Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study.

BACKGROUND: Poor oral health is known to be associated with adverse outcomes, but the frequency and impact of poor oral health on older adults in the acute inpatient setting has been less well studied. OBJECTIVES: We examined the association between oral health, frailty, nutrition and functional decline in hospitalized older adults. DESIGN: Retrospective cross-sectional study. SETTING AND PARTICIPANTS: We included data from 465 inpatients (mean age 79.2±8.3 years) admitted acutely to a tertiary hospital. METHODS: We evaluated oral health using the Revised Oral Assessment Guide (ROAG), frailty using the Clinical Frailty Scale (CFS), malnutrition risk using the Nutritional Screening Tool (NST) and functional status using a modified Katz Activities of Daily Living (ADL) scale. We examined cross-sectional associations of oral health with frailty, malnutrition risk and functional decline on admission, followed by multivariate logistic regression models evaluating the association between poor oral health and the aforementioned outcomes. RESULTS: 343 (73.8%), 100 (21.5%) and 22 (4.7%) were classified as low, moderate and high risk on the ROAG, respectively. Poorer oral health was associated with greater severity of frailty, functional decline on admission and malnutrition risk. Abnormalities in ROAG domains of voice changes, swallowing difficulty, xerostomia, lips and tongue appearance were more frequently present at greater severity of frailty. Poor oral health was associated with frailty [odds ratio (OR): 1.76, 95% confidence interval (CI) 1.05-2.97; P=0.034]; malnutrition risk [OR: 2.76, 95% CI 1.46-5.19, P=0.002] and functional decline [OR: 1.62, 95% CI 1.01-2.59, P=0.046]. CONCLUSIONS: Poor oral health is significantly associated with frailty, malnutrition risk and functional decline in older inpatients. Oral health evaluation, as part of a comprehensive geriatric assessment may be a target for interventions to improve outcomes. Further research including longitudinal outcomes and effectiveness of specific interventions targeted at oral health are warranted in older adults in the inpatient setting.

Use of tantalum cones in primary arthroplasty of acute proximal tibial fractures.

Metaphyseal tantalum cones in primary total knee arthroplasty and their functional outcome is described using 3 case reports over 6 years. 3 knees in 3 elderly individuals (mean age of 70.4 years), with pre-existing osteoarthritis and complex proximal tibial fractures, were operated on. Ambulation with walking frame was achieved from post-operation day 1, with weight-bearing as tolerated. Mean range of motion was 122° and Mean Knee Society Score was 88. All showed improvement in pre-operative limb alignment. Radiological fracture union was achieved on an average of 3 months. All were independent ambulators and pain-free at the latest follow-up. Our case series shows that tantalum cones are associated with significant improvements in clinical scores, patient symptoms, range of movement, early weight-bearing and low rates of complications in complex proximal tibial fractures with poor bone stock.

Incisal orientation and biting efficiency.

Broad-edged 'spatulate' upper and lower incisors are distinctive of catarrhines and platyrrhines who use them in various ways to peel fruits, remove bark, and strip leaves from branches. The incisors of modern humans not only control the bite size of foods during ingestion, but often grip items in a number of non-food related tasks. Such uses have long been implicated for Neandertals as well. Despite the evolutionary importance of incision and the fact that the incisors feature prominently in clinical dentistry (via orthodontic practices designed both to correct incisal misalignments and adjust their orientation), little is known about what affects their functional efficiency. Few mechanical analyses of incisal action have been published and none that seem to take note of the mechanisms of both fracture and friction at the tooth-food interface. Here, we modeled the incisal tip as a wedge, finding that the efficiency of biting foods that fracture elastically is strongly dependent on both the apex angle of the incisor and the coefficient of friction. Based on apex angle measurements from a small sample of human central incisors, the overall efficiency of upper central incisors is predicted to be greatest when the angle between the apex bisector and the direction of applied force is zero. However, this is complicated greatly by friction, particularly for the lower incisors. The analysis probably applies not only to the use of incisors by humans, but also to some extent to frugivorous primates. This model should clarify the mechanics behind incision and can provide a basic foundation upon which more advanced models can be built on in the future.