Association of oral frailty with medical expenditure in older Japanese adults: The study of late-stage older adults in Tottori (START Tottori).

OBJECTS: This study aimed to determine the association between annual medical expenses and oral frailty in later-stage older adults (aged ≥ 75 years). No studies have investigated the association between medical costs and oral frailty, which would elucidate the association between oral frailty and the deterioration of mental and overall physical function. MATERIALS AND METHODS: In this cross-sectional study, 2190 adults (860 men and 1330 women aged 75-94 years) covered by the Medical System for the Elderly and residing in Tottori Prefecture, Japan, between April 2016 and March 2019, were included. Participants were classified into three groups: healthy, pre-orally frail or orally frail, based on dental health screening findings. The medical and dental expenses over the years, number of days of consultations and comorbidities were obtained from the Japanese Health Insurance Claims Database. RESULTS: The number of days of medical and dental consultations and annual medical expenses for outpatient care differed among the three study groups. A significant association was observed between oral frailty and high annual expenses for outpatient medical and dental care. Oral frailty was associated with higher medical expenses in participants with poor masticatory function. Higher and lower dental expenses were associated with subjective poor masticatory function and subjective impairment of swallowing function respectively. CONCLUSION: Medical and dental expenses for orally frail older adults are high, indicating that oral frailty may be related to the occurrence and severity of diseases other than oral health issues. Future studies should examine the mechanism by which oral weakness affects physical and mental functions.

Impact of number of functional teeth on independence of Japanese older adults.

AIM: To examine the relationship between the number of present and functional teeth at baseline and future incidence of loss of independence. METHODS: Participants were community-dwelling older individuals who participated in a comprehensive geriatric health examination conducted in Kusatsu town, Japan, between 2009 and 2015. The primary endpoint was the incidence of loss of independence among participants, defined as the first certification of long-term care insurance in Japan. The numbers of present and functional teeth at baseline were determined via an oral examination. Demographics, clinical variables (e.g., history of chronic diseases and psychosocial factors), blood nutritional markers, physical functions, and perceived masticatory function were assessed. RESULTS: This study included 1121 individuals, and 205 individuals suffered from loss of independence during the follow-up period. Kaplan-Meier estimates of loss of independence for participants with smaller numbers of present and functional teeth were significantly greater than for those with larger numbers of teeth. Cox proportional hazard analyses indicated that a smaller number of present teeth was not a significant risk factor after adjusting for demographic characteristics. However, the number of functional teeth was a significant risk factor after the adjustment (hazard ratio: 1.975 [1.168-3.340]). Additionally, higher hazard ratios were observed in other adjusted models, but they were not statistically significant. CONCLUSIONS: The number of functional teeth may be more closely related to the future incidence of loss of independence than the number of present teeth. This novel finding suggests that prosthodontic rehabilitation for tooth loss possibly prevents the future incidence of this life-event. Geriatr Gerontol Int 2022; 22: 1032-1039.

Determinants of new participation in sports groups among community-dwelling older adults: Analysis of a prospective cohort from The Otassha Study.

Participation in sports groups has health benefits for older adults, such as preventing functional limitations and social isolation. Encouraging participation in sports groups may be an important means of health promotion in older adults. However, there is insufficient research on the determinants of new participation in sports groups to consider effective interventions to promote participation in these groups. We investigated this using data from a 1-year prospective study. Data were obtained from "The Otassha Study" that assessed a cohort of community-dwelling older adults living in an urban area of Japan. Of 769 older adults who participated in a baseline health survey in 2018, 557 participated in a follow-up survey in 2019. We excluded 184 individuals who already participated in sports groups at baseline and 36 with missing data. Participation in sports groups was defined as that occurring more than once a week. Logistic regression analysis was used to identify the determinants of new participation in sports groups, with sociodemographic factors, lifestyle habits, physical functions, cognitive functions, psychological factors, and social factors as independent variables. Forty-one (12.2%) individuals participated in sports groups at follow-up. In the multiple adjusted logistic regression model, new participation in sports groups was significantly associated with female sex (odds ratio [OR] = 5.57, 95% confidence interval [CI]: 1.61‒19.26), engagement in regular exercise (OR = 2.23, 95%CI: 1.03‒4.84), and having a large social network (OR = 1.12, 95%CI: 1.04‒1.20). Physical functions were not associated with new participation. Determinants of new participation were lifestyle habits and social factors, rather than physical functions. Intervention through social networks may be effective in encouraging new participation in sports groups, which, in turn, may facilitate healthy aging.

Factors Associated with Food Form in Long-Term Care Insurance Facilities.

We examined factors related to dietary intake status (food form) of long-term care facility (LTCF) residents to identify factors related to proper food form choice for older individuals requiring nursing care. We surveyed 888 residents from 37 LTCFs in Japan. We evaluated basic information (age, sex, body mass index [BMI]), food form (swallowing-adjusted diet class), Barthel Index (BI), Clinical Dementia Rating (CDR), simply evaluated eating and swallowing functions, the number of present/functional teeth, oral diadochokinesis, repetitive saliva swallowing test (RSST), and modified water swallowing test. To clarify factors associated with food form, participants who had good nutrition by oral intake were categorized into the dysphagic diet (DD) and normal diet (ND) groups. Multi-level analyses were used to detect oral functions associated with food form status. Among objective assessments, BMI (odds ratio [OR] 0.979, 95% confidence interval [CI] - 0.022- to 0.006, p = 0.001), BI (OR 0.993, 95% CI - 0.007 to - 0.004, p < 0.001), CDR 3.0 (OR 1.002, 95% CI 0.002‒0.236, p = 0.046), present teeth (OR 0.993, 95% CI - 0.007 to - 0.001, p = 0.011), functional teeth (OR 0.989, 95% CI - 0.011 to - 0.005, p < 0.001), and RSST (OR 0.960, 95% CI - 0.041 to - 0.007, p = 0.006) were significantly associated with DD vs ND discrimination. Simple evaluations of coughing (OR 1.056, 0.054‒0.198, p = 0.001) and rinsing (OR 1.010, 0.010‒0.174, p = 0.029) could also discriminate food form status. These simple evaluations provide insight into the discrepancies between food form status and eating abilities of LTCF residents. Periodic evaluations by the nursing caregiver may help to prevent aspiration by older individuals with dysphagia.

Pneumonia incidence and oral health management by dental hygienists in long-term care facilities: A 1-year prospective multicentre cohort study.

OBJECTIVE: To investigate the association between oral health management (OHM) by dental hygienists and the occurrence of pneumonia, and determine the effectiveness of OHM in pneumonia prevention. BACKGROUND: In long-term care facilities in Japan, the need for professional OHM is increasing with an increase in the number of severely debilitated residents. MATERIALS AND METHODS: A 1-year prospective multicentre cohort study was conducted using data from 504 residents (63 men; mean age: 87.4 ± 7.8 years) in Japanese long-term care facilities. Basic information, medical history, willingness to engage in oral hygiene behaviour, need for OHM and oral conditions were investigated at baseline. In addition, information on the occurrence of pneumonia was collected using a follow-up survey after one year. A Poisson regression analysis with robust standard errors was conducted, with pneumonia as the dependent variable, and factors associated with OHM and pneumonia occurrence as explanatory variables. RESULTS: Overall, 349 (69.2%) residents required OHM by dental hygienists during that year of follow-up. Of those, 238 (68.2%) were provided with OHM, and 18 (7.5%) developed pneumonia. Among the 111 patients (31.8%) who were not provided with OHM, 21 (18.9%) developed pneumonia. The OHM group had lower pneumonia rates than the non-OHM group (prevalence rate ratio: 0.374; 95% CI: 0.210-0.665). CONCLUSION: Oral health management by dental hygienists was associated with a lower incidence of pneumonia among residents of long-term care facilities, underlining the importance of professional OHM for such individuals. It is recommended that OHM be practised routinely in long-term care facilities.

A comparison of colorimetric and visual methods for the assessment of masticatory performance with color-changeable chewing gum in older persons.

BACKGROUND/PURPOSE: Color-changeable chewing gum is used for the evaluation of masticatory performance. However, it is currently unclear whether colorimetric and visual assessment methods yield consistent results. This study aimed to clarify the consistency between colorimetric and visual methods used for the evaluation of color changes in color-changeable chewing gum. MATERIALS AND METHODS: The sample comprised 644 older persons (mean age, 75.4 ± 6.4 years). The chewing gum was masticated 60 times at the participant's own chewing rate and then expectorated. The color of the chewing gum was evaluated with the ΔE values and a∗ values, measured using a colorimeter, and the 10 Color Shades (10CSh) and 5 Color Scales (5CSc), using visual evaluation. Spearman's correlation analysis was performed to examine the correlation between the results obtained by the four methods. The significance level was set at α = 0.05. RESULTS: The ΔE values, a∗ values, 10CSh scores, and 5CSc scores were all significantly correlated. The highest correlation coefficient (0.979) was between the ΔE values and a∗ values. The lowest correlation coefficient (0.847) was between the a∗ values and 5CSc scores. Decreased masticatory performance was observed with increased age. CONCLUSION: Significant correlations were found for all four methods used in the assessment of masticatory performance with color-changeable chewing gum. While visually based assessments are valid, colorimetric methods are more sensitive to smaller changes in masticatory performance.

Factors associated with follow-up difficulty in longitudinal studies involving community-dwelling older adults.

This study aims to clarify the factors associated with the gradual withdrawal from society in older adults. We defined the stages of follow-up difficulty based on four follow-up surveys on non-respondents of longitudinal mail surveys in community-dwelling older adults to examine the main factors associated with the stages of follow-up difficulty. We conducted a follow-up mail survey (FL1) with respondents of a baseline survey, and three more follow-up surveys with the non-respondents of each previous survey: simplified mail (FL2), postcard (FL3), and home visit surveys (FL4). The respondents of each follow-up survey were defined as a stage of follow-up difficulty; their characteristics concerning social participation and interaction at baseline in each stage were analyzed. The number of respondents in the FL1, FL2, FL3, and FL4 stages and non-respondents (NR) were as follows: 2,361; 462; 234; 84; and 101, respectively. Participation in hobby groups in FL2 and FL3, sports groups in FL4, and neighborhood association and social isolation in NR were significantly associated with the stage of follow-up difficulty. Based on these results, we conclude that the following factors are associated with each stage of follow-up difficulty: 1) a decline in instrumental activities of daily living in the FL2 and FL3 stages, 2) dislike for participating in physical activity such as sports in the FL4 stage, and 3) social isolation, not even belonging to a neighborhood association due to low social interaction in the NR group.

Development and validity of the Computer-Based Cognitive Assessment Tool for intervention in community-dwelling older individuals.

AIM: The Mini-Mental State Examination is a widely used cognitive assessment tool. However, it has several limitations, including the learning effect and interrater reliability. Therefore, we developed a Computer-Based Cognitive Assessment Tool (CompBased-CAT), which runs on a tablet or personal computer. In this study, we examined the validity and discrimination ability of the CompBased-CAT. METHODS: Participants were recruited from the Otasha-Kenshin study carried out in 2016. We included 773 community-dwelling older individuals in Japan (332 men, 441 women, aged 65-97 years). CompBased-CAT scores were converted to z-scores, and the correlation with Mini-Mental State Examination scores was examined using Pearson's correlation coefficient. Furthermore, the ability to discern cognitive impairment was examined using the receiver operating characteristic curve. RESULTS: The Pearson's correlation coefficient for the Mini-Mental State Examination scores and each task component of the CompBased-CAT ranged from 0.24 to 0.41 (P < 0.001), and the correlation coefficient of the total z-scores was 0.51 (P < 0.001). The sensitivity, specificity and area under the receiver operating characteristic curve of the discriminating ability of the CompBased-CATool for cognitive impairment were 0.81, 0.77 and 0.85, respectively. CONCLUSIONS: The CompBased-CAT certainly possesses validity, discriminating ability and utility as a new cognitive assessment tool in community-dwelling older individuals. Geriatr Gerontol Int 2020; ••: ••-••.

The Mini Nutritional Assessment-Short Form as a predictor of nursing home mortality in Japan: A 30-month longitudinal study.

OBJECTIVES: We examined whether the Mini Nutritional Assessment-Short Form (MNA®-SF) predicted mortality in 367 nursing home residents (82% women; mean age = 84.4 ± 8.5 years) in Japan. MEASUREMENTS: We examined participants' basic characteristics (sex, age, height, weight, and medical history), the Barthel index (BI), clinical dementia rating (CDR), and six items of the MNA®-SF. The association between the MNA®-SF and 30-month mortality was assessed using a Cox proportional regression analysis. RESULTS: During the study, 157 (42.8%) participants died. MNA®-SF scores in the Survival group were significantly higher than in the Death group (9.4 ± 2.1 vs. 8.4 ± 2.3, respectively; p < .001). After adjusting for age, sex, history of aspiration pneumonia, BI, and CDR, MNA®-SF scores were significantly associated with 30-month mortality (hazard ratio: 0.89, 95% confidence interval: 0.82-0.97, p = .005). CONCLUSION: The MNA®-SF was an effective predictor of mortality among nursing home residents in Japan, even after adjusting for potential confounders. These results indicate that periodically evaluating nutritional status using the MNA®-SF, and nutritional interventions according to status, may result in maintenance and improvement of nutritional status, as well as lead to reduced mortality.

Social participation reduces isolation among Japanese older people in urban area: A 3-year longitudinal study.

OBJECTIVES: Social isolation is a particular problem among older people and social participation may reduce future isolation. However, it is unclear which types of activities and which level of participation are effective. This study examines the relationship between social participation and isolation among Japanese older people by employing a 3-year longitudinal study. METHODS: A mail survey was sent to 3,518 community-dwelling older people in an urban area in 2014 (baseline: BL). We then conducted follow-up mail survey on respondents who were non-isolated at BL in 2017 (follow-up: FL), with isolation being defined as being in contact with others less than once a week. An analysis was carried out on 1,070 subjects (398 men and 672 women). Social participation is defined by participation in group activities (community, senior club, hobbies, sports, volunteering, politics, industry, and religion). A logistic regression analysis was conducted to determine the association between the types of social participation and the number of organization types at BL, and isolation at FL. RESULTS: At FL, 75 men (18.8%) and 59 women (8.8%) were considered to be isolated. Among the men, participation in a hobby group and sports group both significantly reduced the degree of isolation. Moreover, participation in two organizations and three or more organizations significantly lowered the risk of isolation when compared to non-participants. Among women, there were no significant associations among particular types of social activities and isolation. On the other hand, participation in one organization and three or more organizations significantly reduced their isolation when compared to non-participants. There was a significant linear trend between the number of types of organizations and isolation, regardless of gender. CONCLUSIONS: Participation in social activities reduces future isolation in older people. Encouraging participation in social activities could help reduce negative health outcomes associated with social isolation later in life.

Poor Social Network, Not Living Alone, Is Associated With Incidence of Adverse Health Outcomes in Older Adults.

OBJECTIVE: Although it has been suggested that living alone is a "social risk factor" for adverse health outcomes, poor social network may confound the association. This study aimed to examine whether the interactive effects of living alone and poor social network contribute to adverse health outcomes. DESIGN: A 4-year prospective observational study. SETTING AND PARTICIPANTS: Four hundred community-dwelling older adults living in Itabashi ward, an urban community in Tokyo. They participated in a health checkup (held in 2015 and 2017) and completed all the assessments. METHODS: Participants were classified into 4 groups according to their living arrangements (living alone or not living alone) and social network size, which was assessed using an abbreviated version of the Lubben Social Network Scale-6. Poor social network was defined as the lowest quartile (4th quartile) of the Lubben Social Network Scale-6 score. Adverse health outcomes including disabilities, depressive symptoms, and physical and cognitive functions were measured. RESULTS: Multiple and logistic regression models, adjusted for covariates such as financial status and educational level, showed that living alone and having a poor social network at baseline were significantly associated with increased depression symptoms, reduced grip strength, and disabilities of intellectual activity and social role at follow-up. Furthermore, older adults who did not live alone but had poor social networks showed significantly higher odds of subsequent homebound status and disability in activities of daily living. CONCLUSIONS AND IMPLICATIONS: We found that living alone among older adults is not always a social risk factor for health, and adverse health outcomes among older adults living alone may be confounded by poor social network. Our results also suggest that the effect of poor social network on health status may exceed the effects of living alone. Health professionals must, thus, pay attention to poor social network among older adults.

A 2-year longitudinal study of the relationship between masticatory function and progression to frailty or pre-frailty among community-dwelling Japanese aged 65 and older.

BACKGROUND: An association has recently been reported between frailty and reduced masticatory function; however, the causal relationship remains unclear. OBJECTIVE: The aim of this study was to clarify the relationship between masticatory function and frailty progression. METHODS: Among 6699 individuals aged 65 and older (mean age 72.8 ± 5.2 years) who were invited to participate in comprehensive medical check-ups, 418 who underwent examinations at the Tokyo Metropolitan Institute of Gerontology in both 2013 and 2015 and who met inclusion criteria were included in this study. Frailty was determined with the Kihon Checklist developed by the Japanese Ministry of Health, Labour and Welfare. The following three masticatory functions were evaluated: occlusal force, mixing ability and subjective chewing ability. The following confounding factors were investigated: age, sex, grip strength, comfortable walking speed, Mini-Mental State Examination (MMSE) score, Self-Rating Depression Scale (SDS) score, skeletal mass index (SMI), number of medications taken and number of remaining teeth. Statistical analysis was performed with binomial logistic regression analysis. RESULTS: Logistic regression analysis revealed that comfortable walking speed, SDS score, MMSE score and masticatory function were significantly related to progression to frailty or pre-frailty. Of the three masticatory function items evaluated, mixing ability and subjective chewing ability were related to frailty progression. CONCLUSION: Our results confirm that masticatory function was associated with the progression to pre-frailty or frailty among community-dwelling individuals 65 years and older over the 2-year period of this longitudinal study. Of the masticatory function items evaluated, mixing ability and subjective chewing ability were associated with frailty progression.

Factors affecting masticatory function of community-dwelling older people: Investigation of the differences in the relevant factors for subjective and objective assessment.

OBJECTIVE: This study aimed to examine relevant factors for subjective and objective assessment of masticatory functions and elucidate any differences between the two methods. BACKGROUND: Previous studies have reported that the results of subjective and objective assessment of masticatory function in older people do not necessarily agree. MATERIALS AND METHODS: This study included 487 community-dwelling Japanese older people (205 male and 282 female; mean age 74.1±6.3 years) who participated in a comprehensive geriatric health examination. Basic information (gender and age), higher level of competence in daily living, depression, subjective masticatory function (SMF) and objective masticatory function (OMF) assessments, cognitive function, skeletal muscle mass, handgrip strength, gait speed and oral status (number of remaining and functional teeth, mouth dryness and occlusal force) were recorded. RESULTS: Multiple logistic regression analysis showed that depression (odds ratio [OR]: 1.181, 95% confidence interval [CI]: 1.094-1.275), mouth dryness (OR: 2.037, CI: 1.212-3.423) and occlusal force (OR: 0.997, CI: 0.996-0.999) were significantly associated with SMF, whereas higher level of competence in daily living (OR: 0.730 CI: 0.586-0.910), skeletal muscle mass (OR: 0.521 CI: 0.283-0.960), number of functional teeth (OR: 0.862 CI: 0.775-0.959), number of remaining teeth (OR: 0.868 CI: 0.810-0.930) and occlusal force (OR: 0.994, CI: 0.991-0.998) were associated with OMF. CONCLUSION: Subjective masticatory functionSMF and OMF were associated with different factors, suggesting that both mental and physical factors should be taken into consideration when treating decreased masticatory function.