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. 2020 Oct 29;12(11):3315.
doi: 10.3390/nu12113315.

Impact of the Serum Level of Albumin and Self-Assessed Chewing Ability on Mortality, QOL, and ADLs for Community-Dwelling Older Adults at the Age of 85: A 15 Year Follow up Study

Yoshiaki Nomura  1 , Erika Kakuta  2 , Ayako Okada  1 , Ryoko Otsuka  1 , Mieko Shimada  3 , Yasuko Tomizawa  4 , Chieko Taguchi  5 , Kazumune Arikawa  5 , Hideki Daikoku  6 , Tamotsu Sato  6 , Nobuhiro Hanada  1
Affiliations

Impact of the Serum Level of Albumin and Self-Assessed Chewing Ability on Mortality, QOL, and ADLs for Community-Dwelling Older Adults at the Age of 85: A 15 Year Follow up Study

Yoshiaki Nomura et al. Nutrients. .

Abstract

Quality of life (QOL) and mortality are true endpoints of epidemiological or medical research, especially for community-dwelling older adults. Nutritional status and activities of daily living (ADLs) are associated with QOL and mortality. Good oral health status supports a good nutritional status. The aim of this study was to elucidate the complex structure of these important health-related factors. We surveyed 354 healthy older adults at the age of 85. Nutritional status was evaluated by the serum level of albumin. QOL, ADLs, self-assessed chewing ability, serum albumin level, and mortality during the 15 year follow up period were analyzed. Self-assessed chewing ability was associated with QOL and ADLs. Self-assessed chewing ability for slight-hard foods was associated with mortality in men. However, it was not associated with the serum albumin level. The serum albumin level was associated with mortality in women. These results indicate that maintaining good oral function is not enough. Nutritional instruction in accordance with oral function is indispensable for health promotion in older adults. When planning health promotion strategies for older adults, different strategies are needed for men and women.

Keywords: ADL; QOL; Serum albumin; mortality; self-assessed chewing ability.

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Conflict of interest statement

The authors state that they have no financial or nonfinancial conflicts of interest regarding this research.

Figures

Figure 1
Figure 1
Structure of quality of life of the older subjects at the age of 85. The subscales of the SF 36 consisted of two latent variables, named Function and Role. All paths were statistically significant. BP and PF correlated with both latent variables. Subscales: Physical functioning (PF), Role physical (RP), Body pain (BP), General health (GH), Vitality (VT), Social functioning (SF), Role emotional (RE), Mental health (MH), e: Error variable. SF 36: 36-Item Short-Form Health Survey. REMSEA: root-mean-square error of approximation.
Figure 2
Figure 2
Structure of the ADL. Items of the TIMG Index involved 3 factors. Visiting sick friends and filling out the pension. Pension were correlated with two latent variables. Correlations between latent variables were statistically significant. However, the correlations were very weak. ADL: activity of daily living, TMIG index: The Tokyo Metropolitan Institute of Gerontology index of competence. e: Error variable. REMSEA: root-mean-square error of approximation
Figure 3
Figure 3
Correlations among number of remaining teeth, chewing ability, and serum level of albumin. REMSEA: root-mean-square error of approximation
Figure 4
Figure 4
Survival curves of the significant factors for mortality. (A) Serum levels of albumin for women. (B) Ability to chew Konnyaku-jelly of men. (C) Ability to chew Tubular roll of boiled fish paste of men. (D) Ability to chew Steamed rice of men. (E) Edentulous. (F)Intellectual activity of men.
Figure 5
Figure 5
Overview of the interactions among health-related factors. Black lines indicated statistical significance for both men and women, blue lines indicate significance only in men, red lines indicate significance only in women, and orange lines indicated no significance for either men or women. e: Error variable. QOL: quality of live. ADL: activity of daily living. REMSEA: root-mean-square error of approximation.
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