Impact of the Serum Level of Albumin and Self-Assessed Chewing Ability on Mortality, QOL, and ADLs for Community-Dwelling Older Adults at the Age of 85: A 15 Year Follow up Study

Implication of serum and salivary albumin tests in the recent oral health related epidemiological studies: A narrative review

Albumin is the most abundant protein in human serum and a specific amount of albumin also can be found in the saliva. It has several physiological functions such as blood colloidal osmotic pressure, antioxidant activity, binding and transporting of endogenous and exogenous substrates. We conducted an electronic search across several databases such as PubMed, Scopus, Cochrane, Embase and Science Direct using the relevant MeSH terms and keywords like "albumin", "serum albumin", "salivary albumin", "oral health" "dental caries" and "epidemiology". Only the epidemiological studies published between 2010 and 2023 were included. After the application of the inclusion criteria, a total of 51 studied were included in this narrative review. Serum and salivary albumin tests have been used in various aspects of oral health as a diagnostic and prognostic factor. Some of the results point out to a pattern of association while some of them are inconclusive and even contradictory. This narrative review discusses the role, significance and impact of albumin in epidemiological oral health related studies including the categories of periodontal health and disease, dental caries, oral function and hypofunction, nutrition and malnutrition, tooth loss and its treatment, diabetes and cancer. In addition, it offers a short manual for the researchers on when, where and how to use albumin tests in planning their study designs whether investigating an association or measure them as a covariate.

Mortality risk factors in community-dwelling, subjectively healthy, Swiss older adults: update after 8-years follow-up

BACKGROUND

Worldwide population is ageing, but little is known regarding risk factors associated with increased mortality in subjectively healthy, community-dwelling older adults. We present the updated results of the longest follow-up carried out on Swiss pensioners and we provide results on potential risk factors associated with mortality before the onset of the COVID-19 pandemic.

MATERIALS AND METHODS

Within the SENIORLAB study, we collected demographic data, anthropometric measures, medical history, and laboratory parameters of 1467 subjectively healthy, community-dwelling, Swiss adults aged ≥ 60 years over a median follow-up of 8.79 years. The variables considered in the multivariable Cox-proportional hazard model for mortality during follow-up were selected based on prior knowledge. Two separate models for males and females were calculated; moreover, we fitted the old model obtained in 2018 to the complete follow-up data to highlight differences and similarities.

RESULTS

The population sample included 680 males and 787 females. Age of participants ranged between 60 and 99 years. We experienced 208 deaths throughout the entire follow-up period; no patients were lost at follow-up. The Cox-proportional hazard regression model included female gender, age, albumin levels, smoking status, hypertension, osteoporosis and history of cancer within predictors of mortality over the follow-up period. Consistent findings were obtained also after gender stratification. After fitting the old model, female gender, hypertension, and osteoporosis still showed statistically significant independent associations with all-cause mortality.

CONCLUSIONS

Understanding the predictors of a healthy survival can improve the overall quality of life of the ageing population and simultaneously reduce their global economic burden.

TRIAL REGISTRATION

The present study was registered in the International Standard Randomized Controlled Trial Number registry: https://www.isrctn.com/ISRCTN53778569 (registration date: 27/05/2015).

Spatial-temporal analysis of urban-rural differences in the development of elderly care institutions in China

Background

Aging is both a sign of rising life expectancy per capita and social progress, and a challenge for society. Due to the decline in physiological functions, the rate of illness has increased significantly, leading to a rise in demand for healthcare, life care and other elderly care. With the overlapping impact of an aging population, advanced aging, empty nesting families and the weakening of traditional elderly care functions, the issue of elderly care for the empty nesters, the elderly alone and the disabled has become more prominent and has become a focal point of concern for all sectors of society. As an important supplement to the elderly care service system, institutional care, together with home care, community care and rural care, are mutually complementary.

Methods

The study establishes a panel database of urban and rural elderly-care institutions in 276 cities from 2010 to 2016, and uses comprehensive measurements to reveal the spatial-temporal changes of urban and rural elderly care institutions in China.

Results

First, in terms of spatial pattern, the overall score of elderly care institutions in urban areas shows a "double-high" spatial pattern of higher scores in coastal areas than inland areas, and higher scores in urban areas than in rural areas. In terms of the differences in the scores of secondary indicators, the eastern urban areas have higher scores than the rural areas for the indicators of facilities construction and nursing staff of elderly institutions, while the eastern rural areas have higher scores than their urban counterparts for the indicators of service recipients of elderly institutions. Second, in terms of temporal change, there is a clear "urban progress and rural regression" in the evolution of China's elderly care institutions. Third, in terms of spatial and temporal evolution, there is a clear spatial autocorrelation in the composite scores of urban and rural elderly care institutions in China, and the spatial autocorrelation of the composite scores of elderly care institutions shows a clustering pattern.

Discussion

The contradiction between the limited ability to pay of the elderly people staying in elderly care institutions and the huge demand for elderly care services is bound to affect the sustainability of the development of public elderly care institutions in both urban and rural areas. Due to historical factors, the marketisation of elderly care institutions in China started late and the marketisation of elderly care is not high. As the population ages, China's elderly-care institutions have begun to transform from public institutions of a welfare nature to those with some market mechanisms, but the overall transformation has been slow, resulting in the service guarantee system of elderly-care institutions lagging far behind the actual needs of the elderly. The long-term development of elderly care institutions must introduce market mechanisms, enhance the endogenous dynamics of elderly care institutions, correctly handle the relationship between fairness and efficiency of elderly care services, and improve the professionalism, income and treatment of elderly care staff while compensating for the lack of development of elderly care institutions and the inadequate layout of space, so as to continuously improve the service quality of elderly care institutions.

Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

Does Last Year's Cost Predict the Present Cost? An Application of Machine Leaning for the Japanese Area-Basis Public Health Insurance Database

The increasing healthcare cost imposes a large economic burden for the Japanese government. Predicting the healthcare cost may be a useful tool for policy making. A database of the area-basis public health insurance of one city was analyzed to predict the medical healthcare cost by the dental healthcare cost with a machine learning strategy. The 30,340 subjects who had continued registration of the area-basis public health insurance of Ebina city during April 2017 to September 2018 were analyzed. The sum of the healthcare cost was JPY 13,548,831,930. The per capita healthcare cost was JPY 446,567. The proportion of medical healthcare cost, medication cost, and dental healthcare cost was 78%, 15%, and 7%, respectively. By the results of the neural network model, the medical healthcare cost proportionally depended on the medical healthcare cost of the previous year. The dental healthcare cost of the previous year had a reducing effect on the medical healthcare cost. However, the effect was very small. Oral health may be a risk for chronic diseases. However, when evaluated by the healthcare cost, its effect was very small during the observation period.

Structure and Validity of Questionnaire for Oral Frail Screening

Oral frailty is defined as the mild decline in oral function and located at the early and reversible stage of frailty. Therefore, early detection and early treatment of oral frailty is very useful. Simple and easy questionnaires, such as an oral frailty checklist, have been widely used for the screening and enlightenment of oral frailty of the Japanese people. We evaluate the structure and validity of the oral frailty checklist. The questionnaire of oral frailty was distributed for the citizens more than 50 years old from December 2018 to January 2019. The structural validity of the questionnaire is analyzed by structural equation modeling (SEM). The characteristics of the items are analyzed by Item Response Theory (IRT). The data of 725 subjects (360 men, 359 women, 6 no answer, mean age 71.3 ± 9.05) are analyzed. The questionnaire consisted of three latent variables. Items of "Brushing teeth at least twice a day", "Regular attendance of dental clinic", and "Using denture", had low discrimination ability. The questionnaire used in this study is a useful tool for the screening of oral frailty. However, its scoring system needs to be improved.

Mortality-and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study

Mortality is obviously intended for epidemiological studies of community-dwelling older adults. There are several health-related factors associated with nutritional status and mortality. The aim of this study was to elucidate the risk factor for mortality in community-dwelling oldest-older adults at the age of 90 and clarify the structure of health-related factors associated with mortality. A 10-year follow-up study was performed for 93 subjects at the age of 90. The mean and median of their survival days were 2373 and 2581 days for women, and 1694 and 1793 days for men. By Cox's proportional hazards model, health-related factors associated with mortality were self-assessed for chewing ability, activities of daily living (ADLs), serum albumin, total cholesterol, serum creatinine, and gripping power for women but not for men. These factors interacted with each other, and the association of these factors was different in women and men. Self-assessed chewing ability was a powerful risk factor for mortality in women at the age of 90. It acted independently from nutritional status. For older adults, addressing healthy food choices together with improved oral functions is useful. However, risk factors for mortality may depend on the life stage of subjects. To investigate the risk factor for the mortality, the life course approach is necessary.