title: Factors affecting the formation of membranous substances in the palates of elderly persons requiring nursing care.
abstract: OBJECTIVE
  To determine the causative factor behind the formation of membranous substances in the mouths of elderly patients requiring nursing care.
  
  
  BACKGROUND
  Membranous substances are sometimes observed in the mouths of elderly persons requiring nursing care, and these can lead to bleeding, infection and asphyxiation.
  
  
  METHODS
  In April 2007, samples were collected from 70 patients at C Hospital, Aichi Prefecture, Japan, who were 65 years or older (median age, 81.1 ± 7.7 years). Sixteen of the subjects were confirmed to have a membranous substance containing a keratin degeneration product that had been derived from stratified squamous epithelium. The samples were examined microscopically, and the presence of epithelial components was confirmed through immunohistochemical staining with anti-cytokeratin-1 antibodies.
  
  
  RESULTS
  Decision tree analysis and logistic regression suggest that the leading contributors to the formation of the membranous substances were the method of ingesting nutrients, dryness of the tongue dorsum and open mouth. These three factors are related to elderly persons requiring nursing care with impaired oral cavity function, and it was suggested that dryness of the oral mucosa was the major factor behind the membrane formation.
authors.affiliation: Department of Dentistry, Chiaki Hospital, Medical Corporation, Aichi, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kawase
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ogasawara
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kawase
authors.forename: Nina
authors.initials: N
authors.lastname: Wakimoto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Fa-Chih
authors.initials: FC
authors.lastname: Shen
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kakinoki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D004848:Epithelium / Q000737:chemistry / Q000473:pathology; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization; D006801:Humans; D007103:Immobilization; D007440:Intubation; D053556:Keratin-1 / Q000032:analysis; D007633:Keratins / Q000032:analysis; D008297:Male; D009058:Mouth Breathing / Q000378:metabolism; D009061:Mouth Mucosa / Q000737:chemistry / Q000473:pathology*; D009732:Nursing Care; D010159:Palate / Q000737:chemistry / Q000473:pathology*; D010512:Periodontal Index; D013060:Speech / Q000502:physiology; D014059:Tongue / Q000473:pathology; D014099:Toothbrushing; D014987:Xerostomia / Q000378:metabolism
chemical_list: D053556:Keratin-1; D007633:Keratins