Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients

Abstract

Objective: The aim of this study was to describe relationships between oral status, dysphagia and malnutrition in a hospitalised older people.

Background: Undernutrition in older people is a major concern in geriatric hospital wards. Different factors can modify nutritional status like dysphagia or oral status.

Materials and methods: About 159 consecutive inpatients (108 women, 51 men) were examined. Comprehensive gerontological data at baseline and nutritional status according to BMI, MNA and serum albumin concentration, dependency according to ADL scores, dietary intake, swallowing capacities and oral status were collected. Swallowing capacities and dietary intake were reassessed 1 week after.

Results: Mean age was 85.28 (SD 5.68). Seventy-seven patients were malnourished (MNA) and 34 had dysphagia. Oral treatment was necessary in 142 patients (89.30% of all population). Candidiasis was present in 17 patients and salivary flow reduction in 50. Patients with dysphagia had the lowest dietary intake. After 1 week, patients with dysphagia were retested and dysphagia had abated in three of them. Dysphagia and undernutrition were associated (p < 0.001), and both were related to candidiasis (p < 0.001 and p < 0.01). Dysphagia was also related to salivary hypofunction (p < 0.001), loss of posterior occluding pairs (POPs; p = 0.014), oral self-care dependency (p < 0.001) and self-feeding dependency (p < 0.001). Salivary hypofunction was related to candidiasis (p < 0.001) and loss of POPs (p < 0.05), and candidiasis to loss of POPs (p < 0.01).

Conclusion: Although no causality can be demonstrated, poor oral health was strongly associated with malnutrition, emphasising the importance to develop oral care strategies and to incorporate a dental examination into comprehensive gerontological assessment.

Keywords: Candida; elderly; nutrition; saliva; tooth loss.