title: Interrelationship of oral health status, swallowing function, nutritional status, and cognitive ability with activities of daily living in Japanese elderly people receiving home care services due to physical disabilities.
abstract: OBJECTIVE
  Malnutrition and cognitive impairment lead to declines in activities of daily living (ADL). Nutritional status and cognitive ability have been shown to correlate with oral health status and swallowing function. However, the complex relationship among the factors that affect decline in ADL is not understood. We examined direct and indirect relationships among oral health status, swallowing function, nutritional status, cognitive ability, and ADL in Japanese elderly people living at home and receiving home care services because of physical disabilities.
  
  
  METHODS
  Participants were 286 subjects aged 60 years and older (mean age, 84.5±7.9 years) living at home and receiving home care services. Oral health status (the number of teeth and wearing dentures) was assessed, and swallowing function was examined using cervical auscultation. Additionally, ADL, cognitive ability, and nutritional status were assessed using the Barthel Index, the Clinical Dementia Rating Scale, and the Mini Nutritional Assessment-Short Form, respectively. Path analysis was used to test pathways from these factors to ADL.
  
  
  RESULTS
  The mean number of teeth present in the participants was 8.6±9.9 (edentates, 40.6%). Dysphagia, malnutrition, and severe cognitive impairment were found in 31.1%, 14.0%, and 21.3% of the participants, respectively. Path analysis indicated that poor oral health status and cognitive impairment had a direct effect on denture wearing, and the consequent dysphagia, in addition to cognitive impairment, was positively associated with malnutrition. Malnutrition as well as dysphagia and cognitive impairment directly limited ADL.
  
  
  CONCLUSIONS
  A lower number of teeth are positively related to swallowing dysfunction, whereas denture wearing contributes to recovery of swallowing function. Dysphagia, cognitive impairment, and malnutrition directly and indirectly decreased ADL in elderly people living at home and receiving home nursing care. The findings suggest that preventing tooth loss and encouraging denture wearing when teeth are lost may indirectly contribute to maintaining or improving ADL, mediated by recovery of swallowing function and nutritional status.
authors.affiliation: Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Kyushu University Faculty of Dental Science, Fukuoka, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Furuta
authors.forename: Manae
authors.initials: M
authors.lastname: Komiya-Nonaka
authors.forename: Sumio
authors.initials: S
authors.lastname: Akifusa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shimazaki
authors.forename: Munehisa
authors.initials: M
authors.lastname: Adachi
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kikutani
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications; D003430:Cross-Sectional Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications; D003817:Dentition; D003778:Dentures; D006233:Persons with Disabilities; D004435:Eating / Q000502:physiology; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D057187:Independent Living; D007564:Japan; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D008954:Models, Biological; D009752:Nutritional Status; D009909:Oral Health