Dysphagia and Masticatory Performance as a Mediator of the Xerostomia to Quality of Life Relation in the Older Population

Abstract

Background: The impact of poor oral health in older adults affecting their quality of life is a public health problem. This study assessed the mediating effects of dental status, occlusal condition, dysphagia and masticatory performance on the association between xerostomia and oral health-related quality of life (OHRQoL) in the older population. Methods: Stratified cluster sampling method was used to recuit 1100 community-dwelling adults aged 65 years and older from Kaohsiung, Taiwan. Community care centers were randomly selected based on their geographic classifications (urban, rural, and mountainous areas). Assessments of dental status and occlusal condition were performed by dentists. Information on demographics, physical function, xerostomia dysphagia and depression was collected using face-to-face interview. Masticatory performance was evaluated using color-changeable chewing gum. OHRQoL was measured using Geriatric Oral Health Assessment Index. Hierarchical regression models were utilized to assess the relationship between OHRQoL and physical function, dental status and oral function in older adults. Path analysis was used to estimate direct and indirect pathways between xerostomia and OHRQoL.Results: Participants with xerostomia had a 0.17 OHRQoL reduction (p< .001) comparing to the non-xerostomia, and the direct effect was accounted for 85.0% of the total effect. The dysphagia and the poor masticatory performance were found to have a significant mediating effect on the association between xerostomia and OHRQoL (βs = 0.17 and −0.09, respectively, both p< .001; βs = 0.05 and −0.08, respectively, both p< .001) moreover, potential mediating influences of the number of functional teeth (βs = −0.11 and −0.44, respectively, both p < .001) and poor occlusal condition (βs = 0.09 and 0.12, respectively, both p < .05) on the relationship between xerostomia and masticatory performance were obervered.Conclusions: Dysphagia and poor masticatory performance may serve as a pathway of which xerostomia affects quality of life. Providing early oral function intervention may be a valuable and actionable target for older adults to maintain their quality of life. Our results further suggest that checkup and screening for oral dysfunction is essential to prevent or delay the onset of complications.

Association between the dental occlusion and perceived ability to eat foods of Taiwanese older adults

“…Data were collected using a structured questionnaire developed by Lu et al 29 The questionnaire contained information related to demographics (ie age, sex and education level), physical status (ie body mass index), the SPMSQ score, 26 the ADL score, 27 the GDS score 28 and the ability to eat 14 common foods 15 . To assess content validity, a panel of experts reviewed all the items.…”