[The association between health-related quality of life and voice as evaluated by an acoustic analysis in elderly Japanese nursing home residents].

PURPOSE: We carried out a cross-sectional study investigating the association between health-related quality of life (HRQOL) and voice, as evaluated by an acoustic analysis, in elderly residents of a nursing home. METHODS: The HRQOL of 61 elderly nursing home residents (mean age: 82.1±8.3 years) was assessed via the SF-8 Health Survey questionnaire, Japanese version (SF-8). The subjects' voices were recorded and analyzed by a voice assessment software program, which calculated the pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR). RESULTS: Subjects who scored under the 25th percentile on general health (GH), vitality (VT), or physical summary (PCS) in the SF-8 showed significantly higher PPQ, APQ, and NHR scores in comparison to their counterparts (p<0.05). After adjustment for age, lower GH scores were found to be associated with higher PPQ, APQ, and NHR scores; lower VT scores were associated with higher APQ and NHR scores; and lower PCS scores were associated with higher APQ and NHR scores (p<0.05). CONCLUSION: The results of the acoustic analysis indicated that voice was associated with HRQOL in the elderly nursing home residents of the present study. Among the acoustic parameters that were analyzed, PPQ, APQ, and NHR may be an influential factor that can be used to assess HRQOL, independently of the effects of age, in elderly individuals.

[Oral diadochokinesis among Japanese aged over 55 years: analysis of standard values].

AIM: We investigated oral diadochokinesis (OD) among 212 Japanese aged over 55 years to assess the standard values of articulation ability. METHODS: Each subject repeatedly produced the OD syllables /pa/, /ta/, and /ka/. Subjects were divided into three age-groups (55-64 years, 65-74 years, and over 75 years) and by gender to compare the number of OD syllables per second. We also calculated the lower limit of values that determined the standard range for OD syllables. RESULTS: The number of all OD syllables in the over-75 age-group was significantly lower than in the 55-64 group. The number of OD /pa/ syllables in the over-75 group was significantly lower than in the 65-74 group. The number of OD /ta/ syllables in the 65-74 group was significantly lower than in the 55-64 group. The lower limit of the standard values for OD /pa/, /ta/, and /ka/ was, respectively, as follows: 4.9, 4.7, and 4.5 times in the 55-64 group; 3.8, 4.1, and 3.7 times in the 65-74 group; and 3.8, 3.3, and 2.6 times in the over-75 group. Among women, the number of OD /pa /, /ta/, and /ka/ syllables was significantly lower in the over-75 group than in other age-groups. CONCLUSIONS: We demonstrated that the lower limit of standard OD values is a means of assessing articulation in elderly subjects. We found that OD /ta/ tends to decrease from age 65 years. The decline in articulation ability clearly begins earlier in women than in men.

[Relationship between comprehensive quality of life and factors related to chewing and swallowing function among community-dwelling elderly individuals].

AIM: The purpose of the present study was to examine the relationship between comprehensive quality of life (QOL) and some factors regarding chewing and swallowing function among community-dwelling elderly individuals. METHODS: The subjects were 675 independent elderly persons residing in the northern area of Miyazaki Prefecture, and we obtained the self-administered questionnaires from 545 elderly people. We used "active scale for the elderly (ASE)" and "dysphagia risk assessment for the community-dwelling elderly (DRACE)" to evaluate their comprehensive QOL and function of chewing and swallowing, respectively. Furthermore, we examined some factors such as age, gender, subjective satisfaction with diet and verbal communication. RESULTS: The score of ASE showed a significant decline with age (p<0.01) while the DRACE score increased significantly with age (p<0.01). Pearson's correlation coefficients revealed that the ASE score was significantly related to all of the factors regarding regulation of food intake. Partial correlation coefficients adjusted for age also revealed the same tendency. From the multiple regression analysis, subjective satisfaction with verbal communication, DRACE score, age and appetite were extracted as factors influencing ASE score (adjusted R(2)=0.43, p<0.01). CONCLUSION: Among independent elderly persons residing in the community, the comprehensive QOL was significantly related to factors such as subjective satisfaction with verbal communication, dysphagia risk, age, and appetite.

[Association between activities of daily living and oral diadochokinesis among Japanese elderly individuals in a nursing home].

AIM: We studied the association between the activities of daily living (ADL) and oral diadochokinesis (OD) among 84 Japanese elderly individuals residing in a nursing home. METHODS: We assessed OD in terms of speech and articulation. Each subject repetitively produced the syllables /pa/, /ta/, /ka/ and the sequence /pataka/. We also evaluated comprehensive ADL (basic, BADL; instrumental, IADL; and communicative, CADL) based on the criteria of the ADL-20 and intellectual ability using the revised Hasegawa Dementia Scale (HDS-R). We classified types of OD into a hypokinesia group (less than 3 times per second for OD /pa//ta//ka/ or less than once per second for OD /pataka/) and a repetition exercise maintenance group (more than 3 times per second for OD /pa//ta/ /ka/ or more than once per second for OD /pataka/). RESULTS: After adjusting for age, sex, and HDS-R score, the ADL-20 total score of the hypokinesia group was significantly lower than that of the maintenance group for OD (/pa/ and /pataka/) (p<0.01). The BADL for mobility (BADLm) score in the hypokinesia group for all OD sections was significantly lower than that in the maintenance group (p<0.05). The BADL for self-care score (BADLs) in the hypokinesia group for OD (/pataka/) was lower than that in the maintenance group (p<0.01). The CADL score in the hypokinesia group for OD (/pa/) was lower than that in the maintenance group (p<0.05). CONCLUSION: A decline in OD may have been associated with a decline in ADL in our subjects, suggesting that the rate of decline in OD may affect overall ADL in elderly individuals.

Factors influencing oral health-related quality of life (OHRQoL) among the frail elderly residing in the community with their family.

The purpose of the present study was to identify factors that influence quality of life (QoL) among frail elderly individuals residing in the community, in order to improve the level of home care related to oral health. Participants were 100 pairs comprising elderly individuals requiring care and their family caregivers. Questionnaire items for the family caregivers related to demographic variables, hours spent caregiving per day, and duration of caregiving. Questionnaire items for the elderly recipients of care concerned demographic variables, activities of daily living (ADL), and cognitive status. According to bivariate analysis, oral health-related quality of life (OHRQoL) was significantly related to basic ADL, communication ADL (CADL), dysphagia risk, and duration of caregiving. From multiple regression analysis, dysphagia risk and CADL were extracted as factors influencing OHRQoL. Assessment of OHRQoL will be useful not only to detect oral health needs but also to evaluate the effect of oral health care in the elderly.

[Labial closure force, activities of daily living, and cognitive function in frail elderly persons].

AIM: Few studies have reported the influence of declining labial closure force on ADL among frail elderly persons. We therefore investigated to elucidate the relationships among labial closure force, ADL and cognitive function in frail elderly persons. METHODS: The subjects were 92 frail elderly persons. Labial closure forces were examined using "Lip De Cum". The ADL and cognitive status of the subjects were evaluated using the ADL20 scale and HDS-R respectively. Furthermore, the symptoms related to dysphagia and salivation were evaluated by a patient-reported outcome. RESULTS: The labial closure force was significantly related to total score and each sub-score of the ADL20 scale, and it was also related to HDS-R score. Furthermore, the labial closure force was significantly associated with salivation and 5 symptoms related to dysphagia as follows: weight loss, episodes of pyrexia, difficulties in swallowing, food falling from the mouth, sensation of food being stuck in the esophagus. CONCLUSION: Labial closure force among frail elderly persons correlated with ADL and cognitive function. These findings suggest that declining labial closure force is closely related with decreasing comprehensive physical and mental activities.

Relationship between general health status and the change in chewing ability: a longitudinal study of the frail elderly in Japan over a 3-year period.

OBJECTIVES: The aim of the present study was to identify the onset predictors of a change in chewing ability over a 3-year period in the frail elderly. METHODS: The subjects were frail elderly people living in southern Japan. Data were collected at baseline (n = 92) and 3 years later (n = 60). The dependent variable was a change in self-rated chewing ability. The independent variables were age, gender, number of present teeth, dentition, maximum bite force (evaluated using a pressure-sensitive foil), basic activities of daily living, self-rated general health status, higher level of competence (evaluated using Tokyo Metropolitan Institute of Gerontology index), cognitive status (evaluated by revised Hasegawa Dementia Rating scale), and quality of life (evaluated using Philadelphia Geriatric Center morale scale) at baseline. To identify the most reliable predictors, bivariate analysis and multiple logistic regression analysis were performed, with the change of chewing ability as the dependent variable. RESULTS: Bivariate analysis showed the change in chewing ability was significantly associated with general health status (p < 0.01), number of present teeth (p < 0.05) and maximum bite force (p < 0.01). Backward logistic regression analysis revealed that the most reliable predictor of a change in chewing ability at 3 years was general health status (odds ratio = 6.35, 95% CI = 1.69-23.88). CONCLUSION: The present findings suggest that general health status at baseline produces a change in chewing ability.

Feelings of burden and health-related quality of life among family caregivers looking after the impaired elderly.

The aim of the present study was to examine the relationship between feelings of burden and health-related quality of life (HRQOL) among family caregivers looking after the impaired elderly residing in a community located in southern Japan. Subjects were 85 pairs comprising elderly individuals requiring care and their respective family caregivers. Questionnaire items for the family caregivers related to demographic variables, caregivers' burden, HRQOL, use of public services, hours spent caregiving, duration of caregiving, and satisfaction with verbal communication with family. Questionnaire items for the elderly recipients of care concerned demographic variables, activities of daily living, and cognitive status. According to bivariate analysis, caregivers' burden was significantly related to cognitive status, hours spent caregiving, and each HRQOL subscore except physical function. From multiple regression analysis, subscore of HRQOL with respect to mental health and satisfaction with verbal communication were extracted as influential factors. Final regression coefficient was 0.72 (P<0.01) and coefficient of determination was 0.53. These results suggest that satisfactory mental health status plays an important role in limiting family caregivers' burden.

[Factors affecting subjective satisfaction with verbal communication among the disabled elderly and their family caregivers].

The aims of the present study were to investigate satisfaction with verbal communication among the disabled elderly and their family caregivers; and to find the significantly influential factors of satisfaction with verbal communication. The subjects were 85 disabled elderly and 85 family caregivers. For the disabled elderly, satisfaction with verbal communication, demographic, and physical factors were examined using an interview survey. For the caregivers, satisfaction with verbal communication, demographic factors, and some factors related caregiving were examined using a self-administered questionnaire. In the disabled elderly, 82.4% were satisfied with their verbal communication while 55.3% of family caregivers were satisfied. Satisfaction with verbal communication between the disabled elderly and their caregivers showed low agreement (kappa = 0.17). Bivariate analysis revealed that satisfaction with verbal communication of the disabled elderly was significantly related to ADL (p < 0.01), dysphagia risk (p < 0.05), and ability of comprehension (p < 0.05) while satisfaction with verbal communication of caregivers was significantly related to the gender of the disabled elderly and caregivers' burden. Furthermore, multiple regression analysis showed that the factor most related to satisfaction with verbal communication for the disabled elderly was ability of comprehension (p value = 0.032, odds ratio = 2.960), and the most related factor for their caregivers was the burden evaluated by J-ZBI_8 (p value = 0.004, odds ratio = 0.842). These results suggest that satisfaction with verbal communication of the disabled elderly disagrees with that of the family caregivers, and that some related factors for the disabled elderly are different from those in their family caregivers.

[Care assessment related to dysphagia in the frail elderly].

The purpose of the present study was to investigate some symptoms related to dysphagia, comprehensive health status, and oral care in the frail elderly. The subjects were 92 elderly individuals (30 men, 62 women) above 65 years in a nursing home. The risk factors of dysphagia were evaluated by 15 items of self-assessment and 18 items of assessment by their caregivers. Both assessments contained 12 identical items. Basic ADL, cognitive status, and QOL were evaluated by the Barthel index, HDS-R, and PGC morale scale respectively. The status of oral care was evaluated by the frequency of tooth cleaning a day and the number of total anaerobic bacteria or streptococci in the dental plaque. "Chewing difficulty with hard food" was frequently found (21.74%) in the self-assessment, while "fever" was frequently found in the caregiver's assessment (20.65%). Also, in the duplicate items in both assessments, "anamnesis of pneumonia" showed a high agreement (k = 0.85), while "decline of appetite" had a low agreement (k = 0.27). These results suggest that dual assessment is effective to detect dysphagia. We also investigated the relationship among dysphagia, comprehensive health status, and oral hygiene. The status of dysphagia was related only to the Barthel index (p < 0.01). These results suggest that subjects with decreased basic ADL tend to have some risk factors related to dysphagia, and that subjects with dysphagia risk factors need to improve oral care to prevent aspiration pneumonia.