Search

Yutaka Takata,1 Toshihiro Ansai,2 Inho Soh,2 Shuji Awano,2 Ikuo Nakamichi,1 Sumio Akifusa,3 Kenichi Goto,1 Akihiro Yoshida,2 Hiroki Fujii,1 Ritsuko Fujisawa,1 Kazuo Sonoki31Division of General Internal Medicine, Kyushu Dental University, 2Division of Community Oral Health Development, Kyushu Dental University, 3Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental University, Kitakyushu, JapanAbstract: The relationship between mortality and impaired cognitive function has not been thoroughly investigated in a very elderly community-dwelling population, and little is known about the association of disease-specific mortality with Mini-Mental State Examination (MMSE) subscale scores. Here we evaluated these data in Japanese community-dwelling elderly. In 2003, 85 year-olds (n=207) were enrolled; 205 completed the MMSE for cognitive function and were followed-up for 10 years, during which time 120 participants died, 70 survived, and 17 were lost to follow-up. Thirty-eight deaths were due to cardiovascular disease, 22 to senility, 21 to respiratory disease, and 16 to cancer. All-cause mortality decreased by 4.3% with a 1-point increase in the global MMSE score without adjustment, and it decreased by 6.3% with adjustment for both sex and length of education. Cardiovascular mortality decreased by 7.6% and senility mortality decreased by 9.2% with a 1-point increase in the global MMSE score with adjustment for sex and education. No association was found between respiratory diseases or cancer mortality and global MMSE score. All-cause mortality also decreased with increases in MMSE subscale scores for time orientation, place orientation, delayed recall, naming objects, and listening and obeying. Cardiovascular mortality was also associated with the MMSE subscale of naming objects, and senility mortality was associated with the subscales of time orientation and place orientation. Thus, we found that impaired cognitive function determined by global MMSE score and some MMSE subscale scores were independent predictors of all-cause mortality or mortality due to cardiovascular disease or senility in 85 year-olds.Keywords: cognition, elderly, mortality, community-dwelling, MMSE

Yutaka Takata,1 Toshihiro Ansai,2 Inho Soh,2 Shuji Awano,2 Ikuo Nakamichi,1 Sumio Akifusa,3 Kenichi Goto,1 Akihiro Yoshida,2 Hiroki Fujii,1 Ritsuko Fujisawa,1 Kazuo Sonoki3 1Division of General Internal Medicine, 2Division of Community Oral Health Development, 3Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan Abstract: Little is known about the association between total cholesterol (TC) and all-cause mortality in the elderly (especially the very elderly). Here we examined the association between TC and all-cause mortality in 207 very elderly (85-year-old) participants. In 2003, we performed a baseline laboratory blood examination, and blood pressure (BP) and body mass index (BMI) measurements, and lifestyle questionnaires were completed by the participants. The participants were followed for the subsequent 10 years. As of 2013, of the 207 participants in 2003, 70 participants had survived, 120 individuals had died, and 17 were lost to follow up. The TC values were divided into high-TC (≥209 mg/dL), intermediate-TC (176–208 mg/dL), and low-TC (≤175 mg/dL) categories. With the Kaplan–Meier method, we found that both the high-TC and intermediate-TC participants survived longer than the low-TC participants. The men with high TC survived longer than those with low TC, but no corresponding difference was found for the women. A multivariate Cox proportional hazards regression model, with adjustment for gender, smoking, alcohol intake, history of stroke or heart disease, serum albumin concentration, BMI, and systolic BP, revealed that the total mortality in the low-TC group was 1.7-fold higher than that in the high-TC group. Mortality, adjusted for the same factors, decreased 0.9% with each 1 mg/dL increase in the serum TC concentration and decreased 0.8% with each 1 mg/dL increase in the serum (low-density lipoprotein) LDL-cholesterol (LDL-C) concentration. Our results indicate an association between lower serum TC concentrations and increased all-cause mortality in a community-dwelling, very elderly population. Mortality decreased with the increases in both TC and LDL-C concentrations, after adjustment for various confounding factors. These findings suggest that low TC and low LDL-C may be independent predictors of high mortality in the very elderly. Keyword: community-dwelling, very elderly, LDL-cholesterol, gender difference, prospective cohort

Yutaka Takata,1 Toshihiro Ansai,2 Inho Soh,2 Shuji Awano,2 Ikuo Nakamichi,1 Sumio Akifusa,3 Kenichi Goto,1 Akihiro Yoshida,2 Hiroki Fujii,1 Ritsuko Fujisawa,1 Kazuo Sonoki31Division of General Internal Medicine, 2Division of Community Oral Health Science, 3Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental University, Kitakyushu, JapanBackground: Little is known about the relationship between disease-specific mortality and high-level activities of daily living in the elderly. We examined whether mortality is associated with high-level activities of daily living in an octogenarian population.Methods: We conducted a population-based cross-sectional and prospective cohort study in 693 older persons aged 80 years and living in Japan’s Fukuoka Prefecture. We then evaluated the association between 12-year disease-specific mortality and high-level functional capacity as measured by the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is a standardized multidimensional 13-item instrument; items 1 through 5 are classified as instrumental self-maintenance activity, items 6 through 9 as intellectual activity, items 10 through 13 as social roles activity, and all 13 items together yield total functional capacity.Results: By the 12-year follow-up of the 693 participants, 413 had died, 242 survived, and 38 were unable to be located. Of the 413 who died, 105 died of cardiovascular disease, 73 of respiratory tract disease, 71 of cancer, and 39 of senility. Of the other 125 deaths, 59 were due to other diseases, and the cause of death for 66 participants is not known. The hazard ratio (HR) for all-cause mortality, adjusted for confounding factors with multivariate Cox analyses, fell by 6% (HR 0.937, 95% confidence interval [CI] 0.899–0.978, P = 0.003) with each one-point increase in participants’ scores on the Tokyo Metropolitan Institute of Gerontology Index of total functional capacity. With one-point increases in instrumental self-maintenance activity and in intellectual activity, the HRs for all-cause mortality decreased by 14% (HR 0.856, 95% CI 0.787–0.930, P = 0.000) and 12% (HR 0.884, 95% CI 0.794–0.983, P = 0.023), respectively. Respiratory mortality with HR adjustment fell by 11% (HR 0.887, 95% CI 0.804–0.978, P = 0.016) and 24% (HR 0.760, 95% CI 0.627–0.922, P = 0.005) with one-point increases in the scores of total functional capacity and instrumental self-maintenance activity, respectively. Similarly, mortality due to senility fell by 16% (HR 0.838, 95% CI 0.743–0.946, P = 0.004), 29% (HR 0.707, 95% CI 0.564–0.886, P = 0.003), and 29% (HR 0.710, 95% CI 0.522–0.966, P = 0.029) with one-point increases in the scores of total functional capacity, instrumental self-maintenance activity, and intellectual activity, respectively.Conclusion: These findings suggest that high-level activities of daily living may be an independent predictor of mortality due to all causes, respiratory disease and senility in older persons.Keywords: older persons, community-dwelling, mortality, respiratory death, instrumental ADL

Limited information is available on the temporal association between dentition status and dietary intake. The aim of this 5-year prospective cohort study was to investigate whether impaired dentition was associated with subsequent decline in dietary intake in older Japanese adults. Two hundred and eighty-six community-dwelling Japanese individuals, all aged 75 years at baseline, were included in the study. Functional tooth units (FTUs), defined as a pair of opposing natural or prosthetic teeth excluding third molars (range: 0-14), were counted on the basis of baseline dental examinations. Individuals with ≤5 FTUs were defined as having impaired dentition. Dietary intake was assessed at baseline and 5 years later, using a validated dietary questionnaire. Robust regression analyses were used to evaluate the differences in change in dietary intake between participants with and without impaired functional dentition, after adjustment for potential confounders. Sixty-one study participants (21·3 %) were defined as having impaired dentition. Overall, mean values for all estimated dietary variables (energy, nutrients and food groups) declined over time. Notably, individuals with impaired dentition demonstrated a significantly ( P < 0·05) greater degree of decline in the intake of multiple nutrients (protein, sodium, potassium, calcium, vitamin A, vitamin E and dietary fibre) and food groups (vegetable and meat) than those without impaired dentition, after adjusting for potential confounders. The results of this study describe the temporal association of impaired dentition with the decline in selected nutrient and food group intake among older Japanese adults. [ABSTRACT FROM AUTHOR]

There is limited information on the impact of oral function on mortality among older adults. The aim of this prospective cohort study was to examine whether an objective measure of oral function, maximum bite force ( MBF), is associated with mortality in older adults during a 13-year follow-up period. Five hundred and fifty-nine community-dwelling Japanese (282 men and 277 women) aged 70 years at baseline were included in the study. Medical and dental examinations and a questionnaire survey were conducted at baseline. Maximum bite force was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up investigation to ascertain vital status was conducted 13 years after baseline examinations. Survival rates among MBF tertiles were compared using Cox proportional hazards regression models stratified by sex. There were a total of 111 deaths (82 events for men and 29 for women). Univariable analysis revealed that male participants in the lower MBF tertile had increased risk of all-cause mortality [hazard ratio ( HR) = 1·94, 95% confidence interval ( CI) = 1·13-3·34] compared with those in the upper MBF tertile. This association remained significant after adjustment for confounders (adjusted HR = 1·84, 95% CI = 1·07-3·19). Conversely, no association between MBF and all-cause mortality was observed in female participants. Maximum bite force was independently associated with all-cause mortality in older Japanese male adults. These data provide additional evidence for the association between oral function and geriatric health. [ABSTRACT FROM AUTHOR]

Although the number of sound or decayed teeth has been reported to be associated with cognitive function in elderly populations with dementia, little is known about this association in elderly populations without dementia. We evaluated this relationship, with adjustment for confounding factors, in Japanese populations of 60-year-old ( n = 270; 120 males and 150 females) and 65-year-old ( n = 123; 57 males and 66 females) individuals residing in Fukuoka Prefecture of Japan. Dental examinations were performed in all subjects, along with the Mini-mental state examination (MMSE) for assessing cognitive function. Among the total of 393 subjects, the mean MMSE score was 27·9 ± 1·9, and 391 subjects scored 24 or higher. The mean numbers of sound and decayed teeth were 12·0 ± 6·3 and 0·5 ± 1·2, respectively. Associations were found between the numbers of sound and decayed teeth and MMSE in total subjects and males, but not in females, by multiple regression analysis adjusted for gender, age, level of education, marital status, smoking, alcohol drinking, working status, systolic blood pressure and blood glucose. An association was also found between MMSE and the number of sound teeth in a logistic regression analysis. In conclusion, associations were found between normal-range cognitive function and the numbers of sound and decayed teeth, after adjustment for various confounding factors, in an elderly Japanese population. [ABSTRACT FROM AUTHOR]

Objective: Poor oral health has been reported to be a risk indicator of mortality, however, few data are available regarding the relationship between chewing ability and mortality. We examined the relationship between self-assessed chewing ability and mortality in elderly subjects. Design: Prospective study. Subjects and methods: Participating in the study were 697 people (277 males, 420 females) from 1282 individuals (80 years old) residing in Fukuoka Prefecture, Japan. Data on oral and systemic health status through questionnaires, accompanied by physical and laboratory blood examinations were obtained. Chewing ability was assessed based on the number of types of food each subject reported as able to chew by questionnaire. Results: A total of 108 subjects died between 1998 and 2002. Those with the lowest number of chewable foods were associated with higher risk of mortality than those with the ability to chew all of the 15 types of food surveyed [hazard ratio (HR) = 2.38, 95% confidence interval (95% CI) = 1.07–5.29], though other parameters including current smoking, low serum albumin, and poor physical health status were more significant. Further, reduced chewing ability of soft foods increased the risk (HR = 2.65, 95% CI = 1.20–5.87). Conclusion: Chewing ability was associated with mortality in a population of 80-year-old community residents, and may be a predictor for survival rate. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the relationship between number of remaining teeth and health-related quality of life in community-dwelling elderly.Subjects: A total of 207 participants who were community-dwelling, 85 years of age. Data were from a population-based study of age-related general and oral health in Fukuoka Prefecture, Japan.Measurements: The Japanese version of the Short Form 36 Health Survey (SF-36).Results: The mental component score for the participants, from the SF-36, was higher than the Japanese national norm for those aged > or = 70 years. There were no significant differences in the mean of any scores on the SF-36 by having spouse, living with family, or education level. The mean of the SF-36 scores of physical functioning (PF) and of the physical component scores were significantly higher in the 85-year-old participants with > or = 20 teeth than in those with < or = 19 teeth (p < 0.05 and p < 0.01 respectively). In addition, a significant difference (p < 0.05) was observed between the mean of participants with > or = 20 teeth and those with < or = 19 teeth after adjustment for region where the participant lived, activities of daily living (ADL), and sex. The PF (p < 0.001), role-physical (p < 0.005), bodily pain (p < 0.001), vitality (p < 0.001), social functioning (p < 0.05), and physical component (p < 0.001) scores were significantly higher in participants with a good activities of daily living (ADL) assessment. However, ADL was not associated with the number of teeth.Conclusions: The findings of the present study indicated that 85-year-old participants with > or = 20 teeth had better subjective physical health than those with < or = 19 teeth. [ABSTRACT FROM AUTHOR]

Although tooth loss causes a decrease in masticatory ability, which may influence nutritional status, and impair an individual's general health including physical activity, little is known whether a decrease in chewing ability could result in deterioration in physical fitness in a very elderly population. Thus, the present study evaluated the relationship of chewing ability or teeth number with measures of physical fitness in a sample of 80-years-old in Japan. Cross-sectional survey. A total of 1282 people who were 80-years old and resided in the Fukuoka Prefecture were approached. A total of 697 individuals (277 male, 420 female) agreed to participate. Chewing food number and teeth number were related positively with physical fitness measurements of hand grip strength, leg extensor strength, leg extensor power, stepping rate, and one-leg standing time. However, the significant relationship between the number of teeth and physical ability disappeared after adjustment for various confounders, using multiple regression analysis or logistic regression analysis. On the other hand, the relationship of chewing ability with physical fitness measurements of leg extensor strength, one-leg standing time, or isokinetic leg extensor power remained significant even after adjustment for these confounders. There is a relationship between perceived chewing ability (number of foods considered chewable) and physical fitness in this 80-year-old population. Chewing ability may be an independent predictor of physical fitness, thus preventative dental care aimed at preserving chewing ability may be able to enhance activities of daily life and quality of life in very elderly individuals. [ABSTRACT FROM AUTHOR]

Recent reports have suggested that periodontal disease is a risk factor for coronary heart disease (CHD). However, little is known about the relationship between periodontal disease and CHD in the very elderly. Therefore, we evaluated the association between tooth loss and abnormal ECG findings in octogenarians. Of the 1282 octogenarians in Fukuoka Prefecture, Japan, 697 participated. Oral examinations--including a tooth count and an assessment of the Community Periodontal Index--and a 12-lead ECG were performed. Logistic regression analysis revealed that individuals with < 20 teeth had increased prevalence of ST segment depression, and T-wave abnormalities, after we adjusted for gender, smoking, serum cholesterol and glucose, blood pressure, and body mass index. Compared with individuals with ≥ 20 teeth, edentulous individuals had an increased prevalence of T-wave abnormalities and arrhythmias after adjustment for coronary risk factors. We conclude that tooth loss may be an independent predictor of abnormal ECG findings in octogenarians. [ABSTRACT FROM AUTHOR]