Correlations Between Subjective and Objective Assessments of Oral Frailty in Hemodialysis Patients

 

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Correlations Between Subjective and Objective Assessments of Oral Frailty in Hemodialysis Patients

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Shiho
Kosaka
Shiho Kosaka shiho.kosaka@gmail.com Toho University Nursing Tokyo Japan *
Masami Hamada masamihamada6@gmail.com Josai International University Nursing Chiba Japan -
Toshiki Kutsuna t.kutsuna.1981@gmail.com Tokyo University of Technology Rehabilitation Tokyo Japan -
Seiko Ono seiko.ono@med.toho-u.ac.jp Toho University Nursing Tokyo Japan -
Toshiko Iizuka iizukatk@stf.teu.ac.jp Tokyo University of Technology Nursing Tokyo Japan -
Masahiro To tohmshr@stf.teu.ac.jp Tokyo University of Technology Nursing Tokyo Japan -
Mie Yoshimoto mieyoshimoto20180930@gmail.com Osaka Dental University Oral Health Sciences Osaka Japan -
Yuka Kawate yuka.kawate@gmail.com Mukogawa Women’s University Food Sciences and Nutrition Hyogo Japan -
Miyuki Yokoi bonzmama@gmail.com Matsushita School of Nursing Nursing Osaka Japan -
Chie Ogawa tato.ogawa@gmail.com Maeda Institute of Renal Research Musashikosugi Clinic Kanagawa Japan -
Hitomi Miyata himiyata@katsura.com Kyoto Katsura Hoepital Nephrology Kyoto Japan -
Kunimi Maeda kuni@maeda-irr.com Maeda Institute of Renal Research Shakujii-Koen Jin Clinic Tokyo Japan -
Yuki Ohara yukiohara0701@gmail.com Miyagi Advanced Dental Hygienist Collage Dental hygiene Miyagi Japan -
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 Hemodialysis (HD) patients are becoming increasingly elderly, and their healthy lifespans are often threatened by sarcopenia and physical frailty. Many patients undergoing dialysis experience reduced appetite and malnutrition, with oral frailty (OF) emerging as a significant contributing factor. OF is defined as the accumulation of minor declines in oral function.Therefore, this study aimed to evaluate the subjective and objective oral function in maintenance hemodialysis patients and to consider their relationship.


This study included 205 outpatients undergoing maintenance hemodialysis at three facilities in Japan. In addition to the subjects’ attributes, dialysis condition, and laboratory tests, the subjective OF-5 scale was used to evaluate remaining teeth, decreased chewing and swallowing function, dry mouth, and impaired tongue motor function. Objective assessments corresponding to these five items measured the tooth count, chewing function, swallowing function, tongue moisture content, and tongue motor function. Additional oral function assessments included the intraoral bacterial count, bite force, and oral health status. The analytic methods included  t-tests and chi-square tests to compare the differences between the OF and non-OF groups based on their OF-5 scores.

The subjects’ mean age was 71.2 ± 11.3 years, 159 were male (77.6%), the mean dialysis duration was 107.7 ± 106.3 months, and the diabetes prevalence was 33.3%. The OF group comprised 90 subjects (43.9%) and was significantly older (73.3 y vs 69.1 y). The oral function in the OF group was significantly lower than that in the non-OF group for tongue motor function (pa/ka), chewing function, masticatory force, and swallowing function. Tooth count and oral health status were also significantly lower. No significant differences were observed in the subjects’ dialysis history, dialysis conditions, or laboratory values. The accuracy rate between the subjective and objective OF assessments was low.


The subjective OF prevalence in this study was consistent with that reported in previous studies. The OF group exhibited a significant decline in multiple oral function measures. Previous studies have shown that the removal of blood dialysis fluid reduces saliva volume, leading to a dry mouth. However, in this study, while the subjective dry mouth sensation was significantly higher in the OF group, there was no difference in tongue moisture content. Furthermore, a discrepancy was observed between subjective and objective assessments, suggesting that oral function decline may progress unconsciously. This study suggests that, to improve and maintain the oral health status of hemodialysis patients in the future, it is necessary to perform both subjective and objective assessments on a regular basis.


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