ABSTRACT
Introduction
Poor oral health can influence an individual's dietary intake, which may result in malnutrition. Both problems in oral health and function and malnutrition are common in older people. The aim of the present study was to explore the associations between oral health and oral function and malnutrition in community‐dwelling older people within three different databases.
Methods
Data analyses were performed on three existing Dutch databases (Interrai: n = 3876, LPZ: n = 966, PRIMa mouth CARE: n = 975). Logistic regressions (adjusted for age and gender) tested the relation between oral health and oral function (independent variable) and malnutrition (dependent variable).
Results
Problems in oral health and oral function such as broken teeth (OR: 1.43 [95%CI: 1.12–1.81]), oral pain and discomfort (OR: 2.58 [95%CI: 1.52–4.39]), chewing difficulties (OR: 1.99 [95%CI: 1.54–2.57]), swallowing problems (OR: 6.63 [95%CI: 2.85–15.42]), coughing (OR: 6.05 [95%CI: 2.08–17.61]) and food adaptations (OR: 5.46 [95%CI: 2.60–11.4]) were found to be significantly associated with malnutrition in older people.
Conclusions
This study demonstrated a significant link between oral health problems and oral function with malnutrition in community‐dwelling older people. Oral health care and healthcare professionals need to consider oral health and oral function in relation to nutritional status and vice versa in community‐dwelling older people.
Keywords: interdisciplinary approach, older people, prevalence, tooth loss
1. Introduction
Malnutrition is common among older adults, affecting approximately 11%–35% of Dutch community‐dwelling older people [1]. The aetiology of malnutrition is multifactorial. Age‐related factors, such as cognitive decline, impaired taste and smell, polypharmacy and metabolic effects of systemic diseases can all contribute to the onset of malnutrition [2]. Malnutrition increases morbidity and mortality rates and may aggravate other underlying conditions and diseases.
A number of international publications addressed associations between oral health, oral health problems and nutritional intake or nutritional status. General health conditions, like physical activity, disability, comorbidities, cognitive status and depression were associated with a reduced chewing function [3]. Oral pain, toothache while chewing and compromised chewing ability had a negative effect on nutritional status [4, 5]. Associations were found between malnutrition and hard and soft oral tissue conditions in older people [6]. Also problems in oral function, such as fewer teeth, chewing problems, lower bite force and wearing dentures were associated with a poorer dietary intake among older people [7, 8]. However, there is contradictory evidence about the relationship between denture wearing versus natural teeth, chewing ability and nutritional status [4, 9, 10].
Several Dutch studies have collected data on the health status of community‐dwelling older people, including data on nutritional status, oral health and oral function; yet these data were never analysed for the purpose of investigating the relationship between oral health, oral function and malnutrition. Therefore, the aim of the present study was to explore the associations between oral health, oral function and malnutrition in older people, derived from three different databases.
2. Methods
2.1. Database Selection
First, a list of appropriate recent Dutch databases was made by using existing networks and searching for online information. Second, four selection criteria were used for the selection of appropriate databases: (1) Study population: including adults aged 65 or older, living at home or assessed at their first intake in a nursing home, (2) The database had not been analysed on the associations between self‐perceived or objectively assessed oral health, oral function and malnutrition before, (3) The database contained data on oral health status and oral function, like edentulousness, number of natural teeth, chewing ability, pain, dental checkups and/or oral hygiene, (4) The database contained information about (mal)nutrition, like weight loss and/or nutritional status. After the selection, permission to use the data was sought from the concerning research institutes or research programs.
Database selection, data retrieving and analyses were performed from September 2019 to January 2020. Three Dutch databases with data on oral health and nutritional status/malnutrition were eligible for inclusion in this study: InterRAI, National Prevalence Measurement of Quality of Care (in Dutch known as Landelijke Prevalentiemeting Zorgkwaliteit; LPZ) and PRIMa mouth CARE. The selected databases used different definitions for malnutrition and contained different items regarding oral health. For each database relevant items related to malnutrition and oral health and oral function were selected.
2.2. InterRAI
Cross‐sectional data were obtained from the InterRAI Long Term Care Facilities system (InterRAI TCF 9.1), a standardised assessment tool, performed by trained nurses, to identify the medical conditions and care needs of participants in long‐term care facilities. A more comprehensive description of InterRAI LTCF and the assessment procedure is provided elsewhere [11]. InterRAI is used in approximately 13 countries, and for this study, only Dutch data from 2005 to 2020 were used. We only used the data collected at first admission to a nursing home, because this reflects health status while living at home. For this study, data from 3876 participants of 65 years or older were analysed. Malnutrition was determined as weight loss (> 5% weight loss in the previous month or > 10% weight loss over the past 6 months) or low age‐specific BMI (BMI < 20 for participants aged < 70 years and < 22 for participants aged 70 years and older). All oral health and oral function‐related items were dichotomous variables (yes/no), including the presence of dentures, broken teeth, difficulty chewing, dry mouth, painful mouth and gum inflammation (Table 1).
TABLE 1.
Associations between problems in oral health, oral function and nutritional status derived from the InterRAI database.
| Total N = 3876 (%) | Not malnourished n = 2574 (66.4%) | Malnourished a n = 1302 (33.6%) | OR (95% CI) for being malnourished | Adjusted OR (95% CI) for being malnourished b | |
|---|---|---|---|---|---|
| Age (in years) | |||||
| 65–74 | 490 (12.6) | 235 (15.0) | 65 (14.7) | ||
| 75–84 | 1625 (41.9) | 737 (46.9) | 202 (45.7) | ||
| ≥ 85 | 1761 (45.4) | 599 (38.1) | 175 (39.6) | ||
| Gender | |||||
| Male | 1265 (32.6) | 495 (31.5) | 130 (29.4) | ||
| Female | 2611 (67.4) | 1076 (68.5) | 312 (70.6) | ||
| Wears dentures | |||||
| No | 847 (21.9) | 557 (21.6) | 290 (22.3) | 1 | 1 |
| Yes | 3029 (78.1) | 2017 (78.4) | 1012 (77.7) |
0.96 (0.82–1.13) p = 0.652 |
0.92 (0.78–1.08) p = 0.292 |
| Broken teeth | |||||
| No | 3574 (92.2) | 2395 (93.0) | 1179 (90.6) | 1 | 1 |
| Yes | 302 (7.8) | 179 (7.0) | 123 (9.4) |
1.40 (1.10–1.77) p = 0.006 |
1.43 (1.12–1.81) p = 0.004 |
| Difficulty chewing | |||||
| No | 3618 (93.3) | 2442 (94.9) | 1176 (90.3) | 1 | 1 |
| Yes | 258 (6.7) | 132 (5.1) | 126 (9.7) |
1.98 (1.54–2.56) p < 0.001 |
1.99 (1.54–2.57) p < 0.001 |
| Dry mouth | |||||
| No | 3563 (91.9) | 2374 (92.2) | 1189 (91.3) | 1 | 1 |
| Yes | 313 (8.1) | 200 (7.8) | 113 (8.7) |
1.13 (0.89–1.43) p = 0.327 |
1.11 (0.87–1.42) p = 0.386 |
| Painful mouth | |||||
| No | 3673 (94.8) | 2451 (95.2) | 1222 (939) | 1 | 1 |
| Yes | 203 (5.2) | 123 (4.8) | 80 (6.1) |
1.31 (0.98–1.74) p = 0.072 |
1.28 (0.96–1.71) p = 0.099 |
| Gum inflammation | |||||
| No | 3776 (97.4) | 2507 (97.4) | 1269 (97.5) | 1 | 1 |
| Yes | 100 (2.6) | 67 (2.6) | 33 (2.5) |
0.97 (0.64–1.48) p = 0.973 |
1.02 (0.67–1.56) p = 0.932 |
Malnourished was determined as: > 5% weight loss in previous month or > 10% weight loss over the past 6 months.
Adjusted for age category (65–74, 75–84, ≥ 85) and gender.
2.3. LPZ
Data to this study were obtained from the annual independent National Prevalence Measurement of Quality of Care (LPZ) of Maastricht University [12]. This cross‐sectional multi‐centre point prevalence survey is conducted annually on one day in different healthcare settings in the Netherlands, wherein more than 400 institutions participate with over 40,000 patients, from hospitals, care homes and home care [13].
The population for this study included care‐dependent people receiving community care in the Netherlands. Next to individual patient characteristics, data are collected about the prevalence, prevention and treatment of each care problem at patient level. In addition, specific quality indicators at an institutional level and ward level are measured related to the care problems. After the measurement, institutions enter their data into a web‐based data‐entry program. Institutions receive an overview of their results and the aggregated results of other participating organisations to enable a process of benchmarking [13]. Most recent available data from 2017 and 2018 were included from 966 persons. Malnutrition was determined as BMI < 20 kg/m2 or > 5% weight loss in the last month or > 10% weight loss in the previous 6 months. Selected oral health and oral function items were all dichotomous variables (yes/no), including the presence of an oral health check performed by a dentist, refusing food because of dental problems, coughing, swallowing problems and problems with eating dry food (Table 2).
TABLE 2.
Associations between related problems in oral health, oral function and nutritional status according to the LPZ database.
| Total N = 966 | Not malnourished n = 862 (89.2%) | Malnourished a n = 104 (10.8%) | OR(95% CI) for being malnourished | Adjusted OR (95% CI) for being malnourished b | |
|---|---|---|---|---|---|
| Gender | |||||
| Male | 240 (24.8) | 223 (25.9) | 17 (16.3) | ||
| Female | 726 (75.2) | 639 (74.1) | 87 (83.7) | ||
| Age (in years) | |||||
| 65–75 |
213 (18.5) |
160 (18.6) |
19 (18.3) |
||
| 75–85 | 406 (45.5) | 398 (46.2) | 42 (40.4) | ||
| > 85 | 347 (35.9) | 304 (35.3) | 43 (41.3) | ||
| Malnourished a | |||||
| Yes | 104 (10.8) | 862 (89.2) | 104 (10.8) | ||
| No | 862 (89.2) | ||||
| Swallowing problems | |||||
| No | 939 (97.2) | 845 (98.0) | 94 (90.4) | 1 | 1 |
| Yes | 25 (2.6) | 15 (1.7) | 10 (9.6) |
5.99 (2.62–13.71) p < 0.001 |
6.63 (2.85–15.42) p < 0.001 |
| Unknown | 2 (0.2) | 2 (0.2) | 0 | ||
| Coughing | |||||
| No | 929 (96.2) | 832 (96.5) | 97 (93.3) | 1 | 1 |
| Yes | 15 (1.6) | 9 (1.0) | 6 (5.8) |
5.72 (1.99–16.41) p = 0.001 |
6.05 (2.08–17.61) p = 0.001 |
| Unknown | 22 (2.3) | 21 (2.4) | 1 (1.0) | ||
| Problems with eating dry food | |||||
| No | 899 (93.1) | 801 (92.9) | 98 (94.2) | 1 | 1 |
| Yes | 27 (2.8) | 21 (2.4) | 6 (5.8) |
2.34 (0.92–5.93) p = 0.074 |
2.43 (0.95–6.23) p = 0.064 |
| Unknown | 40 (4.1) | 40 (4.6) | 0 | ||
| Refuse food because of dental problems | |||||
| No | 938 (97.1) | 835 (96.9) | 103 (99.0) | 1 | 1 |
| Yes | 7 (0.7) | 6 (0.7) | 1 (1.0) |
1.35 (0.16–11.33) p = 0.782 |
1.23 (0.15–10.39) p = 0.833 |
| Unknown | 21 (2.2) | 21 (2.4) | 0 | ||
| Last oral health check performed by a dentist | |||||
| Not checked | 203 (21.0) | 183 (21.2) | 20 (19.2) | 1 | 1 |
| Checked | 160 (16.6) | 141 (16.4) | 19 (18.3) |
1.23 (0.63–2.40) p = 0.537 |
1.33 (0.68–2.62) p = 0.407 |
| Unknown | 603 (62.4) | 538 (62.4) | 65 (62.5) | ||
Malnourished was as determined BMI < 20 kg/m2 or > 5% weight loss in 1 months or > 10% weight loss in 6 month.
Adjusted for gender and age (65–75, 75–85 and ≥ 85 years).
2.4. PRIMa Mouth CARE
The PRIMa mouth CARE project was integrated within the so called Om U primary care program that identifies frail older people from the general practitioners' practice. The Om U program comprises three steps: (1) frailty screening using primary electronic medical record data from general practitioners (GP's), (2) frailty assessment using The Groningen Frailty Indicator (GFI) in potentially frail people based on screening in the first step [14] and (3) a comprehensive geriatric assessment at home followed by a tailor‐made care plan for frail people according to the GFI [15]. For the current study, 975 persons who completed the first and second step of Om U were included for analysis.
Within the PRIMa mouth CARE project, data within the Om U approach from electronic medical from the GP and GFI [14] were collected in 2016. Additionally, dental record data and data on two self‐reported oral health questions were gathered. Malnutrition was determined by one item within the GFI questionnaire: self‐reported unintentional weight loss (within 6 months). Oral health items from dental records were extracted 1.5 years retrospectively from study initiation: dental visits within the past 1.5 years (including emergency visits), dental status, caries treatment within the last 1.5 years, tooth extraction in the last 1.5 years, and periodontal status measured by the Dutch Periodontal Screening Index. Self‐reported oral function questions were: ‘Do you experience pain or discomfort in your mouth?’ And ‘did you make dietary adaptations because of this discomfort?’ (yes/sometimes or no; Table 3).
TABLE 3.
Associations between problems in oral health, oral function and nutritional status according to the Prima mouth CARE database.
| Total N = 975 (%) | No Unintentional weight loss n = 910 (93.3%) | Unintentional weight loss a n = 65 (6.7%) | OR (95% CI) for unintentional weight loss | Adjusted OR (95% CI) for unintentional weight loss b | |
|---|---|---|---|---|---|
| Gender | |||||
| Male | 437 (44.8) | 408 (44.8) | 29 (44.6) | ||
| Female | 538 (55.2) | 502 (55.2) | 36 (55.4) | ||
| Age (in years) | |||||
| 65–74 | 499 (51.2) | 469 (51.5) | 30 (46.2) | ||
| 75–84 | 366 (37.5) | 340 (37.4) | 26 (40.0) | ||
| > 85 | 110 (11.3) | 101 (11.1) | 9 (13.8) | ||
| Weight loss last 6 months | |||||
| Yes | 65 (6.7) | 910 (93.3) | 65 (6.7) | ||
| No | 910 (93.3) | ||||
| Regular oral health check last 1.5 years | |||||
| Yes | 718 (73.6) | 672 (73.8) | 46 (70.8) | 1 | 1 |
| No | 257 (26.4) | 238 (26.2) | 19 (29.2) |
1.17 (0.67–2.03) p = 0.59 |
1.13 (0.65–1.98) p = 0.67 |
| Available dental record data | n = 718 (%) | n = 672 (%) | n = 46 (%) | ||
| Oral status | |||||
| Dentulous | 484 (67.4) | 458 (68.2) | 26 (56.5) | 1 | 1 |
| Edentulous | 28 (3.9) | 190 (28.3) | 16 (24.8) |
2.94 (0.95–9.09) p = 0.06 |
2.88 (0.92–8.99) p = 0.07 |
| Partial denture | 206 (28.7) | 24 (3.5) | 4 (8.7) |
1.48 (0.78–2.83) p = 0.23 |
1.46 (0.75–2.84) p = 0.27 |
| Caries last 1.5 year | |||||
| No | 282 (39.3) | 506 (55.6) | 33 (50.8) | 1 | 1 |
| Yes | 436 (60.7) | 404 (44.4) | 32 (49.2) |
1.52 (0.79–2.90) p = 0.21 |
1.50 (0.78–2.86) p = 0.22 |
| Tooth extraction last 1.5 year | |||||
| No | 621 (86.5) | 819 (90.0) | 59 (90.8) | 1 | 1 |
| Yes | 97 (13.5) | 91 (10.0) | 6 (9.2) |
0.96 (0.40–2.32) p = 0.92 |
0.94 (0.39–2.29) p = 0.89 |
| Emergency consultation dentist | |||||
| No | 610 (85.0) | 813 (89.3) | 54 (83.1) | 1 | 1 |
| Yes | 108 (15.0) | 97 (10.7) | 11 (16.9) |
1.86 (0.92–3.79) p = 0.09 |
1.87 (0.91–3.82) p = 0.09 |
| Self‐reported oral health | n = 975 (%) | n = 910 | N = 65 | ||
| Oral pain or discomfort | |||||
| No | 739 (75.8) | 703 (77.3) | 36 (55.4) | 1 | 1 |
| Yes | 229 (23.5) | 202 (22.2) | 27 (41.5) |
2.61 (1.55–4.40) p < 0.001 |
2.58 (1.52–4.39) p < 0.001 |
| Missing | 7 (0.7) | 5 (0.5) | 2 (3.1) | ||
| Food adaptions | |||||
| No | 918 (94.2) | 866 (95.2) | 52 (80.0) | 1 | 1 |
| Yes | 49 (5.0) | 37 (4.1) | 12 (18.5) |
5.40 (2.66–10.97) p < 0.001 |
5.46 (2.60–11.4) p < 0.001 |
| Missing | 8 (0.8) | 7 (0.8) | 1 (1.5) | ||
Malnutrition was determined by self‐reported unintentional weight loss in the previous 6 months.
Adjusted for gender and age (65–75, 75–85 and ≥ 85 years).
2.5. Ethical Approval
This study included data from three Dutch databases. The data collection for these databases has been individually reviewed and approved by local Dutch medical ethical review committees (LPZ‐data: MEC 01‐014; InterRAI: I‐CARE4OLD EU nr: 2021‐0358, Prima Mouth CARE: WAG/mb/16/013553). Assessments were performed for clinical purposes as part of routine care in LPZ and InterRAI databases. Participants were informed that their data could be used for research purposes and that their data would not included if they objected to the use of their data. Both opt‐in and opt‐out procedures were applied in compliance with the EU General Data Protection Regulation. For Prima Mouth Care, participants agreed on data collection and use of data for multiple research purposes. The data in these databases were processed completely anonymously, and therefore, these data cannot be traced back to the subjects.
2.6. Statistical Analyses
All included databases were analysed separately using SPSS version 25.0 (SPSS INC, Chicago, IL, USA). Univariate and multivariate logistic regressions were used to test associations with parameters of oral health or oral function as independent and nutritional status/malnutrition as dependent variables. Two categories were made for oral health status: (1) dental status (natural teeth, wears dentures (full/partial), broken teeth, regular oral health check), (2) Problems in oral health and oral function (caries and/or tooth extraction in the last 1.5 years, emergency consultation of a dentist, difficulty chewing, dry mouth, oral pain or discomfort, painful mouth, gum inflammation, speech problems, eating problems, food adaptions, problems with eating dry food, refuse food because of dental problems). In multivariate analysis, adjustments were made for age (65–75, 75–85 and > 85 years) and gender. Results of the logistic regressions were described as odds ratios with corresponding 95% confidence intervals and p‐values. Strengths of the associations were determined by using the proposed cut‐off values for odds ratios by Olivier et al. (2017) (small = 1.32, medium = 2.38, large = 4.70) [16].
3. Results
Tables 1, 2, 3 show the results of the multivariate logistic regression analysis for each database. The results of the InterRAI database showed a prevalence of 33.6% for malnutrition. Small associations with malnutrition were seen for ‘Broken teeth’ (OR 1.43 [95%CI: 1.12–1.81]) and ‘Difficulty chewing’ (OR 1.99 [95%CI: 1.54–2.57]; Table 1).
The results of the LPZ database showed a prevalence of 10.8% for malnutrition. Multivariate logistic regression analysis demonstrated that the variables ‘Swallowing problems’ (OR: 6.63 [95%CI: 2.85–15.42]) and ‘Coughing’ (OR: 6.05 [95%CI: 2.08–17.61]) were strongly associated with malnutrition (Table 2).
The results of the PRIMa Mouth Care database showed a prevalence of 6.7% for unintentional weight loss. For PRIMa Mouth CARE the variables ‘Oral pain or discomfort’ (OR: 2.58 [95%CI: 1.52–4.39]) and ‘Making dietary adaptations’ (OR: 5.46 [95%CI: 2.60–11.4]) were the variables strongest related to unintentional weight loss (Table 3).
4. Discussion
The aim of this study was to explore associations between oral health, oral function and malnutrition in community‐dwelling older people derived from three different databases. Broken teeth, painful mouth, oral pain and discomfort, difficulty chewing, swallowing problems, dietary adaptions and coughing were associated with malnutrition in different groups of patients and in different health care settings. Prevalence of malnutrition was 10.8%–33.6% and of unintentional weight loss was 6.7%.
As cut‐off values for effect sizes differ per research area, magnitude of effect sizes should therefore be compared to other effect sizes to place them in perspective [17, 18]. In the field of malnutrition, ORs are generally low compared to the proposed cut‐off values by Olivier et al. (2017) and OR of 3 indicate relatively strong associations [16]. In the three databases included in this study, we observed ORs of 1.40–5.99 for different oral health and function problems, which indicates that oral health and function should be considered an important factor in older adults at risk of malnutrition. This is confirmed by another recent study, which showed that oral problems are rather strongly associated with malnutrition in comparison to other health problems in a nursing home population [19].
Our findings are in line with previous studies, in which malnourished community‐dwelling older people had more oral‐health related problems and complaints [20]. Our results also corresponded to other studies that showed associations between poorer self‐rated oral health status or increased swallowing problems and lower body weight [21]. However, a systematic review by O'Keeffe et al. (2019) found contrasting results, which indicated that chewing difficulties, oral pain, gum issues, dental status, swallowing, co‐morbidity, residential status, complaints about the taste of food, and specific nutrient intake were not determinants of malnutrition [5].
The relationship between denture wearing, the number of teeth, and the risk of malnutrition remains unclear. In our study, no significant associations were found between malnutrition and dentures or edentulousness. Our results correspond with the results of other studies, which demonstrated that the number of natural teeth, dentures, occluding pairs and masticatory ability was not significantly associated with elders' risk for malnutrition [4, 9, 10]. In contrast, two studies among nursing home residents described that edentulousness and wearing dentures come with a higher risk of malnutrition [22, 23]. These results imply that additional factors, like the fit of dentures or taste and texture sensation might play a role as well. Wearing dentures causes a minimisation of taste and texture sensation due to the covering of the palate [24]. Taste changes that occur with advancing age, regardless of dental status or wearing dentures, are associated with nutritional status and can lead to poor appetite, changes in food choices and lower nutrient intake [25]. This may result in weight loss or malnutrition.
A poor nutritional status is an important determinant of frailty [26]. Frailty is a geriatric syndrome that affects multiple domains of human functioning and causes a decline of functional status and a reduction in muscle strength [27]. Thereby, frailty influences the performance of activities of daily living (ADL), like the performance of oral hygiene [28]. A lower frequency of toothbrushing and denture cleaning was significantly associated with frailty [29]. Nutritional status, as an important determinant of frailty, and oral health have a complex multifactorial relation, which seems to be influenced by several conditions and linked through several pathways. Still, it is unclear in the process of increasing frailty which factor or condition causes or influences the next problem. Therefore, it is important for healthcare professionals, such as dietitians, dental hygienists, dentists, general practitioners and community nurses to consider problems in oral health and oral function in relation to nutritional status and vice versa in care‐dependent older people [30, 31].
A limitation of this study is the lack of standardised definitions of malnutrition and oral health. This also hinders comparison with other studies. Recently, a consensus was reached on a global set of malnutrition criteria [32]. This will make it easier to compare studies on malnutrition in the future. It is important to note that the main information about oral health and nutritional status was obtained by a healthcare professional and not established by a dietitian or dentist or dental hygienist, except for the information from the dental records from the PRIMa mouth CARE project.
Although the study populations were not standardised across the different databases, the compiled information provides information about a large cross‐sectional sample of Dutch older people. Therefore, this study contributes to more insight into the relationship between oral health, oral function and malnutrition in older people. Aging is accompanied by physiologic changes, which may have a negative impact on nutritional status and oral health behaviour. Psychosocial and environmental factors also affect dietary and oral health, for example, isolation, loneliness, depression, dementia and inadequate finances [33]. These psychosocial and environmental factors have not been investigated in this study. Future research with a standardised longitudinal database is needed to establish more information about the relationship between malnutrition and oral health and oral function.
5. Conclusion
Problems in oral health and oral function such as broken teeth, oral pain and discomfort, chewing difficulties, swallowing problems, coughing and food adaptations were found to be significantly associated with malnutrition in community‐dwelling older people.
6. Clinical Relevance
6.1. Scientific Rationale for Study
Several studies found that problems in oral health and oral function, are associated with a poorer dietary intake among older people.
6.2. Principal Findings
This study found, that problems in oral health and oral function such as broken teeth, oral pain and discomfort, chewing difficulties, swallowing problems, coughing and food adaptations were found to be significantly associated with malnutrition in community‐dwelling older people.
6.3. Practical Implications
Oral health care and healthcare professionals need to consider oral health and oral function in relation to nutritional status and vice versa in community‐dwelling older people.
Author Contributions
All authors approved the submitted version, agree to be personally accountable for their contribution to this review, and ensure that questions related to the accuracy or integrity of any part of this work will be appropriately investigated, resolved and documented. V.H. and E.N. conceptualised the research question and wrote the original draft. B.E., I.E. and H.H. were involved in compiling the databases. V.H, E.N. and J.B. analysed the data. B.E., J.B., H.H., E.H., K.J.‐C., I.E. and M.S. commented on draft versions. M.S. supervised the project and was available for advice.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding: This work was supported and funded by the Taskforce for Applied Research SIA, part of the Dutch Research Council, NWO.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- 1. Schilp J., Kruizenga H. M., Wijnhoven H. A., et al., “High Prevalence of Undernutrition in Dutch Community‐Dwelling Older Individuals,” Nutrition 28, no. 11–12 (2012): 1151–1156, 10.1016/j.nut.2012.02.016. [DOI] [PubMed] [Google Scholar]
- 2. Altenhoevel A., Norman K., Smoliner C., and Peroz I., “The Impact of Self‐Perceived Masticatory Function on Nutrition and Gastrointestinal Complaints in the Elderly,” Journal of Nutrition, Health and Aging 16, no. 2 (2012): 175–178, 10.1007/s12603-011-0342-8. [DOI] [PubMed] [Google Scholar]
- 3. Wright F. A. C., Law G. G., Milledge K. L., et al., “Chewing Function, General Health and the Dentition of Older Australian Men: The Concord Health and Ageing in Men Project,” Community Dentistry and Oral Epidemiology 47, no. 2 (2019): 134–141, 10.1111/cdoe.12435. [DOI] [PubMed] [Google Scholar]
- 4. Kiesswetter E., Hengeveld L. M., Keijser B. J., Volkert D., and Visser M., “Oral Health Determinants of Incident Malnutrition in Community‐Dwelling Older Adults,” Journal of Dentistry 85 (2019): 73–80, 10.1016/j.jdent.2019.05.017. [DOI] [PubMed] [Google Scholar]
- 5. O'Keeffe M., Kelly M., O'Herlihy E., et al., “Potentially Modifiable Determinants of Malnutrition in Older Adults: A Systematic Review,” Clinical Nutrition 38, no. 6 (2019): 2477–2498, 10.1016/j.clnu.2018.12.007. [DOI] [PubMed] [Google Scholar]
- 6. Algra Y., Haverkort E., Kok W., et al., “The Association Between Malnutrition and Oral Health in Older People: A Systematic Review,” Nutrients 13, no. 10 (2021): 3584, 10.3390/nu13103584. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Kiesswetter E., Poggiogalle E., Migliaccio S., et al., “Functional Determinants of Dietary Intake in Community‐Dwelling Older Adults: A DEDIPAC (DEterminants of DIet and Physical ACtivity) Systematic Literature Review,” Public Health Nutrition 21, no. 10 (2018): 1886–1903, 10.1017/S1368980017004244. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Natapov L., Kushnir D., Goldsmith R., Dichtiar R., and Zusman S. P., “Dental Status, Visits, and Functional Ability and Dietary Intake of Elderly in Israel,” Israel Journal Health Policy Research 7, no. 1 (2018): 58, 10.1186/s13584-018-0252-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Su Y., Yuki M., Hirayama K., Sato M., and Han T., “Denture Wearing and Malnutrition Risk Among Community‐Dwelling Older Adults,” Nutrients 12, no. 1 (2020): 151, 10.3390/nu12010151. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Wu L. L., Cheung K. Y., Lam P., and Gao X. L., “Oral Health Indicators for Risk of Malnutrition in Elders,” Journal of Nutrition, Health and Aging 22, no. 2 (2018): 254–261, 10.1007/s12603-017-0887-2. [DOI] [PubMed] [Google Scholar]
- 11. OECD/European Commission , “A Good Life in Old Age? Monitoring and Improving Quality in Long‐Term Care,” OECD Health Policy Studies 2013 (2021): 93–127, 10.1787/9789264194564-en. [DOI] [Google Scholar]
- 12. Halfens R. J., Meesterberends E., Meijers J. M., van Nie N. C., and Schols J. M., “Basiszorg in het Verpleeghuis: Longitudinale Weergave Van Zorgproblemen Gemeten Door de Landelijke Prevalentiemeting Zorgproblemen [Basic Care in Nursing Homes: Longitudinal Presentation of Care Problems Measured With the National Prevalence Measurement of Care Problems (LPZ)],” Tijdschrift voor Gerontologie en Geriatrie 44, no. 6 (2013): 242–252, 10.1007/s12439-013-0046-0. [DOI] [PubMed] [Google Scholar]
- 13. Van Nie‐Visser N. C., Schols J. M., Meesterberends E., et al., “An International Prevalence Measurement of Care Problems: Study Protocol,” Journal of Advanced Nursing 69, no. 9 (2013): e18–e29, 10.1111/jan.12190. [DOI] [PubMed] [Google Scholar]
- 14. Schuurmans H., Steverink N., Lindenberg S., Frieswijk N., and Slaets J. P., “Old or Frail: What Tells Us More?,” Journal of Gerontology. Series A, Biological Sciences and Medical Sciences 59, no. 9 (2004): M962–M965, 10.1093/gerona/59.9.m962. [DOI] [PubMed] [Google Scholar]
- 15. Bleijenberg N., ten Dam V. H., Drubbel I., Numans M. E., de Wit N. J., and Schuurmans M. J., “Development of a Proactive Care Program (U‐CARE) to Preserve Physical Functioning of Frail Older People in Primary Care,” Journal of Nursing Scholarship 45, no. 3 (2013): 230–237, 10.1111/jnu.12023. [DOI] [PubMed] [Google Scholar]
- 16. Olivier J., May W. L., and Bell M. L., “Relative Effect Sizes for Measures of Risk,” Communication in Statistics‐Theory and Methods 46, no. 14 (2017): 6774–6781, 10.1080/03610926.2015.1134575. [DOI] [Google Scholar]
- 17. Pek J. and Flora D. B., “Reporting Effect Sizes in Original Psychological Research: A Discussion and Tutorial,” Psychological Methods 23, no. 2 (2018): 208–225, 10.1037/met0000126. [DOI] [PubMed] [Google Scholar]
- 18. Borkent J. W., Van Hout H. P. J., Feskens E. J. M., Naumann E., and de van der Schueren M. A. E., “Diseases, Health‐Related Problems, and the Incidence of Malnutrition in Lwong‐Term Care Facilities,” International Journal of Environmental Research and Public Health 20, no. 4 (2023): 3170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Bakker M. H., Vissink A., Spoorenberg S. L. W., Jager‐Wittenaar H., Wynia K., and Visser A., “Are Edentulousness, Oral Health Problems and Poor Health‐Related Quality of Life Associated With Malnutrition in Community‐Dwelling Elderly (Aged 75 Years and Over)? A Cross‐Sectional Study,” Nutrients 10, no. 12 (2018): 1965, 10.3390/nu10121965. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Kiesswetter E., Keijser B. J. F., Volkert D., and Visser M., “Association of Oral Health With Body Weight: A Prospective Study in Community‐Dwelling Older Adults,” European Journal of Clinical Nutrition 74, no. 6 (2020): 961–969, 10.1038/s41430-019-0536-4. [DOI] [PubMed] [Google Scholar]
- 21. Fávaro‐Moreira N. C., Krausch‐Hofmann S., Matthys C., et al., “Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data,” Advances in Nutrition 7, no. 3 (2016): 507–522, 10.3945/an.115.011254. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Saarela R. K., Soini H., Hiltunen K., et al., “Dentition Status, Malnutrition and Mortality Among Older Service Housing Residents,” Journal of Nutrition, Health and Aging 18, no. 1 (2014): 34–38, 10.1007/s12603-013-0358-3. [DOI] [PubMed] [Google Scholar]
- 23. Huppertz V. A. L., van der Putten G. J., Halfens R. J. G., Schols J. M. G. A., and de Groot L. C. P. G. M., “Association Between Malnutrition and Oral Health in Dutch Nursing Home Residents: Results of the LPZ Study,” Journal of the American Medical Directors Association 18, no. 11 (2017): 948–954, 10.1016/j.jamda.2017.05.022. [DOI] [PubMed] [Google Scholar]
- 24. Jüch P. W. and Kalk W., “De Invloed Van Een Gebitsprothese op de Smaakgewaarwording [Influence of a Maxillary Complete Denture on Taste Perception Patients Regularly Report an Alteration in Taste Perception After the Insertion],” Nederlands Tijdschrift voor Tandheelkunde 118, no. 11 (2011): 569–574, 10.5177/ntvt.2011.11.11138. [DOI] [PubMed] [Google Scholar]
- 25. Batisse C., Bonnet G., Eschevins C., Hennequin M., and Nicolas E., “The Influence of Oral Health on patients' Food Perception: A Systematic Review,” Journal of Oral Rehabilitation 44, no. 12 (2017): 996–1003, 10.1111/joor.12535. [DOI] [PubMed] [Google Scholar]
- 26. Chang S. F., “Frailty Is a Major Related Factor for at Risk of Malnutrition in Community‐Dwelling Older Adults,” Journal of Nursing Scholarship 49, no. 1 (2017): 63–72, 10.1111/jnu.12258. [DOI] [PubMed] [Google Scholar]
- 27. Chen X., Mao G., and Leng S. X., “Frailty Syndrome: An Overview,” Clinical Interventions in Aging 9 (2014): 433–441, 10.2147/CIA.S45300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Matsuo K., Kito N., Ogawa K., Izumi A., and Masuda Y., “Effects of Textured Foods on Masticatory Muscle Activity in Older Adults With Oral Hypofunction,” Journal of Oral Rehabilitation 47, no. 2 (2020): 180–186, 10.1111/joor.12901. [DOI] [PubMed] [Google Scholar]
- 29. Tuuliainen E., Nihtilä A., Komulainen K., et al., “The Association of Frailty With Oral Cleaning Habits and Oral Hygiene Among Elderly Home Care Clients,” Scandinavian Journal of Caring Sciences 34, no. 4 (2020): 938–947, 10.1111/scs.12801. [DOI] [PubMed] [Google Scholar]
- 30. Jensen G. L., Compher C., Sullivan D. H., and Mullin G. E., “Recognizing Malnutrition in Adults: Definitions and Characteristics, Screening, Assessment, and Team Approach,” JPEN. Journal of parenteral and enteral nutrition 37, no. 6 (2013): 802–807, 10.1177/0148607113492338. [DOI] [PubMed] [Google Scholar]
- 31. Ástvaldsdóttir Á., Boström A. M., Davidson T., et al., “Oral Health and Dental Care of Older Persons‐A Systematic Map of Systematic Reviews,” Gerodontology 35, no. 4 (2018): 290–304, 10.1111/ger.12368. [DOI] [PubMed] [Google Scholar]
- 32. Cederholm T., Jensen G. L., Correia M. I. T. D., et al., “GLIM Criteria for the Diagnosis of Malnutrition ‐ A Consensus Report From the Global Clinical Nutrition Community,” Journal of Cachexia, Sarcopenia and Muscle 10, no. 1 (2019): 207–217, 10.1002/jcsm.12383. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Guyonnet S. and Rolland Y., “Screening for Malnutrition in Older People,” Clinics in Geriatric Medicine 31, no. 3 (2015): 429–437, 10.1016/j.cger.2015.04.009. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.