老年吞咽困难与口腔健康：人口统计学和临床关联的考察

文献信息

中文摘要

背景： 口腔健康是一个可改变的风险因素，对整体健康具有重要影响，尤其是在老年患者群体中。口腔卫生不良与呼吸系统疾病、吸入性肺炎以及糖尿病和心血管疾病等全身性疾病有关。口腔健康是老年吞咽困难患者临床护理的关键组成部分；然而，现有文献有限，无法指导临床医生描述该人群中与口腔健康不佳相关的患者特征。
方法： 这项回顾性研究旨在确定老年吞咽困难人群中患者特征与口腔健康不佳之间的关联。数据收集自2013年至2019年间在美国东北部多个居住和医疗保健机构中接受移动医疗实践提供MBSS服务的29,302名65岁及以上患者。口腔健康不佳根据与口腔分泌物、口腔卫生、黏膜和牙列相关的记录发现被编码为二分类变量。使用多变量逻辑回归模型分析口腔健康状况与人口统计学和临床因素之间的关系。多变量回归分析包括18,395例完整病例。
结果： 结果表明，与口腔健康不佳显著相关的人口统计学变量包括男性（AOR=1.21；95% CI：1.12，1.31）、黑人（AOR=1.42，95% CI=1.15，1.76）以及居住在专业护理机构（AOR=1.17，95% CI：1.02，1.35）。观察到的差异可能反映了口腔医疗保健获取方面的不平等和其他结构性因素，而非患者固有的特征。与口腔健康不佳相关的临床特征包括中度至重度（AOR=3.05，95% CI：1.83，5.06）、重度口腔吞咽困难（AOR=3.98，95% CI：2.35，6.75）、重度咽部吞咽困难（AOR=1.92，95% CI：1.14，3.23）、非行走状态（轮椅AOR=1.47，95% CI：1.19，1.82；卧床/椅绑AOR=1.34，95% CI：1.07，1.67）、进食依赖（需要协助AOR=1.45，95% CI：1.30，1.61；完全依赖进食AOR=1.44，95% CI：1.22，1.71）以及饮食调整（IDDSI 3 AOR=1.29，95% CI：1.13，1.47；IDDSI 4 AOR=1.27，95% CI：1.14，1.43；IDDSI 5 AOR=1.19，95% CI：1.06，1.34；IDDSI 6 AOR=1.17，95% CI：1.06，1.31）。在饮食类别中，被分类为禁食（NPO）的患者口腔健康不佳的几率最高（AOR=2.03，95% CI：1.62，2.53）。
结论： 该研究确定了老年吞咽困难人群中与口腔健康不佳相关的人口统计学和临床特征，为指导预防措施、机构方案和跨学科口腔健康管理方法迈出了第一步。

英文摘要

Oral health is a modifiable risk factor with significant implications for general health, particularly in the geriatric patient population. Poor oral hygiene has been linked to respiratory disease, aspiration pneumonia, and systemic conditions such as diabetes and cardiovascular disease. Oral health is a critical component of clinical care for elderly patients with dysphagia; however, limited literature exists to guide clinicians in describing the patient characteristics associated with inadequate oral health in this population. This retrospective study aimed to identify associations between patient characteristics and inadequate oral health in a geriatric population with dysphagia. Data were collected from 29,302 patients aged 65 and older referred to a regional mobile medical practice providing MBSS services across multiple residential and health care settings in the northeastern United States between 2013 and 2019. Inadequate oral health was coded as a binary variable based on documented findings related to oral secretions, oral hygiene, mucosa, and dentition. A multivariable logistic regression model was used to analyze the relationship between oral health status and both demographic and clinical factors. The multivariable regression analysis included 18,395 complete cases. Results indicated that the demographic variables significantly associated with inadequate oral health included being male (AOR = 1.21; 95% CI: 1.12, 1.31), Black (AOR = 1.42, 95% CI = 1.15, 1.76), and residing in a skilled nursing facility (AOR = 1.17, 95% CI: 1.02, 1.35). Observed disparities may reflect inequities in access to oral healthcare and other structural factors rather than inherent patient characteristics. Clinical characteristics associated with inadequate oral health included moderate-to-severe (AOR = 3.05, 95% CI: 1.83, 5.06), severe oral dysphagia (AOR = 3.98, 95% CI: 2.35, 6.75), profound pharyngeal dysphagia (AOR = 1.92, 95% CI: 1.14, 3.23), non-ambulatory status (wheelchair AOR = 1.47, 95% CI: 1.19, 1.82); chair/bed bound AOR = 1.34, 95% CI: 1.07, 1.67)) dependence for feeding (required assistance AOR = 1.45, 95% CI: 1.30, 1.61; dependent for feeding AOR = 1.44, 95% CI: 1.22, 1.71), and dietary modifications (IDDSI 3 AOR = 1.29, 95% CI: 1.13, 1.47; IDDSI 4 AOR = 1.27, 95% CI: 1.14, 1.43; IDDSI 5 AOR = 1.19, 95% CI: 1.06, 1.34; IDDSI 6 AOR = 1.17, 95% CI: 1.06, 1.31). Among dietary categories, patients classified as nil per os (NPO) had the highest odds of inadequate oral health (AOR = 2.03, 95% CI: 1.62, 2.53). The study identified demographic and clinical characteristics associated with inadequate oral health in this geriatric dysphagia population, offering a first step in guiding preventive efforts, institutional protocols, and interdisciplinary approaches to oral health management.