- Design
- Prospective population cohort
- Population
- 52 789 adults aged ≥65 attending municipal health checks, Okayama, Japan
- Primary outcome
- All-cause mortality to December 2016
- Effect
- Score 3 aHR 1.49 (1.38–1.60); chewing difficulty aHR 1.19 (1.14–1.23); dysphagia aHR 1.18 (1.14–1.23); xerostomia 1.02 (0.98–1.06)
This Japanese cohort followed 52 789 adults aged 65 or over who attended municipal health checks in Okayama in 2006–2007, until 2016. Oral function was scored 0 to 3 from three yes/no questions on the Kihon Checklist: chewing difficulty, choking or swallowing difficulty, and dry mouth.
Mortality rose with each point (adjusted HR 1.09, 1.26 and 1.49 for scores 1, 2 and 3). Chewing difficulty (HR 1.19) and dysphagia (HR 1.18) were each independently associated with mortality; dry mouth was not (HR 1.02).
Three questions take thirty seconds. A 'yes' to chewing or swallowing difficulty is a marker of frailty and malnutrition risk and a reason to look at teeth, dentures, diet and swallow — areas often missed in Indian older adults, many of whom are edentulous without dentures.
- Ask older patients whether they have difficulty chewing, choke when swallowing, or have a dry mouth.
- Examine teeth and dentures, and refer for dental care when chewing is impaired.
- Assess nutrition (weight, MNA) in anyone reporting chewing or swallowing difficulty.
- Refer for swallow assessment when choking or coughing with food is reported.
- Review medicines that cause dry mouth, though dry mouth alone was not linked to mortality.
Why it matters
Oral function is rarely asked about, yet it is a simple marker of frailty and nutrition risk.
Don't overread it
An observational association from self-report; it does not show that treating oral problems reduces mortality.
The statistics, in plain English
A hazard ratio of 1.49 means those with all three problems died at about one and a half times the rate of those with none, after adjustment. The confidence intervals are narrow because the cohort was very large.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for geriatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free