Relationship between dental health and nutrition risk factors in homebound older adults.

Abstract

To the Editor: Adequate nutrition intake is vital for elderly individuals in order for them to maintain good health. With the ever-increasing number of older adults signing up for government-funded nutrition programs such as Meals on Wheels, it is thought that the health of the general population may be deteriorating.1 One program specifically, Metropolitan Inter-Faith Association (MIFA) Meals on Wheels, located in Memphis, Tennessee, provides elderly individuals with one meal each day that meets at least one-third of the daily recommended nutrient requirements.2 There are several barriers to an elderly person receiving optimal nutrition, such as the inability to consume enough fruits and vegetables, which may be due to poor dental health or inadequate dentition. Several articles have reported that elderly individuals commonly have numerous health problems, specifically oral health, including missing teeth, mastication difficulties, and gingivitis.3, 4 If homebound elderly individuals are not receiving adequate oral health care, they could be at risk for severe malnutrition and vitamin deficiencies.2 Older adults have been found to have micronutrient deficiencies consisting of 33% to 55% of their Dietary Reference Intakes.5 One study working with a new Meals on Wheels program found that only 11% of screened participants were well nourished.2 The purpose of this project was to determine whether there is any correlation between dental health and nutrition risk for homebound older adults who participate in Meals on Wheels programs. A quantitative survey was designed to address questions regarding the dental health of elderly homebound individuals (independent variable) receiving homebound meals and relate it to their nutrition risk (dependent variable) (Table 1). The first questionnaire, the “Nutritional Counseling Mini Assessment,” was used to assess participants’ risk of malnutrition. It included questions regarding how many fruits and vegetables they consumed daily and whether respondents were physically able to shop or cook for themselves. Valerie King, the Aging Commission of Tennessee state dietitian, modified this questionnaire. The second questionnaire, which one of the researchers developed, was used to assess the overall dental health of participants in the program. Fifty Meals on Wheels clients were randomly selected and added to 50 previously assessed clients following the same guidelines. Participants included men (n = 14) and women (n = 36) aged 60 and older. The clients used for this study received one meal a day at home. Participants were ineligible for the study if they were younger than 60, were bed ridden, or had severe dementia and were not capable of answering questions. The researcher conducting the study, was also the MIFA-registered dietitian, who completed the interviews. At the end of both questionnaires, total scores were calculated. The independent variable, dental health, was used to determine whether nutrition status affects overall dentition. The questions asked were pertinent because many older adults participating in the MIFA Meals on Wheels program are on Medicare or Medicaid, which do not cover dental treatment. This can be a major barrier for older adults in need of dentures or a replacement of dentures because of improper fit. The number of teeth also tends to decrease with age, so missing teeth may lead to further problems with chewing raw foods, which tend to be nutrient rich. Fruit and vegetable intake is another dependent variable that is used to observe how many fruits and vegetables are consumed daily. Financial difficulty is one main barrier to obtaining fruits and vegetables, although the focus of the study was to observe the direct relationship between dental health and fruit and vegetable intake. No significant relationship was found between nutrition and dental health (correlation coefficient = 0.262, P = .07), although the results indicated this relationship approached significance. A correlation was used to assess for a significant relationship between nutrition and dental health, but the results were not significant (P = .48). T-tests did not show a significant difference between men and women in dental health (P = .61) of nutrition status (P = .22). The literature supports that malnutrition is an increasing risk factor for individuals aged 60 and older. If these individuals do not receive proper oral health care, this may lead to further problems leading to malnutrition.2 Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Ahmed: coauthor. Williams-Hooker: committee and help with design of study. Polly, Roach: committee. Stockton: assistance with analysis. Sponsor's Role: None.