Effect of Combined Oral Management, Rehabilitation, and Nutrition Interventions on Improving Systemic Problems in Older Adults

Abstract

Purpose of Review
Most studies on oral management have focused on the outcomes of single intervention methods. In this review, we conducted a literature search to investigate whether combined oral management, rehabilitation, and nutritional interventions improved the systemic problems in older adults requiring long-term care.

Recent Findings
Supplementing oral care with therapist-led rehabilitation or swallowing exercises resulted in a reduction in the incidence of pneumonia cases during the intervention period. Weekly oral function training, combined with the provision of a high nutritional diet for malnourished older adults, significantly increased serum albumin and total protein levels in the intervention group. A combined intervention program of diet, exercise, and oral care for 11 weeks resulted in a significant increase in body weight, BMI, and social engagement.

Summary
Combined oral management, rehabilitation, and nutritional interventions in older adults requiring long-term care had positive effects on health maintenance.

Full text

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Current Oral Health Reports (2023) 10:81–87
https://doi.org/10.1007/s40496-023-00340-5
Effect ofCombined Oral Management, Rehabilitation, andNutrition
Interventions onImproving Systemic Problems inOlder Adults
KanakoYoshimi1 · KazuharuNakagawa1· KoheiYamaguchi1· YukiNagasawa1· HarukaTohara1
Accepted: 28 June 2023 / Published online: 8 July 2023
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023
Abstract
Purpose of Review Most studies on oral management have focused on the outcomes of single intervention methods. In this
review, we conducted a literature search to investigate whether combined oral management, rehabilitation, and nutritional
interventions improved the systemic problems in older adults requiring long-term care.
Recent Findings Supplementing oral care with therapist-led rehabilitation or swallowing exercises resulted in a reduction in
the incidence of pneumonia cases during the intervention period. Weekly oral function training, combined with the provision
of a high nutritional diet for malnourished older adults, significantly increased serum albumin and total protein levels in the
intervention group. A combined intervention program of diet, exercise, and oral care for 11 weeks resulted in a significant
increase in body weight, BMI, and social engagement.
Summary Combined oral management, rehabilitation, and nutritional interventions in older adults requiring long-term care
had positive effects on health maintenance.
Keywords Oral dysfunction· Dysphagia· Oral health· Rehabilitation· Nutrition· Older adult
Introduction
Poor oral health status in older adults is associated with
an increased risk of future frailty and the need for nursing
care [1]. Deterioration of oral hygiene and function due to
aging or disease is referred to as “oral frailty” and is associ-
ated with cognitive and physical decline [2•]. If appropriate
measures are not taken at an early stage, there is a risk of a
morbid condition called oral hypofunction, which progresses
to dysfunctions such as dysphagia and malnutrition [3].
Therefore, evaluating the oral condition of older adults and
providing guidance and treatment from an early stage are
important for improving their general health and maintaining
their physical functions. Various interventional studies have
reported effective approaches for improving the oral health
status of older adults requiring long-term care. For instance,
oral care provided by dental professionals [4] and the use
of bactericidal mouthwashes targeted against oral bacteria
[5] are effective in improving oral hygiene. Oral function
also improves with oral function exercises [6, 7] and dental
treatment [8]. However, these evaluations are based on the
effects of single interventions, whereas the influence of other
factors and changes in effectiveness are largely unknown.
In recent years, the effects of combined systemic rehabili-
tation and nutritional management interventions have been
reported in the field of rehabilitation. In a study involving older
adults in nursing homes, the control group performed sit-to-
stand exercises four times a day, while the intervention group
performed sit-to-stand exercises in combination with the intake
of a high-protein oral supplement for 12 weeks. Physical func-
tion did not change in either group. However, body weight and
fat-free mass increased in the intervention group [9].
A systematic review and meta-analysis of rehabilita-
tion and nutritional interventions in pre-frail older adults
reported that exercise alone, or in combination with nutri-
tional interventions, significantly improved physical function
[10]. In the field of dentistry, investigating the effectiveness
of a combined approach, in addition to the traditional oral
interventions, may be beneficial for enhancing well-being
and providing long-term care for older adults.
* Kanako Yoshimi
k.yoshimi.gerd@tmd.ac.jp
1 Department ofDysphagia Rehabilitation, Division
ofGerontology andGerodontology, Graduate School
ofMedical andDental Sciences, Tokyo Medical andDental
University (TMDU), 1-5-45, Yushima, Bunkyo-ku,
Tokyo113-8510, Japan
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