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

Abstract

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

The association of frailty with oral cleaning habits and oral hygiene among elderly home care clients

“…This creates growing needs for oral care in the aged population 8,9. Oral diseases are more prevalent in higher age and may lead to pain, infections, tooth loss, reduced salivary flow rate, compromised chewing capacity and consequent impaired nutritional status, which has been shown to be an independent risk factor for mortality in older people 1,5,10,11. Especially among older people with cognitive impairment and compromised functional capacity, obtaining good standards of oral hygiene is difficult and such people are often dependent on support from relatives or caregivers.…”

Prognostic Significance of Oral Frailty on the All-Cause Mortality

“…Decline in tongue pressure, as Tsuga, K., et al observed, was correlated with frailty [29]. For older people, dysphagia was suggested to be an independent factor for frailty and mortality [30,31]. In addition to oral hypofunction, poor oral health, for example, edentulism, periodontal diseases and perceived di culty eating, have been reported to be related to frailty and mortality [16,28,32].…”

Structure and Validity of Questionnaire for Oral Frail Screening

“…Measuring oral function by using devices is time consuming and a burden on screening or on the use of public health facilities. The decrease in oral functions leads to sarcopenia, and this can be a risk of mortality of older subjects [ 25 , 26 ]. Simple questionnaires are more suitable for screening or for the use of public health facilities.…”