Associations between self-assessed masticatory disability and health of community-residing elderly people

An Observational Study on Oral Health and Quality of Life for RPD Wearers in the N-E Region of Romania

There is a lack of information regarding the oral health of the elderly population in Romania; only a few articles have been published about their edentulism, and there are no official data regarding the oral health, OHRQoL, and prosthodontic status of this population. The objective of this study was to assess the relationship between the essential functional qualities of removable partial dentures (RPD) and participants’ oral-health-related wellbeing among an edentulous population from the N-E region in Romania using the OHIP-5-questionnaire. In total, 546 patients from Gr. T. Popa Iasi University were enrolled after following a set of sorting procedures. We used the Kruskal–Wallis test and the Mann–Whitney test to determine whether there were significant differences between the various groups of patients. For questions 1, 2, 3, and 5 of the OHIP, the null hypothesis was rejected, as there were statistically significant differences between the three groups. This study was limited to a specific group. However, it can provide an insight into RPD patients’ happiness when treated in an academic environment.

Eating problems among old home care clients

Aims

The purpose was to examine the prevalence and determinants of self‐reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist.

Methods and Results

The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75‐year‐old home care clients living in Finland. The structured interviews were conducted at the participants' (n = 250) homes. Of the participants, 29% reported poor appetite, 20% had problems with chewing, and 14% had problems with swallowing when asked by a clinical nutritionist. Additionally, 18% reported oral health‐related eating problems when asked by a dental hygienist. Participants with continuous xerostomia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0–9.0) or poor self‐reported oral health (OR: 4.3, 95% CI: 1.4–13.0) had a higher risk for problems with chewing when asked by a clinical nutritionist. Edentulous participants (OR: 3.5, 95% CI: 1.2–10.9) and participants with toothache or problems with dentures (OR: 10.3, 95% CI: 4.0–26.0) had a higher risk for oral health‐related eating problems when asked by a dental hygienist.

Conclusion

Eating problems are common in older adults, and interprofessional collaboration is required for their identification and alleviation.

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.

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

Quality of life (QOL) and mortality are true endpoints of epidemiological or medical research, especially for community-dwelling older adults. Nutritional status and activities of daily living (ADLs) are associated with QOL and mortality. Good oral health status supports a good nutritional status. The aim of this study was to elucidate the complex structure of these important health-related factors. We surveyed 354 healthy older adults at the age of 85. Nutritional status was evaluated by the serum level of albumin. QOL, ADLs, self-assessed chewing ability, serum albumin level, and mortality during the 15 year follow up period were analyzed. Self-assessed chewing ability was associated with QOL and ADLs. Self-assessed chewing ability for slight-hard foods was associated with mortality in men. However, it was not associated with the serum albumin level. The serum albumin level was associated with mortality in women. These results indicate that maintaining good oral function is not enough. Nutritional instruction in accordance with oral function is indispensable for health promotion in older adults. When planning health promotion strategies for older adults, different strategies are needed for men and women.

Association between oral, social, and physical frailty in community-dwelling older adults

OBJECTIVES

Oral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty.

METHODS

Oral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty.

RESULTS

Logistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF.

CONCLUSIONS

These findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.

Effects of self-assessed chewing ability, tooth loss and serum albumin on mortality in 80-year-old individuals: a 20-year follow-up study

Background

The association between dental status and mortality in community-dwelling older adults has been documented by several studies. The aim of this study was to analyze the contribution of self-assessed chewing ability, number of remaining teeth and serum albumin levels to mortality and the interactions between the three factors.

Methods

A 20-year follow-up study was conducted with 666 subjects aged 80 years (from 1996 to 2017) who resided in the 8 areas served by one health center in Iwate Prefecture. Health check-ups including physical fitness measurements were conducted at a meeting place or gymnasium. Medical interview and blood sampling were conducted by physician. Oral examination was examined by dentist. The number of remaining teeth, serum albumin levels, and self-assessed chewing ability were used as predictors of mortality.

Results

Among the 608 subjects (233 men and 375 women) included in this study, only 12 subjects (1.97%) survived after 20 years of follow-up. For men, dental status and serum levels of albumin were significantly associated with mortality. The hazard ratios of self-assessed chewing ability calculated by item response theory analysis and the inability to chew at least one food adjusted for serum albumin and tooth conditions were statistically significant in men. When adjusted by health status evaluated by blood tests, self-assessed chewing ability was statistically significant in men. According to path analysis, self-assessed chewing ability and serum albumin independently affected mortality in men.

Conclusion

Masticatory dysfunction may be an important risk factor for mortality in men, even though it was self-assessed. Retaining chewing ability might be a useful predictor of longevity in older male adults.

Root caries: the intersection between periodontal disease and dental caries in the course of ageing

Caries and periodontitis are the primary non-communicable oral diseases among elderly individuals. The burden of the disease increases with ageing, particularly as the elderly are tending to retain more teeth due to improvement of oral health measures and increased life expectancy. Root caries represents itself as an overlapping pathology, but not necessarily a summation of the two diseases. This narrative commentary discusses the cross-boundary nature of root caries, a periodontal-cariological condition, taking into account the multi-morbidities of ageing. The evidence includes epidemiological and pathophysiological features of root caries, and specific influencing factors of ageing, such as xerostomia, polypharmacy, functional and cognitive impairment and oral ecological alterations. Active or previous history of periodontal disease poses a risk for root caries, whereas the systemic co-morbidities of ageing may also increase the susceptibility to this pathology. It is plausible that root caries is the net outcome of coexisting risk for these conditions. There exists no standardised system for risk assessment and diagnosis that takes into account the interactive effect of caries, periodontitis and the constellation of age-specific influencing factors. As restorative treatment is challenging, cost-effective prevention and diagnosis methods are needed for vulnerable elderly populations. These may include improved clinical registration methods and establishment of individualised prevention and treatment protocols.

How effective is nutrition education aiming to prevent or treat malnutrition in community-dwelling older adults? A systematic review

BACKGROUND

While malnutrition is associated with adverse health outcomes in older adults, little is known about the effectiveness of nutrition education. This systematic review examines the evidence for educational interventions to improve nutritional and other health-related outcomes in community-dwelling older people.

METHODS

Systematic searches of three databases (Embase, Medline and CINAHL) were conducted. Studies testing educational interventions targeting older adults (mean age ≥ 60 years) or their caregivers were eligible for inclusion. Two authors independently assessed trial eligibility, risk of bias and extracted data. Study heterogeneity was high precluding meta-analysis, therefore a narrative synthesis was conducted.

RESULTS

Nine articles reporting on eight studies (n = 7 trials; 1 pre-post-intervention study) met inclusion criteria. There was considerable variability in the format of educational interventions. Nutrition education was either generic or personalised and the intensity was variable (1-6 sessions). We found some evidence (in five out of eight studies) that nutrition education may improve nutrition-related outcomes. Nutrition education involving caregivers was found to reduce nutritional risk in one study, and nutritional counselling following discharge from hospital was found to reduce the risk of readmission in another study. However, the overall quality of the studies was hampered by poor methodology, low sample size and attrition bias, and results need to be interpreted with caution.

CONCLUSIONS

Educational interventions may have potential to improve malnutrition-related outcomes in older people, but the strength of evidence is poor. More robust, larger studies are needed to ascertain the effectiveness of nutritional education interventions in this population.

Social networks, leisure activities and maximum tongue pressure: cross-sectional associations in the Nagasaki Islands Study

OBJECTIVES

Social environment is often associated with health outcomes, but epidemiological evidence for its effect on oral frailty, a potential risk factor for aspiration, is sparse. This study aimed to assess the association between social environment and tongue pressure, as an important measure of oral function. The study focused on family structure, social networks both with and beyond neighbours, and participation in leisure activities.

DESIGN

A population-based cross-sectional study.

SETTING

Annual health check-ups in a rural community in Japan.

PARTICIPANTS

A total of 1982 participants, all over 40 years old. Anyone with missing data for the main outcome (n=14) was excluded.

OUTCOME MEASURES

Tongue pressure was measured three times, and the maximum tongue pressure was used for analysis. A multivariable adjusted regression model was used to calculate parameter estimates (B) for tongue pressure.

RESULTS

Having a social network involving neighbours (B=2.43, P=0.0001) and taking part in leisure activities (B=1.58, P=0.005) were independently associated with higher tongue pressure, but there was no link with social networks beyond neighbours (B=0.23, P=0.77). Sex-specific analyses showed that for men, having a partner was associated with higher tongue pressure, independent of the number of people in the household (B=2.26, P=0.01), but there was no association among women (B=-0.24, P=0.72; P-interaction=0.059).

CONCLUSIONS

Having a social network involving neighbours and taking part in leisure activities were independently associated with higher tongue pressure. Marital status may be an important factor in higher tongue pressure in men.

Self-Reported Masticatory Dysfunction and Mortality in Community Dwelling Elderly Adults: A 9-Year Follow-Up

OBJECTIVES

To evaluate the association, if any, between masticatory dysfunction (MD) and mortality in older adults.

DESIGN

The Invecchiare in Chianti (InCHIANTI) Study, a cohort study with 9-year follow-up.

SETTING

Tuscany, Italy.

PARTICIPANTS

Individuals aged 65 and older (N = 1,155).

MEASUREMENTS

MD was self-reported; Cox regression was used to assess the association between self-reported MD and 9-year all-cause mortality. This association was also evaluated after stratifying according to use of dentures. Analyses were adjusted for potential confounders, including demographic characteristics, lifestyle habits, comorbidities, nutrient intake, medications, and objective parameters.

RESULTS

Four hundred five (35%) participants reported MD. Over the 9-year follow-up, 475 (41%) subjects died. According to Cox regression analysis, self-reported MD was associated with higher mortality (relative risk (RR) = 1.23, 95% confidence interval (CI) = 1.02-1.48), after adjusting for potential confounders. In participants with self-reported MD, uncorrected edentulism was the condition associated with the greatest risk of mortality (RR = 2.10, 95% CI = 1.07-4.14); use of dentures seemed to blunt this association (RR = 1.12, 95% CI = 0.87-1.44).

CONCLUSION

Self-reported MD, chiefly when due to uncorrected edentulism, is associated with 9-year all-cause mortality in community-dwelling elderly adults. Further studies are needed to evaluate whether the timely correction of MD using adequate dentures can increase the survival of older adults.

Associations between higher-level competence and general intelligence in community-dwelling older adults

OBJECTIVES

Higher-level competence is crucial for healthy and socially independent living, and general intelligence may underlie heath status. The aim of this study was to elucidate associations between general intelligence and higher-level competence in elderly individuals without dementia.

METHODS

A total of 207 community-dwelling elderly persons, aged 70-74 years, were enrolled. A personal interview was performed to obtain data on socio-demographic and medical factors; higher-level competence was evaluated using the Tokyo Metropolitan Institute of Gerontology index of competence (TMIG index). Raven's Coloured Progressive Matrices (RCPM) test was used to assess general intelligence. Correlations between the TMIG index, its subscale scores and the RCPM score were evaluated by Spearman's rank correlation coefficients. Ordinal regression models were conducted with the TMIG index and its subscales as the dependent variables, RCPM as the principal independent variable, and age, sex, type of household, employment status, educational background, chronic medical conditions and number of natural teeth as the potential independent variables.

RESULTS

There were significant but weak positive correlations between total score on the TMIG index, scores on the intellectual activity and social role subscales and RCPM score. In ordinal regression models, RCPM and educational background were significantly associated with total score on the TMIG index and the intellectual activity subscale, and only RCPM was associated with the social role subscale score, after adjusting for other potential variables.

CONCLUSION

General intelligence may be significantly associated with higher-level competence, especially with intellectual activity and social role subscales, in community-dwelling older adults.

Missing, unreplaced teeth and risk of all-cause and cardiovascular mortality

BACKGROUND

A dentition of at least 20 teeth is associated with sufficient masticatory efficiency and is a stated health goal of the World Health Organisation. We examined whether subjects with missing, unreplaced teeth had an increased mortality risk.

METHODS

We used data prospectively collected from those participants in the population-based Study of Health in Pomerania who had fewer than 20 remaining teeth, resulting in a sample of 1803 participants with a median age of 64 years. Of those, 188 subjects had 9 or more unreplaced teeth. During a median follow-up period of 9.9 years, 362 subjects died, 128 of whom of cardiovascular causes.

RESULTS

We found that having 9 or more unreplaced teeth was related to all-cause mortality (rate ratio 1.53, 95% CI: 1.11-2.10; adjusted for variables according to causal diagrams: remaining teeth, age, sex, education, income, marital status, partnership, and oral health behaviour) and cardiovascular mortality (rate ratio 1.94, 95% CI: 1.15-3.25). When adjusting not only for the variables according to causal diagrams but also for smoking, alcohol consumption, physical activity, obesity, hypertension, diabetes, and dyslipidemia, the rate ratio was 1.43 (95% CI: 1.05-1.96) for all-cause mortality and 1.88 (95% CI: 1.10-3.21) for cardiovascular mortality.

CONCLUSIONS

A reduced, unrestored dentition is associated with increased mortality risk. Thus, clinicians and dietitians have a responsibility to consider individual chewing ability in nutritional recommendations.

The association of tooth loss with all-cause and circulatory mortality. Is there a benefit of replaced teeth? A systematic review and meta-analysis

We systematically reviewed whether the number of teeth is related to all-cause or circulatory mortality and whether replaced teeth are protective against all-cause or circulatory mortality. The search was based on the PubMed database. All cohort studies published in peer-reviewed journals were selected. Studies on periodontal disease and mortality were excluded if they did not provide information on the number of teeth. Risk estimates from studies with appropriate exposure definition, confounder adjustment and sample size were included in a meta-analysis. Three high-quality studies found a relationship between the number of teeth and circulatory mortality, whereas a moderate study did not. Two out of four moderate- to high-quality studies reported a relationship between the number of teeth and all-cause mortality. No study has investigated whether replaced teeth are protective against mortality. Therefore, denture use was taken as proxy. The methodological quality of studies on denture use and mortality was generally low to moderate. The findings of two moderate studies indicated an effect of prosthodontic replacements on all-cause mortality, which was supported in bias analysis. It is open whether competing risks of cause-specific death other than circulatory mortality reduce an effect of the number of teeth on all-cause mortality. An effect of denture use on circulatory mortality remains to be established, as well as whether the number of replaced teeth affects mortality. Specifying the role of potential pathways by which tooth loss-related mortality is mediated will possibly increase the value of dental treatment for general health.

Self-assessed masticatory ability and hospitalisation costs among the elderly living independently

The escalating medical costs are a social problem in many countries. Masticatory ability is thought to be related to the general health conditions. The purpose of this study was to show relationships between self-assessed masticatory ability and medical costs among the elderly living independently in community. Data on background factors and self-assessed masticatory ability were collected from 702 Japanese elderly persons by questionnaires. An intra-oral examination was performed to examine the number of remaining teeth. Self-assessed masticatory ability was classified into one of three categories: ability to chew all kinds of food (Good), ability to chew only slightly hard food (Fair) or ability to chew only soft or pureed food (Poor). Data on the annual medical excluding dental costs were obtained from the Japanese National Health Insurance system. The Kruskal-Wallis test was used to examine differences in outpatient costs and hospitalisation costs among the three groups of self-assessed masticatory ability. Univariate unconditional logistic regression models and multivariate logistic regression models were used with medical costs as the dependent variable and self-assessed masticatory ability as the principal independent variable. A significant difference (P=0·039) in hospitalisation costs but not outpatient costs was found among the three groups of self-assessed masticatory ability. The multivariate logistic regression analysis showed that severely impaired masticatory ability (Poor) was significantly related to higher costs of hospitalisation. Self-assessed impairment of masticatory ability may be a significant and independent indicator of higher costs of hospitalisation among community-dwelling elderly persons.

Assessment and management of nutrition in older people and its importance to health

Nutrition is an important element of health in the older population and affects the aging process. The prevalence of malnutrition is increasing in this population and is associated with a decline in: functional status, impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, higher hospital readmission rates, and mortality. Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements.

Associations between oral sugar clearance, dental caries, and related factors among 71-year-olds

OBJECTIVE

To investigate the associations between oral sugar clearance and the prevalence of dental decay.

MATERIAL AND METHODS

A total of 92 (44 F, 48 M) 71-year-old subjects in Goteborg, Sweden were consecutively chosen from a representative cohort study. The subjects were examined for: 1) caries-related status, 2) oral function, 3) salivary conditions, 4) cariogenic micro-organisms, and 5) oral sugar clearance. A factor analysis was used to investigate the possible existence of latent variables within these five areas. The latent variables from the factor analyses were used to study the associations between clearance and caries in multivariate regression models.

RESULTS

Only one latent variable relating to oral sugar clearance was found. In the regression model with the latent variable related to oral sugar clearance as a dependent variable and gender plus the latent variables related to oral function and salivary conditions as an independent variable, there were associations with gender and some latent variables reflecting oral function and one reflecting glucose in saliva (R(2)=0.20/0.17). Three latent variables relating to caries-related status were found and these were associated with the number of teeth, the percentage of filled tooth surfaces, and the percentage of decayed tooth surfaces (DS%). In the regression analysis using the latent variable associated with DS% as a dependent variable, this variable was related to the latent variables of oral sugar clearance and to some reflecting oral function, as well as glucose in saliva (R(2)=0.28).

CONCLUSIONS

Oral sugar clearance appears to be independently associated with the prevalence of dental caries in the elderly.

Number of teeth--a predictor of mortality in the elderly? A population study in three Nordic localities

OBJECTIVE

Although associations between number of teeth and mortality have been found in some studies, the results have not been conclusive. The aim of this study was to determine whether dental status at age 75 is an independent predictor of survival in three Nordic populations.

MATERIAL AND METHODS

The baseline study was conducted as part of a comparative Nordic investigation of systematic samples of 75-year-old men and women born in the period 1914-16 (n=1004) and living independently in three Nordic localities: Glostrup in Denmark, Jyväskylä in Finland, and Göteborg in Sweden. Performed in 1989-91, the study included a home interview, a health questionnaire, and a laboratory examination. For the present study, the mortality data of all participants up to age 82 were collected from official registers in 1999.

RESULTS

Lower mortality during 7 years was associated with higher number of remaining teeth at age 75. In Jyväskylä and Göteborg, but not in Glostrup, the association between number of teeth and mortality was statistically significant. For all three samples pooled and adjusted for sex and location, this association was significant (odds ratio 0.866; p<0.001).

CONCLUSIONS

Number of teeth is a significant predictor of 7-year mortality in 75-year-old women independently of a number of factors related to lifestyle, disease, and reduced functional capacity.

Relationship between chewing ability and 4-year mortality in a cohort of 80-year-old Japanese people

OBJECTIVE

Poor oral health has been reported to be a risk indicator of mortality, however, few data are available regarding the relationship between chewing ability and mortality. We examined the relationship between self-assessed chewing ability and mortality in elderly subjects.

DESIGN

Prospective study.

SUBJECTS AND METHODS

Participating in the study were 697 people (277 males, 420 females) from 1282 individuals (80 years old) residing in Fukuoka Prefecture, Japan. Data on oral and systemic health status through questionnaires, accompanied by physical and laboratory blood examinations were obtained. Chewing ability was assessed based on the number of types of food each subject reported as able to chew by questionnaire.

RESULTS

A total of 108 subjects died between 1998 and 2002. Those with the lowest number of chewable foods were associated with higher risk of mortality than those with the ability to chew all of the 15 types of food surveyed [hazard ratio (HR) = 2.38, 95% confidence interval (95% CI) = 1.07-5.29], though other parameters including current smoking, low serum albumin, and poor physical health status were more significant. Further, reduced chewing ability of soft foods increased the risk (HR = 2.65, 95% CI = 1.20-5.87).

CONCLUSION

Chewing ability was associated with mortality in a population of 80-year-old community residents, and may be a predictor for survival rate.

Malnutrition and ageing

This article aims to provide an overview of the problems that exist in relation to malnutrition and the elderly population. The changes that occur in body composition during ageing are described and how this may affect disease risk. The possible metabolic processes behind weight loss are discussed and the numerous factors that affect nutritional status in the older age group are described. Prevention of malnutrition in this group is important and so the roles of nutrition screening and assessment are examined.

Quality of life and masticatory function in denture wearers

Successful prosthodontic treatments for a patient with removable partial dentures including maxillofacial prostheses hopefully brings about psychological wellbeing as well as improved health. The purpose of this study was to investigate the relationship between quality of life (QOL) and the various aspects of denture function. At first, a questionnaire with a visual analog scale with 16 question items concerning denture and/or eating problems, the present state of health, psychological and physical wellbeing, life satisfaction, and QOL was developed. To discuss the validity and reliability of the questionnaire, 48 outpatients who wore a denture were asked to fill it out. Next, to discuss the difference in QOL of the patient with various kinds of dentures and conditions, 103 outpatients were asked to complete the newly developed questionnaire. The questionnaire which contained four factor areas with eight questions for denture patients was developed by factor analysis with Varimax rotation. The reliability of the QOL scale was confirmed by reliability analysis (Cronbach's alpha = 0.784). The QOL score of edentulous patients with a complete denture having some trouble chewing was significantly lower than that of other denture patients. It was suggested that the wearing of a denture significantly affected the QOL of elderly persons.

Relationship Between Self-Assessed Masticatory Disability and 9-Year Mortality in a Cohort of Community-Residing Elderly People

OBJECTIVES

To examine the relationship between self-assessed masticatory disability and mortality.

DESIGN

Prospective.

SETTING

Community based.

PARTICIPANTS

Total of 1,405 randomly selected people aged 65 and older living in Settsu, Osaka Prefecture, in October 1992.

MEASUREMENTS

Data on health status as indicated by disability scores, history of health management, self-assessed masticatory ability, and psychosocial conditions were collected by means of interviews during home visits at the time of enrollment. Nine-year follow-up was completed for 1,245 (88.6%; 398 deceased and 847 alive).

RESULTS

Self-assessed masticatory disability was significantly associated with being 75 and older, having overall disability, not using dental health checks or general health checks, not participating in social activities, not feeling that life is worth living (no ikigai), and finding relationships with people difficult. As for the association between self-assessed masticatory disability and mortality, the estimated survival rate for those with self-assessed masticatory disability was lower than that for those without for each group stratified by sex and age (65-74 and >or=75), and the equality of survival curves according to self-assessed masticatory disability was significant for each group. After controlling for potential predictors of mortality, self-assessed masticatory disability remained as a significant predictor of mortality (adjusted hazard ratio=1.63, 95% confidence interval=1.30-2.03, P<.001).

CONCLUSION

These results indicate that self-assessed masticatory disability may be associated with a greater risk of mortality in community-residing elderly people.

Relationship between dental health and 10-year mortality in a cohort of community-dwelling elderly people

Dental examinations were carried out as part of the Evergreen project, which focuses on functional capacity and health among the elderly residents of the city of Jyväskylä, central Finland. Dental status was examined in 1990 for the whole population born in 1910 (n = 226). Mortality data were collected over 10 yr. The aim of the study was to assess the possible role of dental health as a predictor of mortality. The Kaplan-Meier method was used to analyse survival curves and Cox regression models, with the number of chronic conditions and self-rated health used as covariates in analysing the risks of death. The results showed that the more teeth or filled teeth a subject had, the smaller was their risk for death. The effect of missing teeth was significant after adjusting for the general health variables. Thus, our results support the hypothesis that poor dental health is linked to increased mortality among elderly people.

Utilization of dental health services by community-dwelling older adults in Japan who attended a weekly educational programme

OBJECTIVES

The purpose of this study was to describe dental health services utilization and identify factors which influenced a group of independently living elderly persons in an urban area of Japan.

SUBJECTS

The study sample consisted of 2,990 participants, 83% of the total sample of the Senior Citizen's College, who were 60 years and over.

MEASUREMENTS

Their dental utilization and satisfaction with dental treatment were measured by a questionnaire from 1995 to 1998.

RESULTS

The mean age of the subjects was 66.5 years and 52% were male. Sixty percent of the subjects had visited a dentist within the previous year, and 33% of them had received a regular oral health check-up. The majority of the subjects (63%) were satisfied with their dental treatment. A multiple stepwise logistic regression analysis showed that dental services utilization had a significant positive association with presence of teeth (p < 0.001), being male (p < 0.01) and satisfaction with financial status (p < 0.05). A regular oral health check-ups had a significant association with presence of teeth (p < 0.001), satisfaction with financial status (p < 0.05) and aging (p = 0.001).

CONCLUSIONS

Dental health services utilization was related to the presence of teeth and financial status, rather than age or medical conditions, among independently living elderly persons in an urban area of Japan.