入院中の高齢者における口腔衛生と老年症候群および臨床転帰との関連

Association of oral health with geriatric syndromes and clinical outcomes in hospitalized older adults.

抄録

目的:

急性期入院高齢患者における口腔衛生と老年症候群との関連、および臨床転帰における口腔衛生の役割を評価すること。

OBJECTIVES: To evaluate the relationship between oral health and geriatric disorders, as well as its role in clinical outcomes among acutely admitted older patients.

デザイン:

レトロスペクティブ観察研究を実施した。

DESIGN: A retrospective observational study was conducted.

設定:

台湾中部の医療センターで実施した。

SETTING: The study was conducted at a medical center in central Taiwan.

対象者:

2018年10月1日から2023年3月31日までに老年症候群の急性疾患により入院した65歳以上の患者1,141例（男性651例、女性490例）。

PARTICIPANTS: A total of 1,141 patients (651 males and 490 females), aged 65 years or older, were admitted due to acute illness with geriatric syndromes from October 1, 2018, to March 31, 2023.

測定方法:

併存疾患指数、認知状態、気分、身体機能、栄養状態、可動性、健康関連QOL、虚弱、口腔衛生状態を網羅した包括的老年医学評価（CGA）を実施した。口腔の健康状態は、ベッドサイドでの口腔検査を用いて8～24点の範囲で評価され、8～10点は口腔の健康状態が正常、11～14点は中等度の障害、15～24点は重度の障害を示した。観察された主要アウトカムは院内死亡率であった。

MEASUREMENTS: A comprehensive geriatric assessment (CGA) was conducted, covering the comorbidity index, cognitive status, mood, physical function, nutritional status, mobility, health-related quality of life, frailty, and oral health condition. Oral health was evaluated using a bedside oral examination with scores ranging from 8 to 24, where scores of 8-10 indicated normal oral health, 11-14 indicated moderate impairment, and 15-24 indicated severe impairment. The primary outcome observed was in-hospital mortality.

結果:

参加者のうち、40.5％に認知機能障害、24.8％に抑うつ症状、69.4％に握力低下、36.5％に運動能力低下、78.9％に栄養不良のリスクが認められた。口腔衛生の重度障害は18.8％に認められ、虚弱は85.1％に認められた。口腔衛生の重症度を層別化したところ、併存疾患、ポリファーマシー、認知障害、抑うつ気分、身体活動、移動能力、栄養状態、QOLなどのさまざまなCGAパラメータや、在院日数、院内死亡率などの臨床転帰に群間で差がみられた。単変量解析では、年齢、性別、虚弱、口腔機能障害、合併症指数、栄養状態、認知機能および身体機能はすべて院内死亡率と有意に関連していた。有意な因子を調整した後も、重度の口腔保健機能障害は依然として死亡率と有意に関連していた。

RESULTS: Among the participants, 40.5% experienced cognitive impairment, 24.8% exhibited depressive symptoms, 69.4% had low hand grip strength, 36.5% demonstrated low performance in mobility, and 78.9% were at risk of malnutrition. Severe impairment of oral health was found in 18.8% of the participants, while frailty was observed in 85.1%. Stratification of oral health severity revealed differences in various CGA parameters, including comorbidity, polypharmacy, cognitive impairment, depressive mood, physical activity, mobility, nutritional status, and quality of life, as well as clinical outcomes such as length of stay and in-hospital mortality between the groups. In univariable analysis, age, gender, frailty, oral health impairment, comorbidity index, nutritional status, and cognitive and physical functions were all significantly associated with in-hospital mortality. After adjusting for significant factors, severe oral health impairment remained significantly associated with mortality.

結論:

急性期入院高齢患者において、口腔の健康状態は老年期障害と関連し、院内死亡率と関連していた。転帰を改善するためには、口腔衛生への早期介入が必要かもしれない。

CONCLUSION: In acutely admitted older patients, oral health was associated with geriatric disorders and was linked to in-hospital mortality. Early intervention in oral health may be necessary to improve outcomes.