Quality of life, oral condition and nutritional and physical states of elderly in nursing homes: a multicenter study

Author(s)

Mariana Marinho Davino de Medeiros

• Document type: Master's Dissertation
• Press: Piracicaba, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
• Defense date: 2020-02-18

Examining board members

Renata Cunha Matheus Rodrigues Garcia; Ana Carolina Pero Vizoto; Yuri Wanderley Cavalcanti

• Advisor: Renata Cunha Matheus Rodrigues Garcia

Abstract

The impact of the institutionalization on elderly’s quality of life (QoL) is under discussion. This population presents a poor masticatory function that can compromise their nutrition and Oral Health-Related Quality of Life (OHRQoL). Moreover, malnutrition and frailty are commonly overlapped in institutionalized elderly, causing morbimortality. This dissertation, through three scientific articles, aimed to: (1) verify, through a systematic review and meta-analysis, the influence of the institutionalization on elderly’s QoL; (2) evaluated the influence of presence of teeth and prosthesis on masticatory performance and swallowing threshold in a multicenter sample of nursing homes elders, and the correlation of these masticatory parameters with nutrition and OHRQoL; and (3) investigate, in a multicenter approach, the factors associated with the overlap of frailty and nutrition in institutionalized elderly. For the systematic review, observational studies that assessed QoL of institutionalized and community dwelling elderly were included. Meta-analysis and certainty of evidence were performed. For the second and third articles, institutionalized elders (n=344; mean age(SD)=77.70 (9.10)) were selected from 17 nursing homes of Piracicaba and João Pessoa. Oral examinations were performed to classify the elderly in: edentulous with and without complete dentures (CD) and partially dentate with and without prosthesis. Masticatory performance was assessed using a chewing gum and swallowing threshold by chewing cycles performed until swallow of peanuts. The nutrition was screened by applying Mini Nutrition Assessment Short-Form and measurement of body composition. The OHRQoL was evaluated through Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Pro?le (OHIP-14). Frailty was screened by a modified Fried’s questionnaire. Kruskal-Wallis test (?=0.05) evaluated the influence of presence of teeth and prosthesis on masticatory function. Spearman’s Correlation (?=0.05) correlated masticatory function with nutrition and OHRQoL. Poisson Regression (?=0.05) associated frailty and nutrition overlapped with independent variables, obtaining Prevalence Ratio (PR). The meta-analysis showed a worse QoL for the institutionalized elderly compared to community dwelling ones. Edentulous elderly without CD had lower masticatory performance than edentulous with CD and partially dentate with or without prosthesis (p<0.05). The swallowing threshold of edentulous with CD and partially dentate with prosthesis were greater than those edentulous without CD and partially dentate without prosthesis (p<0.05). Masticatory function was not correlated with nutrition. Masticatory performance was correlated with GOHAI (r2=-0.154) and swallowing threshold with GOHAI (r2=0.162) and OHIP-14 (r2=-0.146). The coexisting of frailty and malnutrition (n=139, 40.5%) was associated with advanced age (PR=1.009), greater number of medications (PR=1.016), greater dependence for ADL (PR=1.061), lower maximal grip strength (PR=0.992) and lower BMI (PR=0.997). It was concluded that institutionalization negatively affect elderly’s QoL. The absence of teeth and prosthesis influenced masticatory performance and swallowing threshold in institutionalized elderly. The masticatory function did not influence institutionalized elders’ nutrition, despite impair their OHRQoL. Frailty and malnutrition overlapped were prevalent and associated with advanced age, greater use of medicines and dependence for ADL, and lower maximal grip strength and BMI (AU)

• FAPESP's process: 18/06185-6 - Oral condition and physical and nutritional status of the elderly in long-stay institutions: multicenter study
• Grantee: Mariana Marinho Davino de Medeiros
• Support Opportunities: Scholarships in Brazil - Master