Factors involved in picky eating in children with disabilities visiting outpatient clinics to receive feeding therapy.

This study aimed to clarify the factors influencing picky eating in children with disabilities based on the hypothesis that primary disease or oral function is involved in picky eating. The subjects were 242 children aged 3-6 years receiving outpatient feeding therapy at our clinic. The subjects' general and oral conditions and picky eating were assessed by their medical recodes. Resultingly, 79 children showed picky eating. Using logistic regression analysis, associated factors of picky eating were primary disease (p = .04), nutritional methods (p = .01), and oral hypersensitivity (p = .04). The relationship with the primary disease suggests the influence of the characteristics of the primary disease. The relationship with oral hypersensitivity may be attributed to avoiding certain sensations. Additionally, the study revealed that the subjects employed tube feeding to compensate for reduced nutritional intake due to picky eating. This study indicated that primary disease and nutritional method as general conditions and oral hypersensitivity as an oral function were possible factors for picky eating. Picky eating was found to occur at varying frequencies depending on the underlying primary disease, especially when the child struggled to tolerate different sensations experienced during meals.

Oral status of older adults receiving home medical care: A cross-sectional study.

AIM: This study examined the oral status and the presence of teeth requiring treatment among older adults receiving home medical care. METHODS: This cross-sectional study was conducted at a Japanese dental clinic specializing in geriatric treatment. We recruited older adults receiving home medical care in the community who had begun to receive domiciliary dental care. The Japanese version of the Oral Health Assessment Tool (OHAT-J), as well as the presence of teeth requiring extraction and the need for assistance in maintaining oral hygiene were used to evaluate the participants' oral health and its association with other items. RESULTS: Ninety-three participants (44 male and 49 female, median age: 87.0 years) were surveyed. The median OHAT-J score was 6. The duration since the previous dental visit was 23 months. Sixty-two (73.8%) of 84 participants with ≥1 natural tooth had severe caries or teeth with severe mobility that required extraction. Logistic analysis revealed that requiring assistance in maintaining oral hygiene, mild dementia, severe dementia, and depression were significantly associated with an OHAT score of ≥6. CONCLUSIONS: Older adults receiving home medical care had poor oral health, with approximately 70% of them requiring tooth extraction. The need for assistance in maintaining oral hygiene and poor mental status contribute to poor oral health. Geriatr Gerontol Int 2024; 24: 706-714.

Problems experienced when swallowing solid oral dosage forms in older Japanese patients with dysphagia: A cross-sectional study.

AIMS: We aimed to assess the difficulty in taking solid oral dosage forms (SODFs) among older people with dysphagia and clarify the relationship between difficulty in swallowing SODFs and swallowing function. METHODS AND RESULTS: Outpatients from a dysphagia clinic aged ≥65 years were asked yes-or-no questions about the applicability of eight items regarding difficulty in taking SODFs. Additionally, a videofluorographic swallowing study (VFSS) was performed to assess their swallowing function. The Kruskal-Wallis test and Spearman's rank correlation coefficient were used to analyze the relationship between difficulty in taking SODFs and swallowing function. RESULTS: Among the 93 participants, the average number of SODFs consumed was 5.8 ± 3.1. In the questionnaire, the average number of "yes" answers was 2.2 ± 2.2, and 65 patients (71.0%) answered "yes" to at least one question. Additionally, no significant relationship was observed between the perceived difficulty in swallowing SODFs and VFSS findings. CONCLUSION: Approximately 70% of participants reported subjective difficulty in taking SODFs, showing that patients uniformly reported perceived difficulty in taking SODFs regardless of actual swallowing function. The results of this study suggest that patients must be questioned thoroughly about their SODFs use, regardless of the objective severity of their dysphagia.

Factors associated with the maintenance in food texture for dependent older people with dysphagia living in nursing home - A retrospective cohort study.

OBJECTIVES: Maintaining the texture of the food that nursing home residents eat is critical for maintaining quality of life and preventing malnutrition. The aim of the present study was to identify the conditions necessary for maintaining food texture for this population. MATERIALS AND METHODS: The study included 143 people for whom reevaluation 1-year post-baseline was possible from among 256 dependent older people who consumed solid food on admission to a nursing home (baseline). The age, sex, primary disease, activities of daily living, nutritional status, oral status, swallowing ability, primitive reflexes, and food texture of the participants were determined. The participants who ate pureed or jelly after 1 year were identified and evaluated to determine factors related to maintenance of a solid diet. RESULTS: A total of 21 participants (14.7%) changed to a pureed or jelly diet after 1 year. Multivariate analysis showed good activities of daily living (p < .05), good swallowing ability (p < .05), and maintained nutritional status (p < .05) to be correlated with solid food maintenance. CONCLUSIONS: Maintaining activities of daily living, feeding and swallowing ability, and nutritional status appear to be important factors for the maintenance of a solid diet.

Usefulness of Telemedicine for Disabled Children Receiving Feeding Therapy.

We performed a retrospective cohort study using medical records of 374 pediatric patients who visited a university dental clinic specializing in dysphagia rehabilitation in Japan between 2019 and 2020 to clarify the usefulness of telemedicine among disabled children receiving feeding therapy. The primary outcome was the feeding developmental stage confirmed at the final evaluation. Propensity score matching was performed between individuals in two treatment groups (in-person and telemedicine) before the final analysis using patients' age, sex, primary disease, gross motor function, and feeding developmental stage as covariates. A total of 36 patients were enrolled in each of the in-person and telemedicine groups. The initial evaluation for the propensity score matched population using the χ2 test showed no significant difference between the two groups in any parameter. The feeding developmental stage evaluated at the final evaluation using the Wilcoxon signed-rank test significantly improved compared with the stage at the initial evaluation in both groups (in-parson group, p = 0.007; telemedicine group, p = 0.013). The difference in level achieved at the final evaluation revealed that the most common level was "unchanged," followed by "improvement by one level" in both groups, indicating that there was no significant difference in the efficacy of feeding therapy between the two groups (p = 0.314). Our results show that telemedicine can achieve the same therapeutic outcomes as in-person therapy to improve feeding function in children with disabilities when receiving feeding therapy.

Two case reports using a proposed oral risk assessment tool for older people near the end of life.

OBJECTIVES: We developed a prototype technique that expresses the need for intervention and the effectiveness of the treatment when "not being at risk of injury to the oral cavity or to general health" due to the presence of teeth or prostheses is taken as the desired outcome of dental treatment for older people near the end of life. The objective of this study was to use the prototype risk assessment matrix to identify the risk for each patient according to their course and show the effectiveness of treatment. MATERIAL AND METHODS: We produced a prototype Dental Risk Map (Dental R-map) based on the risk map method of risk management. Risk is classified into three levels according to the level of tolerability: (A) Risk for which watchful waiting should be included among measures to be considered; (B) risk for which intervention should be considered; or (C) risk requiring urgent intervention. RESULTS: We report the application of this technique to two men in their 80s. Both were assessed as risk tolerability Level C, requiring immediate intervention. Dental treatment eliminated this risk in one and reduced it to Level B in the other. CONCLUSIONS: We developed the prototype Dental R-map to identify oral risks and indicate the need for intervention to address these risks and the effectiveness of treatment for older people near the end of life. We used the Dental R-map for two patients and successfully avoided oral risks that might cause physical injury in both cases until their deaths.

Masticatory movements and food textures in older patients with eating difficulties.

OBJECTIVES: To investigate whether masticatory movements in older patients with eating difficulties were associated with oral motor function, physical function, and appropriate food textures. BACKGROUND: There are few reports on the association between masticatory movements and food textures in older patients with eating difficulties. MATERIALS AND METHODS: This cross-sectional study involved outpatients at a clinic that specialised in eating and swallowing rehabilitation. Masticatory movements were evaluated as normal or abnormal masticatory path patterns. Oral and physical functions were assessed in terms of oral and physical status, muscle strength and motor skills. The appropriate food texture was determined based on fibreoptic endoscopic evaluation of swallowing and a video fluoroscopic swallowing study. The associations between food texture and masticatory organ, muscle strength and motor skills were analysed. RESULTS: A total of 126 outpatients (75 men and 51 women; mean age, 78.2 years; SD, 9.6 years) were included in the analysis. 68 participants (54.0%) showed abnormal masticatory movements. Masticatory movement was associated with masticatory performance (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.98-0.99), oral diadochokinesis (OR = 0.55, CI = 0.35-0.86) and stepping test (OR = 0.92, CI = 0.86-0.97). Masticatory movement (OR = 2.94, CI = 1.23-7.01) and the number of natural teeth (OR = 0.94, CI = 0.89-0.99) were associated with normal food. CONCLUSION: Masticatory movements in older patients with eating difficulties may be associated with appropriate food textures whilst being influenced by individual differences in systemic motor control. Masticatory movements may be as important as teeth to enjoy eating.

Association between masticatory movement and oral and physical function in healthy older women.

PURPOSE: This study examined the association between masticatory movement and oral and physical function in healthy older women using clinical assessments considering central motor control. METHODS: A total of 107 independent older women (mean age, 74.37 ± 4.46 years; age range, 66-84 years) living in the community participated in this cross-sectional study. The subjects selected were those aged 65 years or older with at least 28 teeth and without oral dysfunction, temporomandibular joint (TMJ) disease, cerebrovascular disease, or neuromuscular disease. The following items of oral and physical function were measured: masticatory path pattern, masticatory performance, oral diadochokinesis (ODK), tongue pressure, single-leg stance with eyes open (SLS), stepping test, and grip strength. Logistic regression analysis adjusting for age was performed to investigate the association between masticatory movement and other items. RESULTS: In total, 30.8% of subjects were classified into the abnormal group regarding masticatory path pattern, having a significantly lower value than that of the normal group in masticatory performance (unadjusted p = 0.021). After adjusting for age, the masticatory path pattern was significantly associated with masticatory performance ( p = 0.032); ODK /pa/ ( p < 0.001), /ta/ ( p = 0.022), and /ka/ ( p = 0.016); and stepping test ( p = 0.018). Tongue pressure, SLS, and grip strength were not significantly associated with masticatory path pattern. CONCLUSION: Masticatory movement in older women was associated with masticatory performance, tongue and lip motor skills, and physical agility, which might be influenced by central motor control.

Development of the Sakiika transport test: A practical screening method for patients with oral-phase dysphagia.

PURPOSE: This study aimed to develop a simple screening test for mastication, "the Sakiika (squid jerky) transport test (STT), which evaluates the vertical jaw movement coordinated with the lateral tongue movement during stage I transport, and investigate the possibility of its clinical application. METHODS: The study included 73 people with dysphagia (mean age, 78.5 ± 7.8 years; median age, 79.0 years; interquartile range, 75.0-84.0). The STT evaluated the ability of a participant to transport a piece of squid jerky placed on the midline of the tongue to the molar region. The STT score was defined as the number of vertical jaw movements occurring as the tongue transported food to the molars. A cutoff value was set by comparing the STT scores with masticatory function evaluated via a videofluoroscopic swallowing study and with food texture evaluated using the Food Intake LEVEL Scale (FILS). RESULTS: The STT scores counted by the two examiners had a κ coefficient of 0.79, indicating good reliability. The STT score was significantly associated with both the presence of masticatory movement ( p = 0.019) and food texture classified by FILS ( p = 0.032) at cutoff value of "3" (3 vertical movements). The STT showed 62% sensitivity and 75% specificity for masticatory movements. CONCLUSION: The STT could be a useful screening test to assess the presence or absence of food transportation to the molars for mastication in older patients with dysphagia. In addition, the STT could be useful in identifying the need to modify food texture to meet functions.

COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients.

BACKGROUND: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. METHODS: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. RESULTS: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7-9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. CONCLUSIONS: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL).

Tongue muscle strength affects posterior pharyngeal wall advancement during swallowing: A cross-sectional study of outpatients with dysphagia.

BACKGROUND: Tongue muscle strength is important for swallowing but decreases with age, in association with reduced skeletal muscle mass. However, the relationships between pharyngeal dynamics and both skeletal muscle mass and tongue muscle strength are unknown. OBJECTIVE: To investigate the effect of reductions in tongue muscle strength on pharyngeal movement during swallowing in patients with dysphagia. METHODS: Subjects were selected from male outpatients ≥65 years old who were examined for the main complaint of dysphagia. Patients with history of neurodegenerative disease affecting tongue movement, cerebrovascular disease or oral cancer were excluded. As a result, 82 men (mean age, 80.6 ± 6.8 years) participated. Skeletal muscle mass index (SMI) as physical parameters and maximum tongue pressure (MTP) as tongue muscles strength were measured. Status and dynamics of the pharyngeal organs, including change in posterior pharyngeal wall advancement (PPWA) when swallowing 3.0 mL of moderately thick liquid, were measured by analysing videofluoroscopic images. Simple bivariate correlation and multiple regression analysis were used to statistically analyse correlations between parameters. RESULTS: MTP showed a significant positive correlation with SMI (r = .43, P < .01). PPWA showed a significant negative correlation with MTP (r = -0.30, P < .01), but no association with SMI. CONCLUSIONS: While tongue muscle strength is affected by skeletal muscle mass, posterior pharyngeal wall advancement is not readily affected by decreases in skeletal muscle mass. Posterior pharyngeal wall advancement may increase to compensate for swallowing function among individuals with reduced tongue muscle strength.

Factors predicting the effects of dysphagia rehabilitation on multidimensional functional status in elder outpatients: A prospective cohort study.

OBJECTIVE: This study aimed to clarify the relationship between the oral intake function and functional status, as well as to determine the aspects of functional status potentially predicting the effects of dysphagia rehabilitation in the maintenance stage, in elder outpatients. METHODS: This study was conducted in a clinic, specialised in rehabilitation of patients with dysphagia. The participants were 93 non-tube-fed patients 65 years of age or older. The participants were scheduled to undergo the initial examination for oral intake function and functional status, and then to receive dysphagia rehabilitation for 1 year. After rehabilitation period, oral intake function was re-evaluated, and the elements of functional status potentially related to the effects of dysphagia rehabilitation were determined. RESULTS: It was found that the lower the participants' oral intake function levels, the higher the prevalence of reduced parameters of functional status. After 1-year dysphagia rehabilitation, the oral intake function was maintained or improved in 70 (75.3%) participants, but had diminished in 23 (24.7%). Our analysis revealed that participants with higher Vitality Index scores and MMSE at the time of initial examination were significantly more likely to show maintained or improved oral intake function at 1 year (odds ratio[OR], 1.76; 95% confidence interval [CI], 1.14-2.71; OR, 1.17; 95% CI, 1.06-1.28, respectively). CONCLUSIONS: It became apparent that the lower the oral intake function level at the initial examination, the higher the prevalence of reduced multidimensional functional status. Mental function was found to predict the effects of dysphagia rehabilitation in the maintenance stage.

Effect of dysphagia rehabilitation in patients receiving enteral nutrition at home nursing care: A retrospective cohort study.

OBJECTIVE: We considered the effect of dysphagia rehabilitation and investigated parameters associated with the resumption of oral intake in the elderly patients receiving home nursing care who were not eating by mouth. METHODS: The participants were 116 patients aged ≥65 years (66 men and 50 women, mean age 79.7 ± 8.9 years) who were receiving home nursing care and not eating by mouth because of dysphagia. All patients underwent dysphagia rehabilitation for 6 months with the objective of resuming oral intake. After 6 months of dysphagia rehabilitation, the patients' eating status was assessed using the Functional Oral Intake Scale (FOIS) and the associations of the post-intervention FOIS score with age, history of pneumonia, duration of enteral nutrition, body mass index (BMI), alertness, physical function (ability to walk) and swallowing function at the initial examination. RESULTS: Functional Oral Intake Scale scores increased significantly after 6 months rather than those at the initial evaluation (P < .001). Eighty patients (69.0%) resumed oral intake (FOIS score ≥2), thirty patients (25.9%) of whom became capable of daily oral intake (FOIS score ≥3). Swallowing function was associated with the resumption of oral intake. In addition, physical function before dysphagia rehabilitation was an important factor to resume daily oral intake. CONCLUSIONS: The results of the present study suggest that the resumption of oral intake by patients receiving enteral nutrition requires improvement in swallowing function. In addition, anyone who cannot walk may not recover daily oral intake.

The effects of sarcopenic dysphagia on the dynamics of swallowing organs observed on videofluoroscopic swallowing studies.

OBJECTIVES: The aim of the present study was (a) to determine the relationship of videofluoroscopic swallowing study (VFSS) findings of the swallowing musculature with the diagnostic criteria for sarcopenic dysphagia and (b) to examine the usefulness of VFSS for diagnosing sarcopenic dysphagia. METHODS: The participants were 132 patients (mean age, 80.4 ± 8.8 years). Their skeletal muscle mass, nutritional status and swallowing functions as assessed by VFSS findings were measured. Also, the relationship between the VFSS findings and sarcopenia was examined. RESULTS: Of all the participants, 20 men (mean age, 83.2 ± 6.9 years) and 27 women (mean age, 85.3 ± 6.9 years) were diagnosed with sarcopenia. In men, the amount of laryngeal upward movement (ALUM) was significantly lower and the pharyngeal area was significantly wider in the sarcopenia group than in the non-sarcopenia group. In women, the pharyngeal area was significantly wider in the sarcopenia group than in the non-sarcopenia group. In a logistic regression model, ALUM (odds ratio [OR] 1.135, 95% confidence interval [CI] 1.037-1.241, P = .006) and pharyngeal area (OR 0.028, 95% CI 0.001-0.670, P = .027) was a significant independent factor for the presence or absence of sarcopenia. CONCLUSIONS: The decline in swallowing function of sarcopenia patients was characterised by lower laryngeal movement and enlargement of the pharyngeal cavity due to decreased skeletal muscle mass and decreased muscle strength. The present study suggested the usefulness of measuring ALUM during swallowing and measuring the pharyngeal area with VFSS as indicators of decreased swallowing muscle function in sarcopenia.

Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients.

PURPOSE: The purpose of this study was to examine how skeletal muscle mass influences the effectiveness of dysphagia rehabilitation. METHODS: The cross-sectional study and the prospective cohort study were conducted in a clinic, specialized in rehabilitation of patients with dysphagia, located in Tokyo, Japan. Skeletal muscle mass measurement by bioelectrical impedance analysis and tongue strength measurement were performed on 178 outpatients with dysphagia. In addition, the Barthel Index, Mini Nutritional Assessment-Short Form, and Functional Oral Intake Scale values were measured. Dysphagia rehabilitation was performed, and 88 of the patients who were available for follow-up one year later were included in a follow-up study. In the cross-sectional study, the associations between tongue strength and other factors were examined. In the follow-up study, factors associated with rehabilitation effectiveness, shown by tongue strength, were examined. RESULTS: Tongue strength and skeletal muscle mass were correlated, and both decreased as eating and swallowing function level decreased. After one year of dysphagia rehabilitation, tongue strength and skeletal muscle mass increased. The factors associated with the amount of increase in tongue strength were initial tongue strength and skeletal muscle mass. CONCLUSIONS: For patients with dysphagia, maintenance of skeletal muscle mass was associated with improvement of tongue strength in rehabilitation. This indicates that prevention of sarcopenia in dysphagia patients contributes to the effect of rehabilitation.

Relationship between oral environment and development of pneumonia and acute viral respiratory infection in dependent older individuals.

AIM: The importance of oral care has been recognized for the prevention of airway infections in older individuals who require long-term care. The present prospective cohort study was carried out a decade ago to identify risk factors with numerous intraoral conditions as possible predictors involved in the onset of pneumonia and acute viral respiratory infection (AVRI) in older people requiring long-term care during a 6-month follow-up period (including winter). METHODS: This study included 1785 older individuals residing in 31 long-term care facilities in which dental hygienists were involved in instruction on daily oral care. Primary end-points were development of pneumonia and AVRI during the 6-month follow-up period. Several factors related to each participant's general condition, oral environment, swallowing function and vaccinations (or lack thereof) were evaluated by calibrated dentists and dental hygienists before the study onset. RESULTS: During the 6-month follow-up period, 74 participants (4.1%) developed pneumonia, and 28 participants (1.6%) developed AVRI. Cox proportional hazard analysis showed that poor nutritional status and the presence of dysphagia were significant risk factors for pneumonia onset. The presence of dry mouth and halitosis were significant risk factors for AVRI. CONCLUSIONS: This prospective multicenter cohort study identified poor nutritional status and dysphagia as independent risk factors for the development of pneumonia, and dry mouth and halitosis as independent risk factors for the development of AVRI in older people who require long-term care and who routinely receive professional oral care. Geriatr Gerontol Int 2019; 19: 1136-1140.

Survey of suspected dysphagia prevalence in home-dwelling older people using the 10-Item Eating Assessment Tool (EAT-10).

OBJECTIVE: This study was carried out to determine the prevalence of suspected dysphagia and its features in both independent and dependent older people living at home. MATERIALS AND METHODS: The 10-Item Eating Assessment Tool (EAT-10) questionnaire was sent to 1,000 independent older people and 2,000 dependent older people living at home in a municipal district of Tokyo, Japan. The participants were selected by stratified randomization according to age and care level. We set the cut-off value of EAT-10 at a score of ≥3. The percentage of participants with an EAT-10 score ≥3 was defined as the prevalence of suspected dysphagia. The chi-square test was used for analyzing prevalence in each group. Analysis of the distribution of EAT-10 scores, and comparisons among items, age groups, and care levels to identify symptom features were performed using the Kruskal-Wallis test and Mann-Whitney U test. RESULTS: Valid responses were received from 510 independent older people aged 65 years or older (mean age 75.0 ± 7.2) and 886 dependent older people (mean age 82.3 ± 6.7). The prevalences of suspected dysphagia were 25.1% and 53.8%, respectively, and showed significant increases with advancing age and care level. In both groups, many older people assigned high scores to the item about coughing, whereas individuals requiring high-level care assigned higher scores to the items about not only coughing but also swallowing of solids and quality of life. CONCLUSION: In independent people, approximately one in four individuals showed suspected dysphagia and coughing was the most perceivable symptom. In dependent people, approximately one in two individuals showed suspected dysphagia and their specifically perceivable symptoms were coughing, difficulties in swallowing solids and psychological burden.

Effects of oral ingestion on physical functions before tube feeding in adults with severe motor and intellectual disabilities.

This study aimed to determine the significance of oral ingestion in tube-fed adults. Six males and three females (mean age 48.1 ± 12.4 years) with severe motor and intellectual disabilities were included in this study. The subjects were monitored for cerebral blood flow (CBF) by functional near-infrared spectroscopy imaging, gastric motor function by electrogastrography, and arterial oxygen saturation (SpO2) and pulse rate with a biological data monitoring device. The subjects were divided into two groups, settings A and B. In setting A, after resting for 30 min, the subjects were tube fed a routinely used enteral nutrient solution. In Setting B, the subjects received 10 cc of thickened enteral nutrient solution prior to tube feeding. Cerebral function as measured by CBF significantly increased after tube feeding under setting A (without oral ingestion), as compared to the resting state. Under setting B (with oral ingestion), CBF significantly increased after oral ingestion and after tube feeding. SpO2 significantly decreased under setting B after oral ingestion and after tube feeding. Gastric motor function showed no significant change after tube feeding in either setting. The pulse rate significantly increased before tube feeding as compared to that in the resting state, after feeding as compared to before feeding and after feeding as compared to the resting state. Our data suggest that introducing oral ingestion, at least partially, in tube-fed individuals with severe dysphagia is beneficial in that it can stimulate cerebral function.

Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016.

BACKGROUND: There is growing international interest in identifying the effects of ageing on oral health and on appropriate strategies for managing oral disorders. The Japanese Society of Gerodontology (JSG), as the official representative of researchers and clinicians interested in geriatric dentistry in Japan, makes several recommendations on the concept of "oral hypofunction." AIMS: This study proposes diagnostic criteria and management strategies to reduce the risk of oral hypofunction among older people. CONCEPTUAL FRAMEWORK: We define oral hypofunction as a presentation of 7 oral signs or symptoms: oral uncleanness; oral dryness; decline in occlusal force; decline in motor function of tongue and lips; decline in tongue pressure; decline in chewing function; and decline in swallowing function. The criteria of each symptom were determined based on the data of previous studies, and oral hypofunction was diagnosed if the criteria for 3 or more signs or symptoms were met. CONCLUSIONS: We recommend that more evidence should be gathered from clinical studies and trials to clarify our diagnostic criteria and management strategies.

Relationship between tongue strength and 1-year life expectancy in elderly people needing nursing care.

Tongue strength is a useful indicator of oral function and has been found to decrease with aging and reduced physical functioning. The present study aimed to assess the relationships of tongue strength with physical function, mental function, and nutritional status, and also between these factors and 1-year outcomes, to determine whether tongue strength is related to life expectancy in elderly people needing nursing care. The subjects were 140 elderly individuals requiring needing nursing care (49 men and 91 women; ≥65 years). The investigated items included sex, age, activities of daily living (ADL), comorbidity, cognitive function, nutritional status, eating function, occlusal support, and tongue strength. Furthermore, a follow-up study was conducted 1 year later, and factors related to death were identified. The mean tongue strength of the total 140 subjects was 20.3 ± 8.6 kPa. Tongue strength was assessed relative to each of the investigated items, using the t test and one-way analysis of variance. Tongue strength was significantly related to ADL, comorbidity, cognitive function, calf circumference, food intake, and occlusal support. Fifteen subjects were found to have died at the 1-year follow-up study. We assessed the relationships of 1-year outcomes with each of the factors examined, and 1-year outcomes were found to be significantly related to ADL and tongue strength.