Masticatory Function, Dementia and Autonomy in the Dependent Elderly

• Published in: Ronen Shika Igaku Vol. 14; no. 3; pp. 287 - 296
• Main Authors: Ikeda Yasuhiro, Hirai Toshihiro, Kawakami Tomofumi, Koshino Hisashi, Ishijima Tsutomu, Yoshimaru Yuko
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本老年歯科医学会 2000; Japanese Society of Gerodontology
• Subjects: Dementia; Elderly Nursing Care Plan (MDS/RAPs); Masticatory function; Removable denture; The dependent elderly; 咀嚼機能; 痴呆; 義歯; 要介護高齢者; 高齢者ケアプラン (MDS/RAPs)
• ISSN: 0914-3866; 1884-7323
• DOI: 10.11259/jsg1987.14.287

Recently, the relationship between stomatognathic functions and general health in the elderly has been observed with keen interst. Especially, there are some reports on the imfluence of the occlusal-masticatory function on the brain function. In order to verify the relationship between the masticatory function and the general function of the whole body, 36 dependent elderly persons in a geriatric hospital were investigated. The “Denture Score” was obtained by evaluating denture retention, stability, occlusion and satisfaction. Moreover all the subjects were divided into two groups, the low Denture Score group and the high Denture Score group.The degree of dementia was judged by Hasegawa's Dementia Rating Scale. The “Autonomy Score” was evaluated by using the Criteria of Bed-Ridden Elderly issued by the Ministry of Welfare in Japan. The Voluntary maximal clenching force was measured using the Prescale system®. The “Chewing Score” indicating the masticatory ability was calculated by a food intake questionnaire developed by the authors. The Elderly Nursing Care Plan (MDS/RAPs) developed by the national project in the United States in 1990 was used in this investigation.The results obtained are as foollows.The subjects judged to be dementia accounted for 62.4% of all the subjects.The subjects judged to be pre-bedridden elderly accounted for 38.7% and to be bed-ridden accounted for 61.3% of all the subjects.In the low Denture Score group, 75% of the subjects were judged to be dementia. On the other hand, in the high Denture Score group, 45% of the subjects were judged to be dementia.There was a significant correlation between the “Denture Score” and “Autonomy Score” (p<0.01). There was also a significant correlation between the “Denture Score” and the “Voluntary Maximal Clenching Force” (p<0.05). There was also a significant correlation between the “Denture Score” and the “Chewing Score” (p<0.05).In MDS/RAPs, “Examination of dementia and cognitive loss”, “Examination of psychological well-being”, “Examination of mood state”, “Examination of dental care” and “pressure ulcers” were selected as Resident Assessment Protocols (RAPs).The results of this study suggest that a close relationship exsts between the masticatory function and some measures of physical and mental activity in this group of elderly subjects. 近年, 顎口腔系機能と全身の機能との関連, 特に, 咀嚼機能と脳機能との関連が注目されている。また, 高齢者においては, 咬合・咀嚼が全身の健康保持や寝たきりおよび痴呆の予防などのために重要な役割を果たしていることが示唆されている。本研究では, 老人病院に入院中の36名 (男性9名, 女性27名, 平均年齢82±8.3歳, 全部床義歯装着者26名, 部分床義歯装着者10名) の要介護高齢者における咀嚼機能と痴呆および自立度との関連について調査を行ったところ以下の結果を得た。使用中の義歯の適否を表わす「義歯スコア」と「痴呆スコア」との間には, 統計学的に有意な相関が認められた (p<0.01) 。なお, 「義歯スコア」を「不良」と「良好」の2群に分けた場合, 「義歯スコア不良群」では75%の対象者が痴呆と判定されたのに対し, 「義歯スコア良好群」においては, 45%と有意に減少していた (p<0.05) 。「義歯スコア」と「自立度スコア」の間には統計学的に有意な相関が認められた (p<0.01) 。なお, 「義歯スコア良好群」においては, 「不良群」に比して, 「準寝たきり者」の割合が有意に増加していた (p<0.05) 。「義歯スコア」と「MDS/RAPs」においては, 「義歯スコア不良群」では, 「痴呆状態・認知障害の検討」, 「望ましい人間関係 (心理社会的充足) の検討」, 「気分と落ち込みの検討」, 「口腔ケアの検討」, 「じょく創の兆候」の問題領域を選定された者が多かった。以上の結果から, 要介護高齢者における咀嚼機能と痴呆および自立度との間には, 密接な関連があることが示唆された。