Influence of dental status on dietary intake and survival in community-dwelling elderly subjects

Age and Ageing, Nov, 1997 by Ildebrando Appollonio, Corrado Carabellese, Allessandra Frattola, Marco Trabucchi

Introduction

Several studies (but not all--see [1] for an opposite view) have documented nutritional inadequacies (both deficiencies and excesses) in older populations [2], although the use of different measures of nutritional status sometimes makes it difficult to compare such studies [3].

Nutritional well-being plays an essential role in health promotion and maintenance in older people [4-8]; thus, it is important to identify the main determinants of nutritional status in the elderly population. Dietary habits, food intake and oral health changes are important factors, but their reciprocal effects and relationships with overall nutritional status are complex and controversial [9, 10]. In addition, methodological problems and inconsistencies among the different studies have clouded this area of research [9, 11].

Furthermore, the effects of food intake and oral health status on the general health and survival of old people have received little attention. Our previous studies suggest that most daily nutrient intakes (with some exceptions, e.g. folates) are related to socioeconomic and physical factors [12]. Furthermore, dental status is related m education, cognitive function and a global measure of somatic health represented by the health service utilization scale [13]. The relationships between dietary intake and dental status and effects on quality of life (QOL) and survival of old people have yet to be unravelled [10]. These are the reasons which prompted us to carry out the present analysis.

Subjects and methods

Sample and data collection

The target population was the entire cohort of 70-75-year-old subjects living in the historical centre of Brescia. All inhabitants in this area and living at home were considered eligible for inclusion (n = 1303). The study was carried out in two phases. During the first phase (February-June 1986), data collection was undertaken using a door-to-door method by 10 specifically trained doctors. Of the target population, 1189 subjects (91.3%) agreed to answer a multidimensional questionnaire and to undergo a standardized physical examination, including a comprehensive dental assessment. The reasons for exclusions were (i) refused interview (n = 27) and/or (ii) dental examination (n=12); (iii) out of town (n=65) or (iv) hospitalized (n=10) during the period of the inquiry. Gender distribution and mean age were no different between included and excluded subjects. Further details about this phase of the study have been reported previously [14, 15].

In the second phase of the study, the names of subjects who had died after 6 1/2 years were obtained from the government registry office. The survival status of 52 subjects (4.4% of the phase 1 sample) could not be ascertained (mainly because they had moved to a different town) and they were excluded. Thus, a final sample of 1137 elderly people (87.4% of the initial population) constituted the present study. Those lost to follow-up were not statistically different from the study sample in terms of age, sex, functional and mental or dental status (see below).

Questionnaire

Several baseline demographic variables were recorded using a self-report method: age, gender, educational level, marital status, economic situation and living conditions were documented (Table 1).

Table 1. Frequency distributions in the three subgroups
for baseline variables

                      Number (and %), by group(a)

Variable              A (n = 287)   B (n = 687)     C (n = 163)

Gender
 Male                  96 (33.4)    227 (33.0)       48 (29.4)
 Female               191 (66.6)    460 (67.0)      115 (70.6)

Education (years)
 0-5                   58 (20.2)    192 (27.9)       74 (45.4)(b,c)
 [is greater than]    229 (79.8)    495 (72.1)       89 (54.6)

Marital status
 Single                50 (17.4)    142 (20.7)       28 (17.2)(b)
 Married              132 (46.0)    266 (38.7)       53 (32.5)
 Widowed/divorced     105 (36.6)    279 (40.6)        82 (50.3)

Economic conditions
 Satisfactory          69 (24.2)    142 (20.6)       40 (6.1)(b,c)
 Sufficient           131 (45.6)    316 (45.9)       64 (39.3)
 Insufficient          87 (30.2)    229 (33.4)       89 (54.6)

Living conditions
 Alone                107 (37.3)    281 (40.9)       67 (41.1)
 With other(s)        180 (62.7)    406 (59.1)       96 (58.9)

Motor activities
 None                 225 (78.4)    568 (82.7)      147 (90.2)
 Occasional            49 (17.1)     97 (14.1)        15 (9.2)
 Regular               13 (4.5)      22 (3.2)         1 (0.6)

Smoking
 Yes                   49 (17.1)    171 (24 9)(d)    28 (17.3)
 No                   183 (63.6)    375 (54.5)      104 (63.6)
 Past                  55 (19.2)    141 (20.6)       31 (19.1)

Variable              [chi square]         P-value

Gender
 Male                      0.9                      0.640
 Female

Education (years)
 0-5                      32.6       [is less than] 0.001
 [is greater than]

Marital status
 Single
 Married                  11.5                      0.021
 Widowed/divorced

Economic conditions
 Satisfactory
 Sufficient               42.2       [is less than] 0.001
 Insufficient

Living conditions
 Alone                     1.2                      0.549
 With other(s)

Motor activities
 None
 Occasional               11.5                      0.075
 Regular

Smoking
 Yes                       8.8                      0.012
 No
 Past