Global Self-Rated Health Status Predicts Reasons for Living Among Older Adults

ABSTRACT

This study examined predictors of reasons for living among community-dwelling older adults (N?=?104, M age?=?69.7 years). Participants completed the Geriatric Depression Scale (GDS), the Elders Life Stress Inventory (ELSI), the Life Orientation Test (LOT), and the Reasons for Living Inventory, and also rated their global health status. Standard multiple regression assessed the extent to which age, depression, stress, optimism, and health status predicted total reasons for living. The model explained 12% of the variance in reasons for living (R ²?=?.12, p < .05). Health made the strongest unique and significant contribution to RFL (β?=?0.26, p < .05) and age approached significance (β?=??0.19, p?=?.055). The GDS, ELSI, and LOT all made minimal and non-significant contributions. An implication is that attention to physical health status should be a standard part of suicide risk assessment, especially among older adults. Results suggest that reduced quality of life due to poor overall health may erode an individual's protective factors against suicide.     

Disparities in Oral Health Status Between Older Adults in a Multiethnic Rural Community: The Rural Nutrition and Oral Health Study

OBJECTIVES: To compare oral health status according to ethnicity and socioeconomic status in African-American, American-Indian, and white dentate and edentulous community-dwelling older adults.
DESIGN: Cross-sectional study; data from self-reports and oral examinations.
PARTICIPANTS: A multistage cluster sampling design was used to recruit 635 participants aged 60 and older from rural North Carolina counties with substantial African-American and American-Indian populations.
MEASUREMENTS: Participants completed in-home interviews and oral examinations. Self-reported data included sociodemographic indicators; self-rated oral health status; presence or absence of periodontal disease, bleeding gums, oral pain, dry mouth; and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units.
RESULTS: African Americans and American Indians had significantly lower incomes and educational attainment than whites. Self-rated oral health was significantly better in whites than in African Americans and American Indians. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Of dentate participants, African Americans were significantly more likely than whites to have 11 to 20 teeth and one or two posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables.
CONCLUSION: Oral health disparities in older adults in a multiethnic rural area were largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care.     

The Prevention of Infections in Older Adults: Oral Health

The oral cavity is exposed to the external environment and from a very young age is colonized by infectious agents. Under certain circumstances including poor oral hygiene, dry mouth, trauma, and the use of antibiotics, oral infections can occur. They can result in damage to the oral cavity including teeth and their support structures. Oral infections can also lead to the extension of infection into surrounding tissues and to systemic infections. Chronic oral infection is a recognized risk factor for heart disease. Older adults are at high risk for oral infections and associated complications. Tooth loss, for which infection is the most significant cause, leads to cosmetic changes and a decreased ability to masticate certain foods that can lead to malnutrition. Chronic oral infections and the manipulation of teeth and supporting structures can lead to the hematogenous spread of infection including the infection of artificial joints and endocardial implants. Good oral hygiene, the use of fluoride, regular dental care, and the appropriate use of antibiotics can all reduce oral infections and their associated complications. J Am Geriatr Soc 68:411–416, 2020     

Influence of Poor Oral Health on Physical Frailty: A Population‐Based Cohort Study of Older British Men

Objectives

To investigate the associations between objective and subjective measures of oral health and incident physical frailty.

Design

Cross‐sectional and longitudinal study with 3 years of follow‐up using data from the British Regional Heart Study.

Setting

General practices in 24 British towns.

Participants

Community‐dwelling men aged 71 to 92 (N = 1,622).

Measurements

Objective assessments of oral health included tooth count and periodontal disease. Self‐reported oral health measures included overall self‐rated oral health; dry mouth symptoms; sensitivity to hot, cold, and sweet; and perceived difficulty eating. Frailty was defined using the Fried phenotype as having 3 or more of weight loss, grip strength, exhaustion, slow walking speed, and low physical activity. Incident frailty was assessed after 3 years of follow‐up in 2014.

Results

Three hundred three (19%) men were frail at baseline (aged 71–92). Having fewer than 21 teeth, complete tooth loss, fair to poor self‐rated oral health, difficulty eating, dry mouth, and more oral health problems were associated with greater likelihood of being frail. Of 1,284 men followed for 3 years, 107 (10%) became frail. The risk of incident frailty was higher in participants who were edentulous (odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.03–3.52); had 3 or more dry mouth symptoms (OR = 2.03, 95% CI = 1.18–3.48); and had 1 (OR = 2.34, 95% CI = 1.18–4.64), 2 (OR = 2.30, 95% CI = 1.09–4.84), or 3 or more (OR = 2.72, 95% CI = 1.11–6.64) oral health problems after adjustment for age, smoking, social class, history of cardiovascular disease or diabetes mellitus, and medications related to dry mouth.

Conclusion

The presence of oral health problems was associated with greater risks of being frail and developing frailty in older age. The identification and management of poor oral health in older people could be important in preventing frailty.     

Association Between Dietary Quality of Rural Older Adults and Self‐Reported Food Avoidance and Food Modification Due to Oral Health Problems

OBJECTIVES: To quantify the association between food avoidance and modification due to oral health problems, to examine the association between food practices and dietary quality, and to determine foods associated with these self‐management behaviors. DESIGN: Cross‐sectional. SETTING: Rural North Carolina. PARTICIPANTS: Six hundred thirty‐five community‐dwelling adults aged 60 and older. MEASUREMENTS: Demographic and food frequency data and oral health assessments were obtained during home visits. Avoidance (0, 1–2 foods, 3–14 foods) and modification (0–3 foods, 4–5 foods) due to oral health problems were assessed for foods representing oral health challenges. Food frequency data were converted into Healthy Eating Index‐2005 (HEI‐2005) scores. Linear regression models tested the significance of associations between HEI‐2005 measures and food avoidance and modification. RESULTS: Thirty‐five percent of participants avoided three to 14 foods, and 28% modified four to five foods. After adjusting for age, sex, ethnicity, poverty, education, and tooth loss, total HEI‐2005 score was lower (P<.001) for persons avoiding more foods and higher for persons modifying more foods (P<.001). Those avoiding three to 14 foods consumed more saturated fat and energy from solid fat and added sugar and less nonhydrogenated fat than those avoiding fewer than three foods. Those who modified four to five foods consumed less saturated fat and solid fat and added sugar but more total grains than those modifying fewer than four foods. CONCLUSION: Food avoidance and modification due to oral health problems are associated with significant differences in dietary quality. Approaches to minimize food avoidance and promote food modification by persons having eating difficulties due to oral health conditions are needed.     

Frailty,Frailty Components,and Oral Health: A Systematic Review

A systematic review was conducted to assess the relationship between frailty or one of its components and poor oral health. A search strategy was developed to identify articles related to the research question in the PubMed, EMBASE, Cochrane, LILACS, and SciELO databases that were published in English, Spanish, or Brazilian Portuguese from 1991 to July 2013. Thirty‐five studies were identified, and 12 met the inclusion criteria, seven of which were cross‐sectional and five were cohort studies. Of the 12 articles, five (41.7%) were rated good and seven (58.3%) as fair quality. The published studies applied different oral health and frailty criteria measures. Variations in definitions of outcome measures and study designs limited the ability to draw strong conclusions about the relationship between frailty or prefrailty and poor oral health. None of the studies that were evaluated longitudinally showed whether poor oral health increases the likelihood of developing signs of frailty, although the studies suggest that there may be an association between frailty and oral health. More longitudinal studies are needed to better understand the relationship between frailty and oral health.