Relationship between mastication and malnutrition in community-dwelling older adults: a meta-analysis.

PURPOSE: To determine the relationship between mastication and malnutrition in community-dwelling older adults. RESEARCH STRATEGIES: To establish the eligibility criteria, the acronym PECOS was used: Population: non-institutionalized older adults; Exposure: older adults with malnutrition; Control: older adults without malnutrition; Outcome: masticatory problems in malnourished older adults; Study types: observational studies. SELECTION CRITERIA: It selected studies assessing malnutrition and mastication difficulties in non-institutionalized adults over 60 years old, of both sexes. Mastication and malnutrition were evaluated with questionnaires on self-reported symptoms and clinical and instrumental assessments. There were no restrictions on language, year of publication, or ethnicity. DATA ANALYSIS: The included studies were evaluated for methodological quality with the Joanna Briggs Institute tool for cross-sectional studies. For the cross-sectional studies included, the odds ratio (OR) was calculated with 95% confidence intervals. RESULTS: After searching the databases, 692 references were retrieved, with three studies selected for quantitative and qualitative analysis. The values obtained in the meta-analysis for association show that malnutrition and mastication difficulties were 2.21 times as likely to occur (OR = 2.21; 95%CI = 0.93 - 5.26; I2 = 94%) as individuals without malnutrition (p < 0.001). The assessment of the risk of bias presented a high-risk, a moderate-risk, and a low-risk study. The certainty of evidence was rated very low with the GRADE tool. CONCLUSION: Individuals at risk of malnutrition are 2.21 times as likely to have mastication difficulties.

Relationship between mastication and malnutrition in community-dwelling older adults: a meta-analysis

ABSTRACT Purpose To determine the relationship between mastication and malnutrition in community-dwelling older adults. Research strategies To establish the eligibility criteria, the acronym PECOS was used: Population: non-institutionalized older adults; Exposure: older adults with malnutrition; Control: older adults without malnutrition; Outcome: masticatory problems in malnourished older adults; Study types: observational studies. Selection criteria It selected studies assessing malnutrition and mastication difficulties in non-institutionalized adults over 60 years old, of both sexes. Mastication and malnutrition were evaluated with questionnaires on self-reported symptoms and clinical and instrumental assessments. There were no restrictions on language, year of publication, or ethnicity. Data analysis The included studies were evaluated for methodological quality with the Joanna Briggs Institute tool for cross-sectional studies. For the cross-sectional studies included, the odds ratio (OR) was calculated with 95% confidence intervals. Results After searching the databases, 692 references were retrieved, with three studies selected for quantitative and qualitative analysis. The values obtained in the meta-analysis for association show that malnutrition and mastication difficulties were 2.21 times as likely to occur (OR = 2.21; 95%CI = 0.93 - 5.26; I2 = 94%) as individuals without malnutrition (p < 0.001). The assessment of the risk of bias presented a high-risk, a moderate-risk, and a low-risk study. The certainty of evidence was rated very low with the GRADE tool. Conclusion Individuals at risk of malnutrition are 2.21 times as likely to have mastication difficulties.

Orofacial and cervical myofunctional intervention programmes for older adults: A scoping review.

INTRODUCTION: Senescent stomatognathic systems undergo anatomical changes that are not always compensated by physiology due to associated factors such as poorly fitted dentures, dental changes, and clinical conditions that trigger sarcopenia. When these conditions are not properly addressed, they can lead to nutritional deficiencies. Hence, this study aimed to map orofacial and cervical myofunctional intervention programmes for older adults, evaluate the current research in this area, and formulate suggestions for further investigation. METHODS: Scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and grey literature databases were systematically searched. Studies addressing therapeutic programmes, myofunctional exercises, and their influence on the stomatognathic system of older adults were included. Studies with populations younger than 60 years, residing in long-term care facilities, homes, or hospital care, and with associated comorbidities were excluded, as well as secondary studies. RESULTS: A total of 3098 studies were retrieved. After applying the eligibility criteria, nine studies were eligible for this review. The nine studies were published in English between 2008 and 2021 in the United States, Japan, and South Korea. The participants' mean ages ranged from 64 to 81 years, with a preponderance of females. Six of the studies divided the sample into intervention and control groups. Two studies referred to programmes to promote oral function through facial expression and tongue muscle exercises, salivary gland massage, and swallowing biomechanics. Seven studies report the positive influence of myofunctional exercises on the stomatognathic system. CONCLUSION: The mapping concluded that therapeutic programmes, including educational actions, help prevent orofacial myofunctional disorders, and improve the functionality of the stomatognathic system.

Prevalence of chewing difficulty in older people in long-term care: A systematic review and meta-analysis.

BACKGROUND: Many factors can influence chewing, including age. The ageing process causes morphophysiological changes in the body, including in the performance of the stomatognathic system, which directly affect chewing and swallowing. OBJECTIVE: To determine the prevalence of chewing difficulty in older people in long-term care. METHODS: We searched six electronic databases and the grey literature. Qualitative and quantitative analyses, including risk of bias, were performed on studies that met the inclusion criteria. The meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored by meta-regression. Risk of bias was determined using the Joanna Briggs Institute's Critical Appraisal Checklist. The certainty of evidence was verified using the GRADE tool. RESULTS: Twelve articles were included in the meta-analysis. The pooled prevalence estimate was 35% (95% confidence interval, 0.19-0.54). As heterogeneity still persisted even after sensitivity analysis, the predictors of mean sample age and sample size were meta-regressed to assess whether these covariates explained the variance between effect sizes. The covariable sample size of the study included in the analysis explained 84.3% of the heterogeneity existing in the analysis (R2  = 84.3%; P = .0008). The risk of bias was low in three studies, eight studies had a moderate risk of bias and one study had a high risk of bias. As for the prevalence of chewing difficulty, the GRADE criteria were considered very low. CONCLUSION: About one in three older people in long-term care have difficulty in chewing.

Effects of photobiomodulation combined with orofacial myofunctional therapy on the quality of life of individuals with temporomandibular disorder. / Efeitos da fotobiomodulação associada a terapia miofuncional orofacial na qualidade de vida de indivíduos com disfunção temporomandibular.

PURPOSE: To analyze the impact of photobiomodulation combined with orofacial myofunctional therapy (OMT) on the oral health quality of life (OHQOL) of individuals with temporomandibular disorder, before and after the treatment. METHODS: Blind, controlled, randomized clinical trial with 34 volunteers randomly distributed into two groups: G1, who received OMT combined with photobiomodulation, and G2, treated with OMT combined with inactive laser. The subjects were first assessed with a visual analog scale (VAS) to classify them according to the degree of orofacial pain and with the Oral Health Impact Profile - Short Form (OHIP-14) regarding the impact on the OHQOL. The resulting data were statistically analyzed. The significance level was set at 0.05 (95%). RESULTS: "Physical pain", "psychological discomfort", "physical disability", and "psychological disability" were the aspects with the greatest impact on the OHQOL. The G1 subjects responded positively to their treatment, as well as G2 to theirs. There was a strong positive correlation between VAS and total OHIP-14 score in both groups after the treatment. However, the functional recovery in the control group individuals (G2) was the most perceived positive change in the OHQOL in comparison with the experimental group (G1). CONCLUSION: The people who received photobiomodulation combined with OMT perceived an improvement in the OHQOL, as well as those treated with placebo laser. There was a strong positive correlation in both groups in the improvement of the degree of pain and self-perception of the OHQOL.

OBJETIVO: Analisar o impacto na qualidade de vida relacionada à saúde oral de indivíduos com disfunção temporomandibular, antes e após o tratamento de fotobiomodulação associada a terapia miofuncional orofacial. MÉTODO: Estudo do tipo ensaio clínico randomizado, controlado e cego, com 34 voluntários distribuídos aleatoriamente em dois grupos: G1, que recebeu a Terapia Miofuncional Orofacial (TMO) associada a fotobiomodulação e o G2, tratado pela TMO associada ao laser inativo. Os indivíduos foram submetidos, primeiramente, à avaliação para serem classificados de acordo com o grau da dor orofacial pela Escala Visual Analógica (EVA) e também quanto ao impacto da qualidade de vida relacionada a saúde oral (QVRSO) pelo questionário Oral Health Impact Profile ­ Short form (OHIP-14). Os dados obtidos foram analisados estatisticamente. Foi adotado o nível de significância de 0,05 (95%). RESULTADOS: "Dor física", "desconforto psicológico", "limitação física" e "limitação psicológica" foram os aspectos mais impactantes na QVRSO. O G1 apresentou respostas positivas para o respectivo tratamento, assim como o G2. Observou-se correlação positiva e de grau forte para EVA e escore total do OHIP-14 em ambos os grupos após tratamento. Porém, os indivíduos do grupo controle (G2) evidenciaram que a recuperação funcional foi o aspecto que mais se percebeu de mudança positiva na QVRSO em comparação ao grupo experimental (G1). CONCLUSÃO: As pessoas que receberam fotobiomodulação associada a TMO-perceberam melhora da QVRSO, assim como as tratadas com o laser placebo. Houve correlação positiva e forte em ambos os grupos na melhora do grau da dor e autopercepção da QVRSO.

Accuracy of an epidemiological oropharyngeal dysphagia screening for older adults.

OBJECTIVE: The aim of this study was to determine the accuracy of an epidemiological screening questionnaire for oropharyngeal dysphagia in older people. BACKGROUND: Determining the cut-off point and the accuracy of the self-reported epidemiological questionnaire for screening oropharyngeal dysphagia in older adults is important for mass screening, which may estimate the prevalence of oropharyngeal dysphagia. MATERIALS AND METHODS: This was a cross-sectional diagnostic study with a convenience sample of 70 older adults over 60 years of age of both sexes, aged between 60 and 90 years (mean age 69.2; SD, 7.6). It used a screening questionnaire with nine ordered items response options resulted in a score ranging from 0 to 18. The criterion test was the fiberoptic endoscopic evaluation of swallowing, with analysis of the receiver operating characteristic (ROC), with a 5% significance level. RESULTS: Oropharyngeal dysphagia frequency by the criterion test was 73%, with no significant difference between age and sex. The area under the ROC curve was 0.88 (95% confidence interval: 0.79-0.98) above the cut-off point 3. This screening questionnaire showed good parameters of sensitivity (80%), specificity (89%), positive predictive value (95%), negative predictive value (63%), positive likelihood ratio (7.64), negative likelihood ratio (0.22) and accuracy (83%). CONCLUSIONS: This questionnaire may be a satisfactory screening tool for estimating the prevalence of oropharyngeal dysphagia in older adults.

Sinais e sintomas de disfagia orofaríngea em idosos institucionalizados: revisão integrativa / Signs and symptoms of oropharyngeal dysphagia in institutionalized older adults: an integrative review

RESUMO Objetivo identificar quais são os sinais e sintomas de disfagia orofaríngea mais presentes nos idosos residentes em Instituições de Longa Permanência. Estratégia de pesquisa revisão integrativa realizada em quatro bases de dados: Embase, LILACS, MEDLINE/PubMed e Web of Science, com uso de termos na língua inglesa e aplicação de filtros por idioma e idade. Critérios de seleção estudos disponíveis na forma de texto completo em inglês, português ou espanhol, sem restrição de tempo de publicação, relacionados a idosos residentes em Instituições de Longa Permanência que referiram disfagia orofaríngea. Foram excluídos estudos relacionados a idosos da comunidade ou que estavam em hospitais, e com outras condições de saúde não relacionadas aos problemas de deglutição. Resultados de 389 estudos, 16 foram incluídos nesta revisão, publicados entre os anos de 1986 e 2020. Houve predomínio de participantes do sexo feminino, com média mínima de idade de 71 anos e máxima de 87 anos. Os sinais e sintomas mais frequentes de disfagia orofaríngea foram presença de tosse e engasgo, além de outros relevantes, como pressão de língua diminuída, voz molhada, perda de peso e deglutição lenta. Conclusão de acordo com os estudos revisados, os sinais e sintomas mais frequentes relacionados à disfagia orofaríngea nos idosos institucionalizados foram presença de tosse e engasgo, antes, durante ou após a deglutição.

Abstract Purpose To identify the most prevalent signs and symptoms of oropharyngeal dysphagia in elderly adults who live in old folks' home. Research strategy Integrative review carried out in four databases: Embase, Lilacs, MEDLINE/Pubmed, and Web of Science using English terms and filters for language and age. Selection criteria Studies available in the full-text form in English, Portuguese or Spanish, with no publication time restrictions, related to elderly people living in care homes who reported oropharyngeal dysphagia. Studies related to elderly people in the community or in hospitals and with other health issuesthat were not related to swallowing disorders were excluded. Results Of 389 studies, 16 were included in this review, published between 1986 and 2020. There was a predominance of female participants whose minimum mean age was 71 and maximum, 87. The most frequent signs and symptoms of oropharyngeal dysphagia were the presence of coughing and choking, in addition to other relevant ones, such as diminished tongue pressure, wet voice, weight loss, and slow swallowing. Conclusion According to the reviewed studies, the most frequent signs and symptoms related to oropharyngeal dysphagia in elderly people living in care homes were (the) presence of coughing and choking, before, during or after swallowing.

Prevalence of temporomandibular disorders in musicians: A systematic review and meta-analysis.

OBJECTIVE: To determine the prevalence of temporomandibular disorders (TMD) in musicians. MATERIALS AND METHODS: Electronic database searches and a manual search were performed. Qualitative and quantitative analysis including risk of bias was performed for studies that met the inclusion criteria. A meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored according to the moderating variable through subgroup analysis and metaregression. The certainty of the evidence was assessed using the GRADE tool. RESULTS: A total of 13 articles were included for the meta-analysis. Pooled prevalence estimate was 52.8% (CI 95%; 33.4%-71.7%) for wind instruments, 53.9% (CI 95%; 42.4%-65.2%) for string instruments and 53.9% (CI 95%; 23.5%-82.7%) for string and wind instruments. The average time of use of the musical instrument explained 82.38%, the heterogeneity between the sizes of the effects observed in the analysis (R2  = 82.38%; P < .0001). For prevalence of TMD, the GRADE criteria were considered very low. CONCLUSION: The overall combined prevalence of TMD in musicians was approximately 53.9%, and musicians who use their instruments daily and for a long period of time may have a higher prevalence of TMD. CLINICAL SIGNIFICANCE: Due to the high prevalence of TMD in musicians, health professionals must be careful not to underestimate signs and symptoms and correctly diagnose these cases.

Validity Evidence of an Epidemiological Oropharyngeal Dysphagia Screening Questionnaire for Older Adults.

OBJECTIVE: This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability. METHOD: This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level. RESULTS: The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence. CONCLUSIONS: The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.

Screening for masticatory disorders in older adults (SMDOA): An epidemiological tool.

PURPOSE: Masticatory changes in the older adult population may cause nutritional impairment, so epidemiological studies are important to allow specific public health interventions. Thus, this study aims at constructing and validating an instrument for screening for masticatory disorders in older adults (SMDOA). METHODS: Validation study. First step: validity evidence based on test content. Defining the construct and elaborating the questions by a panel of experts and evaluating the representativeness and relevance of the items in relation to the construct by a committee of 28 experts. Analysis was performed through the Content Validity Index for Items (CVI-I) and the Content Validity Index (CVI). Second stage: validity evidence based on response processes. The questionnaire was applied to 40 older adults (≥60 years) using the cognitive interview strategy. Quantitative and qualitative analysis of the responses was carried out. Third stage: validity evidence based on the internal structure. The instrument was applied to 295 older adult patients and a confirmatory factorial analysis was performed to fit the model. RESULTS: The first version of SMDOA consisted of 16 issues related to chewing. The CVI and CVI-I were satisfactory, and only one question was excluded. The instrument with 15 questions was well evaluated by the older adults, only requiring minor adjustments to the morphosyntax. After the confirmatory factorial analysis, adjustments were made in its internal structure resulting in the 9-question model in two factors regarding function and masticatory perception. CONCLUSIONS: The SMDOA presented good evidence of validity in its content, response processes and internal structure.

Validity evidence of an epidemiological Oropharyngeal dysphagia screening questionnaire for older adults

OBJECTIVE: This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability. METHOD: This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level. RESULTS: The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence. CONCLUSIONS: The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.

Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos--RAVI)--Part I: Validity Evidence Based on Test Content and Response Processes.

PURPOSE: To identify the validity evidence based on the content and response processes of the Rastreamento de Alterações Vocais em Idosos (RAVI; "Screening for Voice Disorders in Older Adults"), an epidemiologic screening for voice disorders in older adults. STUDY DESIGN: This is a prospective, nonrandomized, cross-sectional, validation study. METHODS: Criteria for defining the domains and elaborating the questions were established to confirm the validity evidence based on the content. A multidisciplinary committee of 19 experts evaluated the questions, and the relevance and representation of the domains were analyzed using the Content Validity Index for Items (CVI-I) and the Content Validity Index (CVI), respectively. For validity evidence based on the response processes, 40 individuals of both sexes, aged ≥60 years, were stratified by demographic and socioeconomic condition. They responded to the RAVI, made suggestions, and their verbal and nonverbal reactions were observed. RESULTS: The first version of the RAVI consisted of 20 questions related to sensations and perceptions associated with the voice. Although the CVI value of 0.80 was satisfactory, the CVI-I and the suggestions of the expert committee indicated that the scale needed to be reformulated. Consultation with older adults indicated a need for further adjustment. The preliminary version of the RAVI consisted of 16 questions. CONCLUSIONS: The two aspects of validity evidence described in the present study were essential for adapting the questions to better fit the construct of the questionnaire. Other aspects of validity evidence and reliability analysis will be described in part II of this study.