Xerostomia as a key predictor of physical frailty among community-dwelling older adults in Japan: a five-year prospective cohort study from The Otassha Study

Association between oral dryness and dysphagia in community-dwelling older population

OBJECTIVE

There remains inconsistent recognition of the relationship between oral dryness and dysphagia. This study aimed to investigate whether the degree of oral dryness was related to the prevalence of dysphagia in community-dwelling older adults.

DESIGN

A cross-sectional study.

SETTING

A survey was conducted from March 9 to June 19, 2023, in the Futian community, Yiwu, China.

PARTICIPANTS

3325 older adults aged 65 and above were enrolled.

MEASUREMENTS

Oral dryness was evaluated by self-reported oral dryness and oral moisture instrument. Swallowing problems were screened using the Eating Assessment Tool-10 questionnaire (EAT-10) and 30-ml water swallowing test (WST). T-tests, Chi-square tests, and logistic regression were employed to measure the associations.

RESULTS

The prevalence of subjective oral dryness was 53.7%, with an average oral moisture level of 29.6 ± 2.0. Dysphagia was determined to have a prevalence of 7.7% and 9.5% according to EAT-10 and WST, respectively. Participants with dysphagia exhibited a heightened experience of dry mouth and lower oral moisture (P < .001). The adjusted logistic regression model further suggested that both subjective (adjusted OR = 1.99, 95% CI: 1.46-2.72 for EAT-10) and objective (adjusted OR = 0.92, 95% CI: 0.87-0.97 for EAT-10; adjusted OR = 0.89, 95% CI: 0.84-0.93 for WST) measures of oral dryness were risk factors for dysphagia.

CONCLUSIONS

The presence of oral dryness emerged as a significant risk factor for dysphagia, and the assessment of oral moisture proved to be more sensitive in identifying swallowing problems among older adults.

Association between oral health-related quality of life and physical frailty among community-dwelling older adults: A 2-year longitudinal study

BACKGROUND

Frailty is a major health concern among older adults, and its association with oral health-related quality of life (OHRQoL) remains underexplored in longitudinal studies.

OBJECTIVE

To investigate the association between baseline OHRQoL and physical frailty incidence at a 2-year follow-up in community-dwelling older adults.

DESIGN

Prospective longitudinal study.

SETTING

The study was conducted within the Tosa Longitudinal Aging Study framework in Japan.

PARTICIPANTS

This study included 144 community-dwelling older adults (50 men and 94 women; median age, 81.0 years) with complete data who participated in the Tosa Longitudinal Aging Study in 2016 and 2018 and were not categorized as physical frailty in 2016.

MEASUREMENTS

Baseline assessment included OHRQoL, which was evaluated using the General Oral Health Assessment Index (GOHAI; range 12-60), with higher scores indicating better OHRQoL, oral function, and general health status. The incidence of physical frailty was defined using the revised Japanese version of the Cardiovascular Health Study criteria. The association between the GOHAI score and physical frailty was assessed using logistic regression analysis.

RESULTS

The median baseline GOHAI score was 58. The incidence of frailty after a 2-year follow-up was 13.9 % among the participants (18.0 and 11.7 % for men and women, respectively). Each point of the GOHAI score was associated with an 11 % reduction in frailty risk over 2 years after adjusting by age, sex, number of teeth, Food Diversity Score, Geriatric Depression Scale score, eating alone, smoking, and more than five medications (adjusted odds ratio: 0.893; 95 % confidence interval: 0.810-0.984).

CONCLUSIONS

This longitudinal study showed that a higher baseline OHRQoL, based on the GOHAI score, was linked to a lower incidence of physical frailty among community-dwelling older adults after 2 years.

Poor oral health and dementia risk under time-varying confounding: A cohort study based on marginal structural models

BACKGROUND

Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time-varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time-varying confounder.

METHODS

This nine-year follow-up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self-reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time-varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person-year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03-1.23), edentulousness (HR = 1.20, 95% CI = 1.09-1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02-1.21), and xerostomia (HR = 1.10, 95% CI = 1.01-1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05).

CONCLUSIONS

Even after considering time-varying confounding by cognitive function at baseline and follow-up, we observed significant associations between poor oral health and increased risk of dementia among older adults.

The Prevalence of Xerostomia in Older Thai Individuals with Type II Diabetes Mellitus and Its Association with Type of Toothpaste and Oral Functions: A Cross-Sectional Study Using Questionnaires

AIM

To investigate the prevalence of xerostomia in older people with diabetes mellitus and its impacts on oral functions, as well as to determine potential risk factors for xerostomia.

METHODS

An analytical cross-sectional study was conducted on 623 older type 2 diabetes mellitus (T2DM) Thai people using valid structural questionnaires. Patients were interviewed, and data were recorded. Xerostomia was assessed using subjective symptom questionnaires. Risk factors for xerostomia were analyzed using bivariate and multiple logistic regression analyses.

RESULTS

Among the study participants, 38.4% of the older T2DM people had xerostomia, which is associated with sex, age, type of toothpaste, years of diabetes, hemoglobin A1c level, other systemic diseases, medication, smoking, alcohol consumption, and denture wearing. It was significant that xerostomia was associated with toothpaste containing spicy herbal extracts (OR: 9.32 [3.46 to 15.25]), while toothpaste containing artificial sweeteners tended to lower the risk of xerostomia. In addition, older T2DM adults with xerostomia had greater impaired oral functions, which include difficulties in speaking (OR: 3.31 [1.11 to 9.80]), tasting (OR: 5.12 [3.26 to 8.06]), swallowing (OR: 3.59 [2.32 to 5.53]), and chewing (OR: 3.34 [1.15 to 5.82]).

CONCLUSIONS

Xerostomia is prevalent in older Thai people with T2DM. The results suggest that toothpaste containing spicy herbal extracts might increase the risk of xerostomia, resulting in various oral function problems. Therefore, greater awareness of xerostomia in this group should be raised to monitor dental health, and professionals should work in parallel with other aspects of oral health promotion.

Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.