Significance of Oral Health and Nutrition in Elderly

Zoia Hmelnitcaia,RN

New York City College of Technology

NUR 4090/HD60

Prof. Emerson Ea

July 28, 2015

Oral health and nutrition directly affect each other. Poor nutrition can lead to oral health problems such as tooth decay and erosion. On the other hand, oral health changes associated with aging such as xerostomia, gum disease, cracked or missing teeth and changes in taste buds adversely affect nutritional intake. These changes are not necessarily a normal part of aging, but are more often encountered as people age.

Oral health-related quality of life (OHRQoL) is a “multidimensional construct that includes a subjective evaluation of the individual’s oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self” (Sischo, 2011). A low OHRQoL is directly correlated to malnutrition and a low quality of life (Cousson et al., 2012). Tooth loss can be prevented by meticulous oral care throughout the life, as well as when older. Preserving the natural teeth is optimal. According to Cousson et al. (2012), the older adults that had dentures were at 21.3% risk of being malnourished as opposed to the group that had natural teeth left. However, if people have missing teeth, dentures are strongly recommended. According to Preshaw et al. (2011), wearing dentures showed an improvement in nutritional status and quality of life. Furthermore, a Japanese study of 286 subjects, 60 years or older, showed a positive correlation between oral health and nutrition and that consequently improved the ability to perform ADL’s (Furuta, 2013).

In addition to that, oral disease has been connected with peptic ulcers, respiratory diseases and cardiac problems (Victorian Department of Health, Australia). Pace and McCullough (2010) found an association between poor oral hygiene and respiratory pathogens and around the clock oral care in institutionalized elderly was associated with decreased respiratory complications. Furthermore, poor oral hygiene and appearance, unpleasant odor and dental incapacity can lead to social isolation. Social isolation leads to depression and that in turn can lead to poor nutrition.

Nutrition is an important need for individuals at every life stage. Starting with growth and development, repair and maintenance and ending with disease prevention and management. A nutritionally sound and balanced diet is vital for health. Over or under nutrition is especially harming to older people. As we age, our nutritional needs don’t decrease but in fact there might be an increased need of some micronutrients, however due to loss of lean body mass and decreased level of activity, a lower caloric intake is necessary, therefore it’s important for elderly to consume nutrient dense foods that can meet the micronutrient requirements while not exceeding the recommended caloric intake (World Health Organization [WHO]). An increased caloric intake can lead to obesity that in turn can lead to hyperlipidemia, diabetes and cardiovascular disease. According to WHO, consuming an extra 1-2 serving of fruit and vegetables can reduce the risk of CVD by 30%. Contrastingly malnourishment is often encountered in elderly due to oral changes, depression, and inability to prepare and afford food. A study that included 2602 patients hospitalized in Australia found that older malnourished patients had a longer hospitalization time, more morbidities and experienced more complications than the patients that were well nourished at admission (Charlton et al., 2013). Furthermore, malnutrition in elderly has been associated with a decline in overall functional and cognitive status, decreased muscle function, low bone mass, decreased immunity, anemia, poor recovery from surgery and delayed healing (Ahmed & Haboubi, 2010).

Overall, oral health and nutrition are closely related and have a direct impact on health and quality of life. As nurses, we have an important duty to assess elderly’s nutritional status and advise them to have regular dental check ups.

References

Ahmed, T. & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health. Clinical Interventions in Aging, 5. Retrieved on July 20, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920201/

Charlton, K. E., Batterham, M. J., Bowden, S., Ghosh, A., Caldwell, K., Barone L., …. Milosavljevic, M. (2013). A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes and mortality within 12 months. Clinical Nutrition ESPEN, 8, (3). doi:10.1016/j.clnme.2013.03.004

Cousson, P. Y., Bessadet, M., Nicolas, E., Veyrune, J., Lesourd, B. & Lassauzay, C. (2012). Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers. Gerontology, 29, (2). doi: 10.1111/j.1741-2358.2011.00545.x

Furuta, M., Komiya-Nonaka, M., Akifusa^, S., Shimazaki, Y., Adachi, M., Kinoshita, T., Kikutani, T. & Yamashita, Y. (2013). 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. Community Dentistry and Oral Epidemiology, 41, (2). doi: 10.1111/cdoe.12000

Pace, C. C. & McCullough G. H. (2010). The Association Between Oral Microorgansims and Aspiration Pneumonia in the Institutionalized Elderly: Review and Recommendations. Dysphagia, 25, (4). doi: 10.1007/s00455-010-9298-9

Preshaw, P. M., Walls, A. W. G., Jakubovics, N. S., Moynihan, P. J., Jepson, N. J. A. & Loewy, Z. (2011). Association of removable partial denture use with oral and systemic health. Journal of Dentistry, 39, (11). http://dx.doi.org/10.1016/j.jdent.2011.08.018

Sischo, L. & Broder, H. L. (2011). Oral Health-related Quality of Life. Journal of Dental Research, 90, (11). doi:10.1177/0022034511399918

State Government of Victoria, Australia. Department of Health. (2014). Oral health for older people. Retrieved on July 20, 2015 from http://www.health.vic.gov.au/agedcare/maintaining/oralhealth.htm

World Health Organization. (n.d.). Nutrition for older persons. Retrieved on July 20, 2015 from http://www.who.int/nutrition/topics/ageing/en/index1.html