Chewing Difficulty Should be Included as a Geriatric Syndrome

Chewing ability and its associated factors among community-dwelling older adults in Chengdu, China: A cross-sectional study

AIM

To investigate the current status of chewing ability and analyze the risk factors among Chinese community-dwelling older adults.

METHODS

In this cross-sectional study, color-changeable gum and a color difference meter were used to assess chewing ability in the population. The statistical analysis employed multivariate logistic regression models to identify and quantify the factors influencing chewing ability.

RESULTS

A total of 373 community-dwelling adults aged 65 and older in Chengdu, in the west of China, were included in this study; 64 individuals (17.2%) exhibited signs of poor chewing ability. Female (odds ratio [OR]: 0.124, 95% CI: 0.057-0.268, p < .001), education level with college degree and above (OR: 0.114, 95% CI: 0.030-0.434, p = .001), number of teeth less than 20 (OR: 5.401, 95% CI: 2.509-11.626, p < .001), and decreased oral diadochokinesis (OR: 4.445, 95% CI: 1.775-11.132, p = .001) were significant factors in chewing ability in this study, after adjustment for potential variables.

CONCLUSIONS

The prevalence of decreased chewing ability among Chinese community-dwelling older adults was 17.2% and decreased chewing ability was associated with men, lower education level, less than 20 teeth and decreased oral diadochokinesis.

Oral frailty among dentate and edentate older adults in long-term care

BACKGROUND

The objectives of this study were to compare oral frailty (OFr) among edentate and dentate older adults living in long-term care facilities (LTCF) and to clarify how edentulism and oral disease burden (ODB) of dentate older adults are associated with OFr.

METHODS

The population of this study comprised 94 edentate and 209 dentate residents in LTCF in Helsinki, Finland, who had previously participated in a nutritional study. The participants underwent a clinical oral examination. The dentate residents were further divided into three ODB groups based on asymptotic dental score. The edentate and different ODB groups were compared with each other regarding demographics and oral and medical findings. OFr was defined as ≥ 2 of following: having a diet of soft/pureed food, residue of food in the oral cavity, inability to keep the mouth open during examination, unclearness of speech, dry mouth. The association between OFr and edentulousness and various levels of ODB was analyzed by a multivariate logistic model.

RESULTS

Participants with low ODB had significantly less OFr than their edentate peers (p = 0.009). Furthermore, the edentate and dentate with high ODB had similar odds for OFr.

CONCLUSIONS

Edentulousness and high ODB are equally harmful conditions and may predispose to OFr. This study suggests that maintaining healthy natural teeth and good oral health (low ODB) may protect against OFr.

TRIAL REGISTRATION

The Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the protocols for the nutritional status and oral healthcare studies and the merging of the data, including patient medical records (Register number HUS/968/2017).

Nutritional Risk, Depression, and Physical Function in Older People Living Alone

This study investigated depression and physical function as factors associated with nutritional risk in older adults living alone. The study included 2896 people 65 years or older who lived alone. Data were collected in South Korea between September and November 2020. Descriptive statistics, a chi-squared test, independent samples t-test, weighted multiple regression analysis, and binary logistic regression analysis were performed using IBM SPSS for Windows ver. 23.0. In this study, 44.8% of participants were in the nutritional risk group. Furthermore, 60.9% of those at risk for depression, 75.1% of those with instrumental activities of daily living (IADLs) dependency, and 59.1% of those with chewing limitations were at nutritional risk. The factors that increased nutritional risk in the weighted multiple regression analysis were depression (β = 0.27, p < 0.001), chewing limitations (β = 0.12, p < 0.001), IADL dependency (β = 0.09, p < 0.001), and basic physical movement (β = 0.04, p = 0.020). Binary logistic regression analysis showed that those with IADL dependency had a 2.59 times higher nutritional risk than those with IADL non-dependency (p < 0.001). The nutritional risk group had a higher risk of depression (2.01 times higher [p < 0.001]), chewing limitations (1.76 times higher [p < 0.001]), and basic physical movement limitations (1.35 times higher [p = 0.009]) than the good nutritional group. Therefore, nutritional screening is required of older individuals living alone. To mitigate nutritional risks, it is necessary to assess depression and physical function, including IADL dependency.

Association between Chewing Difficulty and Dietary Ca, Vitamin D, and Mg Intake in Korean Older Adults: 8th Korea National Health and Nutrition Examination Survey (KNHANES) (2020-2021)

Nutrition intake plays a pivotal role in chewing difficulty (CD). This cross-sectional descriptive study aims to explore the associations between CD and the dietary intake of calcium (Ca), vitamin D, and magnesium (Mg) in adults aged 65 and older, utilizing data from the 8th Korea National Health and Nutrition Examination Survey (2020-2021). The chewing function was assessed using a 5-point scale questionnaire that inquired about discomfort experienced during mastication. "Very uncomfortable" and "uncomfortable," two of the five response options, were categorized as being indicative of CD. Dietary intake was assessed through 24 h dietary recall interviews, and nutrient calculations were based on the 10th revised edition of the Korean Food Composition Table. Data (N = 2942) were analyzed using descriptive statistics and multi-logistic regression analyses in a composite sample plan file. Among the 2942 subjects, groups with insufficient daily nutrient intake had significantly higher odds ratios (ORs) for CD compared to their counterparts. In men, the ORs for Ca (1.56), Mg (1.75), and the combined intake of Mg (1.64) with Ca were elevated. In women, the ORs for Ca (1.74), Mg (1.53), and the combined intake of Mg (1.43) with Ca showed similar trends. After adjusting for age, family income, and family size variables, men's ORs for Mg (1.55) and the combined intake of Mg (1.55) with Ca remained elevated, while women's OR for Ca (1.58), Mg (1.42), and the combined intake of Mg (1.34) with Ca remained significant. Dietary vitamin D intake did not significantly impact the OR for CD. After adjusting for natural tooth numbers, self-perceived oral health, and obesity, no significant association was found between CD and these nutrients. In conclusion, this study underscores the importance of promoting the recommended daily intake of magnesium alongside dietary calcium to address CD.

Relationship between oral frailty, health-related quality of life, and survival among long-term care residents

PURPOSE

We evaluated oral frailty (OFr) and its association with health-related quality of life (HRQoL), energy and protein intake, and survival among older long-term care residents.

METHODS

This cross-sectional study with a 3-year follow-up for survival assessed 349 residents in long-term care facilities (73% female, mean age 82 years). We defined OFr with six signs (dry mouth, food residue on oral surfaces, unclear speech, inability to keep mouth open or pain expression during the clinical oral examination, diet pureed/soft) and OFr severity was categorized as Group 1, (mild) = 0-1 signs, Group 2 (moderate) = 2-4 signs, and Group 3 (severe) = 5-6 signs. We measured HRQoL with 15D instrument, and energy and protein intake by a 1- to 2-day food record. Mortality was retrieved from central registers on March 2021.

RESULTS

Of the residents, 15% had 0-1, 67% 2-4 and 18% 5-6 OFr signs. HRQoL decreased linearly from Group 1 to Group 3. OFr correlated with such dimensions of HRQoL as mobility, eating, speech, excretion, usual activities, mental function, and vitality. We found no association between OFr categories and energy and protein intake. Survival decreased linearly from Group 1 to Group 3.

CONCLUSIONS

OFr was common among older long-term care residents and OFr severity predicts poorer outcomes. The six oral signs denoting OFr may be used at the bedside to screen residents at risk for OFr.

Chewing Analysis by Means of Electromagnetic Articulography: Current Developments and New Possibilities

Chewing is a complex procedure that involves sensory feedback and motor impulses controlled by the trigeminal system in the brainstem. The analysis of mandibular movement is a first approximation to understanding these mechanisms. Several recording methods have been tested to achieve this. Video, ultrasound, the use of external markers and kinesiographs are examples of recording systems used in research. Electromagnetic articulography is an alternative method to those previously mentioned. It consists of the use of electromagnetic fields and receiver coils. The receiver coils are placed on the points of interest and the 3D coordinates of movement are saved in binary files. In the Oral Physiology Laboratory of the Dental Sciences Research Center (Centro de Investigación en Ciencias Odontológicas-CICO), in the Faculty of Dentistry at the Universidad de La Frontera (Temuco, Chile) several research studies have been carried out using the AG501 3D EMA articulograph (Carstens Medizinelektronik, Lenglern, Germany). With this device, they developed a series of protocols to record mandibular movement and obtain new information, such as the 3D Posselt polygon, the area of each polygon, individualized masticatory cycles and speed and acceleration profiles. Other investigations have analyzed these parameters, but separately. The AG501 allows for holistic analysis of all these data without altering natural movement. A limitation of this technology is the interference generated by its metallic elements. The aim of the present work is to show the developed methods used to record mandibular movement in the CICO, using the AG501 and compare them with others used in several research studies.

Association between Bone Mineral Density and Oral Frailty on Renal Function: Findings from the Shika Study

The association between oral frailty (OFr) and body action has been investigated, but its association with systemic function remains unclear. Therefore, this cross-sectional study examined the association between OFr with decreased bone mineral density (BMD) and renal function in residents of Shika town, Ishikawa Prefecture, Japan aged ≥40 years. This study included 400 inhabitants. The OFr total score was assessed using three oral domains in the Kihon Checklist (a self-reported comprehensive health checklist), the number of teeth, and brushing frequency per day. Measurements were the estimated glomerular filtration rate (eGFR) and the osteo-sono assessment index (OSI). Using a two-way analysis of covariance (p = 0.002), significantly lower OSI was indicated in the eGFR < 60 and OFr group than in the eGFR of < 60 and non-OFr group after adjusting for age, body mass index, and drinking and smoking status as confounding factors. Multiple logistic regression analysis confirmed this relationship (p = 0.006). Therefore, lower BMD seems to be associated with lower renal function only when accompanied by OFr. Further longitudinal studies are needed to confirm these results.

Dental Care for Older Adults

There is a global increase in the older population. Unfortunately, dental conditions in the older population can sometimes be poor as a result of worsened physical conditions and the cumulative damage caused by dental diseases in the past. Many suffer from oral diseases such as dental caries and periodontal disease but receive no regular dental care. Oral conditions and systemic problems are interrelated. Chronic medical problems and polypharmacy are common among them. These conditions may lead to xerostomia with or without a decrease in saliva output. Additionally, many older adults have deteriorated masticatory function associated with physical health issues such as frailty. Preventive measures are crucial to stop oral diseases from progressing and the replacement of missing teeth is needed when masticatory function is impaired. Older adults also suffer a higher risk of oral cancer because of their less resilient but more permeable oral mucosa. With the increasing need for elderly dental care, dentists should equip themselves with knowledge and skills in geriatric dentistry. They should help older adults to develop and maintain the functional ability that enables well-being in older age. This communication article aims to discuss the relevant medical conditions, common dental diseases, and dental care for older adults.

The Risk of Cardiovascular Disease According to Chewing Status Could Be Modulated by Healthy Diet in Middle-Aged Koreans

To assess whether a healthy diet could change the risk of cardiovascular disease (CVD)-related chewing difficulty (CD) in relation to age distribution. In a cross-sectional study of 9411 middle-aged Koreans from the KNHANES VII. In this study, the Framingham 10-year general CVD risk prediction equations and the Korean Heathy Eating index (KHEI) were used to assess the 10-year estimated risk of CVD and dietary quality, respectively. CD was experienced by 16.7% of the total subjects. Among subjects with CD, the 10-year estimated CVD risk was 8.71% of the subjects in the 30−49 years age group and 30.38% of those in the 50−64 years age group, which is a difference of approximately 3.5 times. Regardless of age distribution, the total score of the KHEI in subjects who had CD was significantly lower than in those who had no CD (NCD) (p = 0.004 for the 30−49 years age group and p < 0.001 for the 50−64 years age group, respectively). Among the subjects with poor KHEI in the 30−49-year age group, the adjusted odds ratio for the 10-year estimated CVD risk of the subjects with CD was 2.204-fold (95% CI = 1.385−3.506) higher using NCD as a reference. The findings showed that dietary quality could modify the risk for CVD according to chewing status.

Influence of oral health on frailty in patients with type 2 diabetes aged 75 years or older

Background

Poor oral health conditions are known to affect frailty in the older adults. Diabetes is a risk factor for both poor oral health and frailty, therefore, oral health status may affect frailty in diabetic patients more than in the general population. The purpose of this study was to evaluate the influence of oral health and other factors on frailty and the relationship among oral health, diabetes and frailty in older adult patients with type 2 diabetes.

Methods

Patients with type 2 diabetes aged 75 years or older were included in this cross-sectional study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty screening index (FSI) classes were evaluated.

Results

Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 12 cases (10.8%) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were found to be factors influencing pre-frailty or frailty. In the evaluation of individual FSI classes, BMI had an influence on those with a FSI ≤2. The cognitive and living functions score was a factor influencing those with FSI ≤3. The oral frailty index was found to have a significant influence on all FSI classes.

Conclusions

Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥75. In this patient population, as frailty progresses, the impact of oral health on frailty may increase.

Trial registration:

This study was retrospectively registered in UMIN-CTR (UMIN000044227).

Development and Validation of a Nomogram for Predicting Sarcopenia in Community-Dwelling Older Adults

OBJECTIVE

To establish and validate a nomogram that predicts the risk of sarcopenia for community-dwelling older residents.

DESIGN

Retrospective study.

SETTING AND PARTICIPANTS

A total of 1050 community-dwelling older adults.

METHODS

Data from a survey of community-dwelling older residents (≥60 years old) in Hunan, China, from June to September 2019 were retrospectively analyzed. The survey included general demographic information, diet, and exercise habits. Sarcopenia diagnosis was according to 2019 Asian Working Group for Sarcopenia criteria. Participants were randomly divided into the development group and validation groups. Independent risk factors were screened by multivariate logistic regression analysis. Based on the independent risk factors, a nomogram model was developed to predict the risk of sarcopenia for community-dwelling older adults. Both in the development and validation sets, the discrimination, calibration, and clinical practicability of the nomogram were verified using receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis, respectively.

RESULTS

Sarcopenia was identified in 263 (25.0%) participants. Age, body mass index, marital status, regular physical activity habit, uninterrupted sedentary time, and dietary diversity score were significant contributors to sarcopenia risk. A nomogram for predicting sarcopenia in community-dwelling older adults was developed using these factors. Receiver operating characteristic curve analysis showed that the area under the curve was 0.827 (95% CI 0.792-0.860) and 0.755 (95% CI 0.680-0.837) in the development and validation sets, respectively. The Hosmer-Lemeshow test yielded P values of .609 and .565, respectively, for the 2 sets. The nomogram demonstrated a high net benefit in the clinical decision curve in both sets.

CONCLUSIONS AND IMPLICATIONS

This study developed and validated a risk prediction nomogram for sarcopenia among community-dwelling older adults. Sarcopenia risk was classified as low (<11%), moderate (11%-70%), and high (>70%). This nomogram provides an accurate visual tool to medical staff, caregivers, and older adults for prediction, early intervention, and graded management of sarcopenia.

Relationship between Fried's frailty phenotype and oral frailty in long-term care residents

BACKGROUND

oral frailty (OFr) may be called a syndrome lacking a consensus on its definition.

OBJECTIVE

the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care.

DESIGN

the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition.

SETTING

participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs).

SUBJECTS

the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland.

METHODS

frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination.

RESULTS

a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties.

CONCLUSIONS

OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.

A systematic review and gap analysis of frailty and oral health characteristics in older adults: A call for clinical translation

OBJECTIVE

This systematic review updates the evidence for association between oral health characteristics and frailty status, identifying gaps in translational dental research and application of frailty assessment into clinical practice.

BACKGROUND

Clinicians have little guidance on stage-appropriate dental treatment for medically complex older adults. Oral health characteristics have been associated with frailty status, determined through validated assessment tools representing a concise measure of health. Translation of frailty assessment into dental practice has not been the focus of previous reviews.

METHODS

Utilising the PRISMA framework for systematic reviews, a comprehensive database search identified articles describing the association of interest. Those included were cross-sectional or longitudinal, in English, included participants aged 50 years or older, used validated frailty assessments and measured clinically relevant oral health outcomes. From 835 screened articles, 26 full-text articles were eligible for quality appraisal and synthesis.

RESULTS

Frailty prevalence ranged from 8.5% to 66.0%. Most studies utilised the Fried frailty criteria. Qualitative synthesis of 17 cross-sectional and nine longitudinal studies demonstrated significant covariate-adjusted association between frailty status and number of teeth, chewing ability, prosthetic characteristics, dental caries, periodontitis, dental utilisation and oral health-related quality of life factors. Variability in findings reflected study sample diversity based on country of study origin, age at recruitment, sample size, frailty assessment type, use of clinical versus self-reported outcome measures and differences in statistical analysis.

CONCLUSION

Despite robust evidence of association with oral health characteristics, frailty assessment has yet to be sufficiently applied to translational dental research and clinical practice.

Factors Related to Depression Associated with Chewing Problems in the Korean Elderly Population

Unlike younger adults, depression in older adults is sometimes related to chewing problems. This study examined the risk factors related to depression associated with chewing problems in 3747 elderly individuals using the Korean National Health and Nutrition Examination Survey. Approximately 41.2% of the total subjects reported chewing problems. There were significant differences in age, education, marital status, individual income, current smoking status, and aerobic physical activity in relation to chewing problems (p < 0.001 for all). The subjects who experienced chewing problems showed a higher score on the EuroQoL 5 Dimension index (p < 0.001) but a lower health-related quality of life than those with no chewing problems (p < 0.001). The prevalence of depression, which was classified by the patient health questionnaire—9, in subjects with chewing problems was approximately 2 times higher than that in those with no chewing problems (p < 0.001). Subjects with chewing problems were found to have a 1.945-fold higher adjusted risk of depression than those who did not have chewing problems (95% CI = 1.583–2.390, p < 0.001), and subjects with high protein consumption showed a 1.410-fold greater risk of depression (95% CI = 1.144–1.739, p = 0.001) than those with low protein consumption.

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.

Nutrition Interventions for Healthy Ageing in Indonesia

Background: Including Indonesia, the elderly population worldwide is on the rise. This situation is closely related to the increase in the incidence and prevalence of non-communicable diseases. Eating behavior is related to the risk of non- communicable the risk of NCDs in the elderly. Therefore, nutrition intervention should be carried out from old age.Objectives: The purpose of this study is to review potential nutritional interventions to prepare for a healthy ageing process in an Indonesian context.Discusion: This review uses social cognition theory to emphasize the importance of nutrition education, the development of nutritional products with biologically active compounds, and practical guidelines that influence individual dietary behavior. Nutritional interventions should take into account Indonesia’s existing food-based balanced nutrition diet guidelines and the dietary patterns of adults and the elderly. Indonesia has a large population, ethnic and cultural diversity, which together affect people’s daily consumption of various foods.Conclusions: Customized nutrition education programs and the development of functional foods are appropriate interventions that can be implemented in Indonesia.

Swallowing and Liking of Vegetable-Enriched Bread Compared With Commercial Breads as Evaluated by Older Adults

Characteristics of food that influence liking and ease-of-chewing and swallowing are not well-understood. Reformulation of bread to improve nutrient density may improve liking, ease-of-chewing and swallowing which could improve dietary intake particularly with aging. The study aimed to compare objectively and subjectively four breads of increasing nutrient density: $1 white (WB) and wheatmeal (WMB) commercial breads and two in-house formulations of vegetable-enriched breads (VB75 or VB100) which incorporated drum-dried pumpkin and sweet corn flours for physical, sensory and ease-of-chewing and swallowing properties. Each bread underwent instrumental texture analysis. The commercial and vegetable-enriched breads were not different by hardness or springiness but the vegetable breads were up to 25% less cohesive, less gummy and less chewy than the commercial breads. Questionnaires and Likert scale (150 mm) responses were completed by 50 physically active volunteers aged 50+ years. Overall liking of the VB75 and VB100 was rated 40% higher than the white and wheatmeal breads. Vegetable-enriched breads were rated as almost 50% easier to chew (mean ± SD; WB 70.53 ± 39.46 mm, WMB 77.68 ± 33.13 mm, VB75 104.78 ± 30.69 mm, VB100 107.58 ± 24.90 mm) and swallow (WB 70.29 ± 37.98 mm, WMB 77.53 ± 34.88 mm, VB75 104.63 ± 28.25 mm, VB100 104.90 ± 25.54 mm). Vegetable-enriched breads compared to white and wheatmeal breads were instrumentally and subjectively less gummy, cohesive and chewy than commercial breads and have the potential to both improve nutrition and "ease of swallowing" in older people. New areas of research should explore other underutilized vegetables for bread enrichment and their ability to aid swallowing and improve nutrition status.

Food consumption frequency of Korean adults based on whether or not having chewing difficulty using 2013-2016 KNHANES by sex-stratified comparative analysis

BACKGROUND/OBJECTIVES

This study examined the associations between food consumption frequency of Korean adults and self-perceived chewing difficulty, using the food frequency questionnaire (FFQ, 112 items) from 2013-2016 of the Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS

Subjects were divided into not difficult in chewing (NDC) and difficult in chewing (DC) groups, with 24.17% being classified into DC. Males and females consumed 35 and 37 items less frequently than the other sex, respectively. Due to the remarkable sex difference in food consumption, sex-stratified one-sided survey regression analysis was performed after adjusted for the effect of age, household income, and self-rated health status.

RESULTS

Thirty-four items of FFQ were significantly less consumed by the DC group. Females exclusively consumed less beverages and alcohol while males showed the same for fruits and milk·dairy products. Consumption frequency of 8 items such as steamed potatoes·grilled potatoes, stir fried beef, other kimchi·fresh vegetable kimchi, orange, sour pork·pork cutlet, tteokbokki and green tea were significant only in males. In contrast, 17 items including cooked rice with other grains and legumes, boiled egg·steamed egg, Korean cabbage kimchi, banana, and tofu stew·soft tofu stew were significant only for females. Finally, items that showed significance for both were 9 items including loaf bread, ready-to-eat cereal, steamed sweet potatoes·grilled sweet potatoes, stir-fried lotus roots·stir-fried burdock, green laver salad·brown seaweed salads, apples, tomato·cherry tomatoes, squid (raw, dried shredded, boiled, stir-fried), and curd type yogurt.

CONCLUSIONS

Findings in this study suggest chewing difficulty may be an important nutritional issue that has to be dealt with for healthful food consumption, with distinct interest of sex.

Development and validation of a chewing function questionnaire for Chinese older adults

OBJECTIVES

To develop and validate a questionnaire for assessing chewing function of Chinese older adults.

METHODS

The chewing function questionnaire was validated on older adults recruited from a dental hospital, an elderly home and three community centers in Hong Kong. The participants were asked to indicate their ability to chew on each of the 20 selected food items and to self-rate their overall chewing ability. Chewing function was objectively assessed by asking the participant to chew a color-changeable gum for 90 s. The color of the chewed gum was assessed using a colorimeter. Participant's maximum bite force was also measured by an electronic detector.

RESULTS

A total of 211 elders participated in this study. Ten out of the 20 food items were selected to create the final unidimensional chewing function questionnaire (CFQ). The overall Cronbach's alpha value for the CFQ was 0.912. The weighted kappa value of each food item ranged from 0.6 to 1. In general, participants with larger color change of the chewed gum had significantly higher median rank of the CFQ total score and of the score of each food item (p < 0.01). The CFQ total score was correlated with the color change of the chewed gum as measured by colorimeter (p < 0.001), the maximum bite force (p < 0.001) and self-rated chewing ability (p < 0.001).

CONCLUSION

The new unidimensional chewing function questionnaire is a valid and reliable questionnaire for assessing self-rated chewing ability of Chinese older adults.

CLINICAL SIGNIFICANCE

The newly developed self-reported questionnaire can be used to assess the chewing function of Chinese older adults and dentists can use the information obtained to discuss with their patients regarding the need for oral function rehabilitation, such as the treatment need for fixed or removable dental prosthesis.

Oral Health Among Older Adults With Complex Needs Living in the Community and in Aged Residential Care Facilities within New Zealand

OBJECTIVES

To describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables.

DESIGN

Secondary analysis of 2 continuously recruited national cohorts.

SETTING AND PARTICIPANTS

Adults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent.

METHODS

All community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models.

RESULTS

Overall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Māori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts.

CONCLUSIONS AND IMPLICATIONS

Heavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.

Did expanded access to denture services improve chewing ability in the Korean older population? Results of a regression discontinuity analysis

The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cut-offs, and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. Future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly.

Combined effect of poor appetite and low masticatory function on sarcopenia in community-dwelling Japanese adults aged ≥ 75 years: A 3-year cohort study

OBJECTIVE

This study aimed to investigate the longitudinal association of the combination of poor appetite (PA) and low masticatory function (LMF) with sarcopenia in community-dwelling older adults.

METHODS

In total, 173 community-dwelling Japanese adults aged ≥ 75 years participated in the 3-year cohort study. Appetite assessment using the Simplified Nutritional Appetite Questionnaire (SNAQ) and masticatory function assessment using spectrophotometric measurement of differences in gum colour before and after masticating colour-changeable chewing gum (ΔE*ab) were performed at baseline. SNAQ score of ≤ 14 was defined as PA. The lowest tertile of ΔE*ab was defined as LMF. Follow-up examinations were administered annually over a 3-year period to determine sarcopenia incidence, which was defined by the criteria proposed by the Asian Working Group for Sarcopenia. Adjusted hazard ratios (HRs) of sarcopenia incidence according to the presence of PA and LMF were calculated using Cox proportional hazards regression models.

RESULTS

At baseline, 81 participants (46.8%) had neither PA nor LMF, 34 (19.7%) had PA alone, 35 (20.2%) had LMF alone, and 23 (13.3%) had both PA and LMF. On follow-up, 31 participants (17.9%) developed sarcopenia. After adjusting for covariates, the adjusted HR for sarcopenia in participants with both PA and LMF was 4.4 (95% confidence interval = 1.6-12.2) compared with those without PA or LMF. PA or LMF alone was not significantly associated with sarcopenia development.

CONCLUSIONS

Coexisting PA and LMF increase the risk of sarcopenia development among community-dwelling Japanese adults aged ≥ 75 years.

The Associations of Income, Education and Income Inequality and Subjective Well-Being among Elderly in Hong Kong-A Multilevel Analysis

Background: Higher income and education and lower income inequality in a neighbourhood have been shown to be related to better mental health outcome in developed countries. However, it is not clear whether these factors would affect the subjective well-being of the elderly, especially in a setting with recent rapid economic development. Methods: This study was conducted in 80 community centres with a total of 7552 community-dwelling elderly (mean age 75.9 years (SD = 7.79), 79% female) in Hong Kong. Income at individual level was measured as perceived disposable income. Education level was also collected. At district level, income was measured by district median household income and education was measured as the proportion of the population with no formal schooling. Income inequality was quantified using Gini coefficients. Low subjective well-being was defined as any one or a combination of the following: not satisfied with life, no meaning of life and being unhappy (Likert scale ≤ 2). Multilevel logistic regression was used to assess the association of income, education and income inequality and low subjective well-being. Results: We found that 15.3% (95% confidence interval (CI): 14.5 to 16.1) of the elderly have low subjective well-being. Compared with elderly who reported a very adequate disposable income, those who reported a very inadequate disposable income are at increased risk of low subjective well-being (OR=5.08, 95%CI: 2.44 to 10.59). Compared with elderly with tertiary education, those with no formal schooling were at higher risk (OR=1.60, 95%CI 1.22 to 2.09). Income inequality was not related to subjective well-being. Conclusions: Elderly with inadequate disposable income and lower education level are more likely to suffer from low subjective well-being. At the neighbourhood level, income inequality was not related to subjective well-being. However, the relationships between neighbourhood income and education level and individuals’ subjective well-being are not clear.

Did Expanded Dental Insurance Improve Chewing Ability in the Older Korean Population? Results of an Interrupted Time-series Analysis

Background

In 2012, the Korean National Health Insurance extended its coverage to include denture services for older adults. We examined whether the new policy resulted in improved chewing ability in the eligible population.

Methods

We used interrupted time-series (ITS) analysis, a quasi-experimental design, to analyze the effect of the policy. We used data from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2016–2018. The study population consisted of two groups: the treatment group, aged 65 years or older and eligible for the dental insurance benefit; and the control group, those younger than 65 years and ineligible. The main evaluated outcome was self-reported chewing difficulty.

Results

The ITS analysis showed that chewing difficulty decreased annually by 0.93% (95% CI, −1.30 to −0.55%) and 0.38% (95% CI, −0.59 to −0.16%) after the policy extension in the older than 65 and younger than 65 groups, respectively. However, we could not conclude that the insurance extension affected chewing difficulty because there was a decrease in the control group as well.

Conclusion

Chewing ability improved in both older and younger adults regardless of dental insurance coverage for older adults. Other exogenous factors probably led to the improvements in chewing ability as well as dental insurance benefits.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.

Combating frailty and sarcopenia in aging populations: Switching to a more positive paradigm

Frailty may be used as a public health indicator of aging well for projection of health and social care resource allocation. Frailty assessments have been adopted by various medical as well as surgical specialties as part of prognosis in influencing choice of therapy, although the assessment tools are even more heterogeneous than those in the gerontological fields. Recently, the World Health Organization called for a life course approach to healthy aging, placing the emphasis on function, expressed as intrinsic capacity, which would address concerns with the negative image of frailty and with the overemphasis on deficits. The impact of social and physical environments is taken into account in the concept of resilience. These are all related concepts that differ in the setting in which they are used. Frailty may be more useful in clinical management in hospitals and residential care homes, as well as in community models of care. Intrinsic capacity could be used for development of health-promotion policies and service models across the life course; mainly primary care with low resource needs, using a step-care approach. Resilience could be considered an overarching holistic concept covering physical, psychological, and environmental domains, which is still in the research arena.