Approaches to Caries Prevention and Therapy in the Elderly

Milk consumption and zinc retention in postmenopausal women : J. Nutr. 1990 120/4 (398–403)

There has been a growing interest in the association between the number of teeth and dietary intake in older populations. However, people around the age of 80 y have frequently lost most of their teeth, and dental prostheses replacing the missing teeth play an important role in masticatory function. Therefore, masticatory function cannot be evaluated by the number of teeth alone. The occlusal force of the complete dental arches is an index of masticatory function, reflecting not only the number of teeth, but the effect of removable dentures. The purpose of this cross-sectional study was to determine the relative importance of the number of teeth and occlusal force in association with dietary intake in 80-y-old Japanese people. This study included 760 community-dwelling Japanese people aged 79 y to 81 y. The authors measured bilateral maximal occlusal force in the intercuspal position using pressure-sensitive sheets. Removable denture wearers kept their dentures in place during the measurements. Energy-adjusted food groups and nutrient intake during the preceding month were assessed by a brief self-administered diet history questionnaire. The authors assessed linear trends in food and nutrient intake in relation to the number of teeth and occlusal force after adjusting for gender and socioeconomic status (education level, financial status, family structure, resident area and BMI). P values of < 0.05 were considered to be statistically significant. The authors found that the number of teeth was not associated with the energy-adjusted intake of any food group examined. In contrast, a decline in occlusal force was significantly associated with a lower intake of vegetables, fish and shellfish, protein, polyunsaturated fatty acids, dietary fiber and most vitamins and minerals ( P for trend < 0.05). We conclude that food and nutrient intake was more closely associated with occlusal force than the number of teeth in community-dwelling Japanese people aged 79 y to 81 y. Knowledge Transfer Statement: This cross-sectional study of older Japanese people showed that, after controlling for considerable covariates, occlusal force rather than the number of teeth is positively associated with energy-adjusted intake of vegetables, fish and shellfish, protein, polyunsaturated fatty acids, dietary fiber and most of vitamins and minerals. This means that reduced occlusal force may unconsciously lead older people toward a habitual unhealthy dietary intake. Older people have frequently lost most of their teeth and require prosthetics to restore masticatory function. Bilateral occlusal force is therefore a better measure of masticatory function than the number of remaining teeth. Our findings suggest that prosthetic rehabilitation is a significant factor in the prevention and management of chronic diseases and frailty through better dietary intake in older populations.

Watch your step: Helping patients avoid falls

The nations of the world are aging. In comparison to decades of the past, older cohorts represent a growing share of the world's population. This trend is the result primarily of declining fertility rates and, secondarily, of increasing longevity. Even those countries that have only recently experienced significant fertility declines are beginning to deal with the effects of an older population, effects that will become more pronounced early in the 21st century. Indeed, although a larger share of the developed world's population is beyond the age of 55 (22% as opposed to 10% in developing nations), more than half of the world's older population lives in developing countries (U.S. Bureau of the Census, 1992).

Background: Frailty is a common condition in older adults, associated with an increased risk of cardiovascular disease (CVD). The triglyceride-glucose index (TyG), a marker of insulin resistance, has also emerged as a potential predictor of CVD risk. Frailty and insulin resistance often coexist in the elderly, however, the combined role of frailty and TyG in the incidence of CVD remain unclear. Purpose: This study investigates the combined association of frailty and TyG with the incidence of CVD in middle-aged and older adults. Methods: This study utilized data from five waves of the China Health and Retirement Longitudinal Study (CHARLS). Frailty status was assessed using the Rockwood frailty index, which classified participants into three categories: robust (FI ≤ 0.10), pre-frail (0.10 &lt; FI &lt; 0.25), and frail (FI ≥ 0.25). The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL) / 2] and categorized based on the median value. The cox regression and mediation analysis were used to assess the association between frailty status, TyG, and the incidence of CVD. Results: A total of 5,997 participants aged 45 years and older (48.40% male; mean age 57.51 ± 8.40 years) with no cardiovascular disease were enrolled in 2011. Over a maximum follow-up period of 9 years, 1,640 (27.3%) individuals developed CVD. After adjusting for potential confounders, the combined impact of frailty status and TyG showed the highest risk in frail individuals with high TyG (HR 2.30, 95% CI: 1.86-2.86), followed by frail individuals with low TyG (HR 1.92, 95% CI: 1.52-2.43), pre-frail individuals with high TyG (HR 1.85, 95% CI: 1.58-2.15), pre-frail individuals with low TyG (HR 1.76, 95% CI: 1.50-2.06), and robust individuals with high TyG (HR 1.17, 95% CI: 1.02-1.36) (Figure 1). Additionally, frailty status was found to significantly mediate 17.21% of the association between TyG and CVD (Figure 2). Conclusions: The results highlight the combined effect and mutual mediation between frailty status and TyG on the incidence of CVD. It is important to consider both frailty status and TyG together in risk assessments for better residual risk stratification and primary prevention of cardiovascular diseases, particularly in older populations.

Background and Aims Hemodialysis patients are at an increased risk of falls, a significant health concern that can lead to serious injuries and reduced quality of life. Several factors contribute to this elevated risk including impaired balance, muscle weakness, and cognitive dysfunction. Nutritional status is increasingly being recognized as a critical factor influencing fall risk in this population. Malnutrition, protein-energy wasting, and micronutrient deficiencies are prevalent in haemodialysis population and can exacerbate their existing fall risk factors. This study will assess the complex interplay between nutritional status and fall risk in the hemodialysis population, exploring the possible underlying mechanisms. It will also investigate other potential risk factors of fall in this population. Method This is a prospective, single centre study, of patients on dialysis for at least 3 months, aged over 18. The study included a total of 68 patients. The patients were followed up for a period of 2 years and were tracked for the occurrence of fall either at home or at our institution. The nutritional status was assessed biannually by the clinical dieticians of the centre. Protein–energy wasting (PEW) was evaluated with anthropometric measurements, including Body Mass Index (BMI) and weight changes over 3 and 6 months. Functional muscle assessment included handgrip strength. It was also supported by a Nutrition Focused Physical Exam (NFPE) to evaluate the muscle loss severity. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria; incorporating weight loss, dietary intake, and muscle mass. Serum albumin levels were recorded at each evaluation. We also collected data from the patient's files that included baseline characteristics, demographic parameters, biochemical markers, hemodialysis parameters, presence of orthostatic hypotension or vision problems and anti-hypertensive medications. We also recorded the ambulatory status of the patient and their mean of transportation to the centre (alone/accompanied). Statistical analysis was performed using IBM SPSS Statistics software, version 22.0. Student's t-test, the Mann-Whitney U test, and chi-square tests were used at the bivariate level, and logistic regressions were done for multivariate analysis. Results The studied population consisted of 68 patients. The mean age (±SD) was 66.5 ± 13.3 years. The mean BMI was 26 ± 5.65 kg/m2. A total of 48.5 % of the patients were female. 38.2% of the patients experienced fall, and of these 46% had fallen once, 46% had fallen twice and 8% had fallen three times. In the bivariate analysis the risk of fall was significantly associated with the age of the patients (P = 0.003), the age at onset of dialysis (P = 0.009), serum albumin levels (P &amp;lt; 0.001) and potassium levels (P = 0.001), muscle loss severity (NFPE) (P = 0.057), the mode of transportation (P = 0.019), the ambulation status (P = 0.001) and the presence of orthostatic hypotension (P = 0.008). Logistic regression analyses’ results showed that muscle loss severity (NFPE) (P = 0.020), albumin levels (P = 0.015), potassium levels (P = 0.53), ambulation status (P = 0.001) and orthostatic hypotension (P = 0.035) were significantly associated with an increased risk of fall. Conclusion Our study revealed a significant contribution of nutritional compromise to fall risks in hemodialysis patients. It showed that the severity of muscle loss along with lower levels of serum albumin and potassium are strongly associated with falls. Additionally, assisted/dependent ambulation and orthostatic hypotension were independently associated with a higher incidence of falls. These findings provide insight into the risk factors associated with falls enabling the development of targeted fall prevention strategies. Further interventional studies are warranted to investigate the effect of nutritional interventions in reducing fall risk in this patient group. Figure 1: (A) Number of falls in the studied population.

Background: Genetic polymorphism of endothelial nitric oxide synthase (eNOS) has been implicated in the risk of diabetic nephropathy (DN), but the published findings were inconsistent. We performed a comprehensive meta-analysis to derive a more precise estimation of the association between genetic polymorphisms of eNOS and the risk of DN. Methods: Six online database were researched on the associations between polymorphisms of eNOS (T786C, G894T, 4b/4a) and DN risk. PRISMA statement and Hardy–Weinberg equilibrium assessment were used in this report. Odds ratio and 95% confidence interval were estimated based on the following genetic contrast/models: allelic model, dominant model, recessive model and co-dominant model. The publication bias and sensitivity analysis were also performed to guarantee the statistical power. Results: A total of 49 case–control studies with 11,990/9754/5131 participants for DN/DM/HC group were eligible for meta-analysis (7/25/31 studies for T786C/G984T/4b/a). For the eNOS-T786C, C allele showed a weak association between C allele and DN risk in DN/T2DM group. For eNOS-G894T, there was an association between T allele and DN risk in the global, Asian and African population in DN/T2DM group. For the eNOS-4b/4a, 4a allele was found contributing significantly to increased DN risk in the global population. Conclusion: Our comprehensive meta-analysis suggests that three polymorphisms of eNOS may be the increased risk factors of DN development, especially in Asian population and T2DM group.

The world's older population is growing rapidly and the need to find measures to combat age-associated decline of physical, mental, and cognitive functions and improve their health-related quality of life (HRQOL) is escalating. Biobran/MGN-3, an arabinoxylan rice bran, has been previously reported to improve the quality of life in cancer patients. The objective of the current study was to examine the effect of a low dose of Biobran/MGN-3 supplementation on the HRQOL in a healthy older adult population. Sixty apparently healthy subjects, 40 males and 20 females, over 56years old were recruited and blindly randomized into two group receiving either placebo or Biobran/MGN-3 (250mg/day for 3months). Participants did not take any vitamins or medications during the study and their health was closely monitored. HRQOL was assessed at the initiation and termination of the study using the previously validated Arabic version of SF-12v2 questionnaire. For all measured HRQOL domains, there was no statistically significant difference in baseline scores between the two groups. Compared to baseline values and placebo-treated subjects, Biobran/MGN-3 supplementation significantly enhanced the levels of physical and mental component summary scores as well as role-physical, bodily pain, vitality, and social functioning subdomain scores. These results show that Biobran/MGN-3 is a promising psychoneuroimmune modulatory agent that could improve the HRQOL in healthy old adults.

The aim of the studies was to determine the effects of calcium carbonate and calcium phosphate supplementation on faecal Lactobacillus spp., with and without a probiotic supplement, in healthy adults. Study 1 comprised of a randomised, double-blind, crossover design; participants (n=15) received 2 capsules/d of 250 mg elemental calcium as calcium carbonate (Ca1) and calcium phosphate (Ca2) each for 2-week periods, with 2-week baseline and washout periods. Study 2 was a randomised, double-blind, crossover design; participants (n=17) received 2 capsules/d of Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011 (probiotic) alone, the probiotic with 2 capsules/d of Ca1, and probiotic with 2 capsules/d of Ca2 each for 2-week periods with 2-week baseline and washout periods. In both studies, stools were collected during the baseline, intervention and washout periods for Lactobacillus spp. quantification and qPCR analyses. Participants completed daily questionnaires of stool frequency and compliance. In Study 1, neither calcium supplement influenced viable counts of resident Lactobacillus spp., genome equivalents of lactic acid bacteria or stool frequency. In Study 2, faecal Lactobacillus spp. counts were significantly enhanced from baseline when the probiotic was administered with Ca2 (4.83±0.30, 5.79±0.31) (P=0.02), but not with Ca1 (4.98±0.31) or with the probiotic alone (5.36±0.31, 5.55±0.29) (not significant). Detection of L. helveticus R0052 and L. rhamnosus R0011 was significantly increased with all treatments, but did not differ among treatments. There were no changes in weekly stool frequency. Calcium phosphate co-administration may increase gastrointestinal survival of orally-administered Lactobacillus spp.

Background Stress urinary incontinence (SUI) is common among older women and may be associated with frailty. Frailty, characterized by reduced physiological reserves and muscle weakness, can impair pelvic floor function and increase the risk of SUI. This study evaluates the association between frailty and SUI using a large dataset. Methods Data from the National Health and Nutrition Examination Survey (NHANES), 2005-2018 were analyzed, including 6,386 women aged ≥20 years with complete frailty and SUI data. Frailty was classified using NHANES-derived criteria. SUI was assessed through self-reported questionnaires. Propensity score matching adjusted for confounders. Logistic regression and Bayesian modeling were applied to evaluate associations. Results SUI prevalence was higher in frail individuals (607 (32.0%) vs. 414 (15.0%), p < 0.001). Frailty independently predicted SUI (OR 1.48; 95% CI 1.25-1.75; p < 0.001). Bayesian modeling demonstrated interconnections between frailty, SUI, and functional limitations. Conclusions Frailty is a significant predictor of SUI in women. Identifying frailty status may improve SUI risk stratification and guide targeted interventions.

China and India's challenges: the other end of the spectrum

BackgroundThere have been concerns about COVID-19 vaccination safety among frail older individuals. We investigated the relationship between COVID-19 mRNA vaccination and mortality among individuals aged ≥ 70 years and whether mortality varies across four groups of health services used.MethodsIn this nationwide cohort study, we included 688,152 individuals aged ≥ 70 years at the start of the Norwegian vaccination campaign (December 27, 2020). We collected individual-level data from the Norwegian Emergency Preparedness Register for COVID-19. Vaccinated and unvaccinated individuals were matched (1:1 ratio) on the date of vaccination based on sociodemographic and clinical characteristics. The main outcome was all-cause mortality during 21 days after first dose of COVID-19 mRNA vaccination. Kaplan-Meier survival functions were estimated for the vaccinated and unvaccinated groups. We used Cox proportional-hazards regression to estimate hazard ratios (HRs) of death between vaccinated and unvaccinated individuals, with associated 95% confidence intervals (CIs), overall and by use of health services (none, home-based, short- and long-term nursing homes) and age group.ResultsBetween December 27, 2020, and March 31, 2021, 420,771 older individuals (61.1%) were vaccinated against COVID-19. The Kaplan-Meier estimates based on the matched study sample showed a small absolute risk difference in all-cause mortality between vaccinated and unvaccinated individuals, with a lower mortality in the vaccinated group (overall HR 0.28 [95% CI: 0.24–0.31]). Similar results were obtained in analyses stratified by use of health services and age group.ConclusionWe found no evidence of increased short-term mortality among vaccinated individuals in the older population after matching on sociodemographic and clinical characteristics affecting vaccination and mortality.

Assessing the effects of a short-term green tea intervention in skin microvascular function and oxygen tension in older and younger adults

Optimizing Medication Use in Older Adults

Kapiteljska njiva is a prehistoric cemetery located in the town of Novo mesto in southern Slovenia. There is a long history of archaeological research at this site, as the first investigations date back to the end of the 19th century. In 2004, an Early Iron Age barrow XVI was investigated. The oldest surviving grave in the barrow is the central grave, numbered XVI/34, which according to its position and the richness of the grave goods, belongs to a woman of higher status. Most likely, she was the first member or initiator of a family that continued to bury its dead in the barrow for the next 300 years. There were no preserved skeletal elements; however, in the head part of the grave, remains of human teeth, mostly the tooth crowns and the shells of enamel from the tooth crowns, were found among the scattered amber beads of a necklace. Moreover, these tooth remains are one of the few human biological materials (mostly fragments of skull and long limb bones) unearthed in this cemetery, reflecting the influence of acidic soil from the burial site. This study aimed to create a dental profile of the deceased in a similar way as during a forensic investigation. The remains were examined macroscopically and stereo-microscopically. The morphological traits were scored following the ASUDAS protocol. Ancestry was estimated by entering these scores into a beta version of the web-based application rASUDAS. Brothwell's system was used for age at death estimation from occlusal attrition. Identification of sex was based on the analysis of sex-specific amelogenin isoforms in dental enamel by nanoflow liquid chromatography tandem mass spectrometry (nanoLC-MS/MS). The present study reveals that the dental remains from Kapiteljska njiva belong to the permanent dentition of a single individual and that only the right upper central incisor and third molar are completely absent. The remains of teeth exhibit a simple external morphology, characterised by the absence of morphological dental traits, with a notable exception of the two-rooted left lower canine. The probability of assigning this individual to the Western Eurasian ancestry group is 98%. According to the degree of dentine exposure on the occlusal surfaces of molars, the estimated age range is 17-25 years. Another line of evidence comes from the observation that the first signs of approximal attrition are present in lower third molars but absent in the only preserved upper counterpart, indicating that the age at which the lower third molars entered into occlusion represents a proxy of the individual's age at death. Data on the chronology of the lower third molar development and eruption in present-day European populations from forensic literature (Brkić et al. 2011; Olze et al. 2008; Selmanagić et al. 2013) and The London Atlas confirm the above age-range estimate. Caution is, however, needed in the interpretation of results, because reference data are not based on the population of the individual's origin. Proteomic analysis classified the individual as a female, which is in line with the archaeological evidence. No pathological lesions or indicators of systemic stress were identified; however, the absence of approximal attrition facets in upper anterior teeth indicates interdental spacing. The results of dental profiling are discussed in the context of historical background, today's clinical knowledge, and epidemiological data.