The relationship between oral and dental health, dysphagia and malnutrition in elderly hospitalised patients.
A range of factors can influence nutritional state, such as dysphagia and oral and dental hygiene.
A recent article sheds light on the importance of oral and dental hygiene in hospitalised patients and the link to the risk of malnutrition. This study was conducted among 159 patients (108 women, 51 men), with an average age of 85 and hospitalised for 4 months.
A series of data was collected in the first three days of hospitalisation:
- patients’ nutritional state by measuring BMI (Body Mass Index), the MNA test (Mini Nutritional Assessment, score from 0 to 14, MNA < 8 being the score of a person considered malnourished) and a dose of albumen (albumen <35g/L for a malnourished state);
- patients’ dependence via the ADL score (Activities of Daily Living, a score of 0 to 6, 6 being the score of an independent person);
- the dietary intake of patients via a 3 day study (expression in kcal / kg of body weight / day and in g of protein / kg of body weight / day;
- their ability to swallow using the water test (the patient is asked to swallow four times using increasing volumes of liquid. The test result is considered abnormal (dysphagia) if the patient toughs during the test or the first minute after the test, or if their voice has changed). ;
- their oral and dental hygiene (examination conducted by a dentist).
Their ability to swallow and the dietary intake of patients is re-assessed after a week of hospitalisation.
The results of this study revealed that 77 patients presented a state of malnutrition (48.5%) using the MNA score, and 34 dysphagia (21.5%). Moreover, amongst all patients, 89.0% needed dental treatment, 17 presented oral infections* (11%) and 50 a reduced flow of saliva (31.5%).
The patients suffering dysphagia were the ones with the lowest dietary intake. Dysphagia and malnutrition were correlated (p < 0,001 ) and the two were linked to oral infections (p < 0,001 et p < 0,01). The results of the study also revealed that hypofunctioning of the saliva system was also linked to oral infections (p < 0,001 ).
Source : Poisson P1, Laffond T, Campos S, Dupuis V, Bourdel-Marchasson I. (2014) Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology; doi: 10.1111/ger.12123. Useful links: http://www.ncbi.nlm.nih.gov
*Oral thrush is a common fungal infection, whose frequency increases in parallel to deficiency in the immune system.