Oral Health in Older Adults at The End of Life

Objectives: Dental professionals face a great challenge in caring for older adults in-the-last-year-of-life. Remarkably declined health and function, together with old age, not only increase risk of oral diseases, but also complicate the clinical management for these individuals. How oral health differs between older adults in-the-last-year-of-life and the general elderly population remains unknown, further increasing difficulty to safely, effectively and ethically manage these individuals. This study’s objective was to explore the association between being in-the-last-year-of-life, oral care capacity and oral health.    

Methods: 1216 participants aged 65 or above were retrospectively recruited from a University-affiliated geriatric dental clinic during 1999-2006. 168 participants in-the-last-year-of-life were retrospectively identified using the National Death Index. Participants’ socioeconomics, medical history, medications, functional status and oral assessment were compared using the ANOVA, Chi-square and Fisher’s exact tests. Participants’ probabilities of death were first calculated using a logistic regression, then adjusted together with mobility, number of remaining teeth, number of filled teeth and oral hygiene status in the final negative binomial regression model to examine the impacts of being in-the-last-year-of-life and oral care capacity on oral health.

Results: Participants in-the-last-year-of-life were older, sicker and more impaired in mobility than those not being in-the-last-year-of-life. 73% of the participants in-the-last-year-of-life lost their ability to perform oral care, significantly higher than that (46%) in those not in-the-last-year-of-life. Compared to those not in-the-last-year-of-life, participants in-the-last-year-of-life had a higher edentulism rate (36% vs. 27%, P<0.0001) and more caries/retained-roots (6.4 vs. 4.9, P=0.0091). After adjusting for other factors, participants in-the-last-year-of-life with and without impaired oral care capacity had 1.4 (95%CI=1.05-1.97) and 0.6 (95%CI=0.33-0.99) times risk, respectively, to have more caries/retained-roots than those not in-the-last-year-of-life and capable to perform oral care.     

Conclusion: Individuals in-the-last-year-of-life have more caries/retained-roots than those not in-the-last-year-of-life. This association may be explained by the compromised oral care capacity among these individuals.