Is compromised oral health associated with a greater risk of mortality among nursing home residents? A controlled clinical study

Klotz, Anna-Luisa; Hassel, Alexander J.; Schröder, Johannes; Rammelsberg, Peter; Zenthöfer, Andreas

doi:10.1007/s40520-017-0811-y

Cited by 29 publications

(28 citation statements)

References 29 publications

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“…Poor oral health was independently associated with a 2.0‐fold higher risk of 1‐year mortality, after adjusting for possible confounders. This finding was consistent with that of Klotz and colleagues, who revealed a 2.3‐fold higher mortality risk among residents of nursing homes with poor oral health, based on ROAG assessments. Improvements in oral health care and disease prevention have resulted in older people retaining more natural teeth .…”

Section: Discussionsupporting

confidence: 92%

Older people with swallowing dysfunction and poor oral health are at greater risk of early death

Hägglund

Koistinen

Olai

et al. 2019

Comm Dent Oral Epid

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This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. AbstractObjectives: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.Methods: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI). Results:The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02-2.75; P = .041 and aHR:1.98, 95% CI 1.07-3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15-5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%). Conclusions:Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations. K E Y W O R D Smortality, nursing homes, oral care, oral hygiene, swallowing disorders | INTRODUC TI ONThe health status of older people is complex, and seldom can a single aspect serve as the sole predictor of outcomes like mortality. 1,2 Many older people have multimorbidity, which leads to greater care dependency and increased mortality risk. 3 Swallowing dysfunction (ie dysphagia) and poor oral health are reported to be highly prevalent among older individuals. These conditions are considered a R E FE R E N C E S

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Section: Discussionsupporting

confidence: 92%

Older people with swallowing dysfunction and poor oral health are at greater risk of early death

Hägglund

Koistinen

Olai

et al. 2019

Comm Dent Oral Epid

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“…This consequently results in a greater risk of mortality. 28,29 Interestingly, a decline in cognitive status did not significantly affect dental and oral health in our study. This might be due to the quite short observation period and minor changes in cognitive status.…”

Section: Discussioncontrasting

confidence: 49%

<p>Short-Term Effects of a Deterioration of General Health on the Oral Health of Nursing-Home Residents</p>

Klotz¹,

Zajac²,

Ehret³

et al. 2020

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The purpose of this study was to identify how changes to general health might affect the oral health of nursing-home residents over a six-month period. Materials and Methods: The study was conducted in nine nursing homes in Germany. Sociodemographic and general data were collected at baseline and after six months. Complete baseline and follow-up data were available for 114 participants. The Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS) were used to identify the presence and, if applicable, severity of dementia among participants. The Apraxia Screen of TULIA (AST) was used to identify motor impairment. A comprehensive dental examination of each participant was also performed. The examination included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMF-T). In addition, dental and denture hygiene were quantitatively assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI), respectively. Global dental treatment needs were evaluated by use of the Oral Health Assessment Tool (OHAT). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting the dependent target variables. Results: During the study period, denture hygiene among the study population worsened by an average of 15%. The regression models detected that a more advanced age (in years) was associated with a less pronounced deterioration of denture hygiene as measured by use of the DHI (−0.806 per additional year of age; p = 0.030). Furthermore, an increase in the level of care needed (coefficient (C): −1.948; p = 0.002) and a more poorly graded assessment of general health compared with the value at baseline (C: 1.054; p = 0.026) were both associated with a deterioration of oral health as evaluated by use of the OHAT. In addition to these results, an increase in care needs was also associated with a deterioration of dental health as evaluated by use of the DMF-T (C: 0.966; p = 0.013). Conclusion: In the short term, a deterioration of general health, including an increase in care needs, seems to be the predominant factor associated with a more pronounced deterioration of oral health among nursing-home residents.

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“…In this context, it should be noted that the deterioration of oral health not only affects chewing function, but also general health by aggravating systemic diseases. This, in turn, results in a greater risk of mortality [26,28].…”

Section: Discussionmentioning

confidence: 99%

Which factors influence the oral health of nursing-home residents with cognitive and motor impairments?

et al. 2020

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Background There is limited information available about the oral and denture hygiene and oral health of nursing-home residents with cognitive and motor impairments. Aims The purpose of this study was to identify factors influencing the oral and denture hygiene and oral health of nursinghome residents with cognitive and motor impairments. Methods The study was performed in nine nursing-homes in Germany. Sociodemographic and general data were collected for all participants (n = 150). The Clinical Dementia Rating (CDR) was used to identify the presence of dementia, and the Apraxia Screening Test (AST) was used to identify motor impairment. A comprehensive dental examination was also performed. This included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMFT). In addition, dental and denture hygiene were assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI). Univariate and multivariate regression models were used to analyse possible factors affecting the dependent target variables. Results In multivariate regression analysis, the factors that most strongly influenced greater PI were a lower number of medications taken (p = 0.018), poorer general health (p = 0.013) and the presence of dementia (p < 0.010). A more advanced age (p = 0.036) and longer nursing-home stay (p = 0.048) had a negative effect on the DHI. Furthermore, gender (p = 0.037, in favour of women), poorer general health (p = 0.003), presence of dementia (p = 0.003), and the absence of natural teeth (p = 0.028) influenced poorer oral health. The factors most strongly influenced greater number of missing teeth were a more advanced age (p = 0.021) and longer nursing-home stay (p = 0.015). In terms of fewer filled teeth, a shorter nursing-home stay (p = 0.002) was the factor most strongly influenced this. Conclusions Poorer general health and the presence of apraxia and cognitive impairment are the main determinants for poorer oral hygiene and oral health among nursing-home residents. A longer nursing-home stay also seems to be relevant for oral health and denture hygiene.

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Is compromised oral health associated with a greater risk of mortality among nursing home residents? A controlled clinical study

Cited by 29 publications

References 29 publications

Older people with swallowing dysfunction and poor oral health are at greater risk of early death

Older people with swallowing dysfunction and poor oral health are at greater risk of early death

<p>Short-Term Effects of a Deterioration of General Health on the Oral Health of Nursing-Home Residents</p>

Which factors influence the oral health of nursing-home residents with cognitive and motor impairments?

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