Lip-closing function of elderly people during ingestion: comparison with young adults.

In this study the relationship between the functional vertical labial pressure and aging during ingestion in the elderly is examined. The subjects were 84 community-dwelling elderly (mean: 79.4 years old), 109 elderly needing long term care (mean: 81.3 years old), and 59 healthy young adults (mean: 32.0 years old) as control. Labial pressure was measured with a pressure sensor embedded in acrylic plate. There was no correlation between age and labial pressure or the coefficient of variation of labial pressure during ingestion. In people with a history of "choking on food", labial pressure was, however, significantly lower (p < 0.01) than people without a history of "choking on food", while the coefficient of variation of labial pressure was significantly higher (p < 0.05). Poor labial pressure and movement were noted in subjects who experienced "choking on food", suggesting that lip-closing function also plays an important role in the pharyngeal stage of feeding/swallowing. On the other hand, the coefficient of variation of labial pressure during ingestion was not changed in the elderly group in comparison to the control group. These results showed that skilled movement of lip-closing might be compensated by labial pressure. Labial pressure and skilled movement were, however, decreased in the elderly needing care because of "choking on food".

[Relation between the level of care needed and frailty for labial functions].

AIM: The purpose of this study was to examine whether the improvement of oral functions could prevent increase in the level of care needed in the elderly by analyzing the relationship between the level of care needed and labial functions. METHODS: The subjects were 114 elderly people who were healthy or needing care (44 men, 70 women; average age 81.3 +/- 6.3 years), all of whom maintained posterior occlusal support with their natural dentition and had no defect in front teeth. They were divided into four groups; Group 1: healthy elderly, Group 2: elderly requiring assistance or Care Category 1, Group 3: elderly requiring Care Categories 2 and 3, Group 4: elderly requiring Care Categories 4 and 5, according to the classification of certification of eligibility for long-term care by the Japanese Ministry of Health, Labor and Welfare. Water-repellent pressure sensors (PS-2KA, Kyowa Electric Co, Japan) were embedded in an acrylic plate. The device was used to measure the labial-closing pressure during 1-gram yogurt ingestion, the maximum labial pressure with effort and the reserve capacity of pressure. Drooling of food as feeding/swallowing dysfunction of the subjects was surveyed. RESULTS: 1) The mean value of labial pressure with effort was 296.4 +/- 153.9 Pa, and that of the reserve capacity of labial pressure was 209.6 +/- 152.3 Pa. They showed significant declines in accordance with the aggravation level of needing care (p < 0.01). 2) The labial pressure with effort and the reserve capacity of pressure in subjects who showed drooling of food symptom were significantly lower compared to those who showed no drooling of food symptom (p < 0.05). CONCLUSION: Labial functions declined in accordance with the increased level of care needed, and a relationship between drooling of food and labial-closing pressure was recognized. It was suggested that the improvement of labial functions might prevent increased need of care.

[Effect of oral function on nutritional improvement in nursing home residents].

The objective of this study is to examine how occlusal status and swallowing function influence the nutritional improvement achieved by appropriate feeding assistance in the institutionalized elderly. We studied 38 residents (mean age 82.04 +/- 7.35 years) in a nursing home. Their nutritional status was evaluated by biochemical analysis, and the following results were obtained: 1) Compared to the levels before intervention, there was a significant increase (p<0.05) after 6 months in serum albumin (3.65 +/- 0.32 g/dl before and 3.77 +/- 0.33 g/dl after assistance), HDL cholesterol (49.39 +/- 13.39 mg/dl before and 53.44 +/- 11.27 mg/dl after assistance), and hemoglobin (11.39 +/- 1.76 g/dl before and 11.75 +/- 1.75 g/dl after assistance) respectively. 2) Among the edentulous elderly, the change in serum albumin was more significant in the subgroup of elderly wearing dentures (3.64 +/- 0.35 g/dl before and 3.92 +/- 0.40 g/dl after assistance). 3) The serum albumin was significantly lower (p<0.05) in the group of people with swallowing disorders before intervention than the group of people with normal swallowing function (those with swallowing disorder 3.48 +/- 0.31; those with normal swallowing function 3.75 +/- 0.29 g/dl), but it did not change significantly after intervention. These results suggested that occlusal support with dentures greatly influences the nutritional intake and appropriate feeding assistance could achieve nutritional improvements for elderly with reduced swallowing function.

Oral care reduces pneumonia in older patients in nursing homes.

OBJECTIVES: Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people. DESIGN: Survey. SETTING: Eleven nursing homes in Japan. PARTICIPANTS: Four hundred seventeen patients randomly assigned to an oral care group or a no oral care group. INTERVENTION: Nurses or caregivers cleaned the patients' teeth by toothbrush after each meal. Swabbing with povidone iodine was additionally used in some cases. Dentists or dental hygienists provided professional care once a week. MEASUREMENTS: Pneumonia, febrile days, death from pneumonia, activities of daily living, and cognitive functions. RESULTS: During follow-up, pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care. Oral care was beneficial in edentate and dentate patients. Activities of daily living and cognitive functions showed a tendency to improve with oral care. CONCLUSION: We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes.