Does poor dental health predict becoming homebound among older Japanese?

BACKGROUND: Being homebound is an important risk factor of functional disability in older people. There is a possibility of bidirectional relationship between homeboundness and dental health. This prospective cohort study examined the association of dental health, which includes social function, on homeboundness in the future. METHODS: The participants were ≥ 65 years, responded to two postal surveys conducted in 2006 and 2010, and were not homebound at baseline. Logistic regression analysis was used to estimate the odds ratios for homeboundness, defined as going out of one's home less than once weekly. Self-reported baseline dental status was used as the main predictor. Age, sex, marital status, educational attainment, income, comorbidity, depression, walking time, living alone, and area of residence were used as covariates. RESULTS: Among 4390 non-homebound respondents, 7.4 % were homebound four years later. The proportions of homebound respondents with < 20 teeth without dentures, < 20 teeth with dentures, and ≥ 20 teeth were 9.7, 8.8, and 4.4 %, respectively. The odds for being homebound in the 65-74-year age group, adjusted for covariates, was 1.78 (95 % CI: 1.01-3.13; p < 0.05) times higher for respondents with < 20 teeth and no dentures than that for respondents with ≥ 20 teeth. Among the participants in the ≥ 75-year age group, a significant association of homeboundness and dental health was not observed. CONCLUSIONS: Among the young-old population, poor dental health predicted future onset of homeboundness, while depressive symptoms did not show any significant association.

Poor Oral Health and Diet in Relation to Weight Loss, Stable Underweight, and Obesity in Community-Dwelling Older Adults: A Cross-Sectional Study From the JAGES 2010 Project.

BACKGROUND: Involuntary weight loss and underweight increase the risks of mortality and disability in older people. However, the association and interaction of poor oral health and dietary intake with body mass index (BMI) have not been elucidated. METHODS: Data were analyzed for 96 794 respondents aged >65 years who were randomly selected from 31 Japanese municipalities in the Japan Gerontological Evaluation Study. Weight loss was defined as ≥2-3 kg of loss over the preceding 6 months. BMI was evaluated in respondents without weight loss. Multiple logistic regression analysis was performed with weight loss, underweight, and obesity as dependent variables and having fewer teeth (<20) and infrequent food intake as independent variables, with adjustment for potential confounders. RESULTS: Weight loss was associated with having fewer teeth (men: odds ratio [OR] 1.3; 95% confidence interval [CI], 1.2-1.3; women: OR 1.2; 95% CI, 1.1-1.3) and infrequent fruit/vegetable intake (men: OR 1.1; 95% CI, 1.1-1.2; women: OR 1.4; 95% CI, 1.3-1.5) and fish/meat intake (OR 1.2; 95% CI, 1.1-1.3 for both sexes). No interaction was observed between having fewer teeth and food intake. Obesity was associated with the same factors: having fewer teeth (ORs 1.2 and 1.3 for men and women, respectively) and infrequent intake of fruit/vegetables (ORs 1.1 and 1.2 for men and women, respectively) and fish/meat (OR 1.1 for both sexes). Infrequent fruit/vegetable intake showed a higher OR for underweight in women with fewer teeth than for others. CONCLUSIONS: Having fewer teeth and infrequent food intake were associated with both weight loss and obesity. A significant interaction was observed in the associations of having fewer teeth and infrequent food intake with underweight in women.

Individual- and community-level social gradients of edentulousness.

BACKGROUND: Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. METHODS: We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates. RESULTS: Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001). CONCLUSIONS: Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.

Distance to retail stores and risk of being homebound among older adults in a city severely affected by the 2011 Great East Japan Earthquake.

BACKGROUND: after the Great East Japan Earthquake in 2011, inactivity and the homebound status of older victims in affected areas have been a serious public health concern owing to the victims' prolonged existence as evacuees in mountainous areas. OBJECTIVE: to evaluate the association between distances to retail stores and risks of being homebound. DESIGN: secondary analysis of cross-sectional interview survey data with a geographical information analysis. SETTING: Rikuzentakata, Iwate, a municipality seriously damaged by the 2011 earthquake and tsunami. SUBJECTS: all Rikuzentakata residents aged 65 or older except for those living in temporary housing (n = 2,327). METHODS: we calculated road distances between each residential address and retail stores, hawker sites and shopping bus stops, accounting for the extra load caused by walking on slopes. The prevalence ratio of being homebound adjusted for age, source of income and morbidity by road distance was estimated using Poisson regression with a generalised estimating equation. RESULTS: those living at distances of 1,200 m or more were 1.78 (95% confidence intervals, 1.03-3.08) times more likely to be homebound (going out only every 4 or more days a week) among men and 1.85 (1.13-3.02) among women, compared with those residing in places <400 m from retail stores or shopping bus stops. The distances were reduced by new hawker and shopping bus services, but the improvements varied greatly across the districts. CONCLUSIONS: access to daily needs is essential to prevent homebound status. Post-disaster community diagnosis in terms of the built environment is important for strategic community restoration.