Lee Yen-Yang, Weng Shuo-Chun, Lee Yu-Shan, Chou Yin-Yi, Kuo Fu-Hsuan, Yang Shu-Hui, Yeh Ya-Hui, Chu Wei-Min, Hsu Chiann-Yi, Lin Shih-Yi, Lin Cheng-Fu
Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
Clin Interv Aging. 2025 Jul 16;20:1049-1061. doi: 10.2147/CIA.S524802. eCollection 2025.
PURPOSE: Oral functional impairment is a critical factor influencing clinical outcomes in hospitalized older adults. Notably, sex disparities in oral health on clinical outcomes remain an often underappreciated aspect.This study aims to investigate the association between oral function, assessed using the bedside oral examination (BOE), and in-hospital mortality, with an emphasis on sex-specific differences. PATIENTS AND METHODS: A retrospective cohort study was conducted involving 1,141 patients aged 65 years and older who were admitted to a medical center in Taiwan between 2018 and 2023. The BOE was a standardized clinical tool that evaluated eight domains of oral health, including swallowing, lips, tongue, saliva, mucous membranes, gingiva, teeth or dentures, and oral odor. Patients were classified into normal, moderate, or severe oral impairment groups. Cox proportional hazards models and Kaplan-Meier survival analysis were used to examine mortality risk, with results stratified by sex. RESULTS: Overall, greater oral functional impairment was associated with higher in-hospital mortality and poorer physical, nutritional, and psychological status. In the sex-stratified analysis, severe oral impairment remained an independent predictor of mortality in male patients (hazard ratio 1.77, 95% confidence interval 1.05 to 2.99, p = 0.032), but not in female patients. Survival differences were statistically significant among men based on oral function levels, as shown by Kaplan-Meier curves (log-rank p = 0.014), while no significant difference was found among women (log-rank p = 0.376). CONCLUSION: Severe oral functional impairment significantly predicts in-hospital mortality among older men, but not women. These findings underscore the importance of sex-specific approaches to risk assessment and intervention. Incorporating oral health screening into routine geriatric care, especially for men, may enhance early identification of high-risk patients and inform targeted strategies to improve clinical outcomes. Further research is warranted to understand the mechanisms underlying these sex differences.
目的：口腔功能障碍是影响住院老年人临床结局的关键因素。值得注意的是，口腔健康在临床结局方面的性别差异仍是一个常被忽视的方面。本研究旨在探讨使用床边口腔检查（BOE）评估的口腔功能与住院死亡率之间的关联，并着重分析性别差异。 患者与方法：进行了一项回顾性队列研究，纳入了2018年至2023年间入住台湾某医疗中心的1141名65岁及以上的患者。床边口腔检查是一种标准化临床工具，评估口腔健康的八个领域，包括吞咽、嘴唇、舌头、唾液、黏膜、牙龈、牙齿或假牙以及口腔气味。患者被分为口腔功能正常、中度或重度受损组。采用Cox比例风险模型和Kaplan-Meier生存分析来检验死亡风险，并按性别进行分层分析。 结果：总体而言，口腔功能障碍越严重，住院死亡率越高，身体、营养和心理状况越差。在按性别分层的分析中，重度口腔功能障碍仍是男性患者死亡的独立预测因素（风险比1.77，95%置信区间1.05至2.99，p = 0.032），但在女性患者中并非如此。根据Kaplan-Meier曲线，男性患者基于口腔功能水平的生存差异具有统计学意义（对数秩检验p = 0.014），而女性患者中未发现显著差异（对数秩检验p = 0.376）。 结论：重度口腔功能障碍显著预测老年男性而非女性的住院死亡率。这些发现强调了针对性别进行风险评估和干预的重要性。将口腔健康筛查纳入常规老年护理，尤其是针对男性，可能会加强对高危患者的早期识别，并为改善临床结局提供有针对性的策略。有必要进一步研究以了解这些性别差异背后的机制。
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