Dental status and incident falls among older Japanese: a prospective cohort study

The mediating effect of nutrition on oral frailty and fall risk in community-dwelling elderly people

BACKGROUND

Population aging is accelerating, particularly in Asian countries. Falls are the leading cause of unintentional injuries in the elderly over 60 years old in China. Hence, it is crucial to anticipate the risk factors associated with fall risk. We aimed to explore whether oral frailty and fall risk were reciprocally related and whether nutrition mediated their association.

METHODS

From October 2022 to March 2023, a total of 409 elderly individuals from the Yangzhou community were selected using the convenience sampling method. Cross-sectional data on older adults' oral frailty, nutrition, and fall risk were collected using questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro.

RESULTS

The fall risk score was 1.0 (ranging from 0 to 4.0), with 107 cases (26.2%) identified as being at risk of falling. Spearman correlation analysis revealed a positive correlation between oral frailty and the risk of falls (rs = 0.430, P < 0.01). Nutrition was found to have a negative correlation with both oral frailty and fall risk (rs=-0.519、-0.457, P < 0.01). When controlling for covariates, it was observed that nutrition mediated the relationship between oral frailty and falls. The mediating effect value accounted for 48.8% of the total effect (P < 0.01).

CONCLUSIONS

Oral frailty was significantly associated with fall risk, and nutrition might be a mediating factor for adverse effects of oral frailty and fall risk. Enhancing the nutrition of older individuals is a vital approach to mitigating fall risk among those with oral frailty.

Concordance in oral frailty five-item checklist and oral hypofunction: Examining their respective characteristics

OBJECTIVES

This study examined the diagnostic concordance and characteristics of the oral frailty five-item checklist (OF-5) and oral hypofunction (OHF).

MATERIALS AND METHODS

In this extensive cross-sectional study, older adults were enrolled at a research hospital frailty clinic between July 2021 and July 2023. The diagnosis of OF-5 and OHF was conducted using the proposed assessment methods. The concordance rate of these criteria was determined by evaluating each patient and calculating the number of patients meeting each diagnosis's criteria. Patients who tested negative for the OF-5 and OHF criteria and those who met only one criterion were included in the OF-5 and OHF characteristic analysis.

RESULTS

A total of 248 patients were included in the analysis (mean age 77.6 ± 6.8 years; 36.7 % men). Among the patients, 114 (46.0 %) and 116 (46.8 %) met the OF-5 and OHF criteria, respectively. Furthermore, 78 (31.5 %) participants met both the OF-5 and OHF criteria, whereas 96 (38.7 %) did not meet either criterion. Moreover, 36 (14.5 %) and 38 (15.3 %) patients tested exclusively positive for OF-5 and OHF, respectively. The OF-5-positive and OHF-negative group showed an older age, lower Mini Nutritional Assessment Short Form score, and higher fall risk than the OF-5-negative and OHF-negative group. However, no significant differences were observed between the OF-5-negative and OHF-positive and OF-5-negative and OHF-negative groups.

CONCLUSION

The concordance rate of OF-5 and OHF diagnoses was 70.2 %. OF-5 showed a potential association with nutritional status and fall risk. Further longitudinal analyses are warranted to explore our study results.

The association of oral frailty with fall risk in community-dwelling older adults: a cross-sectional, observational study

PURPOSE

This cross-sectional study examined the direct association of oral frailty with falls in community-dwelling older adults, controlling for the effects of sarcopenia and physical performance.

METHODS

The participants were 237 community-dwelling older people (age: 76.0 ± 5.7 years, male: 23.6%). Oral frailty was assessed using the Oral Frailty Index-8. History of falls, timed up and go test (TUG), and sarcopenia were also assessed. The association between oral frailty and fall incidence was analyzed using multivariate logistic regression analysis adjusted for TUG and sarcopenia.

RESULTS

Forty-six (19.4%) participants fell, and 130 (54.9%) had a risk of oral frailty. On multivariate logistic regression analysis, oral frailty was significantly associated with fall incidence (odds ratio = 2.38, 95% confidence interval 1.11-5.07), even after adjusting for TUG and sarcopenia.

CONCLUSION

Oral frailty is a possible fall risk factor, independent of sarcopenia and physical performance, in community-dwelling older people.

Complex interplay of oral health, muscle and bone metabolism, and frailty in older individuals

OBJECTIVES

To investigate molecular and clinical background of associations among oral health, muscle and bone metabolism, and frailty incidence in patients with fall and fracture history.

MATERIALS AND METHODS

In total, 88 elderly participants (mean age 71.9 ± 5.8 years) with the distal radius fractures were included. Participants were divided into three groups based on an Oral Health Assessment Tool score. Fried criteria and Mini-nutritional assessments were adopted to diagnose frailty and malnutrition, respectively. Blood samples were collected and analyzed for serum levels of bone turnover markers, proteins, insulin-like growth factor-1, 25-hydroxyvitamin D, and inflammatory cytokines. The mRNA levels of markers of inflammation, muscle synthesis and wasting, and muscle homeostasis regulator in the pronator quadratus muscle were analyzed.

RESULTS

Patients with deteriorated oral health demonstrated a higher prevalence of frailty and malnutrition. Significantly lower serum levels of total protein and higher concentrations of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were detected in patients with poor oral health. Significant interaction effects between oral health and frailty level in gait speed, serum TNF-α, IL-1β, and total protein levels were exhibited. Significantly different mRNA expression levels in the pronator quadratus muscle of TNF-α, IL-1β, NF kB, MYOG, and FOXO1 following the oral health were detected.

CONCLUSION

This study highlights relationship between oral health, nutritional uptake, systemic inflammation, and their combined impact on muscle and bone metabolism, ultimately affecting frailty development in the aging populations.

CLINICAL RELEVANCE

A comprehensive understanding of mutual interactions among oral health, nutrition, and inflammation is essential for managing frailty.

Association between shortened dental configurations and health outcomes: a scoping review

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies. A scoping review was conducted using the PubMed/Medline, Scopus, Web of Science, SciELO and Cochrane databases. Two trained researchers selected studies and extracted data. Studies that investigated the association between shortened dental configurations (exposure) and person-centered outcomes (general and oral health) related to health behavior (dietary patterns). Clinical outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were defined as at least 20/21 teeth or the position of the teeth, including esthetics, dental occlusion and periodontal status (Eichner Index, Shortened Dental Arches, Functional Dentition Classification System, Posterior Occluding Pairs, Functional Tooth Units). The initial search resulted in 12,525 records in English, Portuguese and Spanish, 432 of which addressed the association of interest. General health (n = 203) and oral health (n = 201) were addressed in a similar number of studies. Most outcomes were related to general health (n = 184), the most frequent of which were endocrine, nutritional or metabolic diseases (n = 57) and mental functions (n = 26). Person-centered measures were addressed in 153 studies, most of which were about oral health and oral health-related quality of life (n = 62). Oral health outcomes were predominantly related to intake functions (n = 44) and diseases or disorders of the orofacial complex (n = 24). Dietary patterns (n = 43) and mortality (n = 38) were also studied. The cross-sectional design (n = 257) and non-probabilistic sampling (n = 218) were more frequent. The shortened dental configurations defined by the WHO were the most frequent in the studies (n = 206). The effects of shortened dental configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and measures of oral health-related quality of life. The findings point to a diversity of health outcomes assessed and substantial methodological variability.

Oral Function and the Oral Microbiome in the Elderly in the Kyotango Area

INTRODUCTION

Prevention of tooth loss contributes to an extended life expectancy, namely longevity. Aging-related oral hypofunction, including tooth loss, markedly increases the risks of functional disorder and mortality. Dysbiosis of the oral microbiome has recently been associated with various diseases, such as liver cirrhosis, pancreatic cancer, colorectal cancer, and inflammatory bowel disease. Therefore, the relationship between the oral microbiome and systemic health has been attracting increasing attention. In the present study, we examined oral function and the oral microbiome in the elderly in a world-leading longevity area.

MATERIALS AND METHODS

An oral examination, chewing ability/tongue-lip motor function/saliva tests, and a metagenomic analysis with a 16S rRNA gene-targeting next-generation sequencer were conducted on 78 subjects aged ≥80 years. Twenty-six healthy individuals aged between 20 and 39 years were also investigated as controls. The data obtained were statistically analyzed. The protocol of the present study was approved by the Ethics Review Board of our university (ERB-C-885).

RESULTS

Chewing ability, tongue-lip motor function, and saliva volume were normal in elderly subjects with a current tooth number ≥20, but were significantly lower in those with a current tooth number <20. The oral microbiome in elderly subjects with a current tooth number ≥20 and young controls differed from that in elderly subjects with a current tooth number <20.

CONCLUSION

Tooth number ≥20 in elderly subjects in the longevity area contributed to the maintenance of both oral function and the diversity of the oral microbiome.

Oral function and cumulative long-term care costs among older Japanese adults: a prospective 6-year follow-up study of long care receipt data

OBJECTIVES

This study evaluated the relationship between status of oral function and related long-term care service costs.

DESIGN

This was a prospective 6-year follow-up study of previous survey data.

SETTING

The data were obtained from the Japan Gerontological Evaluation Study conducted between 2010 and 2011.

PARTICIPANTS

The participants were functionally independent older adults in 12 municipalities across Japan.

INTERVENTIONS

Care service benefit costs were tracked over 6 years using publicly available claims records (n=46 616) to monitor respondents' cumulative care costs.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was the cumulative cost of long-term care insurance services during the follow-up period. We adjusted for the presence or absence of oral function problems, age, sex, physical function and socioeconomic and lifestyle background at the time of the baseline survey.

RESULTS

Tobit analysis revealed that, compared with those with no oral function problems, cumulative long-term care service benefit costs for those with one, two or three oral function problems were approximately US$4020, US$4775 and US$82 92, respectively, over 6 years. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. With increase in number of oral function problems, there was a concomitant elevation in the cost of long-term care.

CONCLUSIONS

Oral function in older people was associated with cumulative long-term care insurance costs. The oral function of older people should be maintained to reduce future accumulated long-term care insurance costs. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. The cost of long-term care was amplified as oral problems increased.

Associations between oral health status and risk of fractures in elder adults

Oral health condition, bone mineral density, skeletal muscle mass, fall, fracture, and frailty seem to be strongly interconnected. This study aimed to investigate associations between probability of osteoporotic fractures and oral health in the elderly. In total, 2322 Korean subjects from the 2008-2009 Korea National Health and Nutritional Examination Survey aged over 65 years were included. The 10-year probabilities of major and hip fractures were calculated using the Fracture Risk Assessment (FRAX) tool. Data on anthropometry, skeletal bone mineral density, sociodemographic characteristics, physical activity, individual history of fractures and falls, parental history of osteoporosis, number of teeth, metabolic syndrome, the Decayed, Missing, and Filled permanent Teeth index, and Community Periodontal Index (CPI), were collected. Participants were classified into three groups based on FRAX score for major osteoporotic fractures. A multivariate linear regression analysis was conducted to analyze associations between FRAX scores and oral health-related factors, adjusting for confounding factors. BMI, presence of metabolic syndrome, number of teeth, dental patterns, and CPI score showed significant differences among three groups in males and females. Results from multivariate linear regression analysis demonstrated significant relationships between total tooth number and probabilities of fracture in male and female elderly. The interdisciplinary approach for handling osteoporosis and sarcopenia including dentists, physicians is necessary to facilitate a better quality of life in the elderly.

Effects of Both Japanese-Style Dietary Patterns and Nutrition on Falling Incidents among Community-Dwelling Elderly Individuals: A Cross-Sectional Study

Approximately 20% of the community-dwelling Japanese elderly (≥65 years) experience falling annually, with injury frequency rising with age. Increased nursing home admission/hospitalization risk influences healthy aging and QOL. Nutrition for musculoskeletal health is necessary, though the relationship of falling with nutritional status in the elderly is largely unknown. We investigated falling incidents and nutritional status, including a Japanese-style diet in a community-dwelling cohort. Using a cross-sectional design, 186 subjects (median age 83.0 years, males/females 67/119) were analyzed. Oral and systemic health conditions were assessed. A brief-type self-administered diet history questionnaire (BDHQ) was given for nutritional status. Analysis of covariance (adjusted for gender, age, BMI, articular disease/osteoporosis history, present tooth number, educational level) and the Japanese-Mediterranean diet (jMD) score adapted for Japan were used. The jMD score and falling incidents were significantly associated, with point increases related to a significantly decreased falling risk of 28% (OR: 0.72; 95%CI: 0.57−0.91). Of the 13 jMD food components, fish, eggs, and potatoes had a significant relationship with reduced falling, while significant associations of intake of animal protein, potassium, magnesium, zinc, and cholesterol (p < 0.05) were also observed. The results suggest that the jMD dietary pattern is an important factor for the prevention of falling incidents in elderly individuals.

Periodontal status is associated with oral function in community-dwelling older adults, independent of dentition status

OBJECTIVE

To determine whether periodontal status is associated with oral function, including masticatory performance and occlusal force, among community-dwelling older adults.

BACKGROUND

Although a potential association between periodontal status and oral function has been reported, variations in the root surface area (RSA) of each tooth have not been considered.

METHODS

We used data from a population-based study involving community-dwelling older adults. The RSA with periodontal ligament (RSA-PL), which quantifies the RSA attached to the periodontal ligament and alveolar bone, was calculated based on full-mouth periodontal examination. Masticatory performance was assessed using spectrophotometric measurement of the color (a* value) of color-changing chewing gum. The bilateral maximal occlusal force (MOF) was measured using a pressure-sensitive sheet and dedicated software. The associations of the RSA-PL, a quantitative marker of periodontal tissue support, with the a* value and MOF were assessed using linear regression models.

RESULTS

The analyses included data from 250 adults [60.8% women; age, mean (standard deviation) 82.5 (5.0) years]. On average, the study participants had an RSA-PL of 26.3 cm² , a* value of 25.0, and an MOF value of 555.1 N. After adjustments for potential confounders, including dentition status, age, sex, dental visit regularity, smoking status, physical activity level, depressive symptoms, a history of stroke or diabetes mellitus, and body mass index, the RSA-PL was found to be associated with the a* value [coefficient (per 1 cm² increase): 0.16, 95% confidence interval (CI) 0.10-0.22)] and MOF (coefficient: 9.2, 95% CI 5.3-13.1).

CONCLUSION

This study demonstrated that greater amounts of remaining tooth-supporting structures, indicated by higher RSA-PL values, were associated with better masticatory performance and a higher occlusal force among community-dwelling older adults.

Perceptions on Oral Care Needs, Barriers, and Practices Among Managers and Staff in Long-Term Care Settings for Older People in Flanders, Belgium: A Cross-sectional Survey

Background and Objectives

This study aimed to explore oral health perception and oral care needs, barriers, and current practices as perceived by managers and staff in long-term care organizations for older people in Flanders.

Research Design and Methods

This is a cross-sectional study where 2 questionnaires were developed, one for managers and one for caregivers, and were validated in Flemish long-term care organizations. Descriptive analyses and multivariable generalized linear models evaluated the main outcomes and their associations with determinants such as the size of the organization, the presence of an oral health policy, collaboration with a dentist, among others.

Results

A total of 145 managers and 197 caregivers completed the questionnaire. More than 50% of caregivers and managers perceived their residents’ oral health as mediocre to good. Collaboration with a dentist (B = 0.84) and oral health care involvement (B = 0.08) within the organization showed a strong association with a positive perception of oral health. Lack of time (57%) and care resistance (70%) were the most important barriers perceived by caregivers. Guidelines concerning oral care were not available or were unknown to 52% of the caregivers. Having an oral health policy within the organization was strongly associated with the correct use of guidelines for daily care of natural teeth (B = 1.25) and of dental prosthesis (B = 1.15).

Discussion and Implications

The results emphasize that collaborating with a dentist and the presence of an oral health policy in care organizations are important for a positive perception of the oral health of the residents and for the adoption of guidelines by caregivers and managers. In addition, training on handling care refusal should be included in the overall training. These results are crucial input for the development of a methodology for implementing a structured oral care policy in long-term care facilities.

Is the Number of Missing Teeth Associated With Mortality? A Longitudinal Study Using a National Health Screening Cohort

This study aimed to estimate the risk of mortality related to the number of missing teeth in a South Korean population. The ≥ 40-year-old population of the Korean National Health Insurance Service-Health Screening Cohort 2002–2003 was analyzed. Participants were selected from a total of 220,189 participants and included in groups of 0 teeth lost, 1–2 teeth lost, and ≥ 3 teeth lost. Among the total population, 17,211 participants were included in no missing teeth, 1–2 missing teeth, and ≥ 3 missing teeth and were randomly matched 1:1:1 for age and sex. Mortality from specific causes and all-cause mortality were compared among the groups. The hazard ratio (HR) of the number of missing teeth for all-cause mortality or each cause of mortality was analyzed using Cox proportional hazard models. According to the cause of death, the HRs for metabolic disease, digestive disease, and trauma were greater in the group with ≥ 3 missing teeth than in the no missing teeth group. The group with ≥ 3 missing teeth indicated a 1.19-fold higher HR for all-cause mortality than the no missing teeth group [95% confidence intervals (95% CIs) = 1.12–1.27, P &lt; 0.001]. The group with 1- 2 missing teeth did not show a higher HR for all-cause mortality. In the group with 1–2 missing teeth, the HRs for mortality from mental disease and digestive disease were higher than those in the no missing teeth group. The group with 1–2 missing teeth did not show a higher HR for all-cause mortality. The number of missing teeth was linked with a higher risk of mortality. For specific causes of mortality, mortality from metabolic disease, digestive disease, and trauma was higher in the participants with the number of missing teeth.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Masticatory coefficient and physical functioning in older frail patients admitted for a Comprehensive Gerontological Assessment

BACKGROUND

Physical functioning may be limited in older, frail patients with missing teeth without prosthetic correction. This cross-sectional study examined the relationship between physical performance and the geriatric masticatory coefficient (GMC) in patients who underwent both a comprehensive gerontological assessment (CGA) to improve poly-pathology management and an intra-oral exam.

METHODS

All patients were evaluated based on the following: (corrected) GMC, number of posterior occluding pairs (POPs), short physical performance battery (SPPB) or timed up and go (TUG) test, and mini-nutritional assessment (MNA).

RESULTS

Of the 256 patients (mean age 83.76[SD 6.16], 148F), 75 (29.30%) were malnourished. The corrected GMC was lower in malnourished patients. When adjusted for age, gender, and MNA, the corrected GMC correlated with the TUG time (r=-0.198, p=0.005) and SPPB score (r=0.282, p=0.009). Correlations between GMC and POPs were determined for the SPPB (r=0.269, p=0.013; r=0.319, p=0.004, respectively) but not for the TUG (r=-0.108, p=0.128; r=-0.136, p=0.072).

CONCLUSION

The correlation between physical performance and decreased masticatory capacity was not fully explained by malnutrition in mildly to severely frail and multi-morbid patients; posture may also be impaired by missing teeth. The study of dental care effects on physical performance will provide further insights.

Cognitive Performance and Its Associations with Dental Caries: Results from the Dental, Oral, Medical Epidemiological (DOME) Records-Based Nationwide Study

Relatively few studies have analyzed the association between cognitive performance and dental status. This study aimed to analyze the association between cognitive performance and dental caries. Included were data from the dental, oral, medical epidemiological (DOME) study; cross-sectional records-based research, which integrated large socio-demographic, medical, and dental databases of a nationally representative sample of young to middle-aged military personnel (N = 131,927, mean age: 21.8 ± 5.9 years, age range: 18-50). The cognitive function of draftees is routinely measured at age 17 years using a battery of psychometric tests termed general intelligence score (GIS). The mean number of decayed teeth exhibited a gradient trend from the lowest (3.14 ± 3.58) to the highest GIS category (1.45 ± 2.19) (odds ratio (OR) lowest versus highest = 5.36 (5.06-5.68), p < 0.001). A similar trend was noted for the other dental parameters. The associations between GIS and decayed teeth persisted even after adjusting for socio-demographic parameters and health-related habits. The adjustments attenuated the OR but did not eliminate it (OR lowest versus highest = 3.75 (3.38-4.16)). The study demonstrates an association between cognitive performance and caries, independent of the socio-demographic and health-related habits that were analyzed. Better allocation of resources is recommended, focusing on populations with impaired cognitive performance in need of dental care.

Oral frailty and gait performance in community-dwelling older adults: findings from the Takashimadaira study

PURPOSE

This cross-sectional study compared gait performance between community-dwelling older adults with and without accumulated deficits in oral health, defined as oral frailty.

METHODS

A total of 1,082 individuals (439 men and 643 women; mean age, 77.1 years) from the Takashimadaira study were included in the current analysis. Based on a multifaceted oral health assessment, oral frailty was defined as having three or more of the following six components: (i) fewer teeth, (ii) low masticatory performance, (iii) low articulatory oral motor skills, (iv) low tongue pressure, (v) difficulties in eating, and (vi) swallowing. Eight gait parameters were assessed using an electronic walkway. Gait characteristics comparison between groups with and without oral frailty was performed using multiple linear regression models. Models were adjusted for age, sex, educational status, income, smoking, drinking, physical activity level, height, body mass index, comorbidities, and the presence of chronic pain.

RESULTS

Oral frailty was observed in 227 (21.0%) participants. After adjusting for potential confounders, the participants with oral frailty had slower gait speed, shorter stride and step length, wider step width, and longer double support duration as well as higher variability of stride length and step length.

CONCLUSIONS

Oral frailty was associated with poor gait performance among community-dwelling older adults.

Relationship Between Oral Health and Fractures in Community-Dwelling Older Japanese Adults

OBJECTIVE

To investigate the relationship between poor oral health and the incidence of fall-related fractures in older Japanese individuals.

DESIGN

A 9-year prospective cohort study.

SETTING AND PARTICIPANTS

Participants comprised 937 community-dwelling older Japanese adults aged 70 years or older. They all lived in the Tsurugaya district, a suburban area of Sendai city, and underwent comprehensive geriatric assessment, including an oral examination, in a public facility.

MEASUREMENTS

The exposure variables were related to oral health status (posterior occlusal support, number of remaining teeth, and occlusal force). The outcome measure was the incidence of fall-related fractures, which was determined by National Health Insurance data. Analyzed covariates included age, sex, medical history, smoking, alcohol drinking, educational level, depressive symptoms, cognitive impairment, physical function, body mass index, and history of falls. Statistical relationships were examined by calculating hazard ratios (HRs) at 95% confidence intervals (CIs) using the Cox proportional hazard model.

RESULTS

In the multivariate analysis, the HRs of fall-related fractures were significantly higher in those with unilateral posterior occlusal support (HR, 2.72; 95% CI, 1.13-6.55) and no posterior occlusal support (HR, 2.58; 95% CI, 1.29-5.15) than in those with bilateral posterior occlusal support. The HRs (95% CIs) of fall-related fractures in individuals with 10-19 and 1-9 teeth and edentulous individuals were 1.77 (0.81-3.89), 2.67 (1.24-5.75), and 2.31 (1.01-5.28), respectively, compared to those with ≥20 teeth.

CONCLUSIONS AND IMPLICATIONS

Poor oral health status is a risk factor for the incidence of fall-related fractures in community-dwelling older Japanese individuals. The findings suggest that attention should be focused on oral health status to further understand the risk of fall-related fractures among community-dwelling older adults.

Occlusal support and postural stability in children: An observational study

BACKGROUND

The relationship between uneven occlusal contact and fall risk has been described in elderly participants; however, multiple confounding factors, such as systemic disease or deterioration in vestibular function, have not been well considered. This study aimed to investigate this relationship in pediatric participants at the age of approximately 9-12, where these confounding factors are absent and the replacement of primary molars by permanent ones generally occurs and transiently results in uneven occlusal contact.

METHODS

Sixty-five children (36 boys and 29 girls, mean age: 9.5 ± 1.5 years) were enrolled in this study. Participants were asked whether they had experienced at least two falls within the past 1 year. The occlusal contact area ratio was calculated by dividing the greater half (right or left dental arch) by the smaller half (the other half) with U-shaped pressure sensor sheet. The total length and rectangular area of the center of pressure while standing upright for 10 s were measured with a stabilometer and used as postural sway parameters.

RESULTS

The occlusal contact area ratio significantly correlated with the postural sway parameters. Comparison between those who had experienced the fall incidences and those who had not after propensity score matching that adjusts their overall physical function revealed that there were no significant differences in the postural sway parameters and occlusal contact area ratio regardless of the history of fall incidence.

CONCLUSIONS

Uneven occlusal contact leads to an increase in postural sway in children; however, this may not be associated with fall incidence.

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

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

High Parity Is an Independent Risk Factor for Tooth Loss in Women: A Community-Based Takahata Study in Japan

Risk factors for tooth loss have been widely examined previously. However, no previous study has comprehensively investigated the risk factors, including lifestyle-related specific factors (parity, oral health habits, and socioeconomic status), for fewer than 20 teeth among women in the general population in Japan. This cross-sectional study explored the association of these risk factors, especially parity, with having fewer than 20 teeth among Japanese women. A self-reported questionnaire including items on lifestyle-related risk factors (parity, oral health, diet [e.g., alcohol and sucrose consumption]) and socioeconomic status was sent by post to female residents (age ≥ 40 years) of Takahata town, Yamagata Prefecture, in 2005. Multivariate logistic regression analysis including 3,854 eligible participants was performed to investigate the association between various factors (including parity) and having fewer than 20 teeth. The results indicated that, compared with nulliparous women, women with two, three, and four completed pregnancies had 2.485-, 2.844-, and 4.305-fold increased risk of having fewer than 20 teeth, respectively. Our study is the largest-scale study of the general female population in Japan and the first study to comprehensively investigate risk factors (parity, oral health status, and socioeconomic status) for fewer than 20 teeth. We thus found that higher parity, especially, two or more, was independent risk factors for having less than 20 teeth among Japanese women. In conclusion, the present study emphasizes the importance of good oral health habits in women, especially, during pregnancy and in the postpartum period, to maintain 20 or more teeth.

Chewing Discomfort According to Dental Prosthesis Type in 12,802 Adults: A Cross-Sectional Study

This study examined the prevalence of self-perceived chewing discomfort depending on the type of dental prosthesis used in South Korean adults. The subjects were 12,802 people over 20 years of age who participated in a health interview and dental examination. Chewing discomfort was examined using a self-assessed report with a structured questionnaire. Using multivariable logistic regression analysis, adjusted odds ratios were evaluated along with their 95% confidence intervals (α = 0.05). After adjusting for covariates, including age, gender, smoking, drinking, hypertension, diabetes, body mass index, education, income, and toothbrushing frequency, the odds ratios (95% confidence intervals) for chewing discomfort in groups without a dental prosthesis, with fixed dental prostheses, with removable partial dentures, and with removable complete dentures were 1 (reference), 1.363 (1.213-1.532), 2.275 (1.879-2.753), and 2.483 (1.929-3.197), respectively. The association between the prevalence of chewing discomfort and the type of dental prosthesis used was statistically significant even after adjusting for various confounders (p < 0.0001). The type of dental prosthesis was related to chewing discomfort among South Korean adults.

Association between presence of 20 or more natural teeth and all-cause, cancer-related, and cardiovascular disease-related mortality: Yamagata (Takahata) prospective observational study

BACKGROUND

Several studies have surveyed the relationship between the presence of ≥ 20 natural teeth and mortality. However, very few have evaluated this association over a long-term follow-up of more than ten years within a large population in Japan. This study aimed to prospectively confirm the associations between mortality and the presence of ≥ 20 natural teeth within a community-based population in Japan.

METHODS

A prospective observational study including 2208 participants aged ≥ 40 years was conducted in Takahata Town, Japan, between May 2005 and December 2016. All participants answered a self-administered questionnaire to provide their background characteristics, including their number of teeth. The participants were classified into two categories based on their self-reported number of teeth (< 20 and ≥ 20 teeth). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional-hazards regression model to assess risk factors for all-cause, cancer-, and cardiovascular disease-related mortality.

RESULTS

The total follow-up period was 131.4 ± 24.1 months (mean ± SD). After adjusting for covariates, the risk of all-cause mortality was significantly higher in the group with < 20 teeth than in those with ≥ 20 teeth (HR = 1.604, 95% CI 1.007-2.555, p = 0.047). However, the risk of cancer- and cardiovascular disease-related mortalities was not statistically significant between the two groups.

CONCLUSION

In this study, participants with < 20 teeth had a significantly higher risk of all-cause mortality, although the difference was borderline significant. These results emphasize the importance of having ≥ 20 natural teeth for a healthy life expectancy.

Low Tongue Strength and the Number of Teeth Present Are Associated with Cognitive Decline in Older Japanese Dental Outpatients: A Cross-Sectional Study

To mitigate the impact of dementia, initiating early intervention is important. This study aims to investigate the associations between deterioration in oral function and cognitive decline in older outpatients whose oral health was maintained in the dental clinic. This study included 50 outpatients aged ≥65 years. We used the Japanese version of the Montreal Cognitive Assessment (MoCA-J) to assess cognitive decline. Oral function was evaluated by tongue pressure, masticatory performance, and swallowing ability. A full-mouth periodontal examination was conducted, and the occlusal support and number of teeth were recorded. Odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline (MoCA-J score ≤ 25 points) were calculated using logistic regression models. The age, number of teeth, tongue pressure, and masticatory performance were significantly correlated with cognitive decline (p < 0.05). Logistic regression analyses revealed that cognitive decline was independently associated with age (OR: 1.25; 95% CI: 1.03-1.52; p = 0.024), number of teeth (OR = 0.83; 95% CI: 0.76-1.00; p = 0.047), and lower tongue pressure (OR: 0.87; 95% CI: 0.77-0.98; p = 0.022). Lower tongue pressure and a small number of remaining teeth may be associated with cognitive decline in Japanese outpatients.

Parity and Number of Teeth in Japanese Women: Results from the Japan Nurses' Health Study

Background: Parity is thought to be associated with a decreased number of teeth present in women. However, educational level and social status, which are particularly significant risk factors for loss of teeth, have been heterogeneous in previous observations. This cross-sectional survey aimed to clarify the associations of parity with the risk of having <20 teeth in Japanese female nurses participating in the Japan Nurses' Health Study (JNHS). Methods: In the third follow-up questionnaire of the JNHS, 11,299 women aged 27-82 years participated in this study. The number of participants according to age range was 7,225 (63.9%) aged <50 years and 4,074 (36.1%) aged ≥50 years. Information on parity and risk factors for loss of teeth was collected through a baseline questionnaire and then a follow-up questionnaire. Multivariate logistic regression analysis was used to calculate the adjusted odds ratio (OR) and 95% confidence interval (CI) of having <20 teeth according to parity category. Results: Participants ≥50 years who had experienced three or more deliveries had a significantly higher risk of having <20 teeth than those who had not experienced delivery (OR = 1.59, 95% CI = 1.14-2.20), although this finding was not observed in participants <50 years. In addition to parity, age and current smoking may be independent risk factors for having <20 teeth in Japanese nurses. Conclusions: Higher-parity female nurses ≥50 years may be more likely to lose teeth than those who have not experienced delivery.

Oral health for achieving longevity

Oral frailty is defined as a decrease in oral function accompanied by a decrease in mental and physical functions. Studies showing that people with oral frailty are at high risk of physical frailty, sarcopenia, severe conditions requiring nursing care and death have been reported in Japan. An increase in life expectancy and maintenance of teeth result in a decrease in the effect of the number of teeth. In contrast, a decrease in oral function as a result of aging has been suggested to have major effects on dysfunction and mortality risk. The present report is a narrative review of major clinical studies on the relationships of the number of teeth, dentures, occlusion and oral function with longevity, with the aim of providing information for future studies centered on oral function in Japan or overseas. This review clearly shows the relationships of the number of teeth, dentures, and occlusion with health and longevity. Recent studies have shown that, besides maintenance of the number of teeth, attempting to maintain or increase oral function, having a good diet and maintaining nutritional status are all linked to general health. Decreased oral function is a major risk factor for developing malnutrition and sarcopenia. Oral frailty, a new concept that has been recently introduced in Japan, is considered to have major effects on dental and oral health policies in Japan, in the old-age group, and is expected to be reflected in the dental and oral health policies of various countries, as they also predict increased life expectancies. Geriatr Gerontol Int 2020; ••: ••-••.

Occlusal support is associated with nutritional improvement and recovery of physical function in patients recovering from hip fracture

OBJECTIVE

This study aimed to elucidate the association between occlusal support and nutritional improvement and recovery of activities of daily living (ADLs) among elderly patients recovering from hip fracture.

BACKGROUND

Many patients with hip fracture are malnourished, and malnutrition is associated with poor functional outcomes. Poor oral status is one reason for malnutrition because loss of occlusal support leads to masticatory disorders and can cause nutrient deficiencies.

METHODS

We evaluated 202 elderly patients aged 65 years and older (mean age, 84.9 ± 7.9 years). We assessed nutritional status using the Mini Nutritional Assessment-Short Form and ADLs using functional independence measure (FIM) scores. Occlusal support was recorded in accordance with the Eichner Index. We categorised participants into two groups according to the presence or absence of occlusal support, and statistical analyses were performed to investigate the differences between the groups.

RESULTS

One group contained 152 participants (mean age, 85.5 ± 7.4 years) with occlusal support, and the other group contained 50 participants (mean age, 83.0 ± 8.9 years) without occlusal support. The group with occlusal support had greater gain of FIM and higher FIM efficiency than did the other group. Multivariate analyses showed that occlusal support was independently associated with nutritional improvement [odds ratio (OR) = 4.00, 95% confidence intervals (CI) = 1.90-8.43] and motor FIM efficiency (R²  = .338, P < .001).

CONCLUSIONS

Our findings suggest that occlusal support is associated with nutritional improvement and the recovery of ADLs in patients recovering from hip fracture.

Characterization of oral microbiota in marmosets: Feasibility of using the marmoset as a human oral disease model

With rapid aging of the world’s population, the demand for research, for a better understanding of aging and aging-related disorders, is increasing. Ideally, such research should be conducted on human subjects. However, due to ethical considerations, animals such as rodents and monkeys are used as alternatives. Among these alternative models, non-human primates are preferred because of their similarities with humans. The small South American common marmoset (Callithrix jacchus) may offer several advantages over other non-human primates in terms of its smaller size, shorter life-span, and dental anatomy identical to humans. The purpose of this study was to determine the viability of using the marmoset as a human oral disease model. We collected saliva samples from eight marmosets and eight human subjects. Prokaryotic DNA was extracted from the saliva samples, and 16S bacterial rRNA gene sequencing was performed on each of the samples. Our results indicated that the types of oral microbiomes detected among human and marmoset samples were nearly indistinguishable. In contrast, the oral microbiomes of our human and marmoset subjects were distinctly different from those reported for rats and dogs, which are currently popular research animals. The oral microbiomes of marmosets showed greater diversity than those of humans. However, the oral microbiota of marmosets exhibited less variation than those of humans, which may be attributed to the fact that the marmoset subjects were kept in a controlled environment with identical lifestyles. The characteristics of its oral microbiota, combined with other technical advantages, suggest that the marmoset may provide the best animal model thus far for the study of oral health. This study characterized the oral microbes of the marmoset, thereby providing information to support future application of the marmoset as a model for age-related oral disease.

Association between subjective well-being and presence of primary care dentists in community-dwelling elderly people: A cross-sectional study

OBJECTIVE

The aim was to investigate the relationships between subjective well-being and the existence of primary care dentists in community-dwelling elderly people.

BACKGROUND

Some studies have reported subjective well-being focusing on oral health, but no studies have examined the relationship between subjective well-being and primary care dentists.

METHODS

This cross-sectional study used data from community-dwelling elderly people aged ≥70 years (n = 624). The Philadelphia Geriatric Center Morale Scale (PGCMS; range = 0 [low morale]-17) was used to assess subjective well-being. Additional information regarding age group, sex, medical consulting situation (ambulatory care/home care), primary care dentists, family structure, economic status, health status was collected via questionnaire.

RESULTS

The average PGCMS score in ambulatory care patients (ACP) group who have primary care dentists was highest among community-dwelling elderly people. In a logistic regression model, a low PGCMS score (0-11) was independently correlated to 80-89 age group (OR = 1.70; 95% CI, 1.13-2.54; P = 0.008), ≥90 age group (OR = 3.86; 95% CI, 1.83-8.18; P < 0.001), unsatisfied for economic status (OR = 2.68; 95% CI, 1.59-4.53; P < 0.001), unsatisfied for health status (OR = 3.94; 95% CI, 2.60-5.98; P < 0.001) and having no primary care dentists (OR = 1.81; 95% CI, 1.09-3.01; P = 0.021) in ACP group.

CONCLUSIONS

The subjective well-being of ACP who have primary care dentists was higher than in other people. Primary dentists contributed to the subjective well-being of elderly people.

Dental Status is Associated With Incident Functional Disability in Community-Dwelling Older Japanese: A Prospective Cohort Study Using Propensity Score Matching

Background

A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching.

Methods

Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0–19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status.

Results

As a result of the propensity score matching, 574 participants were selected. Participants with 0–19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01–1.75).

Conclusions

In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability.

Differences in Falls between Older Adult Participants in Group Exercise and Those Who Exercise Alone: A Cross-Sectional Study Using Japan Gerontological Evaluation Study (JAGES) Data

This study examined the difference in falls between older adults who participated in group exercise and those who exercised alone. We used cross-sectional data from the Japan Gerontological Evaluation Study. Data were obtained from functionally independent residents aged 65 years or older across 30 municipalities in Japan (n = 19,257). Logistic regression analysis was performed with experience of multiple falls over the past year as the dependent variable and type of exercise as the independent variable. Respondents were divided into three groups according to how they performed exercise: (1) non-exercisers (NE, no exercise), (2) those who only exercised alone (IE, individual exercise), and (3) those whose exercise included participation in group exercise (GE, group exercise). In total, 887 (4.6%) respondents reported multiple falls. After adjustment for 10 possible confounders, the GE group had an odds ratio (OR) for falls of 0.75 (95% confidence intervals 0.60–0.95) compared with the IE group. After adjustment for physiological factors and a psychological factor, the OR for the GE group increased slightly; however, an association between falls and exercise type was indicated. Older adults who participate in group exercise may receive additional benefits related to falls prevention compared with those who exercise alone.

Teeth and Covariates: Association with Risk of Falls

Purpose

Falls occur commonly in geriatric populations and undesirably influence their life, morbidity, and mortality. The aim of this study was to analyze the association between the number of teeth present among the elderly population and covariates in relation to the risk of falls.

Materials and Methods

This study was conducted at various old age homes in the Klang Valley region of Malaysia involving the geriatric population aged 60 years and above. A detailed questionnaire consisting of sociodemographic data including sex, age, household income, and dental variables such as the number of teeth and chewing difficulty was obtained. The Tinetti test (TT) was used to evaluate the patients' ability to walk, to maintain postural balance, and to determine their risk of falling. The short version of the Geriatric Depression Scale was used to assess depression among the participants, and the Barthel Scale was used to analyze the subject's ability to perform the activities of daily living (ADL).

Results

Statistically significant association was observed in relation to the number of teeth present and risk of falls (p < 0.05). Subjects who had 19 teeth or less in total had moderate to highest risk of falls (p=0.001) in comparison with subjects who had 20 teeth or more. Those aged 70 years and above showed the highest risk of falls (p=0.001) in comparison with the subjects aged between 60 and 69 years. Subjects with depression (p=0.03) and presence of illness related to fall showed statistically significant difference (p=0.001) in comparison with those who did not suffer from the same. Compromised ADL (p=0.001) (which included ability to perform several tasks like indoor mobility, climbing stairs, toilet use, and feeding) and low monthly income (p=0.03) was also observed among subjects who had higher risk of falls.

Conclusion

According to the results achieved, there was a high statistically significant association observed between the number of teeth present, age, depression, ADL, and presence of illness in relation to the risk of falling among the geriatric population. Henceforth, oral rehabilitation of elderly patients with less number of teeth may reduce their risk of falls.

Relationship between status of dentition and incident functional disability in an elderly Japanese population: prospective cohort study of the Tsurugaya project

PURPOSE

The purpose of this study was to examine whether the status of dentition is associated with incident functional disability in elderly people.

METHODS

This prospective cohort study targeted community-dwelling Japanese adults of age ≥70 years (n=838). Participants were classified into the following four groups in accordance with Miyachi's Triangular Classification, which represents the status of dentition on the basis of numbers of remaining teeth and occlusal supports: Zone A, ≥10 occlusal supports; Zone B, 5-9 occlusal supports; Zone D, ≤4 occlusal supports and ≥11 remaining teeth and Zone C, ≤10 remaining teeth. Incident functional disability was defined by the first certification of long-term care insurance in Japan. Data regarding age, sex, body mass index, medical history, smoking, alcohol consumption, education, depressive symptoms, cognitive impairment, social support, history of fall, and subjective masticatory ability were collected.

RESULTS

During follow-up for 5185 person-years, 305 participants experienced functional disability. Considering the follow-up data of  ≥3 years from baseline, participants in Zones C (hazard ratio [HR], 1.98; 95 % confidence interval [CI], 1.26-3.11) and D (HR, 2.50; 95 %CI, 1.54-4.05) were found to be more likely to develop functional disability than those in Zone A (p for trend=0.002).

CONCLUSIONS

Status of dentition was associated with incident functional disability in an elderly Japanese population. The findings of this study suggest that maintenance of remaining teeth and retention of occlusal supports contribute to the prevention of functional disability.

Does poor oral health status increase the risk of falls?: The JAGES Project Longitudinal Study

We sought to examine if self-reported oral health conditions regarding difficulty eating tough foods, dry mouth, choking, number of teeth and denture use are associated with incident falls. Our study was based on panel data from the Japan Gerontological Evaluation Study conducted in 2010 and 2013 using self-administered questionnaires. Data from 19,995 male and 20,858 female community-dwelling older people aged ≥65 years without a history of falls within the previous year in 2010 were analyzed. Multilevel logistic regression models were used to determine the association between poor oral health in 2010 and multiple incident falls in 2013 after adjusting for possible confounders and considering differences in municipalities. The percentage of males and females who reported falls in 2013 were 2.4% and 2.1%, respectively. After adjusting for age, educational attainment, equivalized income, depression, self-rated health, instrumental activities of daily living, body mass index, present illness related to falls, social participation, walking in min/day, alcohol drinking status, and municipality population density, dry mouth in males (odds ratio [OR] = 1.41; 95% confidence interval [CI]: 1.12–1.77) and choking in females (OR = 1.64; 95% CI: 1.27–2.11) were significantly associated with incident falls. Difficulty eating tough foods in both sexes and choking in males were marginally associated with incident falls (p<0.1). Females having 10–19 teeth without dentures (OR = 1.63; 95% CI: 1.14–2.31), ≤9 teeth with dentures (OR = 1.36; 95% CI: 1.03–1.80), and ≤9 without dentures (OR = 1.46; 95% CI: 1.02–2.08) were significantly associated with incident falls compared with those having ≥20 teeth, respectively. These findings suggest that poor oral function, having fewer teeth, and not using dentures are predictors of incident falls. Further studies are needed to determine whether improving oral health can reduce the risk of falls.

Association Between Tooth Loss, Receipt of Dental Care, and Functional Disability in an Elderly Japanese Population: The Tsurugaya Project

OBJECTIVES

To examine whether number of remaining teeth and regular dental care affect incident functional disability in elderly Japanese adults.

DESIGN

Prospective cohort study.

SETTING

Tsurugaya district, Sendai, Japan.

PARTICIPANTS

Community-dwelling individuals aged 70 and older (N = 834).

MEASUREMENTS

The outcome measurement was incident functional disability, defined as first certification of long-term care insurance in Japan, which is determined on the basis of a strictly established uniform nationwide standard. During a median follow-up of 7.9 years (interquartile range 4.8-7.9 years), information on long-term care insurance was obtained from the Sendai Municipal Authority. Oral health was assessed according to number of remaining teeth and presence or absence of regular dental care. Data were also collected on age, sex, body mass index, medical history, smoking, alcohol consumption, duration of education, depressive symptoms, cognitive impairment, physical functioning, and social support.

RESULTS

Participants with 10 to 19 teeth (adjusted hazard ratio (aHR) = 1.42, 95% confidence interval (CI) = 1.03-1.94), one to nine teeth (aHR = 1.46, 95% CI = 1.04-2.03), and no teeth (aHR = 1.49, 95% CI = 1.03-2.14) were more likely to develop functional disability than those with 20 or more teeth. There was no significant difference in risk of functional disability between participants with 20 or more teeth and those with zero to 19 teeth who were receiving regular dental care, whereas those with zero to 19 teeth without regular dental care had a significantly greater risk of functional disability than those with 20 or more teeth (HR = 1.46, 95% CI = 1.11-1.92).

CONCLUSION

Tooth loss was associated with greater risk of functional disability in community-dwelling elderly Japanese. Regular dental care might moderate the risk of functional disability in elderly individuals with missing teeth.

Does poor dental health predict becoming homebound among older Japanese?

Background

Being homebound is an important risk factor of functional disability in older people. There is a possibility of bidirectional relationship between homeboundness and dental health. This prospective cohort study examined the association of dental health, which includes social function, on homeboundness in the future.

Methods

The participants were ≥ 65 years, responded to two postal surveys conducted in 2006 and 2010, and were not homebound at baseline. Logistic regression analysis was used to estimate the odds ratios for homeboundness, defined as going out of one’s home less than once weekly. Self-reported baseline dental status was used as the main predictor. Age, sex, marital status, educational attainment, income, comorbidity, depression, walking time, living alone, and area of residence were used as covariates.

Results

Among 4390 non-homebound respondents, 7.4 % were homebound four years later. The proportions of homebound respondents with < 20 teeth without dentures, < 20 teeth with dentures, and ≥ 20 teeth were 9.7, 8.8, and 4.4 %, respectively. The odds for being homebound in the 65–74-year age group, adjusted for covariates, was 1.78 (95 % CI: 1.01–3.13; p < 0.05) times higher for respondents with < 20 teeth and no dentures than that for respondents with ≥ 20 teeth. Among the participants in the ≥ 75-year age group, a significant association of homeboundness and dental health was not observed.

Conclusions

Among the young-old population, poor dental health predicted future onset of homeboundness, while depressive symptoms did not show any significant association.

Community social capital and tooth loss in Japanese older people: a longitudinal cohort study

OBJECTIVE

To date, no study has prospectively examined the association between social capital (SC) in the community and oral health. The aim of this longitudinal cohort study was to examine the association between both community-level and individual-level SC and tooth loss in older Japanese people.

DESIGN

Prospective cohort study

SETTING

We utilised data from the Japan Gerontological Evaluation Study (JAGES) performed in 2010 and 2013 and conducted in 525 districts.

PARTICIPANTS

The target population was restricted to non-institutionalised people aged 65 years or older. Participants included 51 280 people who responded to two surveys and who had teeth at baseline.

PRIMARY OUTCOME MEASURE

The primary outcome measure was loss of remaining teeth, measured by the downward change of any category of remaining teeth, between baseline and follow-up.

RESULTS

The mean age of the participants was 72.5 years (SD=5.4). During the study period, 8.2% (n=4180) lost one or more of their remaining teeth. Among three community-level SC variables obtained from factor analysis, an indicator of civic participation significantly reduced the risk of tooth loss (OR 0.93; 95% CI 0.88 to 0.99). The individual-level SC variables 'hobby activity participation' and 'sports group participation' were also associated with a reduced risk of tooth loss (OR 0.88; 95% CI 0.81 to 0.95 and OR 0.90; 95% CI 0.82 to 0.99, respectively).

CONCLUSIONS

Living in a community with rich SC and individuals with good SC is associated with lower incidence of tooth loss among older Japanese people.

Dental status and self-assessed chewing ability in 70- and 80-year-old subjects in Sweden

The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self-assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self-assessed chewing ability; (ii) chewing ability is poorer among the 80- than the 70-year-old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70.1% resulting in samples of 5697 70- and 2922 80-year-old subjects. Answers to questions on self-assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70- and 60% of the 80-year-old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self-assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0.46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self-assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self-assessed chewing ability.

Factors associated with falls in community-dwelling older people with focus on participation in sport organizations: the Japan Gerontological Evaluation Study Project

Objective. Promoting participation in sport organizations may be a population strategy for preventing falls in older people. In this study, we examined whether participation in sport organizations is associated with fewer falls in older people even after adjusting for multiple individual and environmental factors. Methods. We used the Japan Gerontological Evaluation Study data of 90,610 people (31 municipalities) who were not eligible for public long-term care. Logistic regression analysis was performed, with multiple falls over the past year as the dependent variable and participation in a sport organization as the independent variable, controlling for 13 factors. These included individual factors related to falls, such as age and sex, and environmental factors such as population density of the habitable area. Results. A total of 6,391 subjects (7.1%) had a history of multiple falls. Despite controlling for 13 variables, those who participated in a sport organization at least once a week were approximately ≥20% less likely to fall than those who did not participate at all (once a week; odds ratio = 0.82 and 95% confidence interval = 0.72–0.95). Conclusion. Participation in a sport organization at least once per week might help prevent falls in the community-dwelling older people.

Social determinants of denture/bridge use: Japan gerontological evaluation study project cross-sectional study in older Japanese

Background

Studies suggest that using a denture/bridge may prevent disability in older people. However, not all older people with few remaining teeth use a denture/bridge. This cross-sectional study aimed to examine the social determinants which promote denture/bridge use among older Japanese.

Methods

A total of 54,388 (25,630 males and 28,758 females) community-dwelling individuals aged 65 or over, living independently, able to perform daily activities, and with 19 or fewer teeth. The dependent variable was denture/bridge use. Socio-demographics, number of teeth, present illness, social participation, social support, and social networks were used as individual-level independent variables. Data for social capital were aggregated and used as local district (n = 561 for males, n = 562 for females) -level independent variables. Number of dentists working in hospitals/clinics per population and population density were used as municipality (n = 28) -level independent variables. Three-level multilevel Poisson regression analysis was performed for each sex.

Results

High equivalent income, low number of teeth, present illness, and living in a municipality with high population density were significantly associated with denture/bridge use in both sexes in the fully adjusted models (p < 0.05). Denture/bridge use was significantly associated with high educational attainment in males and participating in social groups in females in the fully adjusted model (p < 0.05). No significant associations were observed between denture/bridge use and social capital.

Conclusions

Denture/bridge use was significantly associated with high economic status and present illness in both sexes, high educational attainment in males, and participation in social groups in females among community-dwelling older Japanese after adjusting for possible confounders.