Lucie Rapp, Faculty of Dentistry, University Hospital of Toulouse, 3, chemin des Maraîchers, 31400 Toulouse, France,
J Nutr Health Aging. 2021;25(4):484-491. doi: 10.1007/s12603-020-1546-6.
Although many studies associate a poor state of oral health with the risk of undernutrition in both the autonomous and dependent elderly, very few of them consider the frail elderly person. However, the identification of the frail elderly is one of major issues of modern geriatrics. It is at this stage that preventive strategies are the most effective against the risks of dependency. The main objective of our study is to explore the nature of the association between oral health and undernutrition in the frail elderly patient, and to identify the associated factors.
We have used the data of an observational transversal monocentric study, conducted among a population of patients hospitalized for frailty assessment at the Geriatric Frailty Clinic (G.F.C.) for Assessment of Frailty and Prevention of Disability. The enrolment site is the Cité de la Santé, at Toulouse University Hospital. Data were collected from January 25, 2016 February 2, 2018. The data collected sociodemographic characteristics, oral health (Oral Health Assessment Tool), nutritional status (Mini Nutritional Assessment), Body Mass Index, and weight loss according to Fried), frailty (Fried criteria), functional status (Mini Mental State Examination, Activity of Daily Living, Instrumental Activity of Daily Living, Geriatric Depression Scale-15), and behavior (tobacco and alcohol).
We included 1,155 subjects with an average age of 81.9 years, including 65% women. Bivariate analysis indicated a statistically significant association (p<0.05) between a pathological state of oral health and undernutrition, particularly with regard to decay of natural teeth, pathologies of the tongue, gums and tissues, dry mouth, lack of oral cleanliness and presence of dental pain. Multivariate analysis adjusted for socio-demographic, behavioral and functional data confirmed some of these associations, notably between the item gum/mucous membrane and the decrease of the score (p<0.01); this same item and weight loss according to Fried (p<0.01), and the item tongue and weight loss (p<0.05). A statistically significant association appeared between the state of oral health and frailty (item tongue (p<0.01)).
Our study shows a statistically significant association between a pathological state of oral health and nutrition disorders in the frail elderly person. This result confirms the hypothesis postulating that a poor state of oral health would be associated with nutritional disorders among the frail elderly. Our analysis also shows a statistically significant association between a deteriorated state of oral health and frailty. Tongue diseases here increase the risk of frailty for the patient. Our results are, however, limited and do not allow for an analysis of causal effect. It would be useful to complete our study by more refined analyses of risk factors, conducted on a larger sample, and with a follow-up patients over time.
We show here the importance of targeting the frail population in order to screen for oral disease and refer patients for dental care. Ensuring oral health care of frail patients seems indispensable if they are to maintain not only a healthy nutritional state, but also a satisfactory general state of health, thus allowing for successful aging.
尽管许多研究表明，无论在自主或依赖的老年人中，口腔健康状况不佳都与营养不良的风险相关，但很少有研究考虑到体弱老年人。然而，识别体弱老年人是现代老年医学的主要问题之一。正是在这个阶段，预防策略对预防依赖风险最为有效。我们研究的主要目的是探讨口腔健康与体弱老年人营养不良之间的关联，并确定相关因素。
我们使用了一项观察性横断面对比研究的数据，该研究是在老年虚弱诊所（G.F.C.）对虚弱进行评估的人群中进行的，用于评估虚弱和预防残疾。招募地点是图卢兹大学医院的 Cité de la Santé。数据收集于 2016 年 1 月 25 日至 2018 年 2 月 2 日。收集的数据包括社会人口统计学特征、口腔健康（口腔健康评估工具）、营养状况（微型营养评估）、体重指数和体重减轻（根据弗里德）、虚弱（弗里德标准）、功能状态（简易精神状态检查、日常生活活动、日常生活活动工具、老年抑郁量表-15）和行为（烟草和酒精）。
我们纳入了 1155 名平均年龄为 81.9 岁的受试者，其中 65%为女性。 单变量分析表明，口腔健康的病理状态与营养不良之间存在统计学显著关联（p<0.05），特别是与天然牙齿的龋齿、舌、牙龈和组织的病理学、口干、口腔清洁不足和存在牙齿疼痛有关。 调整社会人口统计学、行为和功能数据后的多变量分析证实了其中一些关联，特别是在牙龈/粘膜项与评分下降之间（p<0.01）； 同一项目与根据弗里德的体重减轻（p<0.01）以及舌项和体重减轻（p<0.05）之间存在关联。 口腔健康状况与虚弱之间存在统计学显著关联（舌项（p<0.01））。
我们的研究表明，口腔健康的病理状态与体弱老年人的营养障碍之间存在统计学显著关联。 这一结果证实了这样一种假设，即口腔健康状况不佳与体弱老年人的营养障碍有关。 我们的分析还表明，口腔健康状况恶化与虚弱之间存在统计学显著关联。 在这里，舌病增加了患者虚弱的风险。 然而，我们的结果是有限的，不允许对因果效应进行分析。 通过更精细的风险因素分析、对更大样本的分析以及对患者进行随时间的随访，对我们的研究进行补充将是有用的。
我们在这里表明，针对体弱人群进行口腔疾病筛查并将患者转介至牙科护理非常重要。 如果体弱患者不仅要保持健康的营养状态，还要保持满意的整体健康状态，从而实现健康老龄化，那么确保他们的口腔健康护理似乎是必不可少的。
