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J Am Med Dir Assoc. 2018 Dec 9. pii: S1525-8610(18)30605-4. doi: 10.1016/j.jamda.2018.10.025. [Epub ahead of print]

Burden of Oral Symptoms and Its Associations With Nutrition, Well-Being, and Survival Among Nursing Home Residents.

Author information

1
Department of General Practice, University of Helsinki, Helsinki, Finland.
2
Social Services and Health Care Sector, Oral Health Care, City of Helsinki, Helsinki, Finland.
3
Department of Social Services and Health Care, Developmental and Operational Support, City of Helsinki, Helsinki, Finland.
4
Helsinki University Central Hospital, Unit of Primary Health Care, University of Helsinki, Helsinki, Finland.
5
Department of General Practice, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Unit of Primary Health Care, University of Helsinki, Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi.

Abstract

OBJECTIVES:

To explore how oral problems, chewing problems, dry mouth, and swallowing difficulties cluster and whether their burden is associated with nutritional status, eating habits, gastrointestinal symptoms, psychological well-being, and mortality among institutionalized residents.

DESIGN:

Cross-sectional study with 1-year mortality.

SETTING AND PARTICIPANTS:

3123 residents living in assisted facilities and nursing homes in Helsinki, Finland.

MEASURES:

Trained nurses assessed residents in all nursing homes and assisted living facilities in Helsinki in 2011. A personal interview, the Mini Nutritional Assessment (MNA), oral symptoms, questions about eating habits, and psychological well-being were used to assess each resident. We divided the subjects first according to the number of oral symptoms into 4 groups: no oral symptoms (G0), 1 oral symptom (G1), 2 oral symptoms (G2), and all 3 symptoms (G3); and second according to the symptoms: dry mouth, chewing problems, and swallowing difficulties. The diagnoses and medications were retrieved from medical records, and mortality data were obtained from central registers.

RESULTS:

In all, 26% of the subjects had 1 oral problem (G1), 11% had 2 oral problems (G2), and 4% had all 3 oral problems (G3), whereas 60% (n = 1870) had no oral symptoms. Thus, the oral symptoms moderately overlapped. The burden of oral symptoms was linearly associated with malnutrition, higher numbers of comorbidities, dependency in physical functioning, gastrointestinal symptoms, and eating less and more often alone. The higher the burden of oral symptoms, the lower the self-rated health and psychological well-being. Mortality increased along with the higher oral symptoms burden. Among residents having 1 or more symptoms, 26% had chewing problems, 18% swallowing difficulties, and 15% dry mouth.

CONCLUSIONS/IMPLICATIONS:

The burden of oral health problems was associated in a stepwise fashion with poor health and psychological well-being, malnutrition, and mortality. Clinicians should routinely assess older institutionalized residents' oral health status to improve residents' well-being.

KEYWORDS:

Dry mouth; chewing problems; mortality; oral health; psychological well-being; swallowing difficulty

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