[Development of a staging classification for leisure activities and social communication in dependent elderly persons].

AIM: The aim of this study was to develop a simple staging classification to measure leisure activity and social communication among the elderly at geriatric health care facilities. METHODS: In order to construct a staging scale for measuring the participation of the elderly subjects, we developed a list of 28 items for three domains: leisure activities, social participation and communication. Data were obtained from users of institutional and day care services at geriatric health service facilities. The Rasch model was applied to test the degree of item fit and difficulty. Simple staging scales were constructed based on 12 leisure activity and nine social communication items. The validity and reliability were tested using these newly developed scales according to the Rasch model and assessments of the test-retest reliability. RESULTS: The participants were 3,458 elderly persons, of whom 1,560 were currently using institutional services and 1,898 were using day care services. Among the 28 items, "traveling" was identified as the most difficult and "watching television" was identified as the easiest. Because items related to "social participation," such as volunteer activities, exhibited a low frequency, they were not used in the further analyses. Simple staging scales were constructed by analyzing the remaining items of leisure activities and social communication according to the Rasch model. The thresholds within the scales were determined in order of item difficulty. Cohen's kappa, as assessed by two different evaluators, was 0.75 for leisure activities and 0.77 for social communication. CONCLUSIONS: In this study, we developed staging scales for leisure activity and social communication. The construct validity and test-retest reliability were adequate for both scales. Service providers can improve service quality by using these scales for individual case management of elderly persons in conjunction with existing scales of activities of daily living.

Feeding therapy for children with food refusal.

Disabled children suffer not only from their primary disease, but also from other complications, including food refusal. The purpose of this study was to elucidate the relationship between these conditions and food refusal in disabled children. The effectiveness of feeding therapy in treating food refusal was also examined. The study subjects were 67 disabled children (35 boys and 32 girls; mean age at initial examination: 6.5 years, SD: 6.0 years) who attended the Nippon Dental University Hospital between April 2004 and August 2008. Of them, the 13 subjects who were diagnosed as those who refused food received feeding therapy combined with desensitization therapy for hypersensitivity. Approximately 20% of the subjects showed food refusal symptoms. Primary disease, respiratory impairment and gastroesophageal reflux were not causes of food refusal in this population. There was a significant relationship between food refusal and hypersensitivity (p = 0.021). After receiving feeding therapy, six of the seven subjects with hypersensitivity but without dysphagia at initial examination recovered from food refusal. Food refusal did not significantly correlate with tube feeding. Hypersensitivity and/or tube feeding may induce food refusal. For subjects with these conditions, feeding therapy combined with desensitization therapy is effective in achieving recovery from food refusal.

The degree of tongue-coating reflects lingual motor function in the elderly.

OBJECTIVES: The aim of this study was to examine the relation between the degree of tongue-coating and oral function. BACKGROUND: Tongue-coating is a moss-like deposit which forms over the tongue surface, and includes micro-organisms, food residues, and abrasive epithelia. It is considered that motor function of the tongue and lips and saliva secretion decrease in the aged and have some effect on the accumulation of tongue-coating. Although saliva secretion has been reported as a factor amongst these oral functions in contributing to tongue-coating, the correlation with the motor function of oral structures is unknown. SUBJECTS AND METHODS: The factors that contribute to the accumulation of tongue-coating were examined in 48 subjects of advanced age (mean age 80.8 +/- 7.8 years) with no severe levels of periodontal disease. Changes in the degree of tongue-coating were also examined after oral functional training in these subjects. The frequency of oral cleaning, status of oral hygiene, motor function of the tongue, and masticatory performance were examined as potential factors associated with the degree of coating. RESULTS: The results showed that tongue pressure and the frequency of oral diadochokinesis measured by pronouncing the single syllable 'ka' as an indicator were statistically significantly correlated with the degree of tongue-coating. Several factors in oral function improved with training, and also the degree of tongue-coating decreased in 27 subjects. CONCLUSION: These results suggest a correlation between the degree of tongue-coating and a reduction in lingual motor function and, in addition, possible improvement in level of coating by functional training of the tongue.

Oral motor function and masticatory performance in the community-dwelling elderly.

This study was performed to ascertain the relationships between oral motor functions, such as those of the tongue and lips, and age in the community-dwelling elderly, as well as to investigate the effects of these factors on masticatory performance. The subjects were 268 healthy elderly Japanese living in Kyoto. They were divided into four age groups and further classified into the following two groups by the presence or absence of posterior occlusal support: Eichner A or B1-B3 (group A), and Eichner B4 or C (group B). They were wearing removable or fixed dentures if they had missing teeth. Oral function evaluation items included (1) masticatory performance and (2) oral motor skills. Significant differences were noted among the age groups in tongue pressure within group A (P < 0.01) and group B (P < 0.05), and in the number of repetitions of the syllables /ta/ and /ka/ in group B (/ta/: P < 0.05, /ka/; P < 0.01). The number of natural teeth (beta = 0.463, P < 0.001) in group A and tongue pressure (beta = 0.436, P < 0.001) in group B were the only predictors of masticatory performance when the data were analyzed by multiple regression analysis. The tongue may compensate for the missing teeth in masticatory performance of those elderly who have lost their natural teeth. The results of this study highlight the importance of tongue function in masticatory performance.

Effects of a palatal augmentation prosthesis on lingual function in postoperative patients with oral cancer: coronal section analysis by ultrasonography.

A palatal augmentation prosthesis (PAP) is used in postoperative patients with oral cancer as an intraoral appliance. The purpose of this study was to use ultrasound imaging to evaluate the effects of a PAP on lingual movement dynamics when postoperative patients with oral cancer swallowed food while wearing a PAP and to elucidate the effectiveness of the PAP. The subjects were seven patients with tongue cancer. They wore a PAP as an intraoral device to compensate for postoperative dysfunction after surgery for tongue cancer. The measurements were made by using ultrasonography. Ultrasound images of the lingual movement dynamics of the center of the tongue (central grooving of the tongue in a coronal plane, passing through the distal surfaces of both the left and right lower second premolars) during swallowing were obtained in M mode. The mean duration of lingual-palatal contact was 805.4 +/- 306.0 ms in patients without a PAP and 621.8 +/- 364.9 ms in those with a PAP. The duration decreased significantly in patients wearing a PAP (P = 0.03). The mean total duration of lingual movement was 1612.2 +/- 478.3 ms in patients without a PAP and 1245.6 +/- 272.5 ms in those with a PAP. The mean total duration decreased significantly in patients with a PAP (P = 0.03). The study results indicated that wearing an intraoral appliance may effectively help lingual movement on swallowing in postoperative patients with oral cancer.

[Relation between the level of care needed and frailty for labial functions].

AIM: The purpose of this study was to examine whether the improvement of oral functions could prevent increase in the level of care needed in the elderly by analyzing the relationship between the level of care needed and labial functions. METHODS: The subjects were 114 elderly people who were healthy or needing care (44 men, 70 women; average age 81.3 +/- 6.3 years), all of whom maintained posterior occlusal support with their natural dentition and had no defect in front teeth. They were divided into four groups; Group 1: healthy elderly, Group 2: elderly requiring assistance or Care Category 1, Group 3: elderly requiring Care Categories 2 and 3, Group 4: elderly requiring Care Categories 4 and 5, according to the classification of certification of eligibility for long-term care by the Japanese Ministry of Health, Labor and Welfare. Water-repellent pressure sensors (PS-2KA, Kyowa Electric Co, Japan) were embedded in an acrylic plate. The device was used to measure the labial-closing pressure during 1-gram yogurt ingestion, the maximum labial pressure with effort and the reserve capacity of pressure. Drooling of food as feeding/swallowing dysfunction of the subjects was surveyed. RESULTS: 1) The mean value of labial pressure with effort was 296.4 +/- 153.9 Pa, and that of the reserve capacity of labial pressure was 209.6 +/- 152.3 Pa. They showed significant declines in accordance with the aggravation level of needing care (p < 0.01). 2) The labial pressure with effort and the reserve capacity of pressure in subjects who showed drooling of food symptom were significantly lower compared to those who showed no drooling of food symptom (p < 0.05). CONCLUSION: Labial functions declined in accordance with the increased level of care needed, and a relationship between drooling of food and labial-closing pressure was recognized. It was suggested that the improvement of labial functions might prevent increased need of care.

Case presentation: dental treatment with PAP for ALS patient.

The aim of this study was to evaluate the effect of Palatal Augmentation Prosthesis (PAP) for an Amyotrophic Lateral Sclerosis (ALS) patient. The patient's palatogram was taken during swallowing to assess her lingual function. A PAP was provided to assist her with feeding and swallowing functions. The patient's lingual pressure strength showed increases, and she was able to feed well using PAP. This devise was useful for assisting lingual dysfunctions due to various diseases.

[Effect of oral function on nutritional improvement in nursing home residents].

The objective of this study is to examine how occlusal status and swallowing function influence the nutritional improvement achieved by appropriate feeding assistance in the institutionalized elderly. We studied 38 residents (mean age 82.04 +/- 7.35 years) in a nursing home. Their nutritional status was evaluated by biochemical analysis, and the following results were obtained: 1) Compared to the levels before intervention, there was a significant increase (p<0.05) after 6 months in serum albumin (3.65 +/- 0.32 g/dl before and 3.77 +/- 0.33 g/dl after assistance), HDL cholesterol (49.39 +/- 13.39 mg/dl before and 53.44 +/- 11.27 mg/dl after assistance), and hemoglobin (11.39 +/- 1.76 g/dl before and 11.75 +/- 1.75 g/dl after assistance) respectively. 2) Among the edentulous elderly, the change in serum albumin was more significant in the subgroup of elderly wearing dentures (3.64 +/- 0.35 g/dl before and 3.92 +/- 0.40 g/dl after assistance). 3) The serum albumin was significantly lower (p<0.05) in the group of people with swallowing disorders before intervention than the group of people with normal swallowing function (those with swallowing disorder 3.48 +/- 0.31; those with normal swallowing function 3.75 +/- 0.29 g/dl), but it did not change significantly after intervention. These results suggested that occlusal support with dentures greatly influences the nutritional intake and appropriate feeding assistance could achieve nutritional improvements for elderly with reduced swallowing function.

Stimulation of Na-dependent phosphate transport by platelet-derived growth factor in rat aortic smooth muscle cells.

We investigated the effect of platelet-derived growth factor B homodimer (PDGF-BB) on inorganic phosphate (Pi) transport activity, which has been reported to be involved in the mechanism of atherosclerosis, in A-10 rat aortic vascular smooth muscle cells (VSMCs). PDGF-BB time- and dose-dependently stimulated Pi transport in A-10 cells. Using northern blot analysis, the PDGF-BB-enhanced Pi transporter (PiT) in A-10 cells was identified as Pit-1 (Glvr-1), a member of the type III Na-dependent PiT. An inhibitor of PDGF beta-receptor tyrosine kinase suppressed PDGF-BB-induced Pi transport. Both a protein kinase C (PKC) inhibitor calphostin C and PKC down regulation suppressed the stimulatory effect of PDGF-BB on Pi transport. On the other hand, inhibition of mitogen-activated protein (MAP) kinases by selective inhibitors did not affect Pi transport. Ly294002, a phosphatidylinositol (PI) 3-kinase inhibitor, partially attenuated PDGF-BB-induced Pi transport. A selective inhibitor of S(6) kinase, rapamycin, reduced this effect of PDGF-BB, while Akt kinase inhibitor did not. In summary, these results indicated that PDGF-BB is a potent and selective stimulator of Pi transport in VSMCs. The mechanism responsible for this effect is not mediated by MAP kinase, but involves activation of PKC, PI 3-kinase and S(6) kinase.