiko Fukui
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Castrejón-Pérez RC, Wanyonyi KL, García-Vázquez PE, Cruz-Hervert LP, Ramírez-Aldana R, Borges-Yáñez SA. Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis. Gerodontology 2023; 40:372-381. [PMID: 36358062 DOI: 10.1111/ger.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people. BACKGROUND Studies suggest that the association between frailty and oral conditions are mediated by nutrition. MATERIALS AND METHODS This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome. RESULTS Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index. CONCLUSION Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.
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Affiliation(s)
| | | | - Paola E García-Vázquez
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luis Pablo Cruz-Hervert
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
| | - S Aída Borges-Yáñez
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
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11
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Hama Y, Hosoda A, Kubota C, Guo R, Soeda H, Yamaguchi K, Okada M, Minakuchi S. Factors related to masticatory performance in junior and senior high school students and young adults: A cross-sectional study. J Prosthodont Res 2023; 67:424-429. [PMID: 36351617 DOI: 10.2186/jpr.jpr_d_22_00137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE Maintaining good masticatory function from a young age promotes lifelong health, yet limited studies have explored masticatory performance in young individuals. We investigated the relationship of sex, age, and individual oral functions with masticatory performance among junior and senior high school students and young adults. METHODS This cross-sectional study included students aged 12-13, 14-15, and 16-17 years (groups S1, S2, and S3, respectively) and young adults aged 20-40 years (group YA). We assessed oral functions, the number of functional teeth, and anthropometric measurements. Masticatory performance was evaluated using color-changeable chewing gum. We analyzed sex-related differences in each group and age-related differences in each sex. Multiple linear regression analysis was performed using masticatory performance as the dependent variable to investigate related factors. RESULTS Among the 522 children and 100 young adults, males exhibited significantly higher masticatory performance than females in groups S1, S3, and YA. Among males, groups S2, S3, and YA exhibited significantly higher masticatory performance than group S1. Among females, group S2 exhibited higher masticatory performance than groups S1 and S3. Male sex, the maximum occlusal force and tongue pressure, and the number of functional teeth were significantly correlated with masticatory performance. CONCLUSIONS Masticatory function development differed by sex, with males exhibiting higher masticatory performance than females. We identified that male sex, the maximum occlusal force and tongue pressure, and the number of functional teeth were significantly associated with masticatory performance. Our findings provide a basis for masticatory performance assessment in different age groups.
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Affiliation(s)
- Yohei Hama
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akemi Hosoda
- Division of Medical Nutrition, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan
| | - Chieko Kubota
- Major of Oral Health Sciences, Department of Health Sciences, Saitama Prefectural University, Japan
| | - Ruoyan Guo
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitomi Soeda
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuzumi Okada
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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12
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Kimble R, Papacosta AO, Lennon LT, Whincup PH, Weyant RJ, Mathers JC, Wannamethee SG, Ramsay SE. The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States. J Am Med Dir Assoc 2023; 24:468-474.e3. [PMID: 36584971 PMCID: PMC10398566 DOI: 10.1016/j.jamda.2022.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the prospective associations between oral health and progression of physical frailty in older adults. DESIGN Prospective analysis. SETTING AND PARTICIPANTS Data are from the British Regional Heart Study (BRHS) comprising 2137 men aged 71 to 92 years from 24 British towns and the Health, Aging, and Body Composition (HABC) Study of 3075 men and women aged 70 to 79 years. METHODS Oral health markers included denture use, tooth count, periodontal disease, self-rated oral health, dry mouth, and perceived difficulty eating. Physical frailty progression after ∼8 years follow-up was determined based on 2 scoring tools: the Fried frailty phenotype (for physical frailty) and the Gill index (for severe frailty). Logistic regression models were conducted to examine the associations between oral health markers and progression to frailty and severe frailty, adjusted for sociodemographic, behavioral, and health-related factors. RESULTS After full adjustment, progression to frailty was associated with dentition [per each additional tooth, odds ratio (OR) 0.97; 95% CI: 0.95-1.00], <21 teeth with (OR 1.74; 95% CI: 1.02-2.96) or without denture use (OR 2.45; 95% CI 1.15-5.21), and symptoms of dry mouth (OR ≥1.8; 95% CI ≥ 1.06-3.10) in the BRHS cohort. In the HABC Study, progression to frailty was associated with dry mouth (OR 2.62; 95% CI 1.05-6.55), self-reported difficulty eating (OR 2.12; 95% CI 1.28-3.50) and ≥2 cumulative oral health problems (OR 2.29; 95% CI 1.17-4.50). Progression to severe frailty was associated with edentulism (OR 4.44; 95% CI 1.39-14.15) and <21 teeth without dentures after full adjustment. CONCLUSIONS AND IMPLICATIONS These findings indicate that oral health problems, particularly tooth loss and dry mouth, in older adults are associated with progression to frailty in later life. Additional research is needed to determine if interventions aimed at maintaining (or improving) oral health can contribute to reducing the risk, and worsening, of physical frailty in older adults.
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Affiliation(s)
- Rachel Kimble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Division of Sport and Exercise Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, UK.
| | - A Olia Papacosta
- Department of Primary Care and Population Health, UCL, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, UCL, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John C Mathers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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13
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Tani A, Mizutani S, Kishimoto H, Oku S, Iyota K, Chu T, Liu X, Kashiwazaki H. The Impact of Nutrition and Oral Function Exercise on among Community-Dwelling Older People. Nutrients 2023; 15:nu15071607. [PMID: 37049448 PMCID: PMC10097015 DOI: 10.3390/nu15071607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Oral function (OF) decline in older people is associated with nutritional deficiencies, which increases frailty risk and the need for nursing care. We investigated whether the delivery of an oral function improvement program on a tablet device was as effective as delivery through a paper-based program. We also investigated the association between tongue pressure (TP) improvement and nutritional status at the baseline. The participants involved in the study were 26 community-dwelling older people with low TP, <30 kPa, aged ≥65 years, who were enrolled in a randomized controlled trial for a month in Itoshima City, Fukuoka, Japan. Oral and physical functions and body composition were measured at the baseline and at follow-up. Two-way analysis of variance revealed that body mass index (p = 0.004) increased, and maximum masticatory performance (p = 0.010), maximum TP (p = 0.035), and oral diadochokinesis /pa/ and /ka/ (p = 0.009 and 0.017, respectively) improved in a month. Participants with higher TP improvement showed an increased intake of animal proteins at the baseline: fish (p = 0.022), meat (p = 0.029), and egg (p = 0.009). OF exercises for improving TP were associated with higher animal protein intake at the baseline. This study has been registered with the UMIN Clinical Trials Registry (UMIN 000050292).
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14
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Zhang J, Xu G, Xu L. Number of Teeth and Denture Use Are Associated with Frailty among Chinese Older Adults: A Cohort Study Based on the CLHLS from 2008 to 2018. J Nutr Health Aging 2023; 27:972-979. [PMID: 37997718 DOI: 10.1007/s12603-023-2014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/01/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES The aim of this study was to determine the association between oral health and the development of frailty over a 10-year period in older Chinese adults. DESIGN This was a cohort study. SETTING AND PARTICIPANTS The data in this study were derived from the 2008, 2011, 2014 and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The final analysis included 1155 older adults who had complete data for the Frailty Index (FI) and the other factors(oral health, sociodemographics, etc) that were analyzed in the study. MEASUREMENTS Frailty was assessed by the FI, which consists of 40 deficits(self-health assessments, diseases, physical functions,etc). Multivariable logistic regression was carried out to calculate the odds ratios (ORs) of the independent variables,which were obtained from investigator surveys and self-reports, in association with the development of frailty. RESULTS The prevalence of frailty at baseline was 22.94%, and the 10-year incidence of frailty was 24.16% (215/890). Age, number of natural teeth, use of dentures, toothache and sex were independent risk factors for frailty at baseline. After full adjustment, multivariate logistic regression analysis indicated that compared with having ≥21 teeth, edentulism (ORs 3.575; 95% CI 2.095,6.101) and partial tooth loss (ORs 2.448; 95% CI 1.592,3.766) were associated with progression to frailty. Compared with those with ≥21 teeth, those with <21 teeth and without dentures (ORs 2.617; 95% CI 1.713,3.999) were more likely to progress to frailty. CONCLUSION The loss of natural teeth is associated with the progression of frailty in older Chinese adults and denture using can help lower the odds of being frailty. Further research on maintain natural teeth and the appropriate use of dentures may help to establish effective frailty prevention strategies for the older adults.
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Affiliation(s)
- J Zhang
- Liyu Xu, Department of Geriatrics, Zhejiang Hospital, Hangzhou 310013, People's Republic of China, ; Tel. :+86 13486183817
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15
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Miyano T, Kaneko R, Kimura T, Maruoka M, Kishimura A, Kato K, Furuta M, Yamashita Y. Dietary Problems Are Associated with Frailty Status in Older People with Fewer Teeth in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316260. [PMID: 36498332 PMCID: PMC9738370 DOI: 10.3390/ijerph192316260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 06/01/2023]
Abstract
This study aimed to investigate the association between dietary problems and frailty according to tooth loss in older Japanese people. This cross-sectional study included 160 older people (mean age 82.6 years) from Japan. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria, which consists of (i) weight loss > 5% in the past year, (ii) inability to perform five chair stands, and (iii) self-perceived reduced energy level. Frailty was defined as the presence of ≥2 items of SOF criteria. Multivariate logistic regression analyses were performed with frailty as the dependent variable and dietary problems as the independent variable, stratified according to having <20 teeth. Low appetite and no enjoyment of eating were associated with frailty after adjusting for covariates in participants with <20 teeth. Dietary problems, including low appetite, eating alone, and negative attitudes toward enjoyment of eating were associated with a self-perceived reduced energy level in participants with <20 teeth. However, this association was not observed in participants with ≥20 teeth. In older people with fewer teeth, dietary problems have been suggested to be associated with frailty. Therefore, it may be necessary to pay attention to dietary problems, especially in older people with tooth loss.
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Affiliation(s)
- Takashi Miyano
- Graduate School of Systems Life Sciences, Kyushu University, Fukuoka 819-0395, Japan
- Nissan Chemical Corporation, Tokyo 103-6119, Japan
| | - Ryosuke Kaneko
- Department of Applied Chemistry, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan
| | - Toshihide Kimura
- Manno-Cho Kokumin Kenko Hoken Soda Dental Clinic, Takamatsu 766-0201, Japan
| | - Misa Maruoka
- Manno-Cho Kokumin Kenko Hoken Soda Dental Clinic, Takamatsu 766-0201, Japan
| | - Akihiro Kishimura
- Department of Applied Chemistry, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan
- Center for Future Chemistry, Kyushu University, Fukuoka 819-0395, Japan
- Center for Molecular Systems, Kyushu University, Fukuoka 819-0395, Japan
| | - Koichiro Kato
- Department of Applied Chemistry, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan
- Center for Molecular Systems, Kyushu University, Fukuoka 819-0395, Japan
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
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Arai M, Kato H, Kato T. Functional quantification of oral motor cortex at rest and during tasks using activity phase ratio: A zero-setting vector functional near-infrared spectroscopy study. Front Physiol 2022; 13:833871. [PMID: 36213249 PMCID: PMC9539688 DOI: 10.3389/fphys.2022.833871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Oral frailty associated with oral hypokinesia may cause dementia. Functional near-infrared spectroscopy (fNIRS) can be used while the participants are in seating position with few restrictions. Thus, it is useful for assessing brain function, particularly oral motor activity. However, methods for identifying oral motor cortex (OMC) activation via the scalp have not been established. The current study aimed to detect OMC activation, an indicator of activity phase ratio (APR), which reflects increased oxygen consumption (0 < [deoxyhemoglobin (ΔDeoxyHb) or 0 < {[ΔDeoxyHb- oxyhemoglobin (ΔOxyHb)/√2]}, via fNIRS to accurately identify local brain activity. The APR, calculated via zero-set vector analysis, is a novel index for quantifying brain function both temporally and spatially at rest and during tasks. In total, 14 healthy participants performed bite tasks for 3 s per side for 10 times while in the sitting position. Then, time-series data on concentration changes in ΔOxyHb and ΔDeoxyHb were obtained via fNIRS. The anatomical location of the OMC was determined using a pooled data set of three-dimensional magnetic resonance images collected in advance from 40 healthy adults. In the zero-set vector analysis, the average change in ΔOxyHb and ΔDeoxyHb concentrations was utilized to calculate the APR percentage in 140 trials. The significant regions (z-score of ≥2.0) of the APR and ΔOxyHb in the task were compared. During the bite task, the APR significantly increased within the estimated OMC region (56–84 mm lateral to Cz and 4–20 mm anterior to Cz) in both the right and left hemispheres. By contrast, the ΔOxyHb concentrations increased on the bite side alone beyond the OMC region. The mean APR at rest for 2 s before the task showed 59.5%–62.2% in the left and right OMCs. The average APR for 3 s during the task showed 75.3% for the left OMC and 75.7% for the right OMC during the left bite task, and 65.9% for the left OMC and 80.9% for the right OMC during the right bite task. Interestingly, the average increase in APR for the left and right OMCs for the left bite task and the right bite task was 13.9% and 13.7%, respectively, showing almost a close match. The time course of the APR was more limited to the bite task segment than that of ΔOxyHb or ΔDexyHb concentration, and it increased in the OMC. Hence, the APR can quantitatively monitor both the resting and active states of the OMC in the left and right hemispheres. Using the zero-set vector-based fNIRS, the APR can be a valid indicator of oral motor function and bite force.
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Affiliation(s)
- Masaaki Arai
- Department of Oral Biomedical Research, Total Health Advisers Co., Chiba, Japan
| | - Hikaru Kato
- Department of Brain Environmental Research, KatoBrain Co., Ltd., Tokyo, Japan
| | - Toshinori Kato
- Department of Brain Environmental Research, KatoBrain Co., Ltd., Tokyo, Japan
- Correspondence: Toshinori Kato,
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Kojima G, Taniguchi Y, Iwasaki M, Aoyama R, Urano T. Associations between self-reported masticatory dysfunction and frailty: A systematic review and meta-analysis. PLoS One 2022; 17:e0273812. [PMID: 36084116 PMCID: PMC9462797 DOI: 10.1371/journal.pone.0273812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Oral health is a key factor of overall health and closely associated with well-being and quality of life. Mastication is one the most important oral functions and may deteriorate with aging. Evidence on association between masticatory dysfunction and frailty in the literature is scarce and not coherent. METHODS A search strategy was developed to conduct a systematic review of the literature in PubMed, CINAHL, and AMED in accordance with the PRISMA 2020 guidelines. We searched for studies published in 2000 or later that examined associations between self-reported masticatory dysfunction and frailty risk. The reference lists of the relevant articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of association between self-reported masticatory dysfunction and the risk of frailty by fixed-effects meta-analysis. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Publication bias was assessed by visually inspecting a funnel plot. RESULTS A total of 285 studies were identified by the literature search. Among 5 studies selected for this review, 4 cross-sectional studies including a total of 7425 individuals were used for meta-analysis. The pooled results by a fixed-effects model showed that there was a significant association between self-reported masticatory dysfunction and frailty risk (pooled OR = 1.83, 95%CI = 1.55-2.18, p<0.00001). There was no evidence of publication bias observed. CONCLUSIONS This systematic review and meta-analysis highlighted pooled cross-sectional evidence that community-dwelling older people who report masticatory dysfunction are significantly more likely to be frail than those who do not. The limitations of this study are: inclusion of only cross-sectional studies, no gold standard to measure masticatory functions, self-reported information on masticatory function, and the limited number of included studies. More longitudinal studies are warranted for further understanding of the causal pathways and elucidate underlying mechanisms. Registration: PROSPERO CRD42021277173.
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Affiliation(s)
- Gotaro Kojima
- Department of Research, Dr. AGA Clinic, Tokyo, Japan
| | - Yu Taniguchi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | | | - Reijiro Aoyama
- Department of Japanese Studies, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tomohiko Urano
- Department of Geriatric Medicine, International University of Health and Welfare, Chiba, Japan
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Sakai K, Nakayama E, Yoneoka D, Sakata N, Iijima K, Tanaka T, Hayashi K, Sakuma K, Hoshino E. Association of Oral Function and Dysphagia with Frailty and Sarcopenia in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Cells 2022; 11:2199. [PMID: 35883642 PMCID: PMC9316124 DOI: 10.3390/cells11142199] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/11/2022] Open
Abstract
Studies investigating the associations of oral function and dysphagia with frailty and sarcopenia in community-dwelling older adults are increasing; however, they have not been systematically summarized. We conducted a systematic review to investigate these associations. We searched electronic databases and synthesized relevant data using conventional (frequentist-style) and Bayesian meta-analyses. Twenty-four studies were found to be eligible for our review, including 20 cross-sectional and four prospective cohort studies. Older adults with frailty or sarcopenia had lower tongue pressure, according to the results of conventional meta-analysis (mean difference [95% confidence interval or credible interval]: -6.80 kPa [-10.22 to -3.38] for frailty and -5.40 kPa [-6.62 to -4.17] for sarcopenia) and Bayesian meta-analysis (-6.90 kPa [-9.0 to -4.8] for frailty, -5.35 kPa [-6.78 to -3.89] for sarcopenia). People with frailty had a higher odds ratio (OR) for dysphagia according to the results of conventional meta-analysis (3.99 [2.17 to 7.32]) and Bayesian meta-analysis (1.38 [0.77 to 1.98]). However, the results were inconclusive for people with sarcopenia. A prospective association could not be determined because of the lack of information and the limited number of studies. Decreased oral function and dysphagia can be important characteristics of frailty and sarcopenia in community-dwelling older adults.
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Affiliation(s)
- Kotomi Sakai
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan;
- Heisei Medical Welfare Group Research Institute, Tokyo 151-0053, Japan;
| | - Enri Nakayama
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo 101-8310, Japan;
| | - Daisuke Yoneoka
- Infectious Disease Surveillance Center at the National Institute of Infectious Diseases, Tokyo 162-8640, Japan;
- Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo 160-8582, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
| | - Nobuo Sakata
- Heisei Medical Welfare Group Research Institute, Tokyo 151-0053, Japan;
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8654, Japan; (K.I.); (T.T.)
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-8654, Japan
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8654, Japan; (K.I.); (T.T.)
| | - Kuniyoshi Hayashi
- Institute of Religion and Culture, Kyoto Women’s University, Kyoto 605-8501, Japan;
| | - Kunihiro Sakuma
- Institute for Liberal Arts, Environment and Society, Tokyo Institute of Technology, Tokyo 152-8550, Japan;
| | - Eri Hoshino
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan;
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Fan Y, Shu X, Leung KCM, Lo ECM. Associations of general health conditions with masticatory performance and maximum bite force in older adults: A systematic review of cross-sectional studies. J Dent 2022; 123:104186. [PMID: 35691453 DOI: 10.1016/j.jdent.2022.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To give an overview of the current evidence on the associations of general health conditions with masticatory performance and maximum bite force in older adults. DATA/SOURCES Three electronic databases (Medline via PubMed, Embase via Ovid and CINAHL Plus via EBSCOhost) were searched up to September 2021 for cross-sectional studies on general health conditions and masticatory performance or maximum bite force in older adults. Methodological quality of the included studies was independently evaluated based on Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Data on the associations between general health conditions and masticatory performance or maximum bite force were extracted. STUDY SELECTION Of the 5133 records identified, 39 studies (43 articles) were included in this review. Significant negative associations were found between masticatory performance and stroke, sarcopenia, amyotrophic lateral sclerosis, chronic obstructive pulmonary disease, dyspepsia, dysphagia, anorexia, and carotid atherosclerosis. Significant negative association was found between maximum bite force and sarcopenia. There were equivocal results on the association between masticatory performance and diabetes mellitus, and between maximum bite force and stroke, and amyotrophic lateral sclerosis. There was no significant association between masticatory performance and metabolic syndrome, and between maximum bite force and progress of Parkinson's disease. Most studies revealed positive associations of physical function with masticatory performance and maximum bite force. CONCLUSIONS Negative associations between masticatory function of older adults and presence of several systemic diseases have been reported in a number of studies while there are positive associations between masticatory function and some physical function indicators. CLINICAL SIGNIFICANCE This study provides valuable information on the association of masticatory function with general health, which draws clinicians' attention to the masticatory function of older adults who suffer from certain systemic diseases or physical dysfunction, and to the need to improve their masticatory ability to achieve healthy aging.
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Affiliation(s)
- Yanpin Fan
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Xin Shu
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Katherine Chiu Man Leung
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Edward Chin Man Lo
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong.
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Hong SW, Kang JH. Relationship between skeletal bone mineral density and subjective masticatory difficulty. BMC Oral Health 2022; 22:136. [PMID: 35448990 PMCID: PMC9027039 DOI: 10.1186/s12903-022-02172-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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Arenas-Márquez MJ, Tôrres LHDN, Borim FSA, Yassuda MS, Neri AL, Sousa MDLRD. Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210234.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Verificar se a perda de função mastigatória aumenta o risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. Métodos Foi adotado um delineamento de coorte prospectivo sobre a base de dados do estudo FIBRA (Fragilidade em Idosos Brasileiros), com linha de base realizada em 2008-2009 e seguimento em 2016-2018, transcorrendo em média 100,2 ± 9,2 meses. A variável desfecho foi a incidência de fragilidade, a variável de exposição foi a função mastigatória conforme a condição de edentulismo e autorrelato de dificuldade mastigatória. As variáveis de ajuste foram condições sociodemográficas, comportamentais e de saúde geral. Foi utilizado um modelo de regressão de Poisson, com variância robusta, estimando o risco relativo Resultados a incidência acumulada de fragilidade aos oito anos em média foi de 30 casos a cada 100 participantes edêntulos com dificuldade mastigatória, que apresentaram maior risco de desenvolver fragilidade (RR:1,75 IC 95% 1,09-2,81) do que os idosos dentados sem dificuldade mastigatória, independentemente de tabagismo (RR: 1,71 IC 95% 1,07-2,73) e de condição socioeconômica (RR: 1,72 IC 95% 1,13-2,62). Conclusão A perda de função mastigatória aumentou o risco de fragilidade em idosos.Futuras pesquisas deverão estudar se a reabilitação da função mastigatória contribui para diminuir esse risco.
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Arenas-Márquez MJ, Tôrres LHDN, Borim FSA, Yassuda MS, Neri AL, Sousa MDLRD. Masticatory function loss and frailty risk in community-dwelling older people in the State of São Paulo. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210234.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.
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Takahara M, Shiraiwa T, Maeno Y, Yamamoto K, Shiraiwa Y, Yoshida Y, Nishioka N, Katakami N, Shimomura I. Screening for a Decreased Masticatory Function by a Color-changeable Chewing Gum Test in Patients with Metabolic Disease. Intern Med 2022; 61:781-787. [PMID: 35296621 PMCID: PMC8987249 DOI: 10.2169/internalmedicine.8082-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective This study aimed to reveal the screening performance of a color-changeable chewing gum test for a decreased masticatory function in the assessment of oral hypofunction in patients with metabolic diseases. Methods We analyzed 1,000 patients with metabolic diseases, including diabetes, dyslipidemia, hypertension, and hyperuricemia. A decreased masticatory function was diagnosed by a gummy jelly test. Patients were asked to chew a test gum, which changed from green to red by thorough mastication, 60 times for 1 minute. The color change was visually evaluated using the color scale, from 1 (green-dominant) to 10 points (red-dominant), and was colorimetrically quantified as delta E in the L*a*b* color space. The screening performance for a decreased masticatory function was evaluated with the receiver operating characteristic (ROC) curve. Results Seventy-seven patients (7.7%) were diagnosed with a decreased masticatory function. The mean color scale and delta E of the gum test were 6.7±1.8 points and 42.9±6.7 units, respectively. The area under the ROC curve was 0.822 (95% confidence interval, 0.768-0.872) for the color scale and 0.838 (0.781-0.890) for delta E (p=0.41). The optimal cut-off point of the color scale was 5.5 (5.0-6.5) points, whereas that of delta E was 37.7 (35.5-38.8) units. The optimal cut-off points were not significantly different between the subgroups divided by clinical characteristics. Conclusions A color-changeable chewing gum test using the color scale as well as delta E would be a useful tool for screening patients with metabolic diseases for a decreased masticatory function in the assessment of oral hypofunction.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Japan
| | | | | | | | | | | | | | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Japan
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Relationship between Oral Hypofunction, and Protein Intake: A Cross-Sectional Study in Local Community-Dwelling Adults. Nutrients 2021; 13:nu13124377. [PMID: 34959928 PMCID: PMC8705970 DOI: 10.3390/nu13124377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/09/2023] Open
Abstract
Few studies have investigated the relationship between nutritional status and comprehensive assessment of oral hypofunction, especially protein intake-related sarcopenia. Thus, we explored these relationships in a large-scale cross-sectional cohort study using the seven-item evaluation for oral hypofunction and Diet History Questionnaire for nutritional assessment. We used the data from 1004 individuals who participated in the 2019 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan for analysis. We found that individuals with oral hypofunction were significantly older with a lower skeletal muscle index. Although there were few foods that had a significant difference between the groups with and without oral hypofunction, the consumption of beans and meats was significantly lower in women and men in the oral hypofunction group, respectively. According to the lower limit of the tentative dietary goal defined in Japan, comprehensive evaluation of oral hypofunction was significantly and independently associated with protein intake in both men and women (odds ratio, 1.70; 95% confidence interval, 1.21-2.35). In conclusion, we found that oral hypofunction was associated with targeted protein intake for sarcopenia and frailty prevention in middle-aged and older community-dwelling adults. Comprehensive evaluation of oral function with intervention in cases of hypofunction could inform clinicians to better prevent sarcopenia.
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Ohara Y, Kawai H, Shirobe M, Iwasaki M, Motokawa K, Edahiro A, Kim H, Fujiwara Y, Ihara K, Watanabe Y, Obuchi S, Hirano H. Association between dry mouth and physical frailty among community-dwelling older adults in Japan: The Otassha Study. Gerodontology 2021; 39:41-48. [PMID: 34762315 DOI: 10.1111/ger.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To elucidate the relationship between physical frailty and dry mouth among community-dwelling older adults in Japan. BACKGROUND Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty. MATERIALS AND METHODS This cross-sectional study included 643 individuals (mean age, 73.9 years) from the Otassha Study in 2019. Xerostomia was assessed using the 5-item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation. RESULTS Among the participants, 4.5% and 49.8% had physical frailty and pre-frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one-point increase in SXI, 1.12; 95% confidence interval, 1.06-1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty. CONCLUSION Xerostomia is associated with physical frailty among community-dwelling older adults in Japan. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hisashi Kawai
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Keiko Motokawa
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hunkyung Kim
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Kazuhige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yutaka Watanabe
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Dental and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Yoshida M, Hiraoka A, Takeda C, Mori T, Maruyama M, Yoshikawa M, Tsuga K. Oral hypofunction and its relation to frailty and sarcopenia in community-dwelling older people. Gerodontology 2021; 39:26-32. [PMID: 34727388 DOI: 10.1111/ger.12603] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/20/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the frequency of oral hypofunction in community-dwelling older people and determine its relationship with frailty and sarcopenia. BACKGROUND Previous studies have shown that frailty and sarcopenia are associated with decreased oral function. However, these studies have only evaluated frailty or sarcopenia alone and have not evaluated their relationship with each other. MATERIALS AND METHODS The participants were community-dwelling independent older people in Kyoto. Their oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function). Oral hypofunction was defined as abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre-frail and frail) according to the frailty phenotype and deficit-accumulation models. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) Consensus. The relationships between oral function and frailty were analysed using logistic regression analyses, after adjusting for sarcopenia. RESULTS Among the 340 participants that were analysed (69 men, 271 women; average age: 75.0 years), 182 (53.5%) had oral hypofunction (40 men, 142 women; average age: 76.8 years). There was a significant relationship between oral hypofunction and deficit-accumulation model-assessed frailty, after adjusting for sarcopenia. CONCLUSION Almost half of the community-dwelling older people have oral hypofunction, which is significantly related to comprehensive frailty and sarcopenia.
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Affiliation(s)
- Mitsuyoshi Yoshida
- Department of Dentistry & Oral-Maxillofacial Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Chiho Takeda
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Takahiro Mori
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Mariko Maruyama
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
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Resident and Institutional-Level Factors, Frailty, and Nursing Homes Residents. Nurs Res 2021; 71:E1-E9. [PMID: 34620773 DOI: 10.1097/nnr.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frailty is a major cause of adverse health outcomes such as hospitalization, falls, disability, and morbidity among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES This study aimed to examine the trend of frailty over time (at baseline, with 6-month and 12-month follow-ups) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.
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Medeiros MMDD, Figueredo OMCD, Pinheiro MA, Oliveira LFSD, Wanderley RL, Araújo ECFD, Cavalcanti YW, Rodrigues Garcia RCM. Prosthetic rehabilitation status, dental prosthesis functionality and masticatory function in nursing home residents. Gerodontology 2021; 39:310-319. [PMID: 34476837 DOI: 10.1111/ger.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the association of masticatory function with prosthetic rehabilitation status and dental prosthesis functionality in nursing home residents. BACKGROUND Prosthetic rehabilitation status and dental prosthesis functionality may adversely affect mastication of older people, and this relationship is underestimated in nursing home residents. MATERIALS AND METHODS This cross-sectional study included 179 nursing home residents who used dental prostheses [mean (SD) age: 78.9 (9.0) years]. Masticatory function data were determined by assessing (a) masticatory performance using two-colour chewing gum, and (b) swallowing thresholds by counting the number of peanut chewing cycles. Older adults were categorised as: (1) using dental prostheses in both jaws (n = 100) and (2) partially dentate using removable partial dental prostheses (RPDPs) or complete dentures (CDs) in only one jaw (n = 41), or (3) edentulous using CD in only one jaw (n = 38). Stability, retention, occlusion, vertical dimension and defects were considered in assessing dental prosthesis functionality. RESULTS Greater variance of hue (VOH) of the chewing gum and lower swallowing thresholds (worse masticatory function) was associated with edentulous using CD in only one jaw. Older adults wearing dental prostheses with poor occlusion and vertical dimensions presented worse masticatory function. Dental prosthesis stability was associated with lower VOH values. Higher number of chewing cycles while eating peanuts was associated with non-broken dental prosthesis use. CONCLUSION Edentulous participants using CD in only one jaw and non-functional dental prosthesis use negatively affect the masticatory function of nursing home residents.
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Affiliation(s)
| | | | - Mayara Abreu Pinheiro
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
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Sun FC, Li HC, Wang HH. The Effect of Group Music Therapy with Physical Activities to Prevent Frailty in Older People Living in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168791. [PMID: 34444540 PMCID: PMC8393929 DOI: 10.3390/ijerph18168791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The frail elderly are prone to falls and fractures, which can result in dependency, disability, admission to institutions, and even death. They are at increased risk of frailty due to decreased physical activity, cognitive decline, and depression. Some evidence suggests that music therapy with physical activities may be particularly beneficial. OBJECTIVE This study aimed to investigate the intervention effect of music therapy with physical activities (MTPA) on frail elderly in the community. METHODS A quasi-experimental design was adopted. We selected 10 community care centers in southern Taiwan, in which elderly people over the age of 65 were assigned to a MTPA group and a comparison group after obtaining their informed consent. The MTPA group performed group music activities once a week for 120 min for 12 weeks, while the comparison group only continued with their daily activities. Instruments in this study included the Kihon Checklist, Senior Fitness Test (with Body Mass Index (BMI) and seven physical fitness items), Mini-Mental Status Examination (MMSE), and Geriatric Depression Scale Short Form (GDS-SF). RESULTS A total of 132 community elders agreed to participate in this study, and 122 completed both the pretest and posttest, with 62 in the music therapy group and 60 in the comparison group. The results of ANCOVA showed that after intervention, except for BMI, the Kihon frailty assessment, seven fitness scores individually and in total, MMSE, and depression showed significant improvements in the music therapy group relative to the comparison group (all p < 0.05). CONCLUSION MTPA can improve the frailty index, cognitive function, depression, and physical fitness index in the community elderly. The results of this study can be used as a reference for the design of activities for the community elderly, to provide them with appropriate activities, improve their physical functions, and improve or delay their disability.
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Affiliation(s)
- Feng-Ching Sun
- Kaohsiung Municipal United Hospital, No. 976, Zhonghua 1st Rd., Gushan Dist., Kaohsiung City 804114, Taiwan;
- College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
| | - Hui-Chi Li
- College of Nursing, Asia University, 500 Lioufeng Rd., Wufeng, Taichung 41354, Taiwan;
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel./Fax: +886-7-3121101 (ext. 2624)
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Dibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, Daniele A, De Pergola G, Bortone I, Lampignano L, Giannelli G, Panza F. Oral frailty and its determinants in older age: a systematic review. THE LANCET HEALTHY LONGEVITY 2021; 2:e507-e520. [DOI: 10.1016/s2666-7568(21)00143-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
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Slashcheva LD, Karjalahti E, Hassett LC, Smith B, Chamberlain AM. A systematic review and gap analysis of frailty and oral health characteristics in older adults: A call for clinical translation. Gerodontology 2021; 38:338-350. [PMID: 34331353 DOI: 10.1111/ger.12577] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This systematic review updates the evidence for association between oral health characteristics and frailty status, identifying gaps in translational dental research and application of frailty assessment into clinical practice. BACKGROUND Clinicians have little guidance on stage-appropriate dental treatment for medically complex older adults. Oral health characteristics have been associated with frailty status, determined through validated assessment tools representing a concise measure of health. Translation of frailty assessment into dental practice has not been the focus of previous reviews. METHODS Utilising the PRISMA framework for systematic reviews, a comprehensive database search identified articles describing the association of interest. Those included were cross-sectional or longitudinal, in English, included participants aged 50 years or older, used validated frailty assessments and measured clinically relevant oral health outcomes. From 835 screened articles, 26 full-text articles were eligible for quality appraisal and synthesis. RESULTS Frailty prevalence ranged from 8.5% to 66.0%. Most studies utilised the Fried frailty criteria. Qualitative synthesis of 17 cross-sectional and nine longitudinal studies demonstrated significant covariate-adjusted association between frailty status and number of teeth, chewing ability, prosthetic characteristics, dental caries, periodontitis, dental utilisation and oral health-related quality of life factors. Variability in findings reflected study sample diversity based on country of study origin, age at recruitment, sample size, frailty assessment type, use of clinical versus self-reported outcome measures and differences in statistical analysis. CONCLUSION Despite robust evidence of association with oral health characteristics, frailty assessment has yet to be sufficiently applied to translational dental research and clinical practice.
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Affiliation(s)
- Lyubov D Slashcheva
- Department of Dental Specialties, Mayo Clinic, Rochester, MN, USA.,Apple Tree Dental, Rochester, MN, USA
| | - Erika Karjalahti
- Roseman University College of Dental Medicine, Henderson, NV, USA
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Shih YH, Hong ZR, Hsia SM, Yang SY, Shieh TM. A High Masticatory Muscle Tone Predicts the Risk of Malnutrition and Frailty in Inpatient Older Adults: A Cross-Sectional Study. Gerontology 2021; 68:295-301. [PMID: 34139690 DOI: 10.1159/000516627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The prevalence of malnutrition among inpatient older adults is as high as 20∼50%. Masticatory performance is known to affect the nutritional status of individuals. However, an objective measurement to reflect the real status of masticatory muscle performance is lacking at the bedside. METHODS This pilot study analyzed the masticatory performance using surface electromyography (sEMG) of masticatory muscles that measures both muscle strength and muscle tone at the bedside. The nutritional status was measured using the Mini Nutritional Assessment tool. The handgrip strength was measured using a hand dynamometer. The statistical data were analyzed using SPSS 25 software. RESULTS The data revealed that female inpatient older adults more frequently had substandard handgrip strength (p = 0.028), an at-risk and poor nutritional status (p = 0.005), and a higher masseter muscle tone (p = 0.024). Inpatient older adults with an at-risk and poor nutritional status had an older age (p = 0.016), lower handgrip strength (p = 0.001), and higher average masseter muscle tone (p = 0.01). A high masseter muscle tone predicted the risk of having an at-risk and poor nutritional status. The at-risk or poor nutritional status predicted having a substandard handgrip strength by 5-fold. CONCLUSIONS A high masticatory muscle tone predicts malnutrition and frailty. Medical professionals should combat masticatory dysfunction-induced malnutrition by detecting masticatory muscle performance using sEMG and referring patients to dental professionals. Additionally, encouraging inpatient older adults to perform oral motor exercise is recommended.
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Affiliation(s)
- Yin-Hwa Shih
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Zhen-Rong Hong
- Division of Clinical Nutrition, Asia University Hospital, Taichung, Taiwan
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Shang-Yu Yang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
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Nakamura M, Hamada T, Tanaka A, Nishi K, Kume K, Goto Y, Beppu M, Hijioka H, Higashi Y, Tabata H, Mori K, Mishima Y, Uchino Y, Yamashiro K, Matsumura Y, Makizako H, Kubozono T, Tabira T, Takenaka T, Ohishi M, Sugiura T. Association of Oral Hypofunction with Frailty, Sarcopenia, and Mild Cognitive Impairment: A Cross-Sectional Study of Community-Dwelling Japanese Older Adults. J Clin Med 2021; 10:1626. [PMID: 33921265 PMCID: PMC8068799 DOI: 10.3390/jcm10081626] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Maya Nakamura
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Tomofumi Hamada
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
- Department of Oral & Maxillofacial Surgery, Hakuaikai Medical Cooperation, Sagara Hospital, Kagoshima 892-0833, Japan
| | - Akihiko Tanaka
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Keitaro Nishi
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Kenichi Kume
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Yuichi Goto
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Mahiro Beppu
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Hiroshi Hijioka
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Yutaro Higashi
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Hiroaki Tabata
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Kazuki Mori
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Yumiko Mishima
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Yoshinori Uchino
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Kouta Yamashiro
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Yoshiaki Matsumura
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-0075, Japan;
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (T.K.); (M.O.)
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-0085, Japan;
| | - Toshihiro Takenaka
- Tarumizu Municipal Medical Center, Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (T.K.); (M.O.)
| | - Tsuyoshi Sugiura
- Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-0075, Japan; (M.N.); (T.H.); (A.T.); (K.N.); (K.K.); (Y.G.); (M.B.); (H.H.); (Y.H.); (H.T.); (K.M.); (Y.M.); (Y.U.); (K.Y.); (Y.M.)
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Kim HJ, Lee JY, Lee ES, Jung HJ, Ahn HJ, Jung HI, Kim BI. Simple oral exercise with chewing gum for improving oral function in older adults. Aging Clin Exp Res 2021; 33:1023-1031. [PMID: 32476089 DOI: 10.1007/s40520-020-01606-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/18/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND As general and oral health are closely interrelated, promoting oral health may extend a healthy life expectancy. AIMS To evaluate the long-term effects of simple oral exercise (SOE) and chewing gum exercise on mastication, salivation, and swallowing function in adults aged ≥ 65 years. METHODS Ninety-six participants were assigned to control, SOE, and GOE (chewing gum exercise with SOE) groups. The SOE comprised exercises to improve mastication, salivation, and swallowing function. Control group participants performed no exercises. The intervention period was 8 weeks, followed by a 3-week maintenance period. The Mixing Ability Index (MAI), occlusal force, unstimulated saliva, and repetitive saliva swallowing test were evaluated at baseline and 2, 5, 8, and 11 weeks later. Self-reported discomfort was re-evaluated after 8 weeks. RESULTS After 8 weeks, mean MAI differences from baseline significantly increased in both groups; the increase in the GOE group was largest and four times higher than in the control group. Mean differences of occlusal force from baseline increased by 56 N (SOE group) and 60 N (GOE group). The increase of salivation was greater in the SOE (3.6-fold) and GOE (2.2-fold) groups than in the control group. Furthermore, 27% and 18% of SOE and GOE group participants, respectively, were re-categorized as having good swallowing function. Participants reported less discomfort as oral functions improved. DISCUSSION These findings may facilitate the development of clinical practice guidelines for optimal oral care in older adults. CONCLUSION While both SOE and GOE may improve oral function in older adults, GOE is recommended for those with impaired mastication. TRIAL REGISTRATION KCT0003305, retrospectively registered 31/10/2018.
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Kugimiya Y, Motokawa K, Yamamoto K, Hayakawa M, Mikami Y, Iwasaki M, Ohara Y, Shirobe M, Edahiro A, Watanabe Y, Obuchi S, Kawai H, Kera T, Fujiwara Y, Ihara K, Kim H, Hirano H. [Relationship between the rate of a decreased oral function and the nutrient intake in community-dwelling older persons: An examination using oral function-related items in a questionnaire for latter-stage elderly people]. Nihon Ronen Igakkai Zasshi 2021; 58:91-100. [PMID: 33627567 DOI: 10.3143/geriatrics.58.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To determine the rate of a decreased oral function using questions from the Kihon checklist corresponding to the Questionnaire for Latter-stage Elderly People and to clarify nutrient intake in older persons. METHODS This study targeted 511 older people (217 men, 294 women, average age 73.1±5.6 years old). Their oral function was evaluated using questions on the masticatory function and swallowing function from the Kihon checklist, corresponding to questions on the oral function in the Questionnaire for Latter-stage Elderly People. Participants who had at least one symptom measured were defined as the applicable group (AG). In addition, to evaluate the nutrient intake of the participants, interviews were conducted using the Food Frequency Questionnaire Based on Food Groups. RESULTS The rate of inclusion in the AG was 32.9% for the total sample, 28.2% for early-stage elderly people, and 40.1% for latter-stage elderly people. The AG rates did not differ significantly between men and women. For latter-stage elderly people, the protein-energy ratio and intakes of total energy, protein, pantothenic acid, folic acid, vitamin B6, niacin, vitamin K, copper, zinc, phosphorus, magnesium, potassium, and total dietary fiber were significantly lower in the AG than in the non-AG. CONCLUSION The evaluation of placement in the AG through questions on the oral function from the Kihon checklist corresponding to the Questionnaire for Latter-stage Elderly People demonstrated that the rate of a decreased oral function was higher in latter-stage elderly people than in early-stage elderly people. In addition, the latter-stage elderly people in the AG had a lower nutrient intake.
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Affiliation(s)
- Yoshihiro Kugimiya
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Kaori Yamamoto
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology.,Graduate School of Food and Nutritional Sciences, Toyo University
| | - Misato Hayakawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Yurie Mikami
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Yuki Ohara
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Maki Shirobe
- The Tokyo Metropolitan Support Center for Preventative Long-term and Frail Elderly Care, Tokyo Metropolitan Institute of Gerontology
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology.,Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University
| | - Shuichi Obuchi
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology
| | - Hisashi Kawai
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology
| | - Takeshi Kera
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology.,Faculty of Health Care, Takasaki University of Health and Welfare
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University School of Medicine
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
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Horibe Y, Matsuo K, Ikebe K, Minakuchi S, Sato Y, Sakurai K, Ueda T. Relationship between two pressure-sensitive films for testing reduced occlusal force in diagnostic criteria for oral hypofunction. Gerodontology 2021; 39:3-9. [PMID: 33554405 DOI: 10.1111/ger.12538] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/07/2021] [Accepted: 01/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To measure the occlusal force in the same group of patients with the Dental Prescale 50H type R and the Dental Prescale II, examine the association between them, and determine the reference value for Dental Prescale II that corresponds to the 50H type R 200 N reference value used to make a diagnosis of oral hypofunction. BACKGROUND Reduced occlusal force, a measure of frailty in older persons, was previously determined with Prescale 50H type R pressure-sensitive film, but it has been replaced by the Prescale II. MATERIALS AND METHODS The study participants were 441 men and women aged ≥ 65 (mean, 71.8 ± 5.3) years. The occlusal force was measured with the two different types of pressure-sensitive film, and their association was examined. Receiver operating characteristic curves for the Prescale II measured values were created with the 200 N reference value used for the 50H type R film as the cut-off value. RESULTS The analysis set included 391 participants for whom measurements were obtained using both the 50H type R and the Prescale II. Linear regression analysis produced regression equations, and a ROC curve analysis provided reference values of 500 N for the Prescale II (without pressure filter) and 350 N for the Prescale II (with pressure filter). CONCLUSION In occlusal force tests for making a diagnosis of oral hypofunction, reference values for the Prescale II (without pressure filter) and for the Prescale II (with pressure filter) were determined. The findings suggested that the Prescale II can be used as a diagnostic examination for oral hypofunction.
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Affiliation(s)
- Yasuhiro Horibe
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Sato
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Kaoru Sakurai
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Takayuki Ueda
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
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Nishida T, Yamabe K, Honda S. The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults. Nutrients 2021; 13:nu13020512. [PMID: 33557341 PMCID: PMC7915146 DOI: 10.3390/nu13020512] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9-8.2) and frailty status (OR: 2.3; 95% CI: 1.0-5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo 859-6305, Japan;
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
- Correspondence: ; Tel.: +81-95-819-7945
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Badewy R, Singh H, Quiñonez C, Singhal S. Impact of Poor Oral Health on Community-Dwelling Seniors: A Scoping Review. Health Serv Insights 2021; 14:1178632921989734. [PMID: 33597810 PMCID: PMC7841244 DOI: 10.1177/1178632921989734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
The aim of this scoping review was to determine health-related impacts of poor oral health among community-dwelling seniors. Using MeSH terms and keywords such as elderly, general health, geriatrics, 3 electronic databases-Medline, CINAHL, and Age Line were searched. Title and abstracts were independently screened by 3 reviewers, followed by full-texts review. A total of 131 articles met our inclusion criteria, the majority of these studies were prospective cohort (77%, n = 103), and conducted in Japan (42 %, n = 55). These studies were categorized into 16 general health outcomes, with mortality (24%, n = 34), and mental health disorders (21%, n = 30) being the most common outcomes linked with poor oral health. 90% (n = 120) of the included studies reported that poor oral health in seniors can subsequently lead to a higher risk of poor general health outcomes among this population. Improving access to oral healthcare services for elderly can help not only reduce the burden of oral diseases in this population group but also address the morbidity and mortality associated with other general health diseases and conditions caused due to poor oral health. Findings from this study can help identify shortcomings in existing oral healthcare programs for elderly and develop future programs and services to improve access and utilization of oral care services by elderly.
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Affiliation(s)
- Rana Badewy
- Faculty of Dentistry, University of
Toronto, Toronto, ON, Canada
| | | | - Carlos Quiñonez
- Faculty of Dentistry, Director of
Graduate Program in Dental Public Health, University of Toronto, Toronto, ON,
Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of
Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON,
Canada
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Oliveira TFSD, Embaló B, Pereira MC, Borges SC, Mello ALSFD. Oral health of homebound older adults followed by primary care: a cross sectional study. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.220038.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract Objective to characterize the life, health, and oral health conditions of homebound older people registered in the primary care teams and oral homecare provided. Method cross-sectional, household based study with a convenience sample, in Florianópolis, southern Brazil. Data collection through a questionnaire and clinical oral examination which included sociodemographic variables, condition of teeth and mucosa, oral hygiene, access to dental care and dentist providing homecare. Absolute and relative frequency analysis and bivariate analysis (chi-square, CI=95%) were performed. Results 123 older people participated with mean age of 81.3 years, 62.6% were women. Living with a caregiver were 87%, 60% were domiciled for up to 5 years, and 89.4% were frail. Regarding the presence of teeth, 56.1% were edentulous and 40.5% had from 1 to 8 teeth. Root remains were observed in 12.8%, untreated caries lesions in 25.2%, visible biofilm in 69.9%, tooth mobility in 57.7% and mucosal lesions in 8.9% of the elders; 45.5% needed help with oral hygiene and 24.4% did not perform daily mouth cleaning. The difficulty in accessing dental care due to homeboundness was reported by 32.5% and home visits provided by the dentist occurred in only 16.3%. Conclusion the oral health of the older adults studied is poor due to the presence of oral problems that require intervention. There is dependence on third parties for oral care, which is not consistently guaranteed at home. The study points to the need for dental homecare provided by public health services.
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Important determinants to take into account to optimize protein nutrition in the elderly: solutions to a complex equation. Proc Nutr Soc 2020; 80:207-220. [PMID: 33198824 DOI: 10.1017/s0029665120007934] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
During ageing, skeletal muscle develops anabolic resistance towards the stimulation of protein synthesis induced by dietary amino acids. The stimulation of muscle protein synthesis after food intake remains insufficient, even with a protein intake recommended for healthy adults. This alteration is one of the mechanisms known to be responsible for the decrease of muscle mass and function during ageing, namely sarcopenia. Increasing dietary protein intake above the current RDA(0⋅83 g/kg/d) has been strongly suggested to overcome the anabolic resistance observed. It is also specified that the dietary protein ingested should be of good quality. A protein of good quality is a protein whose amino acid (AA) composition covers the requirement of each AA when ingested at the RDA. However, the biological value of proteins may vary among dietary sources in which AA composition could be unbalanced. In the present review, we suggest that the quality of a dietary protein is also related to several other determinants. These determinants include the speed of digestion of dietary proteins, the presence of specific AA, the food matrix in which the dietary proteins are included, the processes involved in the production of food products (milk gelation and cooking temperature), the energy supply and its nature, and the interaction between nutrients before ingestion. Particular attention is given to plant proteins for nutrition of the elderly. Finally, the timing of protein intake and its association with the desynchronized intake of energetic nutrients are discussed.
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Nutritional Status and Oral Frailty: A Community Based Study. Nutrients 2020; 12:nu12092886. [PMID: 32967313 PMCID: PMC7551233 DOI: 10.3390/nu12092886] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022] Open
Abstract
Compromised oral health can alter food choices. Poor masticatory function leads to imbalanced food intake and undesirable nutritional status. The associations among nutritional status, oral health behavior, and self-assessed oral functions status were investigated using a community-based survey. In total, 701 subjects more than 50 years old living Ebina city located southwest of the capital Tokyo were investigated. The number of remaining teeth was counted by dental hygienists. Oral health behavior and self-assessed oral functions were evaluated by oral frailty checklist. Nutritional status was evaluated by the brief-type self-administered diet history questionnaire using Dietary Reference Intakes for Japanese as reference. More than 80% of subjects’ intakes of vitamin B12, pantothenic acid, copper, and proteins were sufficient. In contrast, only 19% of subjects’ intake of vitamin A was sufficient and 35.5% for vitamin B1. More than 90% of subjects’ intakes of vitamin D and vitamin K were sufficient. Only 35.5% of subjects’ intakes of dietary fiber were sufficient. Overall, 88.9% of subjects had excess salt. The number of remaining teeth was not correlated with nutritional intakes. Oral health behavior significantly correlated with nutritional intakes. Oral functions are important for food choice; however, oral functions were not directly correlated with nutritional intakes. Comprehensive health instructions including nutrition and oral health education is necessary for health promotion.
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Abstract
PURPOSE Sarcopenia has recently been attracting attention as an early sign of the need for nursing care in older adults. Some studies have reported that oral health is related to sarcopenia and its diagnostic factors (hand grip strength, walking speed, and skeletal muscle mass). However, the relationship between oral health and sarcopenia remains poorly investigated and no review to date has compiled the available research on this relationship. The aim of this review was to summarize the current evidence describing the association between oral health and sarcopenia. STUDY SELECTION The internet database PubMed was searched using various combinations of related and synonymous keywords for "oral" or "dental" or "oral health" or "oral function" and "sarcopenia" or "walking speed" or "hand grip strength" or "skeletal muscle mass." A total of 27 studies found to be eligible were critically evaluated and their key findings were summarized. RESULTS Most of the studies were cross-sectional and conducted in Japan. A wide range of oral factors, including number of teeth, occlusal support, periodontal state, occlusal force, mastication, tongue pressure, and swallowing, were covered. The overall findings were that oral health indices could be significantly associated with sarcopenia and its diagnostic factors. CONCLUSIONS Relationships may exist between aspects of oral health and sarcopenia or its diagnostic factors. However, reports showing associations between oral health and sarcopenia are scarce, and definitive conclusions could not be drawn. Further longitudinal studies are necessary to confirm these relationships.
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Affiliation(s)
- Kodai Hatta
- Osaka University Graduate School of Dentistry, Department of Prosthodontics, Gerodontology and Oral Rehabilitatiom Osaka
| | - Kazunori Ikebe
- Osaka University Graduate School of Dentistry, Department of Prosthodontics, Gerodontology and Oral Rehabilitatiom Osaka
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Shimazaki Y, Nonoyama T, Tsushita K, Arai H, Matsushita K, Uchibori N. Oral hypofunction and its association with frailty in community‐dwelling older people. Geriatr Gerontol Int 2020; 20:917-926. [DOI: 10.1111/ggi.14015] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/04/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshihiro Shimazaki
- Department of Preventive Dentistry and Dental Public Health School of Dentistry, Aichi Gakuin University Aichi Japan
| | - Toshiya Nonoyama
- Department of Preventive Dentistry and Dental Public Health School of Dentistry, Aichi Gakuin University Aichi Japan
| | - Kazuyo Tsushita
- Comprehensive Health Science Center Aichi Health Promotion Public Interest Foundation Aichi Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology Aichi Japan
| | - Kenji Matsushita
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology Aichi Japan
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Watanabe D, Yoshida T, Yokoyama K, Yoshinaka Y, Watanabe Y, Kikutani T, Yoshida M, Yamada Y, Kimura M. Association between Mixing Ability of Masticatory Functions Measured Using Color-Changing Chewing Gum and Frailty among Japanese Older Adults: The Kyoto-Kameoka Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4555. [PMID: 32599944 PMCID: PMC7345877 DOI: 10.3390/ijerph17124555] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022]
Abstract
The relationship between mixing ability of masticatory functions and frailty has not been well evaluated. This study investigated the prevalence of physical and comprehensive frailty and its association with mixing ability in 1106 older adults aged ≥65 years who underwent physical examination as part of the Japanese Kyoto-Kameoka Study. Mixing ability was assessed using color-changing chewing gum (1-5 points, 5 representing the best mixing ability). Participants were divided into four groups (5 points, 4 points, 3 points, and 1 or 2 points). The modified Japanese versions of the Cardiovascular Health Study (mJ-CHS) criteria and the validated Kihon Checklist (KCL) were used to assess physical and comprehensive frailty, respectively. Multivariate logistic regression was used to evaluate the association between frailty and mixing ability. The prevalence of physical and comprehensive frailty was 11.8% and 27.9%, respectively. After adjusting for confounders, the odds ratios of physical and comprehensive frailty comparing the highest to the lowest chewing gum score groups were 3.64 (95% confidence interval (CI): 1.62 to 8.18; p for trend = 0.001) and 2.09 (95% CI: 1.09 to 4.03; p for trend = 0.009), respectively. Mixing-ability tests involving chewing gum may be an indicator associated with both physical and comprehensive frailty.
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Affiliation(s)
- Daiki Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Senior Citizen’s Welfare Section, Kameoka City Government, Kyoto 621-8501, Japan
| | - Keiichi Yokoyama
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yasuko Yoshinaka
- Center for Faculty Development, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
| | - Yuya Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Faculty of Health and Sports Science, Doshisha University, Kyoto 610-0394, Japan
| | - Takeshi Kikutani
- Division of Rehabilitation for Speech and Swallowing Disorders, Nippon Dental University, Tokyo 184-0011, Japan;
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima 739-0046, Japan;
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Department of Nursing, Doshisha Women’s College of Liberal Arts, Kyoto 610-0395, Japan
| | - Kyoto-Kameoka Study Group
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
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Shiraishi A, Wakabayashi H, Yoshimura Y. Oral Management in Rehabilitation Medicine: Oral Frailty, Oral Sarcopenia, and Hospital-Associated Oral Problems. J Nutr Health Aging 2020; 24:1094-1099. [PMID: 33244566 PMCID: PMC7349468 DOI: 10.1007/s12603-020-1439-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/14/2022]
Abstract
Oral health is a crucial but often neglected aspect of rehabilitation medicine. Approximately 71% of hospitalized rehabilitation patients and 91% of hospitalized acute care patients have impaired oral health. Poor oral condition in hospitalized patients can be attributed to factors such as age, physical dependency, cognitive decline, malnutrition, low skeletal muscle mass and strength, and multimorbidity. Another major factor is a lack of knowledge and interest in oral problems among health care workers. Recently, new concepts have been proposed, such as oral frailty, oral sarcopenia, and hospital-associated oral problems. Oral frailty, the accumulation of a slightly poor status of oral conditions and function, strongly predicts physical frailty, dysphagia, malnutrition, need for long-term care, and mortality in community-dwelling older adults. Oral sarcopenia refers to sarcopenia associated with oral conditions and function, although its definition has not yet been fully discussed. Hospital-associated oral problems are caused by disease, disease treatment, surgery, endotracheal intubation, poor self-care abilities, lack of care by medical staff, drugs, and iatrogenic factors during hospitalization. Furthermore, oral problems have negative impacts on rehabilitation outcomes, which include functional recovery, length of hospital stay, discharge home, and in-hospital mortality. Oral health management provided by dental hygienists improves not only oral status and function, swallowing function, and nutritional status but also activities of daily living, discharge home, and in-hospital mortality in post-acute rehabilitation. Oral rehabilitation, promotion, education, and medical-dental collaboration can be effective interventions for oral problems and therefore are necessary to improve rehabilitation outcomes.
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Affiliation(s)
- A Shiraishi
- Hidetaka Wakabayashi, Dpt. of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Japan., 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, , Tel: +81-3-3353-8111, FAX: +81-3-5269-7639
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Izumi M, Sonoki K, Ohta Y, Fukuhara M, Nagata M, Akifusa S. Impact of Tongue Pressure and Peak Expiratory Flow Rate on Nutritional Status of Older Residents of Nursing Homes in Japan: A Cross-Sectional Study. J Nutr Health Aging 2020; 24:512-517. [PMID: 32346690 DOI: 10.1007/s12603-020-1347-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Swallowing function is critical for continuing oral feeding to prevent frailty in older adults. In this study, we investigated the impact of tongue pressure and pulmonary function on the nutritional status of older adults. DESIGN, SETTING, PARTICIPANTS This cross-sectional study was conducted in Kitakyushu, Japan from August 2017 to November 2018. Fifty-two residents aged >65 years of age from three nursing care insurance facilities in Kitakyushu City, Japan were recruited. MEASUREMENTS Oral health status, swallowing function, nutritional status using a mini nutritional assessment short form (MNA-SF), cognitive function, activities of daily living, peak expiratory flow rate (PEFR) for pulmonary function, and tongue pressure were assessed. The associations between nutritional status and the above factors were analysed using a logistic regression model. RESULTS Participants were divided into two groups: well-nourished group (MNA-SF ≤12) and undernutrition group (MNA-SF <12). Multivariate logistic regression analysis revealed that the correlations of PEFR [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.23-0.89 p=0.033) and tongue pressure (OR = 0.88, 95% CI = 0.88-0.99, p=0.029) remained significant even after adjustment with possible confounders. CONCLUSION Maximum tongue pressure and PEFR in older adults were significantly associated with their nutritional status. These findings suggest that maintaining oral and pulmonary function may be a preventive factor against a decrease in the nutritional status of older frail adults.
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Affiliation(s)
- M Izumi
- Sumio Akifusa, School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan. E-mail:
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Okura M, Ogita M, Arai H. Are Self-Reported Masticatory Ability and Regular Dental Care Related to Mortality? J Nutr Health Aging 2020; 24:262-268. [PMID: 32115606 DOI: 10.1007/s12603-020-1314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of the study was to examine whether a combination of self-reported masticatory ability and regular dental care is linked to mortality and issuance of new long-term care insurance (LTCI) service certifications. METHODS Older residents in institutions or in need of LTCI certification requirements were excluded, and self-administered questionnaires were sent to 5,400 older adults in 2013; these participants were followed for 5 years. The total response rate was 94.3%, and our final sample comprised 4,824 older adults (89.3%). We used 3 items to assess self-reported masticatory ability and regular dental care. These included (1) decline in chewing abilities of the posterior teeth on either side, (2) not brushing one's own teeth or dentures at least once a day, and (3) not visiting the dentist at least once a year. RESULTS The mean age of the participants at baseline was 75.9 years, and 58.4% of them were women. Main outcomes included mortality (n = 562) or new LTCI certification requirements (n = 1187) during the 5-year period. Multivariate analyses revealed that a poor score on masticatory ability and on regular dental care produced significant adverse health outcomes leading to earlier negative outcomes. The score is considered poor as it increases relative to the 0-point reference. DISCUSSION Regular dental care (both self-and professional care) and maintaining masticatory ability are both important. Hence, public activities focusing on preventive oral health from middle age onward is important.
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Affiliation(s)
- M Okura
- Mika Okura, Kyoto University, Department of Human Health Science, 53 kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto 606-8507, Japan,
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Choi JH, Kang JH, Koh SB, Kim NH, Kho HS. Development of an Oral and Maxillofacial Frailty Index: A preliminary study. J Oral Rehabil 2019; 47:187-195. [PMID: 31520535 DOI: 10.1111/joor.12890] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/24/2019] [Accepted: 09/11/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study is to develop an index to measure oral and maxillofacial frailty in older adults as an acceptable screening tool. METHODS Three hundred adults (aged ≥ 50 years) participated in this study by telephone interview. Ten candidate items for the Oral and Maxillofacial Frailty Index (OMFI) and 20 matched detailed items for oral and maxillofacial functions were asked. Information about sociodemographic and oral health-related variables was also obtained. The test-retest reliability of the 10 candidate items was determined. Correlations of the 10 candidate items with the 20 detailed items or sociodemographic and oral health-related variables were analysed to test the validity of the candidate items. To suggest optimal items for the OMFI, five different models with different numbers of items were constructed and evaluated based on their associations with main variables. RESULTS The overall internal consistency of the 10 candidate items was .704, and the Cronbach's alpha value of each item was .23-.55. The test-retest reliability was excellent. There were significant correlations between the 10 candidate and 20 matched detailed items. The score of the 10 candidate items was significantly different according to gender, education level and oral health-related variables. The final five items for the OMFI were difficulties in chewing, the necessity of water when eating dry food, difficulties in jaw or tongue movements, difficulties in speaking or pronunciation and difficulties in facial expression. CONCLUSIONS The five items could be used as a screening tool for evaluating oral and maxillofacial frailty in older adults.
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Affiliation(s)
- Jee-Hye Choi
- Department of Dental Hygiene, Yonsei University, Wonju, Korea
| | - Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Baek Koh
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.,Institute of Genomic Cohort, Yonsei University, Wonju, Korea
| | - Nam-Hee Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.,Institute on Aging, Seoul National University, Seoul, Korea
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Nomura Y, Okada A, Kakuta E, Otsuka R, Sogabe K, Yamane K, Yamamoto T, Shigeta Y, Shigemoto S, Ogawa T, Hanada N. Consistency of supplied food and dentition status of the elderly in residential care homes. BMC Oral Health 2019; 19:74. [PMID: 31046753 PMCID: PMC6498674 DOI: 10.1186/s12903-019-0770-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background The association between oral health and malnutrition has been investigated in detail. The nutrition of elderly subjects in residential care homes is determined by caregivers, dietitians or nutritionists and managed by changing the consistency of their supplied food. However, few reports have described the relationship between oral condition and supplied food consistency. The objective of this study was to determine dentition status and care levels that correlate with supplied food consistency among elderly residents of care facilities. In addition, we estimated the care level at which ordinary food consistency can be supplied by caregivers who cannot diagnose dental status. Method Several factors, including dentition, wearing removable dentures, meals categorized as ordinary or processed (sliced, mashed, or liquefied), and care levels according to the Japanese standardized care-needs certification system were investigated in 276 elderly residents (male, n = 56; female, n = 220; mean age, 87.68 ± 5.94 years) of 12 fee-based care facilities. Results The results of this study showed that care levels were significantly correlated with the consistency of the food supplied to the residents. When supplied food consistency was categorized as ordinary or processed, the number of remaining teeth and the number of tooth contact pairs, either natural or artificial, were statistically significant. From logistic regression analysis, it was determined that the numbers of tooth contact pairs were statistically significant among residents requiring high levels of care. Conclusion The number of tooth contact pairs, either natural or artificial, was one of the contributing factors for deciding supplied food consistency among elderly residents of care facilities. Elderly residents requiring less than care level 3 should have ordinary meals. Electronic supplementary material The online version of this article (10.1186/s12903-019-0770-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan.
| | - Ayako Okada
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Erika Kakuta
- Department of Oral Microbiology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Ryoko Otsuka
- Department of Translational Research, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Kaoru Sogabe
- Department of Translational Research, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Kiyoshige Yamane
- Yamane Dental Clinic KUNSHIKAI Medical Corporation, 7-9, Tennojiya, Yao-shi, Osaka, 581-0025, Japan
| | - Taku Yamamoto
- Supercourt Co, Ltd, 1-7-7, Nishihommachi, Nishi-ku Osaka-shi, Osaka, 550-0005, Japan
| | - Yuko Shigeta
- Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Shuji Shigemoto
- Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Takumi Ogawa
- Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
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Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23:771-787. [PMID: 31641726 PMCID: PMC6800406 DOI: 10.1007/s12603-019-1273-z] [Citation(s) in RCA: 451] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.
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Affiliation(s)
- E Dent
- E. Dent, Torrens University Australia, Adelaide, Australia,
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