Oral Health Status Is Associated with Common Medical Comorbidities in Older Hospital Inpatients

Abstract

Objectives: To investigate oral health status and abnormalities in older adults admitted acutely to the hospital and explore the association with common medical comorbidities.

Design: Cross-sectional study.

Setting: Hospital.

Participants: All individuals aged 70 and older (mean age 84.4, 61.4% female) admitted to a geriatric service over 3 months (N = 202).

Measurements: In-person assessment using the Oral Health Assessment Tool (OHAT) (range 0-2, 2 = poorest) for lips, tongue, gums and soft tissue, saliva, teeth, dentures, oral cleanliness, and dental pain. Comorbidities and medications were also recorded.

Results: One hundred twenty-eight (63%) participants had full or partial dentures, and 31 (15%) were edentulous. Median OHAT score was 6 (interquartile range 5-8). Of the eight domains, saliva scored worst, with 53% scoring 2. On univariate analysis, the highest (poorest) tertile of OHAT (score ≥8) was associated with dementia (odds ratio (OR) = 2.41, 95% confidence interval (CI) = 1.13-5.12, P = .02), moderate to severe renal impairment (estimated glomerular filtration rate <30 mL/min per 1.73 m(2) at discharge) (OR = 5.52, 95% CI = 1.54-19.69, P = .009), recent anticholinergic medication burden (P = .02), and low oral pH (P = .05). On multivariate analysis adjusted for oral pH and anticholinergic medication burden, dementia (OR = 2.29, P = .02) and moderate to severe renal impairment (OR = 5.64, P = .01) were independently associated with the highest tertile of OHAT. Charlson Comorbidity Index (includes renal disease, dementia) was associated with OHAT on univariate analysis (Spearman rho = 0.19, P = .01) but not when adjusted for oral pH (P = .10).

Conclusion: Poorer oral health was not uncommon and was associated with dementia and renal impairment even after adjustment for anticholinergic medication and oral pH. Oral health screening should be considered for vulnerable populations.

Keywords: anticholinergics; dementia; dental care; elderly; oral health; renal insufficiency.