Oral Health and Undernutrition in the Frail Elderly Persons

INTRODUCTION

Although many studies associate a poor state of oral health with the risk of undernutrition in both the autonomous and dependent elderly, very few of them consider the frail elderly person. However, the identification of the frail elderly is one of major issues of modern geriatrics. It is at this stage that preventive strategies are the most effective against the risks of dependency. The main objective of our study is to explore the nature of the association between oral health and undernutrition in the frail elderly patient, and to identify the associated factors.

MATERIALS AND METHODS

We have used the data of an observational transversal monocentric study, conducted among a population of patients hospitalized for frailty assessment at the Geriatric Frailty Clinic (G.F.C.) for Assessment of Frailty and Prevention of Disability. The enrolment site is the Cité de la Santé, at Toulouse University Hospital. Data were collected from January 25, 2016 February 2, 2018. The data collected sociodemographic characteristics, oral health (Oral Health Assessment Tool), nutritional status (Mini Nutritional Assessment), Body Mass Index, and weight loss according to Fried), frailty (Fried criteria), functional status (Mini Mental State Examination, Activity of Daily Living, Instrumental Activity of Daily Living, Geriatric Depression Scale-15), and behavior (tobacco and alcohol).

RESULTS

We included 1,155 subjects with an average age of 81.9 years, including 65% women. Bivariate analysis indicated a statistically significant association (p<0.05) between a pathological state of oral health and undernutrition, particularly with regard to decay of natural teeth, pathologies of the tongue, gums and tissues, dry mouth, lack of oral cleanliness and presence of dental pain. Multivariate analysis adjusted for socio-demographic, behavioral and functional data confirmed some of these associations, notably between the item gum/mucous membrane and the decrease of the score (p<0.01); this same item and weight loss according to Fried (p<0.01), and the item tongue and weight loss (p<0.05). A statistically significant association appeared between the state of oral health and frailty (item tongue (p<0.01)).

DISCUSSION

Our study shows a statistically significant association between a pathological state of oral health and nutrition disorders in the frail elderly person. This result confirms the hypothesis postulating that a poor state of oral health would be associated with nutritional disorders among the frail elderly. Our analysis also shows a statistically significant association between a deteriorated state of oral health and frailty. Tongue diseases here increase the risk of frailty for the patient. Our results are, however, limited and do not allow for an analysis of causal effect. It would be useful to complete our study by more refined analyses of risk factors, conducted on a larger sample, and with a follow-up patients over time.

CONCLUSION

We show here the importance of targeting the frail population in order to screen for oral disease and refer patients for dental care. Ensuring oral health care of frail patients seems indispensable if they are to maintain not only a healthy nutritional state, but also a satisfactory general state of health, thus allowing for successful aging.

Chain dynamics of human dermis by Thermostimulated currents: A tool for new markers of aging

BACKGROUND/PURPOSE

The purpose of this clinical study was to identify dielectric markers to complete a previous thermal and vibrational study on the molecular and organizational changes in human dermis during intrinsic and extrinsic aging.

METHODS

Sun-exposed and non-exposed skin biopsies were collected from 28 women devised in two groups (20-30 and ≥60 years old). The dielectric relaxation modes associated with localized and delocalized dynamics in the fresh and dehydrated state were determined by the Thermostimulated currents technique (TSC).

RESULTS

Intrinsic and extrinsic aging induced significant evolution of some of the dielectric parameters of localized and delocalized dynamics of human skin. With photo-aging, freezable water forms a segregated phase in dermis and its dynamics is close to free water, what evidences the major role of extrinsic aging on water organization in human skin. Moreover, TSC indicators highlight the restriction of localized mobility with intrinsic aging due to glycation, and the cumulative effect of chronological aging and photo-exposition on the molecular mobility of the main structural proteins of the dermis at the mesoscopic scale.

CONCLUSION

TSC is a well-suited technique to scan the molecular mobility of human skin. It can be uses as a relevant complement of vibrational and thermal characterization to follow human skin modifications with intrinsic and extrinsic aging.

Oral Health and the Frail Elderly

INTRODUCTION

The relationships between oral health conditions and frailty have rarely been explored. A systematic review of frailty components and oral health concluded that differences in study population endpoint criteria and study design cannot establish a relationship between frailty and oral health.

OBJECTIVE

This study aims to describe the distribution of the OHAT (Oral Health Assessment Tool) score in a population of frail subjects and to assess associated parameters (age, socio-economic status, living conditions, education level, nutritional habits, cognitive functioning, autonomy).

DESIGN

Cross-sectional observational study among patients referred to the Geriatric Frailty Clinic.

MEASUREMENTS

1314 patients participated in different standardized tests to evaluate their health status, cognitive and affective functioning, adaptation to usual daily activities, nutritional status, and oral health status.

RESULTS

The risk of oral health deterioration was higher with the appearance of frailty: the OHAT increased significantly with the Fried Frailty Score (p<0.001). Physical performance and oral health were correlated (p<0.001). The OHAT score and the MNA (Mini Nutritional Assessment) score were significantly correlated: oral status seemed better for malnourished subjects (p<0.001). Dementia significantly increased the risk of an unhealthy oral status (p<0.001). There was no significant correlation between oral status and depression, just a trend.

CONCLUSION

This pilot study establishes a relationship between the OHAT and Fried Frailty Criteria in a population of frail elderly. It must be expanded to follow the distribution of the different items composing the OHAT score (items assessing lips; tongue; gums and tissues; saliva; natural teeth; dentures; oral cleanliness; and dental pain) with different parameters (age, socio-economic status, living conditions, educational level, medical history, drug treatment, nutritional habits, cognitive functioning, disabilities and handicaps).

Dynamic mechanical properties of oral mucosa: Comparison with polymeric soft denture liners

The purpose of this work was to characterize the viscoelastic behaviour of oral mucosa and compare it with the dynamic mechanical properties of different soft liners. For this purpose, a sample of pig oral mucosa and six commercialized soft liner samples have been investigated. A comparison was also carried with the first suitable hard rubber for dental prosthetics: vulcanite. Creep recovery (CR) and dynamic mechanical analysis (DMA) have been used to determine the mechanical modulus of oral mucosa and soft liners respectively. The Poisson ratio is used to compare mucosa bulk modulus and soft liner shear modulus. The biomechanical concept of conventional complete dentures needs a good adjustment of dynamic mechanical impedance between the base and oral mucosa. The viscoelastic mechanical property of the oral mucosa as a referent biopolymer has been confirmed in vitro. The modulus value, adjusted for old patients in physiological conditions, is in the order of 3 MPa. This study underlines the plasticization effect of absorbed water on the mechanical properties of the underlying tissue. This study allows us to define some characteristics of the most adapted biomaterial according to the clinical exigency. The required biomaterial must display the following properties: compatibility and chemical resistance with biological environment perpetuated mechanical properties during physiological conditions and clinical use, good adjustment of dynamic mechanical impedance with supporting mucosa and easy sample processing.