Qualitative analysis of the vocabulary used in work logs of a preventive programme for elderly oral function and nutrition.

BACKGROUND: In Japan, day care services for elders include programmes aimed at improving nutrition and oral and motor functions. Few studies have qualitatively assessed these interventions. OBJECTIVE: To qualitatively search for the characteristic words used in the work logs of a preventive programme on oral function and nutrition for elders by intervention period and intervention type． METHODS: We included 83 participants (81.3 ± 8.2 years) from four day care services in Japan and divided them into the following groups randomly: those who received oral function intervention only, nutritional intervention only and those who received combined oral function plus nutritional intervention. The interventions were conducted twice per month for 24 months. Data from handwritten work logs were entered into a computer as text files. Monitoring of frequently appearing words, co-occurrence analysis and cross-tabulation by intervention period and intervention types was conducted using text mining analysis. RESULTS: Correspondence analysis revealed that the words used during 1-6 months and 7-12 months were similar in participants' subjective content, and those used in objective content in 13-18 months and 19-24 months were similar. These results indicate that subjective improvements increased after 13 months, and it was maintained within 24 months. The combined intervention type is ideal for oral and nutrition problems. CONCLUSION: Because this text mining approach revealed the changes in the words used and could be used to monitor any subjective improvement, this approach may help evaluate the effects of preventive care.

Development of the Japanese version of the Council on Nutrition Appetite Questionnaire and its simplified versions, and evaluation of their reliability, validity, and reproducibility.

BACKGROUND: Because few Japanese questionnaires assess the elderly's appetite, there is an urgent need to develop an appetite questionnaire with verified reliability, validity, and reproducibility. METHODS: We translated and back-translated the Council on Nutrition Appetite Questionnaire (CNAQ), which has eight items, into Japanese (CNAQ-J), as well as the Simplified Nutritional Appetite Questionnaire (SNAQ-J), which includes four CNAQ-J-derived items. Using structural equation modeling, we examined the CNAQ-J structure based on data of 649 Japanese elderly people in 2013, including individuals having a certain degree of cognitive impairment, and we developed the SNAQ for the Japanese elderly (SNAQ-JE) according to an exploratory factor analysis. Confirmatory factor analyses on the appetite questionnaires were conducted to probe fitting to the model. We computed Cronbach's α coefficients and criterion-referenced/-related validity figures examining associations of the three appetite battery scores with body mass index (BMI) values and with nutrition-related questionnaire values. Test-retest reproducibility of appetite tools was scrutinized over an approximately 2-week interval. RESULTS: An exploratory factor analysis demonstrated that the CNAQ-J was constructed of one factor (appetite), yielding the SNAQ-JE, which includes four questions derived from the CNAQ-J. The three appetite instruments showed almost equivalent fitting to the model and reproducibility. The CNAQ-J and SNAQ-JE demonstrated satisfactory reliability and significant criterion-referenced/-related validity values, including BMIs, but the SNAQ-J included a low factor-loading item, exhibited less satisfactory reliability and had a non-significant relationship to BMI. CONCLUSIONS: The CNAQ-J and SNAQ-JE may be applied to assess the appetite of Japanese elderly, including persons with some cognitive impairment.

Feasibility of Oral Function Evaluation According to Dementia Severity in Older Adults with Alzheimer's Disease.

Oral function evaluation in older adults with dementia is important for determining appropriate and practical dietary support plans; however, it can be challenging due to their difficulties in comprehending instructions and cooperating during assessments. The feasibility of oral function evaluation has not been well studied. This cross-sectional study aimed to determine the feasibility of oral function evaluation in older adults with Alzheimer's disease (AD) according to Functional Assessment Staging of Alzheimer's Disease (FAST) stages. In total, 428 older adults with AD (45 men and 383 women; mean age: 87.2 ± 6.2 years) were included. Multilevel logistic regression models were used to examine the prevalence of participants who were unable to perform oral function evaluations, including oral diadochokinesis (ODK), repeated saliva swallow test (RSST), and modified water swallow test (MWST). In comparison to the reference category (combined FAST stage 1-3), FAST stage 7 was associated with the infeasibility of ODK (adjusted odds ratio, 95% confidence interval = 26.7, 4.2-168.6), RSST (5.9, 2.2-16.1), and MWST (8.7, 1.6-48.5, respectively). Oral function evaluation is difficult in older adults with severe AD. Simpler and more practical swallowing function assessments and indicators that can be routinely observed are required.

Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study.

Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.

Relationship between Mortality and Oral Function of Older People Requiring Long-Term Care in Rural Areas of Japan: A Four-Year Prospective Cohort Study.

Oral ingestion influences the life sustenance, quality of life, and dignity of older adults. Thus, it is an important issue in medical care and the welfare of older adults. The purpose of this four-year prospective cohort study was to investigate the relationship between mortality and oral function among older adults who required long-term care and were living in different settings in a rural area of Japan. This study included 289 participants aged 65 and older who required long-term care and lived in the former Omorimachi area in Yokote City, Akita Prefecture, located in northern Japan. Following the baseline survey, mortality data were collected over four years; 102 participants (35.3%) died during that time. A significant difference was noted in the overall survival rates between the groups with good and deterioration of oral function such as oral dryness, rinsing ability, swallowing function, and articulation, based on Log-rank test results. After adjusting for various potential confounders using Cox proportional-hazards regression, oral dryness (HR: 1.83, 95% confidence interval: 1.12-3.00) was significantly associated with mortality within four years. This study revealed that oral dryness influences the life prognosis of older adults who receive long-term care in different settings.

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.

Three-dimensional high-speed optical coherence tomography imaging of lamina cribrosa in glaucoma.

OBJECTIVE: To evaluate the appearance of the optic nerve head and lamina cribrosa in patients with glaucoma using spectral/Fourier-domain optical coherence tomography (SD-OCT) and to test for a correlation between lamina cribrosa thickness measured on SD-OCT images and visual field loss. DESIGN: Observational case series. PARTICIPANTS: We evaluated 52 eyes of 30 patients with glaucoma or ocular hypertension. METHODS: The high-speed SD-OCT equipment used was a prototype system developed for 3-dimensional (3D) imaging. It had a sensitivity of 98 decibels (dB), a tissue axial resolution of 4.3 mum, and an acquisition rate of approximately 18,700 axial scans per second. For 3D analyses, a raster scan protocol of 256 x 256 axial scans covering a 2.8 x 2.8 mm disc area was used. Lamina cribrosa thickness was measured on 3D images using 3D image processing software. Correlation between lamina cribrosa thickness and mean deviation (MD) values obtained using static automatic perimetry were tested for statistical significance. MAIN OUTCOME MEASURES: Clarity of lamina cribrosa features, lamina cribrosa thickness, and MD values on static automatic perimetry. RESULTS: On 3D images, the lamina cribrosa appeared clearly as a highly reflective plate that was bowed posteriorly and contained many circular areas of low reflectivity. The dots of low reflectivity visible just beneath the anterior surface of the lamina cribrosa in en face cross-sections corresponded with dots representing lamina pores in color fundus photographs. The mean (+/-1 standard deviation) thickness of the lamina cribrosa was 190.5+/-52.7 mum (range, 80.5-329.0). Spearman rank testing and linear regression analysis showed that lamina cribrosa thickness correlated significantly with MD (Spearman sigma = 0.744; P<0.001; r(2) = 0.493; P<0.001). Different observers performed measurements of the lamina cribrosa thickness in SD-OCT cross-sectional images with high reproducibility (intraclass correlation coefficient = 0.784). CONCLUSIONS: These 3D SD-OCT imaging clearly demonstrated the 3D structure of the lamina cribrosa and allowed measurement of its thickness, which correlated significantly with visual field loss, in living patients with glaucoma. This noninvasive imaging technique should facilitate investigations of structural changes in the optic nerve head lamina cribrosa in eyes with optic nerve damage due to glaucoma. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Oral function as an indexing parameter for mild cognitive impairment in older adults.

AIM: To investigate the association between mild cognitive impairment (MCI) and oral status, and to develop an oral-based screening index for MCI. METHODS: A cross-sectional study was carried out in a total of 5104 community-dwelling adults (aged ≥65 years) from the Obu Study of Health Promotion for the Elderly. Screening for MCI included a standardized personal interview, Mini-Mental State Examination, Geriatrics and Gerontology-Functional Assessment Tool (which included 8 tasks used to assess logical memory, word list memory, attention and executive function, processing speed, and visuospatial skill) and oral status. RESULTS: In our study, 930 individuals were diagnosed with MCI, whereas the remaining 2669 were not. Both men and women with MCI showed a significantly lower number of functional and present teeth, poorer oral diadochokinesis, and less palpation of masseter muscle tension (P < 0.01). Discriminant analysis of participants with MCI, between categories of pertinence and non-pertinence, showed significant associations for age, sex, educational background, handgrip strength, Geriatric Depression Scale score, Mini-Mental State Examination score, history of heart disease, albumin level and oral diadochokinesis representing oral motor skill. Although the diagnosis rate of our screening index for MCI was not high, it was in the acceptable range as a screening index. CONCLUSIONS: Oral motor skill, such as lip movement, might be impaired in patients with MCI. Detecting decreasing oral motor dexterity supports the early detection of MCI, and might be key to improve the prognosis of dementia. Geriatr Gerontol Int 2018; 18: 790-798.

Measurement of retinal nerve fiber layer thickness and macular volume for glaucoma detection using optical coherence tomography.

PURPOSE: To evaluate retinal nerve fiber layer (RNFL) thickness and macular volume in normal eyes and in the eyes of patients with glaucoma, and to compare the usefulness of these measurements in diagnosing glaucomatous eyes. METHODS: Eighty-one eyes were divided into three groups: normal control (n = 31), early glaucoma [n = 31, mean deviation (MD) >or= -6 dB], and advanced glaucoma (n = 19, MD < -6 dB). The RNFL thickness and macular volume were measured using Stratus OCT (optical coherence tomography). Then, the diagnostic power of these parameters was evaluated. RESULTS: In eyes with early glaucoma, RNFL thickness was decreased significantly in eight of the 12 peripapillary sectors, and macular volume was decreased significantly in six of the nine macular sectors, compared with normal eyes. In the advanced glaucoma eyes, RNFL and macular volume were decreased throughout, except in RNFL thickness in the papillomacular region, and in retinal thickness in the foveal region. The area under the receiver-operating characteristic curve (AUROC) of the average RNFL (0.963) was larger than the macular volume (0.919). CONCLUSIONS: Both peripapillary RNFL thickness and macular volume were decreased even in the early stage of glaucoma. Average RNFL thickness had greater diagnostic power than macular volume.

[Visual field defects in high myopic glaucoma compared with moderate myopic glaucoma].

PURPOSE: To demonstrate the visual field defects characteristic of high myopic glaucoma eyes. METHODS: Eighty-one high myopic glaucoma eyes (< or = -8 diopter(D)) and eighty moderate myopic glaucoma eyes(-3 D approximately -6 D) from patients under the age of 60 were enrolled in this study. Visual acuity, Mean Deviation (MD) of Humphrey visual field analyzer (HFA) central 30-2 program, and the pattern of central visual field defect especially at the early stage of glaucoma (MD > or = -10 dB) were compared between high and moderate myopic groups. RESULTS: HFA examination revealed significant differences in MD values between the high and moderate myopic groups (-11.8 +/- 8.9 dB and -8.4 +/- 6.9 dB, respectively, p = 0.02). Average logMAR visual acuity of the high myopic group was significantly worse than that of the moderate myopic group. The analyses of the pattern of visual field defects especially at an early glaucoma stage demonstrated that there was no specifically damaged area, such as cecocentral scotoma, in high myopic glaucoma subjects. The nasal upper area of the fixation point was the area most affected in both groups. CONCLUSIONS: High myopic glaucoma eyes demonstrated significantly lower MD and visual acuity compared to those of moderate myopic glaucoma eyes. However, at an early stage of glaucoma, no visual field defect characteristic of high myopia was observed.

Relationship Between Frailty and Oral Function in Community-Dwelling Elderly Adults.

OBJECTIVES: To determine the standard values of and age-related changes in objective oral function of healthy older people; compare oral function of robust, prefrail, and frail older people; and determine the association between oral function and frailty. DESIGN: Cross-sectional analysis. SETTING: General community. PARTICIPANTS: Elderly adults (≥65) from the Obu Study of Health Promotion for the Elderly were included and assigned to the robust, prefrail, and frail groups (N = 4,720). MEASUREMENTS: Each participant underwent detailed physical testing to assess frailty. The frailty phenotype was defined according to the presence of limitations in three or more of the following five domains: mobility, strength, endurance, physical activity, and nutrition. The numbers of present teeth and functional teeth were counted, and occlusal force, masseter muscle thickness, and oral diadochokinesis (ODK) rate were measured, along with sociodemographic and functional status, comorbidities, and blood chemistry. RESULTS: The number of present teeth, occlusal force, masseter muscle thickness, and ODK rate decreased with age. The frail group had significantly fewer present teeth (women aged ≥70), lower occlusal force (women aged ≥70; men aged ≥80), lower masseter muscle thickness, and lower ODK rate than the robust group. Multivariate analysis indicated that age, Geriatric Depression Scale score, skeletal muscle mass index, Mini-Mental State Examination score, hypertension, diabetes mellitus, albumin and triglyceride levels, and oral function were significantly associated with frailty. CONCLUSION: Age-related differences in oral function were found in older adults. Moreover, frail older individuals had significantly poorer oral function than prefrail and robust individuals. The risk of frailty was associated with lower occlusal force, masseter muscle thickness, and ODK rate.

Scanning laser polarimetry with variable corneal compensation and optical coherence tomography in tilted disk.

PURPOSE: To determine whether scanning laser polarimetry with variable corneal compensation (GDx-VCC) or optical coherence tomography (OCT) is helpful for the analysis of the retinal nerve fiber layer (RNFL) thickness in glaucoma subjects with tilted disk. DESIGN: Retrospective case-control study. METHODS: We included 21 glaucomatous eyes with tilted disk and 35 glaucomatous eyes without tilted disk. Peripapillary RNFL thickness measurement by GDx-VCC and OCT, and also visual field testing with a Humphrey Field Analyzer program 30-2 (HFA) were performed in all subjects. RESULTS: In the group without tilted disk, the RNFL thickness values obtained with GDx-VCC and OCT analysis had a good correlation with mean deviation (MD), and clearly showed stage-dependent reduction. Conversely, in the group with tilted disk, a discrepancy in the RNFL measurement between GDx-VCC and OCT was observed. The correlation of RNFL measurement to the visual field was further examined at each hemifield (superior and inferior). In the group without tilted disk, the measurements of both instruments at each hemifield were in good correlation with the mean pattern deviation values. However, in the group with tilted disk, the GDx-VCC derived values did not correlate with the visual field defect in both hemifields, whereas OCT was in good association with both mean pattern deviation values. Infrared images acquired with a wavelength of nearly 780 nm revealed a high reflex from the sclera in the tilted disk. CONCLUSIONS: Our study has suggested that RNFL analysis by OCT is more suitable for the glaucoma assessment in the tilted disk compared with GDx-VCC.

Factors associated with older adults' need for oral hygiene management by dental professionals.

AIM: The aim of the present study was to assess the need for oral hygiene management by dental professionals among older adults requiring long-term care, and to collect basic data for building a dental treatment framework on a regional level. Although healthcare providers are aware of the importance of oral care for older adults requiring long-term care, reports claim that the provision of oral care is insufficient, and a framework is being built for the provision of oral hygiene management by dental professionals. METHODS: A survey on lifestyle and oral health was carried out on 372 older adults requiring long-term care in one town in Japan. Binomial logistic regression analysis was carried out to assess factors affecting the need for oral hygiene management. RESULTS: A total of 66.1% of participants required oral hygiene management. The Barthel Index, Clinical Dementia Rating, oral hygiene status and other factors differed significantly with the presence or absence of oral hygiene management need. In addition to variables related to oral hygiene status (dental plaque and tongue coating), factors that significantly affected oral hygiene management need included the Clinical Dementia Rating (odds ratio 2.63, 95% confidence interval 1.08-6.41). CONCLUSIONS: The results of the present study suggest that the need for oral hygiene management by dental professionals increases as dementia advances. However, current systems that provide regional dental care are structured based on the level of care need and the degree of independence. A dementia perspective needs to be added to these systems. Geriatr Gerontol Int 2016; 16: 956-962.