Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults

Abstract

Objective Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a ten-year period, and determine if these subgroups predicted oral health outcomes. Methods Secondary analysis of data from the Health and Retirement Survey. The sample was 944 adults age 65+ who participated in the oral health module in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998–2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008. Results Three distinct subgroups were identified using zero inflated Poisson regression models: (a) minimal depressive symptoms over the study period (43%), (b) low but generally stable level of depressive symptoms (41%), and (c) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p<0.0001) and poorer self-rated oral health (p=0.0003) compared to those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism. Conclusions Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

Heterogeneity in long-term trajectories of depressive symptoms: Patterns, predictors and outcomes

“…The authors found no differences in blood pressure, blood glucose or cholesterol between the different depression trajectory classes. Hybels et al (2015) found that older adults with depression trajectories characterized by higher symptom burdens were more likely to experience oral health problems. Several studies (Andreescu et al, 2008; Liang et al, 2011; Kuchibhatla et al, 2012) found that trajectories with higher depressive symptom burden were associated with higher mortality among older adults.…”

Oral health care for patients with Alzheimer's disease: An update

“…For instance, memory and executive function losses can compromise their ability to perform oral hygiene in a regular and appropriate fashion . Depression may influence oral health through biological pathways such as disruption of the immune system and hyposalivation linked to antidepressants; or nonbiological pathways, such as reduced self‐care and reduced usage of dental services due to depressive symptoms . Cognitive enhancing drugs like cholinesterase inhibitors and memantine, used to treat Alzheimer's disease, have not been shown to have significant oral side effects.…”

“…46 ROHD risk factors are related to three main groups, that is, general health conditions, social support, and oral health conditions. 46 Among the ROHD risk factors related to general health, neurodegenerative conditions and dementia are considered as significant risk factors and treatment plan modifiers, 7,11 as well as conditions that often accompany dementia, like depression 47 and polypharmacy. 48,49 Older adults with cognitive impairment have many functional losses that can impair their ability to keep their oral hygiene routines.…”

“…8 Depression may influence oral health through biological pathways such as disruption of the immune system and hyposalivation linked to antidepressants; or nonbiological pathways, such as reduced self-care and reduced usage of dental services due to depressive symptoms. 47 Cognitive enhancing drugs like cholinesterase inhibitors and memantine, used to treat Alzheimer's disease, have not been shown to have significant oral side effects. However, some medications used to help with challenging behaviors commonly observed in Alzheimer's disease have dry mouth as a common side effect, such as the antidepressant citalopram.…”

A Teaching Tool for Establishing Risk of Oral Health Deterioration in Elderly Patients: Development, Implementation, and Evaluation at a U.S. Dental School

“…Common systemic health problems among the elderly that cause a decline in general function include, but are not limited to, neuro-degenerative conditions and dementia, [13][14][15] diabetes, [16][17][18] depression, 15,19 polypharmacy, 18,20,21 arthritis, 17 and stroke. 17,22 These systemic health problems can impact oral health in many ways.…”