Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population

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Abstract

Background

The impact of poor oral health on older adults’ quality of life is a public health problem. In this study, the mediating effects of dental status, occlusal condition, dysphagia, and masticatory performance on the association between xerostomia and oral health-related quality of life (OHRQoL) were assessed in the older adult population.

Methods

Stratified cluster sampling was used to recruit 1076 community-dwelling adults aged 65 years and older from Kaohsiung, Taiwan. Community care centers were randomly selected according to their geographic classifications (urban, rural, or mountainous areas). Assessments of dental status and occlusal condition were performed by dentists. Information on demographics, physical function, xerostomia, dysphagia and depression was collected through face-to-face interviews. Masticatory performance was evaluated using color-changeable chewing gum. OHRQoL was measured using the Geriatric Oral Health Assessment Index. Hierarchical regression models were used to assess the relationships between OHRQoL and physical function, dental status and oral function in older adults. Path analysis was used to estimate direct and indirect pathways between xerostomia and OHRQoL.

Results

Participants with xerostomia exhibited a 0.20 OHRQoL reduction ( p < .001) compared with patients with no xerostomia, and the direct effect accounted for 83.3% of the total effect. Dysphagia and masticatory performance were found to exert significant mediating effects on the association between xerostomia and OHRQoL (βs = 0.20 and − 0.12, respectively; both p < .001; βs = 0.06 and − 0.09, respectively; both p < .05). Moreover, potential mediating effects of the number of functional teeth (βs = − 0.11 and − 0.43, respectively; both p < .001) and occlusal condition (βs = 0.09 and 0.13, respectively; both p < .05) on the relationship between xerostomia and masticatory performance were noted.

Conclusions

Dysphagia and masticatory performance may serve as pathways through which xerostomia affects quality of life. Early oral function intervention may be a valuable and actionable target for older adults to maintain quality of life. Our results further suggest that checkup and screening for oral dysfunction are essential to prevent or delay the onset of complications.

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Most cited references 38

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Principles and Practice of Structural Equation Modeling, Fourth Edition

Rex B. Kline (2015)

Emphasizing concepts and rationale over mathematical minutiae, this is the most widely used, complete, and accessible structural equation modeling (SEM) text. Continuing the tradition of using real data examples from a variety of disciplines, the significantly revised fourth edition incorporates recent developments such as Pearl's graphing theory and the structural causal model (SCM), measurement invariance, and more. Readers gain a comprehensive understanding of all phases of SEM, from data collection and screening to the interpretation and reporting of the results. Learning is enhanced by exercises with answers, rules to remember, and topic boxes. The companion website supplies data, syntax, and output for the book's examples--now including files for Amos, EQS, LISREL, Mplus, Stata, and R (lavaan). New to This Edition *Extensively revised to cover important new topics: Pearl's graphing theory and the SCM, causal inference frameworks, conditional process modeling, path models for longitudinal data, item response theory, and more. *Chapters on best practices in all stages of SEM, measurement invariance in confirmatory factor analysis, and significance testing issues and bootstrapping. *Expanded coverage of psychometrics. *Additional computer tools: online files for all detailed examples, previously provided in EQS, LISREL, and Mplus, are now also given in Amos, Stata, and R (lavaan). *Reorganized to cover the specification, identification, and analysis of observed variable models separately from latent variable models. Pedagogical Features *Exercises with answers, plus end-of-chapter annotated lists of further reading. *Real examples of troublesome data, demonstrating how to handle typical problems in analyses. *Topic boxes on specialized issues, such as causes of nonpositive definite correlations. *Boxed rules to remember. *Website promoting a learn-by-doing approach, including syntax and data files for six widely used SEM computer tools.

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Eric Pfeiffer (1975)

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

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European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

Laura Baijens, Père Clavé, Patrick Cras … (2016)

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

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Author and article information

Contributors

Hsiao-Ling Huang:

ORCID: http://orcid.org/0000-0002-1180-9011

hhuang@kmu.edu.tw

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 2 December 2020

Publication date PMC-release: 2 December 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 521

Affiliations

[1 ]GRID grid.412019.f, ISNI 0000 0000 9476 5696, Department of Oral Hygiene, College of Dental Medicine, , Kaohsiung Medical University, ; No. 100 Shih-Chuan 1st Road, Kaohsiung City, 807 Taiwan

[2 ]Department of Oral Hygiene, Hsin Sheng Junior College of Medical Care and Management, Taoyuan City, Taiwan

[3 ]GRID grid.412019.f, ISNI 0000 0000 9476 5696, School of Dentistry, College of Dental Medicine, , Kaohsiung Medical University, ; Kaohsiung City, Taiwan

[4 ]GRID grid.412027.2, ISNI 0000 0004 0620 9374, Department of Dentistry, , Kaohsiung Medical University Hospital, ; Kaohsiung City, Taiwan

[5 ]Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan

[6 ]GRID grid.412019.f, ISNI 0000 0000 9476 5696, Department of Public Health, College of Health Sciences and Research Center for Environmental Medicine, , Kaohsiung Medical University, ; Kaohsiung City, Taiwan

[7 ]GRID grid.64337.35, ISNI 0000 0001 0662 7451, School of Public Health, Health Sciences Center, , Louisiana State University, ; New Orleans, LA USA

Author information

Hsiao-Ling Huang http://orcid.org/0000-0002-1180-9011

Article

Publisher ID: 1901

DOI: 10.1186/s12877-020-01901-4

PMC ID: 7709251

PubMed ID: 33267812

SO-VID: 89a8e62f-a46d-4914-87a6-73f9b7684357

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 May 2020

Date accepted : 12 November 2020

Funding

Funded by: National Health Research Institutes, Taiwan (ROC)

Award ID: NHRI-107AI-PHCO-03181808

Award Recipient : Hsiao-Ling Huang

Funded by: FundRef http://dx.doi.org/10.13039/501100004663, Ministry of Science and Technology, Taiwan;

Award ID: MOST108-2314-B-037-061

Award Recipient : Hsiao-Ling Huang

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ScienceOpen disciplines: Geriatric medicine

Keywords: xerostomia,dysphagia,masticatory performance,oral health-related quality of life,path analysis

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ScienceOpen disciplines: Geriatric medicine

Keywords: xerostomia, dysphagia, masticatory performance, oral health-related quality of life, path analysis

Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population

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Conclusions

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Hearing Loss and Restoration

Most cited references 38

Principles and Practice of Structural Equation Modeling, Fourth Edition

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.

European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

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