Eating and communication difficulties as mediators of the relationship between tooth loss and functional disability in middle-aged and older adults

Yin, Zhenhua; Yang, Jia Mei; Huang, Chuanying; Sun, Huibin; Wu, Yili

doi:10.1016/j.jdent.2020.103331

Cited by 22 publications

(27 citation statements)

References 36 publications

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“…19 Furthermore, only in the BRHS, tooth loss was associated with greater incidence of ADL difficulties, in accordance with previous studies. 18,19,40 Additionally, only in the BRHS, periodontal disease was associated with greater incidence of mobility limitations. Periodontal disease is a chronic inflammatory disease and is associated with elevated oral and systemic inflammation.…”

Section: Discussionsupporting

confidence: 90%

“…One potential direction is that poor oral health, specifically tooth loss, can influence the development of disability, including activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility limitations, in older age. [16][17][18][19][20][21] Nevertheless, limited evidence exists for the associations between oral health and incidence of mobility limitations, defined by difficulty walking and going up stairs, which is a key feature of functional independence. 22 Little is also known about the association of periodontal disease and self-reported oral health measures with incident disability in older adults.…”

Section: Introductionmentioning

confidence: 99%

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Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

Kotronia

Brown

Papacosta

et al. 2022

J American Geriatrics Society

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Background Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. Methods We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71–80 years). Oral health measures included tooth loss, periodontal disease, self‐rated oral health, and self‐reported dry mouth. Participants were followed for onset of disability over a follow‐up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. Results In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self‐report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27–3.42; OR = 1.73, 95% CI 1.03–2.90). Fair/poor self‐rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13–3.06), and fair/poor self‐rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04–1.94). Conclusions Oral health problems in older adults, particularly tooth loss, self‐reported dry mouth and self‐rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

Kotronia

Brown

Papacosta

et al. 2022

J American Geriatrics Society

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“…The mediation analysis method suggested by Karlson, Holms, and Breen (KHB) can be used to examine multiple pathways between the exposure and the outcome (Kohler et al 2011). Using the KHB method, a previous study investigated the mediation effects of communication and eating difficulty on the association between tooth loss and future functional disability (Yin et al 2020). Functional disabilities among older adults could be one of the consequences of dementia.…”

Section: Introductionmentioning

confidence: 99%

Oral Status and Dementia Onset: Mediation of Nutritional and Social Factors

et al. 2021

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Some modifiable risk factors for dementia are closely related to oral health. Although eating and speaking abilities are fundamental oral functions, limited studies have focused on the effect of malnutrition and lack of social interaction between oral health and dementia. We investigated the mediating effects of nutritional and social factors on the association between the number of teeth and the incidence of dementia. This 6-y cohort study used data from the Japan Gerontological Evaluation Study targeting older adults aged 65 y and above. The number of teeth (exposure) and covariates in 2010 (baseline survey), mediators (weight loss, vegetable and fruit intake, homeboundness, social network) in 2013, and the onset of dementia (outcome) between 2013 and 2016 were obtained. The Karlson–Holm–Breen mediation method was applied. A total of 35,744 participants were included (54.0% women). The mean age at baseline was 73.1 ± 5.5 y for men and 73.2 ± 5.5 y for women. A total of 1,776 participants (5.0%) had dementia during the follow-up period. There was a significant total effect of the number of teeth on the onset of dementia (hazard ratio, 1.14; 95% CI, 1.01–1.28). Controlling for nutritional and social mediators, the effect of the number of teeth was reduced to 1.10 (95% CI, 0.98–1.25), leaving an indirect effect of 1.03 (95% CI, 1.02–1.04). In the sex-stratified analysis, the proportion mediated by weight loss was 6.35% for men and 4.07% for women. The proportions mediated by vegetable and fruit intake and homeboundness were 4.44% and 4.83% for men and 8.45% and 0.93% for women, respectively. Furthermore, the proportion mediated by social networks was 13.79% for men and 4.00% for women. Tooth loss was associated with the onset of dementia. Nutritional and social factors partially mediated this association.

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“…However, there may be further systemic consequences as tooth loss could lead to altered dietary choices and intake, resulting in malnutrition and subsequent debilitating conditions such as diabetes and cardiovascular diseases. 8 Many countries have developed health models to address the dental care needs of the majority, with a strong emphasis on prevention rather than rehabilitation. To this end, disease prevention is a multi-stage process that must be addressed on three levels: "Primary prevention protects individuals against disease by placing barriers between the agent and the host.…”

Section: Discussionmentioning

confidence: 99%

Can you afford to smile? The Economic disparities in oral health care provision

2022

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Tooth loss can have a negative impact on a patient’s quality of life. However, many patients cannot afford the treatment necessary to restore their dentition optimally. Their final choice may be dictated by what they can afford rather than consideration of the advantages, disadvantages or biological sacrifices associated with proposed options. At the same time, clinicians often express feelings of helplessness and stress when confronted with having to decide on, and provide treatment that is within the patient’s financial means, rather than according to what they deem to be “best practice”. This paper uses a patient case to illustrate how the four-principle approach proposed by Beauchamps and Childress (1983) can be used during treatment planning, and to justify the final decision making process.

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Eating and communication difficulties as mediators of the relationship between tooth loss and functional disability in middle-aged and older adults

Cited by 22 publications

References 36 publications

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

Oral Status and Dementia Onset: Mediation of Nutritional and Social Factors

Can you afford to smile? The Economic disparities in oral health care provision

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