Effects of dental treatment on the quality of life and activities of daily living in institutionalized elderly in Japan
Introduction
Even faster than in most Western and Asian countries, Japanese society is aging. People 65 years and older constituted 20.1% of the Japanese population according to the 2005 census (http://www.stat.go.jp/data/kokusei/2005/index.htm). Maintaining good health and quality of life (QOL) is essential for the benefit of both individuals and society. Moreover, a growing number of elderly people are opting to spend the last years of their lives in long-term care facilities (Grbich et al., 2005, Hirakawa et al., 2007).
Oral health care in long-term facilities, however, has repeatedly been documented as being less than ideal (Sweeney et al., 2007, Unlüer et al., 2007). Two studies have reported the effects of oral care on health status in nursing home elderly. Yoneyama et al. (2002) reported that improving oral hygiene could lower the risk of respiratory infections, while Watando et al. (2004) suggested that intensive oral care reduced the incidence of pneumonia by improving the cough reflex sensitivity in those who were physically disabled or suffering from mental deterioration.
Yoshino et al. (2001) showed an improvement in the activities of daily living (ADL) with intensive oral care among elderly nursing home patients with dysphagia due to cerebrovascular disease. Their finding suggested that oral care reduced the risk of pneumonia by improving the swallowing reflex and overall functional status. Eating begins from the anticipatory stage and proceeds through preparatory, lingual, pharyngeal, and esophageal stages (Leopold and Kagel, 1983). Maintaining oral function with dental treatments also might improve ADL, but the effects of dental treatments on the ADL in the elderly have not been sufficiently examined.
Impairment of oral health has a negative impact on the QOL of the elderly (Mariño et al., 2008). Some studies have found that ADL are an important determinant of the QOL of elderly nursing home residents (Tseng and Wang, 2001, Tu et al., 2006). Therefore, we focused on this relationship and conducted a controlled study to determine whether dental treatments affect the QOL and ADL in institutionalized elderly.
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Subjects and study design
This was a controlled study conducted at seven nursing homes in Japan between September and November 2007. The study consisted of three phases: subject screening and enrollment, and allocation into intervention and control groups; baseline assessments of all subjects; an intervention phase in which the intervention group received dental treatment. Outcome data were collected 6 weeks after baseline.
Those who met the following two criteria were eligible for participation: residence in the
Results
In September 2007, we allocated 30 subjects (12 men and 18 women) to the study, 15 each to the intervention and control groups, respectively. Five withdrawals occurred, three in the intervention group and two in the control group. Of the withdrawals in the intervention group, one rejected the dental treatments and two had to discontinue treatments because their health worsened. In the control group, one rejected the dental treatments and the other died within 6 weeks.
One subject in the
Discussion
In this controlled, 6-week study, we found that the dental treatments for institutionalized elderly increased the oral health-related QOL and the expression function in the ADL. No significant beneficial effects on feeding or transfer function were found, while dressing function tended to increase. To our knowledge, this is the first controlled study involving nursing home residents to show that dental treatments influence the ADL and QOL.
With old age, increased dependency affects the QOL
Conflict of interest
None.
Acknowledgments
This study was supported in part by research grants from the Ministry of Health, Labour and Welfare of Japan. We thank Professor Nobuhiro Hanada and Dr Yoshiaki Nomura of the Department of Translational Research, School of Dentistry, Tsurumi University, for their kind support in the course of this research.
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