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      Oral Health and nutritional status in nursing home residents—results of an explorative cross-sectional pilot study

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          Abstract

          Background

          This study was performed to assess oral and nutritional status of nursing home residents in a region of Lower Saxony, Germany. The aim was to show potential associations between oral status (dentate or edentulous), further anamnestic factors (dementia, age, smoking) and the risk for malnutrition in this population.

          Methods

          In this observational cross-sectional pilot study of residents from four nursing homes Mini Nutritional Assessment (MNA), Body-Mass-Index (BMI), dental status (DMF-T) and periodontal situation (PSR ®/PSI) were recorded. Associations of recorded factors with oral health and nutritional status were examined in univariate and multivariate analysis.

          Results

          Eighty-seven residents participated in the study (mean age: 84.1 years; female: 72%, demented: 47%). Average BMI was 26.2 kg/m 2; according MNA 52% were at risk for malnutrition. 48% of the residents were edentulous, and the average DMF-T of dentulous was 25.0 (3.7) (D-T: 2.0 [3.1], M-T: 15.0 [8.3], F-T: 8.0 [7.4]); PSR ®/PSI 3 and 4 (need for periodontal treatment) showed 79% of residents. In univariate analysis dementia (OR 2.5 CI 95 1.1–5.6) but not being edentulous (OR 2.0 CI 95 0.8–5.8) were associated with being at risk for malnutrition. Dementia remained associated in multivariate analysis adjusting for age and sex, (OR 3.1 CI 95 1.2–8.2) and additionally being edentulous (OR 2.8 CI 95 1.1–7.3) became associated significantly. Furthermore, nursing home residents with dementia had more remaining teeth (OR 2.5 CI 95 1.1–5.9).

          Conclusion

          Dementia was a stronger predictor for risk of malnutrition in nursing home residents than being edentulous. Further studies to elucidate the possible role of oral health as cofactor for malnutrition in dementia are needed.

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          Most cited references35

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          The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.

          The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.
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            Dementia and oral health among subjects aged 75 years or older.

             To study the association between diagnosed dementia and oral health, focusing on the type of dementia, among an elderly population aged 75 years or older.
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              Functional units, chewing, swallowing, and food avoidance among the elderly.

              The number of teeth in the dentition was compared with the number and types of dental functional units (opposing tooth pairs) to correlate the number of functional units with complaints about chewing and swallowing in the elderly. Complaints of oral pharyngeal function and food avoidance practices were compared with the number and types of functional units. A convenience sample of 602 elderly subjects (468 men, 134 women, mean age 70 years) were interviewed and examined dentally. Functional unit measures, which included functional arrangement of the teeth and the number and type of teeth present, were found to be more discriminatory and descriptive of masticatory potential than the more number of teeth. Elderly persons (> or = 60 years of age) with reduced numbers of functional units tended to report difficulty chewing, avoidance of stringy foods (including meat), crunchy foods (including vegetables), and dry solid foods (including breads), and difficulty in swallowing. Removable prostheses did not appear to prevent these consequences and, at least in this elderly population, did not appear to be equivalent to natural teeth in terms of masticatory potential. It is possible that compromised dental function results in the swallowing of poorly chewed food, food avoidance patterns, dietary inadequacies, and systemic changes favoring illness, reduced vigor, debilitation, and shortened life expectancy. Emphasis should be placed on maintaining natural teeth whenever possible.
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                Author and article information

                Contributors
                +49 341 97 21211 , dirk.ziebolz@medizin.uni-leipzig.de
                info@zahnarzt-praxis-werner.de
                gerhard.schmalz@medizin.uni-leipzig.de
                ina.nitschke@dgaz.org
                rainer.haak@medizin.uni-leipzig.de
                rainer.mausberg@med.uni-goettingen.de
                jchenot@uni-greifswald.de
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                31 January 2017
                31 January 2017
                2017
                : 17
                : 39
                Affiliations
                [1 ]ISNI 0000 0001 2230 9752, GRID grid.9647.c, Department of Cariology, Endodontology and Periodontology, , University of Leipzig, ; Liebigstr. 12, D 04103 Leipzig, Germany
                [2 ]Dental practice, Goettingen, Germany
                [3 ]ISNI 0000 0001 2230 9752, GRID grid.9647.c, Department of Prosthodontics and Materials Science, , University of Leipzig, ; Leipzig, Germany
                [4 ]ISNI 0000 0001 0482 5331, GRID grid.411984.1, Deptartment of Preventive Dentistry, Periodontology and Cariology, , University University Medical Center, ; Goettingen, Germany
                [5 ]GRID grid.5603.0, Department of General Practice, , Institute for Community Medicine, University Medicine Greifswald, ; Greifswald, Germany
                [6 ]ISNI 0000 0004 1937 0650, GRID grid.7400.3, Clinic of Geriatric and Special Care Dentistry, Center of Dentistry, , University of Zurich, ; Zurich, Switzerland
                Author information
                http://orcid.org/0000-0002-9810-2368
                Article
                429
                10.1186/s12877-017-0429-0
                5282867
                28143415
                f4353844-7800-4b5d-86e5-7536a29a557e
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.

                History
                : 21 July 2016
                : 21 January 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Geriatric medicine
                oral health,nutritional status,nursing home,dementia
                Geriatric medicine
                oral health, nutritional status, nursing home, dementia

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