Determinants of change in oral health-related quality of life over 7 years among older Japanese

Association Between Changes in Oral Health-Related Quality of Life and Depressive Symptoms in the Korean Elderly Population

Objectives: The aim of this study was to examine the association between changes in oral health related quality of life (OHRQoL) and depressive symptoms in the elderly South Koreans.

Methods: We used the 2018 and 2020 Korean Longitudinal Study of Ageing data. Our study population was a total of 3,604 participants aged over 65 in 2018. The independent variable of interest was the changes in the Geriatric Oral Health Assessment Index as OHRQoL between 2018 and 2022. The dependent variable was depressive symptoms in 2020. Multivariable logistic regression analyzed the associations between changes in OHRQoL and depressive symptoms.

Results: Participants with improvement in OHRQoL over 2-year period were likely to have fewer depressive symptoms in 2020. Especially, changes in the oral pain and discomfort dimension score was associated with depressive symptoms. A decline in oral physical function, such as difficulty in chewing and speaking, was also associated with depressive symptoms.

Conclusion: Negative change in OHRQoL is a risk factor for depression in elderly. This results suggest the importance of maintaining good oral health in later life, as a protective factor against depression.

Oral Health-Related Quality of Life from Young Adulthood to Mid-Life

Quality of life varies with time, often worsening, and is affected by circumstances, events, and exposures at different stages of life. Little is known about how oral health-related quality of life (OHRQoL) changes during middle age. We investigated OHRQoL changes from age 32 to 45 years among participants in a population-based birth cohort, along with clinical and socio-behavioural associations. Generalised estimating equation models were used to investigate the association between OHRQoL (assessed at ages 32, 38, and 45 years; n = 844), and the socioeconomic position in childhood (up to age 15 years) and adulthood (ages 26 through to 45 years), dental self-care (dental services utilisation and tooth brushing), oral conditions (such as tooth loss), and experiencing a dry mouth. The multivariable analyses were controlled for sex and personality traits. At each stage of life, those of a lower socioeconomic status were at greater risk of experiencing OHRQoL impacts. Those who engaged in favourable dental self-care habits (the regular use of dental services and at least twice daily tooth brushing) experienced fewer impacts. A social disadvantage at any stage of life has enduring deleterious effects on one's quality of life in middle age. Ensuring access to timely and appropriate dental health services in adulthood may reduce the impacts of oral conditions on one's quality of life.

Development of a scale for assessing meal satisfaction in older adults: Meal satisfaction assessment questionnaire (MSAQ)

This meal satisfaction assessment questionnaire for older adults (MSAQ) focuses on assessing meal satisfaction rather than only measuring physical functioning or the risk of malnutrition in older people. By looking at the factors that influence meal satisfaction in older adults through a comprehensive literature review, this study develops a scale for measuring meal satisfaction in older people. For content and face validation, a 61-item questionnaire was administered to 290 people using a five-point scale. Through Exploratory Factor Analysis (EFA), a 16-Item six-factor questionnaire for the assessment of meal satisfaction was developed, and its validity and reliability were tested. The development of this scale not only helps to measure meal satisfaction and dissatisfaction but also contributes to improving life satisfaction in older adults. Assessing meal satisfaction could contribute to developing care plans and treatment directions and help care professionals understand the values, identities, wellbeing, and general health issues of older adults.

Impact of Poor Oral Health on Community-Dwelling Seniors: A Scoping Review

The aim of this scoping review was to determine health-related impacts of poor oral health among community-dwelling seniors. Using MeSH terms and keywords such as elderly, general health, geriatrics, 3 electronic databases-Medline, CINAHL, and Age Line were searched. Title and abstracts were independently screened by 3 reviewers, followed by full-texts review. A total of 131 articles met our inclusion criteria, the majority of these studies were prospective cohort (77%, n = 103), and conducted in Japan (42 %, n = 55). These studies were categorized into 16 general health outcomes, with mortality (24%, n = 34), and mental health disorders (21%, n = 30) being the most common outcomes linked with poor oral health. 90% (n = 120) of the included studies reported that poor oral health in seniors can subsequently lead to a higher risk of poor general health outcomes among this population. Improving access to oral healthcare services for elderly can help not only reduce the burden of oral diseases in this population group but also address the morbidity and mortality associated with other general health diseases and conditions caused due to poor oral health. Findings from this study can help identify shortcomings in existing oral healthcare programs for elderly and develop future programs and services to improve access and utilization of oral care services by elderly.

Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population

Background

The impact of poor oral health on older adults’ quality of life is a public health problem. In this study, the mediating effects of dental status, occlusal condition, dysphagia, and masticatory performance on the association between xerostomia and oral health-related quality of life (OHRQoL) were assessed in the older adult population.

Methods

Stratified cluster sampling was used to recruit 1076 community-dwelling adults aged 65 years and older from Kaohsiung, Taiwan. Community care centers were randomly selected according to their geographic classifications (urban, rural, or mountainous areas). Assessments of dental status and occlusal condition were performed by dentists. Information on demographics, physical function, xerostomia, dysphagia and depression was collected through face-to-face interviews. Masticatory performance was evaluated using color-changeable chewing gum. OHRQoL was measured using the Geriatric Oral Health Assessment Index. Hierarchical regression models were used to assess the relationships between OHRQoL and physical function, dental status and oral function in older adults. Path analysis was used to estimate direct and indirect pathways between xerostomia and OHRQoL.

Results

Participants with xerostomia exhibited a 0.20 OHRQoL reduction (p < .001) compared with patients with no xerostomia, and the direct effect accounted for 83.3% of the total effect. Dysphagia and masticatory performance were found to exert significant mediating effects on the association between xerostomia and OHRQoL (βs = 0.20 and − 0.12, respectively; both p < .001; βs = 0.06 and − 0.09, respectively; both p < .05). Moreover, potential mediating effects of the number of functional teeth (βs = − 0.11 and − 0.43, respectively; both p < .001) and occlusal condition (βs = 0.09 and 0.13, respectively; both p < .05) on the relationship between xerostomia and masticatory performance were noted.

Conclusions

Dysphagia and masticatory performance may serve as pathways through which xerostomia affects quality of life. Early oral function intervention may be a valuable and actionable target for older adults to maintain quality of life. Our results further suggest that checkup and screening for oral dysfunction are essential to prevent or delay the onset of complications.

Are Self-Reported Masticatory Ability and Regular Dental Care Related to Mortality?

AIM

The aim of the study was to examine whether a combination of self-reported masticatory ability and regular dental care is linked to mortality and issuance of new long-term care insurance (LTCI) service certifications.

METHODS

Older residents in institutions or in need of LTCI certification requirements were excluded, and self-administered questionnaires were sent to 5,400 older adults in 2013; these participants were followed for 5 years. The total response rate was 94.3%, and our final sample comprised 4,824 older adults (89.3%). We used 3 items to assess self-reported masticatory ability and regular dental care. These included (1) decline in chewing abilities of the posterior teeth on either side, (2) not brushing one's own teeth or dentures at least once a day, and (3) not visiting the dentist at least once a year.

RESULTS

The mean age of the participants at baseline was 75.9 years, and 58.4% of them were women. Main outcomes included mortality (n = 562) or new LTCI certification requirements (n = 1187) during the 5-year period. Multivariate analyses revealed that a poor score on masticatory ability and on regular dental care produced significant adverse health outcomes leading to earlier negative outcomes. The score is considered poor as it increases relative to the 0-point reference.

DISCUSSION

Regular dental care (both self-and professional care) and maintaining masticatory ability are both important. Hence, public activities focusing on preventive oral health from middle age onward is important.

The Factors Influencing Meal Satisfaction in Older Adults: A Systematic Review and Meta-analysis

PURPOSE

The aim of this study was to identify factors influencing meal satisfaction in older adults.

METHODS

Authors searched four databases Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, and KoreaMed using the following key search terms: "(elderly-mp. OR aged), AND (meal OR food OR eating OR feeding), AND satisfaction." Only articles published between January 1946 and May 2018 were considered. The preferred reporting items for systematic reviews and meta-analyses guidelines were adopted for quality assessment. The authors ultimately selected 7 of 1,695 references for review and meta-analysis.

RESULTS

A meta-analysis was conducted to determine the factors influencing meal satisfaction in older adults aged more than 60 years. The results showed that meal satisfaction was low when age increased and the individual was served frozen meals. Satisfaction with meals was high when food choices were available and individuals were served high-quality food and when the food smelled and tasted good or was personally tailored. Satisfaction was also high when individuals ate with their families. Moreover, meal satisfaction seemed to be influenced by physical health, whereas it did not show a significant correlation with mental health.

CONCLUSION

Intending to improve the quality of life of older adults by increasing their meal satisfaction, the authors pointed out factors that institutions should attend to when providing meals to older adults. To contribute to the lack of any existing conceptual and theoretical framework in this field, further steps to be taken by the authors shall involve concept analysis that would assist in building a conceptual framework.

The Eating Experience: Adaptive and Maladaptive Strategies of Older Adults with Tooth Loss

OBJECTIVE

To explore the eating experience and eating-related quality of life (ERQOL) of community-dwelling older adults with tooth loss.

METHOD

Nineteen older adults from the clinics of a northeast US dental school who met inclusion criteria (>65 y old, <20 teeth, and no dentures) composed the sample. For this mixed methods study, demographic characteristics, number and location of teeth, Mini Nutritional Assessment-Short Form score, and anthropometrics data were collected; semistructured interviews were conducted to collect in-depth information about the eating experience and ERQOL. Thematic analysis was completed with NVivo 12 software (QSR International).

RESULTS

Participants' mean age was 71.3 y (SD = 5.2); 52.6% (n = 10) were women; 63.2% (n = 12) were Black or African American. The mean Mini Nutritional Assessment-Short Form score of 12.1 was reflective of normal nutrition status; 31.6% (n = 6) of patients were at risk for malnutrition or were malnourished. Fifteen percent (n = 3) were fully edentulous; 84.2% (n = 16) had 1 to 19 teeth (mean = 10.8, SD = 6.5). The 2 overarching themes identified were adaptive and maladaptive behavioral responses to tooth loss. Adaptive strategies included modification in food preparation and cooking methods, food texture selection, meal timing, and approaches to chewing. Maladaptive behaviors included food avoidance and limiting eating and smiling in front of others. Psychosocial factors, including finances, limited food choices and ERQOL, whereas the support of family and friends enhanced ERQOL according to participants.

CONCLUSION

Older adults with tooth loss exhibit both adaptive and maladaptive behaviors that affect their eating experience, dietary intake, and ERQOL. While many expressed positive adaptive coping strategies, they also described maladaptive behaviors, including avoidance of healthy foods and limiting eating during social interactions, which may affect their nutritional status and overall health and well-being. Further research is needed to explore how duration and severity of tooth loss influence these behaviors and risk of malnutrition. Interprofessional approaches are needed to support positive adaptation and coping with tooth loss.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by health professionals treating patients with tooth loss in an effort to improve their eating experience and eating-related quality of life. The findings provide data to support further studies and the need for evidence-based guidelines and educational materials to meet the unique needs of older adults with tooth loss.

Changes in oral health-related quality of life (OHRQoL) related to long-term utilization of dental care among older people

OBJECTIVE

To examine whether long-term utilization of dental care, treatment with fillings and crowns and persistent tooth loss between age 50 and 65 years associate with subsequent changes in OHRQoL from age 65 to 70 years.

METHOD

In 1992, a census of 50-year-olds received invitation to participate in a questionnaire survey. Of 6346 respondents, 3585 completed follow-ups in 1997, 2002, 2007 and 2012. OHRQoL was measured using the Oral Impacts on Daily Performances (OIDP) inventory.

RESULTS

Around 70.4%, 11.2% and 18.4% confirmed respectively, no change, worsening, and improvement in OIDP scores between age 65 and 70 years. Compared to those being permanent non-routine dental attenders, ORs of improving and worsening of OIDP were respectively, 0.4 and 0.6 if being a permanent routine dental attender. ORs for improving OIDP was 1.6 if reporting persistent specialist attendance and 2.5 if having received crowns and fillings. Participants with permanent tooth loss were most likely to both worsen and improve OIDP.

CONCLUSION

Long-term routine dental attendance and permanent tooth loss occurred as predictors simultaneously for improvement and worsening of OIDP. Accumulation of advantages and disadvantages throughout the life-course increases and decreases the probability of improvement and worsening in OIDP among older people in Sweden.

Relationship between gerotranscendence and oral health-related quality of life

OBJECTIVES

The purpose of our cross-sectional study was to investigate the relationship between gerotranscendence and oral health-related quality of life (OHR-QOL). To our knowledge, this is the first study to investigate the relationship between gerotranscendence and OHR-QOL.

METHODS

Participants (total n = 1969; 70-year-old group, n = 999; 80-year-old group, n = 970) were drawn from resident lists in four areas of Japan: one urban area and one rural area in each of two geographical regions. OHR-QOL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Measurement of occlusal force was performed using pressure-sensitive sheets. Gerotranscendence was assessed with the Japanese Gerotranscendence Scale Revised (JGS-R). We used multiple linear regression analysis to examine the relationships among OHR-QOL and other variables.

RESULTS

Geriatric Oral Health Assessment Index score was significantly correlated with occlusal force, number of teeth, financial status and JGS-R score on linear regression analysis.

CONCLUSION

Degree of gerotranscendence was significantly and independently correlated with degree of OHR-QOL in our sample.

Bite Force Recording Devices - A Review

In dental research, bite force serves as a valuable parameter to evaluate the efficacy of masticatory system. A variety of devices with different design and working principle have been used to record bite force, but no single device is capable to record all the required forces. One may find it difficult to choose a device that will fulfil the purpose of recording bite force for research. So, the present review aims to report and compare the wide range of devices and will help in describing their uses for recording bite force.

Heritability of the Number of Teeth in Middle-Aged and Older Danish Twins

Tooth loss is a common health concern in older adults. We aimed to estimate the relative contributions of genetic and environmental factors to the variation in the number of teeth in middle-aged and older populations using a population-based cohort of Danish twins. The study included 5,269 Danish middle-aged or older twins who provided data on the number of teeth at baseline by structured interviews. The data were analyzed using univariate liability threshold modeling, stratified by sex and age, to estimate familial risk of tooth loss as well as estimates of heritability. In the whole cohorts, 23% of participants were edentate and 53% had retained 20 or more teeth. A statistical model including additive genetic factors and environmental factors partly shared by co-twins and partly unique to each individual twin gave the best statistical fit for the number of teeth in both age categories as well as in men and women. Overall, additive genetic factors explained 36% (95% confidence interval [CI]: 23% to 49%), common environmental factors 20% (95% CI: 9% to 31%), and unique environmental factors 44% (95% CI: 40% to 48%) of the total variation of the number of teeth. This study indicates that a substantial part of the variation in tooth loss is explained by genetic as well as environmental factors shared by co-twins. Our results implied that family background importantly affects tooth loss in both the middle-aged and the older populations. Family history is thus an important factor to take into account in dental health care.

The role of orthodontics in the regeneration of the degenerated dentition

The demand for regeneration of a degenerated dentition has been increasing as a result of the development of societies, where the life expectancy is increasing and fighting age-related changes is in focus. Whereas removable dentures were acceptable and considered a norm earlier, patients do, to an increasing degree,demand fixed prosthetics; consequently, the development of implants has had an important impact. The balance in the chewing organ will change with time, due to age-related changes within the bone and the loss of teeth due to caries or periodontal disease, and malocclusions may develop or aggravate. The re-establishment of an aesthetical and functional satisfactory solution cannot be reached by replacing teeth by fixed prosthodontics and implants. The aim of this update was threefold: firstly, to demonstrate that age-related changes, often unnoticed by both the patient and the general dentist, can lead to degeneration of the dentition; secondly, to explain how an interdisciplinary approach can make regeneration of even severe degeneration possible; and finally, to show the importance of the general dentist in the maintenance of the obtained results. Treatments should not aim for short-term results but focus on maintainable results.

Examination of the Relationship between Oral Health and Arterial Sclerosis without Genetic Confounding through the Study of Older Japanese Twins

OBJECTIVE

Although researchers have recently demonstrated a relationship between oral health and arterial sclerosis, the genetic contribution to this relationship has been ignored even though genetic factors are expected to have some effect on various diseases. The aim of this study was to evaluate oral health as a significant risk factor related to arterial sclerosis after eliminating genetic confounding through study of older Japanese twins.

SUBJECTS AND METHODS

Medical and dental surveys were conducted individually for 106 Japanese twin pairs over the age of 50 years. Maximal carotid intima-media thickness (IMT-Cmax) was measured as a surrogate marker of arterial sclerosis. IMT-Cmax > 1.0 mm was diagnosed as arterial sclerosis. All of the twins were examined for the number of remaining teeth, masticatory performance, and periodontal status. We evaluated each measurement related with IMT-Cmax and arterial sclerosis using generalized estimating equations analysis adjusted for potential risk factors. For non-smoking monozygotic twins, a regression analysis using a "between within" model was conducted to evaluate the relationship between IMT-Cmax and the number of teeth as the environmental factor controlling genetic and familial confounding.

RESULTS

We examined 91 monozygotic and 15 dizygotic twin pairs (males: 42, females: 64) with a mean (± standard deviation) age of 67.4 ± 10.0 years. Out of all of the oral health-related measurements collected, only the number of teeth was significantly related to arterial sclerosis (odds ratio: 0.72, 95% confidence interval: 0.52-0.99 per five teeth). Regression analysis showed a significant association between the IMT-Cmax and the number of teeth as an environmental factor (p = 0.037).

CONCLUSIONS

Analysis of monozygotic twins older than 50 years of age showed that having fewer teeth could be a significant environmental factor related to arterial sclerosis, even after controlling for genetic and familial confounding.

Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden

BACKGROUND

Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

METHODS

In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

RESULTS

Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

CONCLUSIONS

Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.