Community‐dwelling elderly with chewing difficulties are more disabled, depressed and have lower quality of life scores

Since 2006, the Japanese Ministry of Health, Welfare and Labor has recommended to screen swallowing and chewing abilities with the community-based comprehensive health-check examination to prevent disability of the elderly population. However, nationwide data of the actual condition of chewing disability in the community-dwelling elderly in Japan remains to be collected and be put in order. To address this important issue in a cross-sectional study in a community in Japan, we analyzed prevalence of elderly subjects with chewing difficulty associated with comprehensive geriatric assessment. The study population consisted of 877 people aged 65 years and older (309 men, 568 women; mean age, 75.6 years; standard deviation, 6.7) living in Tosa, Kochi Prefecture, Japan (the response rate of questionnaire was 59.3% and the complete answering rate was 50.0% of the eligible population in the town). Using self-reported questionnaires, chewing difficulty was screened along with additional assessment of activities of daily living (ADL), depression and subjective quality of life (QOL) in community-dwelling elderly subjects in 2007. Each elderly subject was asked, “In the past 6 months, do you feel chewing difficulty when you eat hard foods?” to identify the deterioration in chewing ability on a yes/no basis. For the assessment of basic ADL, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 3 to 0 (3, completely independent; 2, need some help; 1, need help much; 0, completely dependent) into a basic ADL score (0–21). For assessing higherlevel ADL, each subject rated his/her independence in the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). This assessment consists of a 13-item index including three sublevels of competence: instrumental self-maintenance (0–5), intellectual activity (0–4) and social role (0–4). We screened for depressive symptoms using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15). Quantitative QOL were assessed using a 100 mm visual analog scale (worst QOL on the left end of the scale, best on the right) in the following five items: subjective sense of health, relationship with family, relationship with friends, financial satisfaction and subjective happiness. SPSS statistical software package ver. 16.0 (SPSS, Chicago, IL, USA) was used for statistical analysis with a significance of P < 005. Table 1 shows the comparison of scores in ADL, GDS-15 and subjective QOL between elderly subjects with and without chewing difficulty. The proportion of elderly who had chewing difficulty was 35.2% in this population. The elderly subjects with chewing difficulty were significantly older than those without chewing difficulty (77.5 vs 75.5 years). Mean scores in each ADL were significantly lower in the elderly with chewing difficulty than those without chewing difficulty after the adjustment for the effect of age. Mean score in GDS15 was significantly higher and subjective QOL were lower in the elderly with chewing difficulty than those without. A significantly close association between Correspondence: ••. Email: •• 1