Objective and subjective masticatory function in older individuals

Introduction: Oral health in the older population has improved, both in Sweden and in a global perspective. Oral health that has been associated to other, more general health perspectives such as nutrition and cognition, but also presents new challenges for the dental community. Oral health is a broad construct, but it has been shown that when older patients rate different oral health related concepts, the ability to masticate food is important. Objective: The overall aim of this thesis was to explore how to assess objective and subjective masticatory function in older individuals, their possible relationships and assocoiation to nutrition as well as cognitive functions. Methods and results: Study I systematically investigated and identified methods that have been developed to objectively assess masticatory function, also known as masticatory performance and to rate their measurement properties. Bibliographic databases were searched, including MEDLINE, Embase, Web of Science Core Collection, Cochrane, and Cinahl. Eligible papers that satisfied predefined inclusion and exclusion criteria were appraised independently by two investigators. Four other investigators independently appraised any measurement properties of the methods according to the consensus-based standards for the selection of health measurement instruments checklist. The qualities of the measurement properties were evaluated using predefined criteria. The level of evidence was rated by using data synthesis for each MP assessment method, where the rating was a product of methodological quality and measurement properties quality. Forty-six out of 9,908 articles were appraised, and the assessment methods were categorized as comminution (n = 21), mixing ability (n = 23), or other methods (n = 2). Different measurement properties were identified, in decreasing order construct validity (n = 30), reliability (n = 22), measurement error (n = 9), criterion validity (n = 6), and responsiveness (n = 4). Study II focused on older individual’s subjective and self-perceived notion of their masticatory function, known as masticatory ability. The aim of the study was to explore what factors seem to be important for older individuals’ masticatory ability and how it impacts daily life. Qualitative methodology and in-depth interviews were used, and the design was inspired by the qualitative method Grounded Theory. The final sample consisted of twelve older participants. Three categories developed from the data; Deteriorating oral health and functional loss, Eating habits, Prosthetic rehabilitation and function. A core category named Adaptation emerged that describes how individuals successfully adapt to a decreased function and despite this develop a positive view of their masticatory ability. Study III was a retrospective longitudinal study that examined the association between reduced posterior occlusal support and cognition in different cognitive domains and whether poor masticatory function increased the risk of dementia. Data came from a population–based study with up to 22 years of follow-up of 544 cognitively intact adults aged ≥50. Cognitive domains were assessed at baseline and at follow-ups and masticatory function was assessed using the Eichner Index and categorized according to the number of posterior occlusal zones. At baseline, 147 (27.0%) participants were placed in Eichner category A, 169 (31.1%) in B and 228 (41.9%) in C. After the age of 65, participants in Eichner category B and C showed an accelerated decline in spatial/fluid abilities. Eichner categories B or C were not associated with an increased risk of dementia, compared to category A. In study IV a group of 355 individuals with care dependency and functional limitations, aged 60 and older were included. By home visits, the participants underwent an oral examination and answered chewing related questions. Nutritional status was assessed using the Mini Nutritional Assessment. A total of 196 individuals met the age requirement. Of these, 86 subjects were able to answer the questions. The study did not report any concluding significant associations between the subdomains of masticatory function or the nutritional variables. Conclusion: Methods to assess masticatory performance are often labor intensive and not fitted to a clinical setting. Further research is needed to find masticatory measurement methods, that are useful both in clinical contexts and research. Older individuals with at deteriorating oral function tend to overrate their masticatory ability and self-reported questionnaires seem less useful. With the chosen instruments in this thesis, a low number of occluding contacts was not associated to an increased risk of dementia or nutritional variables

The Relation between Masticatory Function and Nutrition in Older Individuals, Dependent on Supportive Care for Daily Living

Introduction: Associations between masticatory function and nutritional status have been suggested. Masticatory function can be divided into two subdomains, the objective capacity of an individual to mix solid food and the individual’s subjectively assessed ability to masticate solid food. Aim: The aims of this study were to assess the relationship between these subdomains and nutritional variables in older, care-dependent individuals. Materials and methods: From a group of 355 individuals with care dependency and functional limitations, individuals aged 60 and older were selected. By home visits, the subjects underwent an oral examination and answered chewing related questions. Nutritional status was assessed using the Mini Nutritional Assessment. A total of 196 individuals met the age requirement of 60 years or older. Of these, 86 subjects were able to answer the questions. Results: We could not find any concluding significant associations between the subdomains of masticatory function or the nutritional variables. Conclusions: The absence of associations could be explained by the lack of standardized and validated methods to assess masticatory function and they possibly reflect varying underlying constructs. Self-reported questionnaires seem less useful among older and care-dependent individuals, while an objective clinical measurement will be needed when evaluating masticatory function

Systematic review of measurement properties of methods for objectively assessing masticatory performance

The objectives of this study is to identify methods for objectively assessing masticatory performance (MP) and to evaluate their measurement properties. A secondary objective was to identify any reported adverse events associated with the methods to assess MP. Bibliographic databases were searched, including MEDLINE, Embase, Web of Science Core Collection, Cochrane, and Cinahl databases. Eligible papers that satisfied predefined inclusion and exclusion criteria were appraised independently by two investigators. Four other investigators independently appraised any measurement properties of the assessment method according to the consensus‐based standards for the selection of health measurement instruments checklist. The qualities of the measurement properties were evaluated using predefined criteria. The level of evidence was rated by using data synthesis for each MP assessment method, where the rating was a product of methodological quality and measurement properties quality. All studies were quality assessed separately, initially, and subsequently for each method. Studies that described the use of identical assessment method received an individual score, and the pooled sum score resulted in an overall evidence synthesis. The level of evidence was synthesized across studies with an overall conclusion, that is, unknown, conflicting, limited, moderate, or strong evidence. Forty‐six out of 9,908 articles were appraised, and the assessment methods were categorized as comminution (n = 21), mixing ability (n = 23), or other methods (n = 2). Different measurement properties were identified, in decreasing order construct validity (n = 30), reliability (n = 22), measurement error (n = 9), criterion validity (n = 6), and responsiveness (n = 4). No adverse events associated with any assessment methods were reported. In a clinical setting or as a diagnostic method, there are no gold standard methods for assessing MP with a strong level of evidence for all measurement properties. All available assessment methods with variable level of evidence require lab‐intensive equipment, such as sieves or digital image software. Clinical trials with sufficient sample size, to infer trueness and precision, are needed for evaluating diagnostic values of available methods for assessing masticatory performance

The Relation between Masticatory Function and Nutrition in Older Individuals, Dependent on Supportive Care for Daily Living

Introduction: Associations between masticatory function and nutritional status have been suggested. Masticatory function can be divided into two subdomains, the objective capacity of an individual to mix solid food and the individual's subjectively assessed ability to masticate solid food. Aim: The aims of this study were to assess the relationship between these subdomains and nutritional variables in older, care-dependent individuals. Materials and methods: From a group of 355 individuals with care dependency and functional limitations, individuals aged 60 and older were selected. By home visits, the subjects underwent an oral examination and answered chewing related questions. Nutritional status was assessed using the Mini Nutritional Assessment. A total of 196 individuals met the age requirement of 60 years or older. Of these, 86 subjects were able to answer the questions. Results: We could not find any concluding significant associations between the subdomains of masticatory function or the nutritional variables. Conclusions: The absence of associations could be explained by the lack of standardized and validated methods to assess masticatory function and they possibly reflect varying underlying constructs. Self-reported questionnaires seem less useful among older and care-dependent individuals, while an objective clinical measurement will be needed when evaluating masticatory function

Methods for objectively assessing clinical masticatory performance: protocol for a systematic review

Background Chewing and masticatory function constitutes one of the most important oral health factors that affect quality of life, especially in older individuals. Little consensus currently exists regarding ways to objectively assess clinical masticatory performance (in this context, performance refers an individual’s objective ability to mix or comminute food bolus). That said, many methods were developed to assess masticatory performance. Consequently, systematic review of the literature would be of great value when it comes to identifying various methods for objectively assessing clinical masticatory performance and for evaluating these methods. Design This study protocol describes a systematic review that intends to (i) identify methods to objectively assess clinical masticatory performance and (ii) evaluate psychometric properties (such as validity and reliability) of the identified methods. A systematic literature search is required to do so in these sources: MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection (Thomson Reuters), Cochrane (Wiley), and Cinahl (Ebsco). Inclusion criteria: studies in scientific, full-text articles; development articles; validation articles; studies of the general adult population, ages ≥18. Exclusion criteria: topics and article types that cover interview methods and self-reported questionnaires; methods/instruments that measure subjective masticatory performance; qualitative studies and case studies; opinion and editorial pieces; animal studies; studies of humans with severe oral health complications. Discussion This systematic review will result in a comprehensive assessment of various methods designed to objectively measure clinical masticatory performance. This systematic review will rate these methods, assess their reliability and validity, and identify one or more methods that can be recommended for use in clinical and scientific environments. From what is currently known, no systematic evaluation of various methods for objectively assessing clinical masticatory performance has been published

Cuba e a eterna guerra fria : mudanças internas e política externa nos anos 90

Qual o impacto e o que aconteceu com Cuba depois da queda do bloco soviético? Que mudanças políticas e econômicas ocorreram no país nos anos 90? Como Cuba reorientou sua política externa para superar o embargo americano e o isolamento internacional? O presente trabalho procura responder a estas questões, combinando duas dimensões que se interagem. No plano interno, analisa as transformações sociais, políticas e econômicas que se realizaram na ilha e que, orientadas pela lógica da sobrevivência, permitiram certa recuperação econômica e a manutenção das conquistas sociais da revolução. No plano externo, analisa a política externa cubana nos anos 90 que, fundamentadas na afirmação da soberania nacional e no desenvolvimento da Diplomacia Social, permitiu a superação do isolamento e a reinserção no mundo globalizado, processo este ainda inconcluso

Additional file 4: of Methods for objectively assessing clinical masticatory performance: protocol for a systematic review

Definitions of measurement properties. (DOCX 16 kb

The relation of poor mastication with cognition and dementia risk : a population-based longitudinal study

We investigated the effect of poor masticatory ability on cognitive trajectories and dementia risk in older adults. 544 cognitively intact adults aged =50 were followed for up to 22 years. Cognitive domains (verbal, spatial/fluid, memory, and perceptual speed) were assessed at baseline and follow-ups. Dementia was ascertained according to standard criteria. Masticatory ability was assessed using the Eichner Index and categorized according to the number of posterior occlusal zones: A (all four), B (3-1), and C (none). At baseline, 147 (27.0%) participants were in Eichner category A, 169 (31.1%) in B and 228 (41.9%) in C. After the age of 65, participants in Eichner category B and C showed an accelerated decline in spatial/fluid abilities (beta: -0.16, 95% CI: -0.30 to -0.03) and (beta: -0.15, 95% CI: -0.28 to -0.02), respectively. Over the follow-up, 52 incident dementia cases were identified. Eichner categories B or C were not associated with an increased risk of dementia, compared to category A (Hazard Ratio [HR]: 0.83, 95% CI: 0.39 to 1.76 and HR: 0.63, 95% CI: 0.30 to 1.29, respectively). Poor masticatory ability is associated with an accelerated cognitive decline in fluid/spatial abilities, however it was not related to a higher risk of dementia

Additional file 5: of Methods for objectively assessing clinical masticatory performance: protocol for a systematic review

COSMIN checklist domains. (DOCX 14 kb