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Fei Y, Niu S, Xi X, Tang W, Zhao Y, Zhang G, Yu X, Li C, Li X, Liu Y, Li Y, Yin Y, Cui Y, Li X. Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study. BMC Geriatr 2024; 24:468. [PMID: 38811863 PMCID: PMC11134949 DOI: 10.1186/s12877-024-05056-4] [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: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Oral frailty is reported to increase the risk of new onset of mild cognitive impairment. Whereas, the association of oral frailty with cognition among older adults in both physical frail and non-physical frail status has not been sufficiently explored, and whether there are sex differences in the association is unclear. This study investigated the association of oral frailty and physical frailty with global cognitive function and executive function among older adults, as well as the sex differences in such association. METHODS This cross-sectional study included 307 participants aged ≥ 60 years old from communities between June 2023 and August 2023, in Nanjing, China. Global cognitive function and executive function were assessed by using the Montreal Cognitive Assessment (MoCA) and Trail Making Tests A (TMT-A), respectively. Oral frailty was identified by the combination of natural tooth, Oral Frailty Index-8 (OFI-8), and oral diadochokinesis. Physical frailty was measured by using Fried phenotype model which contained 5 criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Multiple linear regression analyses for overall participants and stratified by sex and presence or absence of physical frailty were performed, respectively, to examine the association between oral frailty and cognitive functions. RESULTS The median age of participants was 70 years old. The study included 158 (51.5%) females, 53 (17.3%) individuals with physical frailty, and 65 (21.2%) participants with oral frailty. After adjustment, the association between oral frailty and global cognitive function was observed in the physical frailty group (B = -2.67, 95% Confidence Interval [CI]: -5.27 to -0.07, p = 0.045) and the females with physical frailty (B = -4, 95% CI: -7.41 to -0.58, p = 0.024). Oral frailty was associated with executive function in overall participants (B = 0.12, 95% CI: 0.01 to 0.22, p = 0.037), physical frailty group (B = 23.68, 95% CI: 1.37 to 45.99, p = 0.038). In the adjusted models, oral frailty was significantly associated with executive function in all females (B = 0.21, 95% CI: 0.05 to 0.36, p = 0.009), in females without physical frailty (B = 0.19, 95% CI: 0.02 to 0.36, p = 0.027), and in females with physical frailty (B = 48.69, 95% CI: 7.17 to 90.21, p = 0.024). CONCLUSIONS Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, particularly among females. It is ponderable to consider sex differences and facilitate the management of physical frailty when it comes to promoting cognitive health based on the perspective of oral health among older adults.
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Affiliation(s)
- Yang Fei
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Shuzhen Niu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xueru Xi
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Wenping Tang
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ge Zhang
- Department of Geriatrics (Geriatric Neurology), the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, China
| | - Xiaohong Yu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xinru Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ying Liu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yaxin Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Yan Cui
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
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Park HJ, Jung EH, Kim SM, Park SC, Jo MJ, Lee YS, Kim SH, Han SY. Assessment of oral hypofunction and its association with age among Korean community-dwelling older adults. BMC Oral Health 2024; 24:441. [PMID: 38600517 PMCID: PMC11007876 DOI: 10.1186/s12903-024-04180-2] [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: 09/01/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Due to the increasing proportion of older adults in Korea and growing interest in aging, the concepts of oral aging and oral hypofunction have recently been introduced. Thus, it is necessary to investigate the age-specific oral function levels of Korean older adults and develop expert intervention methods for healthy aging. METHODS Dysphagia, independence of daily living, and oral hypofunction were assessed in 206 older adults living in Wonju, Gangwon State, South Korea. Subjective dysphagia was assessed through self-report questionnaires using the Dysphagia Handicap Index (DHI), the Korean version of Eating Assessment Tool-10, and the Korean version of the Modified Barthel Index. In addition, the oral hypofunction assessment items included decreased chewing ability, occlusal pressure, tongue pressure, oral dryness, and oral cleanliness. RESULTS DHI increased significantly with age, with those in their 80 s reporting the most difficulty swallowing. Oral function in terms of chewing ability (maximum occlusal pressure and number of remaining teeth), maximum occlusal pressure, and maximum tongue pressure also declined with increasing age. While there was no significant difference in oral dryness by age, those in their 80 s had dry mouth according to the criteria of the oral moisture checking device. CONCLUSIONS In an assessment of oral function in community-dwelling, independent Korean older adults, the number of items that were assessed as oral hypofunction increased with age. The findings can be used to standardize the oral hypofunction assessment item and develop age-based individualized intervention plans for the early management of oral health and individual oral myofunctional rehabilitation in Korean community-dwelling older adults.
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Affiliation(s)
- Hye-Jin Park
- Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Eun-Ha Jung
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Soo-Min Kim
- Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Seong-Chan Park
- Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Min-Ji Jo
- Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Yun-Seon Lee
- Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Sung-Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea
| | - Sun-Young Han
- Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea.
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Yin Y, Zhao Y, Fei Y, Liu Y, Ji Y, Shan E, Niu S, Xing Y, Ding J, Li X. Epidemiology and risk factors of oral frailty among older people: an observational study from China. BMC Oral Health 2024; 24:368. [PMID: 38515048 PMCID: PMC10958975 DOI: 10.1186/s12903-024-04149-1] [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: 12/20/2023] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES This study aimed to compare the prevalence of oral frailty among community-dwelling older people in Nanjing, China with the usage of different measurements, and to investigate the potential risk factors of oral frailty. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 338 community-dwelling older people in Nanjing, China were recruited. METHODS Oral frailty was measured based on the Oral Frailty Index-8 (OFI-8) scale and other measurement methods including the number of natural teeth (TN), repetitive saliva-swallowing test (RSST), and oral diadochokinesis (ODK). The chi-square test and the binary logistic regression analysis were performed to identify potential risk factors for oral frailty. RESULTS There were 310 participants included in the analysis. Prevalence of oral frailty by using the OFI-8, OFI-8 + TN, OFI-8 + ODK, OFI-8 + TN + ODK and RSST measurement methods were 69.0%, 27.4%, 51.9%, 21.0% and 2.9%, respectively. Passive smoking (OR = 2.04; 95%CI 1.03-4.03), being widowed/unmarried (OR1 = 2.53; 95%CI 1.25-5.10; OR2 = 2.94; 95%CI 1.12-7.77), pre-frailty (OR = 1.76; 95%CI 1.03-3.01), frailty (OR = 3.01; 95%CI 1.39-6.54), and aged 80 years and above (OR = 3.99; 95%CI 1.35-11.81) were found to be risk factors of oral frailty by the usage of the four kinds of measurement methods. CONCLUSIONS AND IMPLICATIONS The definition and diagnostic criteria of oral frailty are strongly needed to be unified in future research. Only subjective assessment is not enough for assessing oral frailty. Among objective indicators, RSST is not suitable as a screening method for oral frailty. In addition, objective indicators including TN and ODK should be valued for early screening and preventive interventions. The risk factors of oral frailty include physical frailty, passive smoking, and being widowed.
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Affiliation(s)
- Yueheng Yin
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Ying Liu
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Yun Ji
- Chunhua Community Health Service Centre, Nanjing, 211166, Jiangsu, China
| | - Enfang Shan
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Shuzhen Niu
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China
| | - Jingjing Ding
- Sir Run Run Hospital of Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - XianWen Li
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu, China.
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Chan AKY, Chu CH, Ogawa H, Lai EHH. Improving oral health of older adults for healthy ageing. J Dent Sci 2024; 19:1-7. [PMID: 38303786 PMCID: PMC10829734 DOI: 10.1016/j.jds.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/13/2023] [Indexed: 02/03/2024] Open
Abstract
The objective of this article is to discuss the importance of oral health in achieving healthy ageing and the role of all stakeholders in improving oral health for older adults. The World Health Organization defined healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age. It recognized healthy ageing as an important goal and the key to turn population ageing from a challenge to an opportunity. Healthy ageing has positive impacts on individual older adults, their families and societies. It enhances quality of life of older adults, strengthen family bonding of families and reduce resource demand of the societies. Maintaining oral health and function is essential in healthy ageing. Oral health affects systemic health, cognitive health and psychological health. Oral functions such as eating ensure nutritional health in older adults. Most oral diseases are preventable and oral function decline can be recovered by intervention. Unfortunately, oral diseases remain prevalent and oral function decline is being neglected in older adults. Policy makers, national dental associations, academics and healthcare professionals should collaborate to provide a patient-centred, comprehensive and integrated care to older adults. Health policy reforms are needed to reduce the global oral health inequalities in older adults. Population-wide prevention should be accessible, affordable and available to older adults. Universal oral health coverage is crucial for integration of oral health into general health care.
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Affiliation(s)
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Hiroshi Ogawa
- Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Eddie Hsiang-Hua Lai
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Oral Health, Ministry of Health and Welfare, Taipei, Taiwan
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Takeuchi N, Sawada N, Ekuni D, Morita M. Association between oral condition and subjective psychological well-being among older adults attending a university hospital dental clinic: A cross-sectional study. PLoS One 2023; 18:e0295078. [PMID: 38015962 PMCID: PMC10684071 DOI: 10.1371/journal.pone.0295078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
Positive psychological well-being has a favorable impact on survival rates in both healthy and unhealthy populations. Oral health is also associated with psychological well-being, is multidimensional in nature, and includes physical, psychological, emotional, and social domains that are integral to overall health and well-being. This study aimed to identify the associations between individual and environmental characteristics, oral condition and nutritional status in relation to subjective well-being among older adults using the Wilson and Cleary conceptual model. The participants were older adults (age ≥ 60 years) attending a university hospital. Subjective well-being was assessed using the World Health Organization-5 Well-Being Index, oral condition was assessed based on the number of bacteria in the tongue coating, oral wettability, tongue pressure, occlusal force, oral diadochokinesis, and masticatory ability, and subjective swallowing function was assessed using the Eating Assessment Tool, number of remaining teeth, and number of functional teeth. In addition, factors related to well-being, including social networks, life-space mobility, nutritional status, smoking history, drinking history, and medical history were assessed. In the analysis, structural equation modeling was used to investigate the association between oral condition and subjective well-being. Confirmatory factor analysis revealed oral condition as a latent variable, including tongue pressure, oral diadochokinesis /pa/, /ta/, /ka/, occlusal force, masticatory ability, subjective swallowing function, and number of functional teeth. Structural Equation Modeling revealed that oral condition was positively correlated with nutritional status, and nutritional status was positively correlated with the World Health Organization-5 Well-Being Index. These findings suggest that oral condition may influence subjective well-being via nutritional status or social environmental factors.
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Affiliation(s)
- Noriko Takeuchi
- Department of Preventive Dentistry, Okayama University Hospital, Okayama, Okayama, Japan
| | - Nanami Sawada
- Department of Preventive Dentistry, Okayama University Hospital, Okayama, Okayama, Japan
| | - Daisuke Ekuni
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Okayama, Japan
| | - Manabu Morita
- Department of Oral Health, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, Japan
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Bukhary DM. Teeth Rehabilitation and Nutritional Influence on Diabetic Patients: A Review. Cureus 2023; 15:e46182. [PMID: 37790059 PMCID: PMC10544288 DOI: 10.7759/cureus.46182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/05/2023] Open
Abstract
Diabetes mellitus (DM) is a globally prevalent endocrine and metabolic disorder characterized by hyperglycemia. Its complications significantly impact both the quality and longevity of the patient's life with a substantial burden on the healthcare system. Missing teeth make individuals more susceptible to malnutrition compared to those with functional teeth. This is especially true for people with diabetes, as the condition is closely linked to both oral health and food intake. Natural teeth loss can significantly reduce an individual's ability to chew food, leading to a decrease in the quality and quantity of their nutrition. Prosthodontics is a dental specialty that replaces missing teeth with artificial ones. Replacing missing teeth may prevent the risk of malnutrition due to decreased ability to chew. Good oral health is important for overall health, especially for those with conditions such as diabetes. Artificial teeth replacement may improve nutrition intake by improving chewing ability. Therefore, the ultimate objective of rehabilitating a patient's oral cavity is to replace the shape and function in terms of chewing performance to a degree that is as close to normal as feasible. The purpose of this review is to explore the literature showing the link between natural teeth loss and nutrition in individuals with DM, with a special focus on prosthodontic management. Several oral complications occur in diabetic patients specifically teeth loss, which in turn affects mastication function. This in turn cause malnutrition and affect glucose level. It is imperative for healthcare providers to take an interdisciplinary approach in order to improve the dental and nutritional status and overall well-being of DM patients.
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Affiliation(s)
- Dalea M Bukhary
- Department of Oral and Maxillofacial Prosthodontics, King Abdulaziz University, Jeddah, SAU
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Limpuangthip N, Komin O. Association between oral hypofunction and general health: a systematic review. BMC Oral Health 2023; 23:591. [PMID: 37620920 PMCID: PMC10463691 DOI: 10.1186/s12903-023-03305-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Oral hypofunction comprises 7 oral function conditions, including mastication, swallowing, pronouncing, oral hygiene, and oral dryness. However, it remains unresolved whether having oral hypofunction and each individual condition adversely affect general health. This study aimed to investigate the association between oral hypofunction and general health, encompassing physical, psychological, and social dimensions. METHODS Oral hypofunction was diagnosed following the criteria proposed by the 2016 Japan Society of Gerodontology, comprising 7 oral function conditions. Oral hypofunction was diagnosed when at least 3 conditions presented. The selected studies eligible for reviewing were based on the PI(E)CO criteria: P (population), adult and older adults; I/E (intervention/exposure), having oral hypofunction by considering overall and individual 7 oral function conditions; C (comparator), not having oral hypofunction; O (outcome), the general health status, encompassing physical, psychological, and social dimensions. Electronic search limited to English articles was performed through PubMed, Scopus, and Cochrane Database of Systematic Reviews databases from January 2016 to June 2023. The included studies were assessed for quaility and risk of bias using the modified Newcastle-Ottawa scale. Qualitative analyses were performed on the general outcome, and having oral hypofunction considering overall and individual oral function conditions. RESULTS Ten studies were included in the final syntheses. One was a prospective cohort, one was a case-control, and the others were cross-sectional studies. All included studies were high quality. General health outcomes were mostly frailty, sarcopenia, and malnutrition, whereas mild cognitive impairment,social withdrawal, and gastric cancer prognosis were identified in one of the included studies. The association between general health and having oral hypofunction was stronger than when considering an individual condition. The health outcomes were predominantly associated with mastication and swallowing, whereas their relationships with oral hygiene and dryness were less likely to be reported. CONCLUSIONS The present review found an association between the presence of oral hypofunction and impaired general health. However, the specific impact on individual physical, psychological, and social dimensions cannot be distinctly delineated. Further prospective studies are required to clarify the causal-effect relationship between oral and general health.
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Affiliation(s)
- Nareudee Limpuangthip
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
| | - Orapin Komin
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand.
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