Serum levels of vitamin D and periodontal inflammation in community-dwelling older Japanese adults: The Otassha Study.

AIM: To evaluate the association between vitamin D status and periodontal inflammation as determined by the periodontal inflamed surface area (PISA) in community-dwelling older adults. MATERIALS AND METHODS: This cross-sectional study included 467 Japanese adults (mean age = 73.1 years) who underwent full-mouth periodontal examinations and measurements of serum levels of 25-hydroxyvitamin D (25(OH)D). We used linear regression and restricted cubic spline models to analyse the association between exposure (serum 25(OH)D) and outcome (PISA). RESULTS: The linear regression model showed that, after adjusting for potential confounders, participants in the lowest quartile of serum 25(OH)D had 41.0 mm2 more PISA (95% confidence interval [CI]: 4.6-77.5) than the reference group (the highest quartile of serum 25(OH)D). The spline model showed that the association between serum 25(OH)D and PISA was non-linear and restricted to the low 25(OH)D range. PISA initially sharply decreased as serum 25(OH)D increased, and then the decreasing trend slowed and plateaued. The inflection point with the minimum PISA value was a serum 25(OH)D level of 27.1 ng/mL, above which there was no decreasing trend in PISA with increasing serum 25(OH)D levels. CONCLUSIONS: Low vitamin D status had an L-shaped association with periodontal inflammation in this cohort of Japanese adults.

Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial.

INTRODUCTION: Oral frailty describes a trivial decline in the oral function and is considered to be related to frailty. Thus, effective management of oral frailty could prevent or ameliorate physical frailty and the need for care. However, there is a lack of consensus regarding specific interventions for oral frailty. In this cluster-randomized controlled trial, we investigated the effects of a newly developed oral frailty measures program mentored by dentists and dental hygienists for elderly people in a clinical setting. METHODS: Of 3,296 participants included in a field survey, 219 who regularly visited dental clinics and met at least 3 of the following 6 criteria for oral frailty were considered eligible: <20 natural teeth, decreased chewing ability, decreased articulatory oral-motor skills, decreased tongue pressure, and substantial subjective difficulties in eating and swallowing. After applying the inclusion and exclusion criteria, we studied 51 patients in the intervention group (14 men and 37 women; mean age, 78.6 years) and 32 patients in the control group (7 men and 25 women; mean age, 78.0 years). We implemented a 12-week oral frailty measures program only for the intervention group. The program included preparatory oral exercises, mouth-opening training, tongue pressure training, prosodic training, and masticatory training. Primary outcome measures were the chewing ability score, articulatory oral motor skill for /ta/, tongue pressure, subjective difficulty in eating tough foods, and subjective difficulty in swallowing. We compared baseline characteristics using the Mann-Whitney U and χ2 tests for continuous and categorical variables, respectively. A repeated-measures two-way ANOVA was used to determine the efficacy of independent intervention variables, following the Wilcoxon signed-rank test. The groups (intervention/control) and time (baseline/week 12) were the independent variables. Oral frailty measures were the dependent variables. RESULTS: Baseline characteristics and assessment results were similar between groups. We observed significant improvements in the intervention group in terms of articulatory oral motor skill for /ta/ and tongue pressure (p < 0.001). No improvements were observed in the control group. DISCUSSION/CONCLUSION: Our results suggest that our oral frailty measures program effectively alleviates oral frailty. Future studies are needed to clarify the impact on preventing physical frailty and improving the nutritional status.

Association between dry mouth and physical frailty among community-dwelling older adults in Japan: The Otassha Study.

OBJECTIVE: To elucidate the relationship between physical frailty and dry mouth among community-dwelling older adults in Japan. BACKGROUND: Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty. MATERIALS AND METHODS: This cross-sectional study included 643 individuals (mean age, 73.9 years) from the Otassha Study in 2019. Xerostomia was assessed using the 5-item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation. RESULTS: Among the participants, 4.5% and 49.8% had physical frailty and pre-frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one-point increase in SXI, 1.12; 95% confidence interval, 1.06-1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty. CONCLUSION: Xerostomia is associated with physical frailty among community-dwelling older adults in Japan. CLINICAL TRIAL REGISTRATION: Not applicable.

Oral hypofunction and malnutrition among community-dwelling older adults: Evidence from the Otassha study.

OBJECTIVE: This study investigated the association between oral hypofunction and malnutrition among community-dwelling older adults. BACKGROUND: Oral hypofunction, a 7-component phenotype of the clinical features of oral health, has been described in Japan. Data about its association with nutritional status are limited. MATERIALS AND METHODS: This cross-sectional study enrolled 715 adults (mean age, 73.5 years; range, 65-91 years) from the Otassha Study. Oral hypofunction was defined as the presence of ≥3 of the following 7 components: poor oral hygiene; oral dryness; low occlusal force; low articulatory oral motor skill; low tongue pressure; low masticatory performance; and compromised swallowing function. The Mini Nutritional Assessment® -Short Form (MNA® -SF) was used to assess the nutritional status. Malnutrition was defined as having an MNA® -SF score of seven or less. The association between oral hypofunction and nutritional status was evaluated using ordinal logistic regression analyses. RESULTS: The prevalence rates of oral hypofunction and malnutrition were 42.7% and 4.1%, respectively. Multivariable Poisson regression analyses revealed that oral hypofunction was associated with malnutrition. The adjusted relative risk of malnutrition in the study participants with oral hypofunction was 3.00 with a 95% confidence interval of 1.29-6.98. CONCLUSION: Community-dwelling older adults whose oral functions were compromised in multiple aspects had poor nutritional status.

[Association between issues in activities and psychosocial health status in the social positions of older residents' community-based activities: a cross-sectional study].

Objectives　When local governments and community nurses provide support for community-based activities led by older residents, it is imperative to reduce the burden of participants in leadership positions. This study aimed to identify the issues associated with the activities by social position, such as leadership, support, and regular participation, to discuss effective support for community-based activities and to examine the association between social position, relating issues, and psychosocial health.Methods　Participants in community-based activities were recruited by the local government in Tokyo, Japan. Overall, 2,367 people from 155 activity groups from 40 municipalities responded. Social positions in the groups were defined as leaders who manage activities; supporters who support leaders; and regular members who do not have any specific role. The participants chose the issues of community-based activities from 10 items. Psychosocial health was measured by the WHO-5 well-being index (WHO-5) and Lubben social network scale-6 (LSNS-6). The relationship between recognition of issues and social positions were examined by the chi-square test. Interaction effects of social positions and issues (with or without) on the WHO-5 and LSNS-6 were investigated using a two-way analysis of covariance.Results　The final sample comprised 2,096 respondents: 174 leaders, 296 supporters, and 1,626 regular members. There was a significant association between recognition of social positions and issues in the groups: respondents who reported no issues in the activities comprised 8.6% of the leaders, 27.7% of the supporters, and 53.6% of the regular members (P<0.001). There was a large difference in recognition between roles for issues related to group management, such as the lack of management members. There was no significant interaction between these issues and social positions in either WHO-5 or LSNS-6 (P=0.729, P=0.171, respectively). The main effect of the social positions was significant in both analyses (P<0.001). The leaders and supporters showed significantly higher WHO-5 and LSNS-6 scores than regular members.Conclusion　The issues that the participants reported differed by social positions in activities. It may be effective to provide support according to the difficulty of sharing issues within the group. Regardless of whether or not the participants report issues, leaders and supporters had improved psychosocial health than regular members. The study concludes that organizational position in community-based activities may offer health benefits for older adults.

Interrelationships among whole-body skeletal muscle mass, masseter muscle mass, oral function, and dentition status in older Japanese adults.

BACKGROUND: Generalized loss of skeletal muscle mass (SMM) may modulate or otherwise affect the loss of masseter muscle mass and be responsible for low masseter muscle performance and strength (i.e., low oral function). Moreover, dentition status can affect oral function independent of the muscle state. This cross-sectional study aimed to simultaneously investigate the relationships among whole-body SMM, masseter muscle mass, oral function (masseter muscle performance and strength), and dentition status in 1349 Japanese adults (mean age = 73.6 years). METHODS: We determined the estimated masseter muscle mass (e-MMM) based on morphological measurements of the masseter muscle. Masseter muscle performance was assessed via masticatory performance evaluation scores using gum, and strength was assessed as the maximal occlusal force. Dentition status was assessed as the number of functional teeth. SMM was measured by bioelectrical impedance analysis. Structural equation modeling stratified by sex was employed to investigate associations among SMM, e-MMM, gum score, occlusal force, and number of functional teeth. RESULTS: The direct path from SMM to e-MMM was statistically significant, as was the direct path from e-MMM to oral function (gum score and maximum occlusal force) for both sexes. We additionally confirmed that SMM indirectly affected gum score and maximum occlusal force via e-MMM (men; standardized coefficient [95% CI] = 3.64 [1.31 to 5.96] for maximum occlusal force and 0.01 [0.01 to 0.02] for gum score, women; 2.01 [0.38 to 3.81] for maximum occlusal force and 0.01 [0.002 to 0.01] for gum score). The number of functional teeth had direct effects on e-MMM, gum score, and maximum occlusal force. CONCLUSIONS: Low SMM was significantly indirectly associated with poor oral function through a low masseter muscle mass, and dentition status was independently associated with oral function.

The effect of multimodal comprehensive care methodology training on oral health care professionals' empathy for patients with dementia.

BACKGROUND: The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. METHODS: This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants' empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). RESULTS: The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. CONCLUSIONS: The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals' empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687 . Registered 4 September 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586.

[Effective support based on length of participation for community-based activities led by older residents].

Objectives　Community-based activities led by older residents are important in preventing long-term care and enhancing social participation among older persons in Japan. Local governments and community nurses are required to support these activities. However, there is no knowledge about the issues of residents who participate in community-based activities, which is essential for the effective support of community-based activities. We aimed to examine the association between the length of participation and recognized issues among community-based activities.Methods　Through the local governments in Tokyo, we recruited participants from community-based activity groups; 2,367 people from 155 activity groups from 40 municipalities responded. The presence or absence of 10 items of recognized issues, such as lack of management members and lack of teachers, were examined. The number of years of participation in the activity was divided into four groups: "less than 1 year," "more than 1 year and less than 2 years," "more than 2 years and less than 4 years," and "more than 4 years." Logistic regression analysis was conducted to examine the association between the length of participation and recognized issues.Results　The number of analyzed respondents was 2,194 (14.5% were male and the average age was 76.9 years). Compared to "less than 1 year" group, the "more than 2 years and less than 4 year" group recognized "aging of group" (OR=1.92), "lack of management members" (OR=1.61), and "health condition of participants" (OR=1.47) as issues. In the "more than 4 years" group, "aging of group" (OR=3.24), "lack of management members" (OR=2.63), "lack of participants" (OR=2.12), "health condition of participants" (OR=1.95), "mannerism of activities" (OR=1.62), and "lack of place" (OR=1.48) were recognized as issues.Conclusion　Issues recognized by participants in community-based activities differed depending on the number of years they had been participating in the activity. This suggests that it is necessary to provide appropriate support taking the length of participation into account. For example, the issue of the "health condition of participants" was recognized by participants who had been participating in the activity for approximately two years. Consequently, "lack of participants" may have occurred in participants who have been participating in the activity for four years. Therefore, promoting the health management of participants from the early phase of community-based activity would be effective in preventing dropout.

[The oral function of community-dwelling older adults complaining of an oral function deterioration: An examination using the oral function-related items of the Questionnaire for Latter-stage Elderly People].

AIM: The oral function-related items of the newly developed "Questionnaire for Latter-stage Elderly People" are based on two items of the Kihon checklist assessing the masticatory and swallowing functions. In this study, we estimated the questionnaire's application rate and investigated the oral function of the respondents. METHODS: Included were 699 older adults (274 men/425 women, average age, 73.4±6.6 years old). Those who responded positively to the related items were considered to have decreased swallowing and masticatory functions. The specific oral function was assessed based on the number of present and functional teeth; oral hygiene; oral moisture; occlusal force; oral diadochokinesis /pa/, /ta/, /ka/; tongue pressure; mixing ability; shearing ability; and Eating Assessment Tool (EAT)-10 (reference, score ≥3). RESULTS: The rates of decreased masticatory and swallowing functions were 21.5% and 26.6%, respectively, while 7.4% of participants had both. Those with a decreased masticatory function showed fewer present teeth; a lower occlusal force, oral diadochokinesis /pa/, mixing ability, shearing ability, and higher EAT-10 scores.Those with a decreased swallowing function only had higher EAT-10 scores. In the early- and latter-stage elderly, the decreased masticatory function rates were 15.6% and 29.4%, respectively, the decreased swallowing function rates were 27.8% and 25.0%, respectively, and the rates of both decreased masticatory and swallowing functions were 6.0% and 9.5%, respectively. CONCLUSION: The older adults who responded positively to the related questionnaire items, especially for items related to masticatory function, had a decreased oral function in multiple respects. The items related to the oral function in the Questionnaire for Latter-stage Elderly People are considered useful for identifying older adults with a decreased oral function.

[Relationship between the rate of a decreased oral function and the nutrient intake in community-dwelling older persons: An examination using oral function-related items in a questionnaire for latter-stage elderly people].

AIM: To determine the rate of a decreased oral function using questions from the Kihon checklist corresponding to the Questionnaire for Latter-stage Elderly People and to clarify nutrient intake in older persons. METHODS: This study targeted 511 older people (217 men, 294 women, average age 73.1±5.6 years old). Their oral function was evaluated using questions on the masticatory function and swallowing function from the Kihon checklist, corresponding to questions on the oral function in the Questionnaire for Latter-stage Elderly People. Participants who had at least one symptom measured were defined as the applicable group (AG). In addition, to evaluate the nutrient intake of the participants, interviews were conducted using the Food Frequency Questionnaire Based on Food Groups. RESULTS: The rate of inclusion in the AG was 32.9% for the total sample, 28.2% for early-stage elderly people, and 40.1% for latter-stage elderly people. The AG rates did not differ significantly between men and women. For latter-stage elderly people, the protein-energy ratio and intakes of total energy, protein, pantothenic acid, folic acid, vitamin B6, niacin, vitamin K, copper, zinc, phosphorus, magnesium, potassium, and total dietary fiber were significantly lower in the AG than in the non-AG. CONCLUSION: The evaluation of placement in the AG through questions on the oral function from the Kihon checklist corresponding to the Questionnaire for Latter-stage Elderly People demonstrated that the rate of a decreased oral function was higher in latter-stage elderly people than in early-stage elderly people. In addition, the latter-stage elderly people in the AG had a lower nutrient intake.

Association between anorexia and hyposalivation in community-dwelling older adults in Japan: a 6-year longitudinal study.

BACKGROUND: Hyposalivation is associated with the nutritional status. Anorexia of ageing, defined as an age-related decrease in appetite and food intake, presents even in healthy adults and is considered an independent predictor of malnutrition, frailty, and mortality. However, the relationship between anorexia and hyposalivation of ageing is unclear. Thus, the present longitudinal study aimed to investigate the incidence of hyposalivation and its relationship with anorexia in community-dwelling older people in Japan. METHODS: The study population comprised 220 individuals (80 men and 140 women) aged 65-86 years at baseline. The participants underwent comprehensive health check-ups, including dental examinations and anthropometry, and face-to-face interviews in 2013 and 2019. Hyposalivation was determined on the basis of the unstimulated salivary flow rate measured using the modified cotton roll method. Anorexia was defined as a score of ≤29 in the Japanese version of the Council on Nutrition Appetite Questionnaire. Logistic regression analyses were used to test whether the presence of anorexia at baseline was an independent predictor of hyposalivation. RESULTS: Hyposalivation developed at a rate of 19.5% during the 6-year observation period. Anorexia was observed in 95 (43.2%) participants at baseline. After adjusting for potential confounding factors, anorexia (adjusted odds ratio [AOR], 2.65; 95% confidence interval [CI], 1.26-5.57) and polypharmacy (AOR, 3.29; CI, 1.06-10.19) were significant predictors of hyposalivation. CONCLUSION: Loss of appetite is independently correlated with and a risk factor for hyposalivation in older adults. Anorexia of ageing may have negative effects on the salivary flow rate in such settings. Salivation should be a standard feature in clinical assessments of the older adults.

Development of a simple method to measure masseter muscle mass.

OBJECTIVE: To develop a simple method to estimate masseter muscle mass. BACKGROUND: The masseter muscle is important for optimal oral function. A decrease in the masseter muscle mass may affect the oral and physical function of the whole body; therefore, it is an important entity to measure. However, to date, no easy measurement method has been developed for the same. Herein, we devised a simple method to estimate masseter muscle mass. In addition, we compared our method with magnetic resonance imaging (MRI) and skeletal muscle mass (SMM) to verify its validity. MATERIALS AND METHODS: We recorded the age, sex, masseter muscle mass (by MRI), number of retained natural teeth, number of functional teeth, length and thickness of masseter muscle, and skeletal muscle mass in 53 community-dwelling elderly people (21 men and 32 women, average age 72.9 ± 4.5 years). The estimated masseter muscle mass was calculated by multiplying the length, width and thickness of the muscle. RESULTS: The correlation coefficient between masseter muscle mass and estimated masseter muscle mass was r = .903; thus, a strong correlation was recognised. The correlation coefficient between the estimated masseter muscle mass and SMM was r = .279, considering age and sex. CONCLUSION: We obtained substantial results using our method for estimating the masseter muscle mass and verified its validity by comparing it with masseter muscle mass measured by MRI and SMM. We believe that our proposed technique is simple and useful for estimating masseter muscle mass.

Rate of oral frailty and oral hypofunction in rural community-dwelling older Japanese individuals.

OBJECTIVE: To clarify the rate of oral frailty and oral hypofunction in rural community-dwelling older adults in Japan. BACKGROUND: Recently, the oral function of Japanese older adults has been evaluated multilaterally based on two concepts: oral frailty and oral hypofunction. Oral frailty is defined as a decrease in the oral function accompanied by a decrease in mental and physical functions. Oral hypofunction is a disease where the oral function is comprehensively decreased. However, their rates have not yet been elucidated. MATERIALS AND METHODS: Oral frailty and oral hypofunction were evaluated in 679 older adults from rural areas. To investigate the differences in occurrence rates due to the evaluation methods, one of the subordinate symptoms of oral hypofunction, the reduced occlusal force, was evaluated based on both the occlusal force (main method) and the number of teeth (alternative method). RESULTS: The rate of oral frailty was 22.3% in men and 22.7% in women. The rate of oral hypofunction was 39.0% in men and 46.9% in women. The overall rate of oral hypofunction was 43.6% when the reduced occlusal force of oral hypofunction was evaluated using the main method and 46.4% when evaluated using the alternative method. The proportion of participants with decreased occlusal force, the number of present teeth, oral diadochokinesis, tongue pressure and masticatory performance increased with age in both men and women. CONCLUSION: Among rural community-dwelling older adults, the rate of oral frailty was 22.5% and that of oral hypofunction was 43.6%.

Validity of a visual scoring method using gummy jelly for evaluating chewing efficiency in a large-scale epidemiological survey.

BACKGROUND: Several methods exist for objectively evaluating chewing efficiency by using gummy jelly. However, the validity of the subjective visual evaluation of chewing efficiency has not been assessed. OBJECTIVE: To verify with an epidemiological study, the validity of a visual scoring method using gummy jelly by testing the relationship between masticatory performance (MP) using a fully automatic measuring system and visual score (VS) using a visual scoring method. METHODS: Community-dwelling elderly individuals (n = 1234) ≥70 years old participated. One evaluator measured VS consecutively after participants chewed the gummy jelly (ie, actual-VS). The chewed jelly was photographed. Two evaluators used the photograph to measure the gummy jelly (ie, photo-VS). To test the validity of both methods, the correlation between actual-VS and MP and between photo-VS and MP were analysed. Inter-rater reliability between the evaluators of photo-VS was analysed. RESULTS: Significant correlations existed between actual-VS and MP and between photo-VS and MP (r = 0.86-0.87; P < 0.001). The intra-class correlation coefficient of the inter-rater reliability for photo-VS was very high (0.93; P < 0.001; 95% confidence interval: 0.877-0.953); however, the distribution of photo-VS deviated slightly from the actual-VS. A large coefficient of variation in the MP for low VSs suggested the influence of incomplete comminution, which was not reflected by the VS, and the accidental swallowing of small pieces during chewing. CONCLUSION: The VS deviated slightly from the MP calculated using a fully automated method; however, the VS can be utilised for epidemiological surveys with numerous participants.

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.

Oral function and nutritional status among the elderly with facial and oral tactile hypersensitivity who are under long-term care.

Objective　In oral health care, a refusal action can cause difficulties, and tactile hypersensitivity (TH) may be a contributing factor. People with TH of the face and mouth clench their jaws. Despite numerous reports on TH among children with disabilities, reports on TH in the elderly who are under long-term care are scarce. The purpose of this study was to investigate TH among the elderly who are under long-term care.Methods　We selected 80 residents (8 men and 72 women; mean age: 91.1±6.2y) in a Tokyo nursing home and investigated the presence of TH in them. We also obtained patients' (1) basic information (sex, age, stage of long-term care needs (SCN), and the degree of independent living (IL)); (2) oral information (swallowing status, choking tendency, and intraoral residue); and (3) nutritional information (serum albumin (Alb) levels and body mass index (BMI)). We assessed the face (the forehead, cheek, and perioral area) and the intraoral environment (buccal mucosa, buccal cavity, and palate) as testing sites for TH, using the tester's palm and forefinger. We confirmed the presence of TH when the tested areas reacted partially or fully by shuddering. We classified the subjects into 2 groups based on the presence or absence of TH and analyzed our results using a chi-square test and Mann-Whitney U test. This investigation was approved by the Dentistry Ethics Screening Committee, Tokyo Medical and Dental University.Results　A total of 18 residents were diagnosed with TH (22.5%). Significant differences in SCN, IL, choking tendency, intraoral residue, swallowing status, serum Alb levels, and BMI (P<0.05) were reported between this group and the non-TH group.Conclusion　We demonstrated that residents with TH were in an advanced SCN and had a lower IL score and a decreased swallowing and nutritional status. Therefore, oral health care, promotion of nutritional status, and meal support are particularly important for the elderly with TH.

Relationship between a gum-chewing routine and oral, physical, and cognitive functions of community-dwelling older adults: A Kashiwa cohort study.

AIM: As associations between oral function and general health have been reported in community-dwelling older adults, easily implementable preventive measures are urgently required. We focused on the health benefits of gum chewing, as no studies have been carried out on the impact of gum-chewing routines on the health of older adults. This cross-sectional study aimed to determine whether the gum-chewing routine is associated with oral, physical and cognitive functions in community-dwelling older adults. METHODS: This study included 1617 community-dwelling older participants in a health survey carried out in 2021. The gum-chewing routine and weekly chewing time were assessed using a self-administered questionnaire. The outcome measures, including actual measurements of oral function, physical function, cognitive function, dietary intake and lifestyle, were evaluated using self-administered questionnaires or health surveys. RESULTS: We analyzed 1474 (mean age 76.1 ± 5.8 years, 45% women) participants for whom all data were not missing, and 14% of them had a gum-chewing routine for more than 30 min weekly. Oral functions were significantly higher in older adults with a gum-chewing routine, and there were substantially fewer participants with oral frailty (adjusted odds ratio 0.581, 95% confidence interval 0.340-0.993). Additionally, cognitive and physical functions, including grip strength, were significantly higher in the gum-chewing routine group. CONCLUSIONS: Community-dwelling older adults with a gum-chewing routine have higher oral, physical and cognitive functions. These findings indicate that a gum-chewing routine might contribute to maintaining oral function and preventing frailty. Geriatr Gerontol Int 2024; 24: 68-74.

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.

Prevalence of oral frailty and its association with dietary variety, social engagement, and physical frailty: Results from the Oral Frailty 5-Item Checklist.

AIM: This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty. METHODS: We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score ≤3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score ≥3). RESULTS: A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94). CONCLUSIONS: Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. Geriatr Gerontol Int 2024; 24: 371-377.

Serum albumin redox state as an indicator of dietary protein intake among community-dwelling older adults.

BACKGROUND AND AIMS: Serum markers capable of detecting mild levels of undernutrition, such as insufficient dietary protein intake (IDPI), have not been established among community-dwelling older adults. Although the serum albumin redox state, expressed as the ratio of reduced albumin (Alb) to total Alb (the reduced albumin ratio), has the potential to overcome this challenge, empirical epidemiological data are lacking. This study aimed to investigate the association between a serum reduced Alb ratio and dietary protein intake among community-dwelling older adults. METHODS: This study analyzed cross-sectional data from 1,005 community dwelling population (572 males and 433 females) aged 70-84 years who participated in the Itabashi Longitudinal Study on Aging. Exclusion criteria included participants with incomplete data, individuals with a history of kidney disease and high C-reactive protein (CRP) levels. The dietary protein intake was estimated using validated food frequency questionnaires. The IDPI was defined as not meeting the level recommended by the Dietary Reference Intakes for Japanese (Men ≥60 g/day, Women ≥50 g/day). RESULTS: IDPI was observed in 14.1% of the study population. Logistic regression analyses adjusted for sex, age, body weight and malnutrition showed that a serum reduced Alb ratio was significantly associated with IDPI (odds ratio = 0.962, 95% confidence interval = 0.926-0.999), whereas serum albumin concentration was not (odds ratio = 0.549, 95% confidence interval = 0.285-1.061). CONCLUSIONS: A serum reduced Alb ratio would be a useful indicator of protein insufficiency among community-dwelling older adults.