Study Finds Multiple Causes for Eating Difficulties in Older Adults Receiving Long-Term Care

As part of the University of Eastern Finland’s Nutrition, Oral Health, and Medication study, researchers investigated the causes of malnutrition in elderly home-care clients.¹ They found lack of appetite to be a key player in poor nutrition as people age. Assorted other factors are, however, also implicated, including medical issues, cognitive disorders, medication effects, financial circumstances, and poor oral health.

Perhaps unsurprisingly, studies have shown a clear association between a lower intake of nutrients and tooth loss. And while dental appliances—such as dentures—can help, ill-fitting versions can lead wearers to avoid certain foods. Such issues are especially evident when chewing is required to ingest certain foods. In these cases, malnutrition may develop as food choices veer toward those that are easily chewed, in lieu of those with a denser, perhaps more nutritive structure. But the problem appears to be more complex.

CONSIDERING ALL THE ANGLES

Taking a multidisciplinary approach, the researchers investigated the pervasiveness and causes of eating difficulties among elderly home-care clients. They engaged three dental hygienists, a clinical nutritionist, a pharmacist, and the subjects’ home health care nurses to interview 250 participants age 75 years and older. If a participant was not able to reply to the questions in the structured interview, a caregiver or nurse assisted the participant.

Their research revealed multiple causes for malnutrition in this population. However, the study focused on eating problems. Per study design, a clinical nutritionist asked clients questions about eating difficulties related to chewing, swallowing, or poor appetite. A dental hygienist queried clients in regard to eating difficulties related to oral health.

The study showed that of the participants, 29% reported poor appetite, 20% had problems with chewing and 14% had problems with swallowing. Additionally, 18% reported oral health-related eating problems. 

INTERPROFESSIONAL COLLABORATION IS KEY

The researchers found that eating problems were common in the home-care clients, and all correlated with poor nutritional status and reduced food intake over 3 months. Participants with continuous xerostomia or poor self-reported oral health had a higher risk for chewing and swallowing difficulties and cited these as problems. Those with xerostomia also reported poor appetite, which may be associated with prescription drug use. Edentulous participants and those with toothaches or denture problems were also at higher risk for oral health-related eating problems. 

Although poor appetite as a cause for malnutrition was a chief finding in the study, the researchers concluded that good oral health maintenance is critical for the ability to eat in older adults. Because of the multifactored aspects of this problem, they advise that in studying eating difficulties in older populations, information collecting on eating problems should be broad, continuous, and multidisciplinary. They concluded that interprofessional collaboration was necessary to gather the most useful information as respondent’s answers may vary depending on which healthcare professional is asking.

The research underscores the value of proper oral health care for seniors and the availability of oral healthcare aids designed for those whose manual dexterity has diminished. For example, power toothbrushes with enhanced grips, oral irrigators, interdental cleaners, and oral lubricants can offer tremendous benefits for some seniors.

REFERENCE

1. Salmi A, Komulainen K, Nihtilä A, et al. Eating problems among old home care clients. Clin Exp Dent Res. May 8, 2022. Online ahead of print.