J Korean Acad Oral Health.  2024 Dec;48(4):210-215. 10.11149/jkaoh.2024.48.4.210.

Changes in activities of daily living according to oral function in Korean community-dwelling older adults: a follow-up study

• Kim JE
• Choi YH

• KMID: 2563486
• DOI: http://doi.org/10.11149/jkaoh.2024.48.4.210

Abstract

Objectives
This study aimed to investigate the relationship between oral function and activities of daily living among older adults in Korea. Specifically, it examines how changes in oral health over time impact the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores using longitudinal data from the Korean Social Life, Health, and Aging Project (KSHAP). This study aims to identify the oral functions that significantly affect these abilities, thereby contributing to strategies for maintaining healthy aging.
Methods
Data from the KSHAP Cohort K (Wave 4 in 2016 and Wave 5 in 2019) were analyzed. A total of 454 participants were included, after excluding those with incomplete data. Oral function was assessed using subjective self-reported measures of chewing and swallowing abilities, and salivary function. ADL and IADL were evaluated using Korean-specific tools (K-ADL and K-IADL, respectively), with higher scores indicating greater dependency. Statistical analyses included crosstabulations, independent t-tests, and generalized estimating equations (GEE) to assess the relationship between oral function and changes in ADL/IADL over time, with adjustments for covariates such as age, gender, socioeconomic status, and comorbidities.
Results
Significant differences in ADL and IADL limitations were observed based on oral function. Participants with fewer teeth (0-10) were more likely to experience functional limitations than those with more teeth (21-32). Regression analyses using GEE revealed that difficulty in chewing (B=0.067, P=0.044) and swallowing (B=0.445, P<0.001) were associated with increased ADL dependency. For IADL, swallowing difficulty moderately affected dependency (B=0.234, P=0.003). These findings suggest that ADL limitations are more closely associated with oral function than are IADL limitations, highlighting the physiological importance of basic oral functions, such as chewing and swallowing, in daily activities.
Conclusions
This study demonstrates that oral health plays a critical role in maintaining activities of daily living among older adults, with ADL being more affected than IADL. A decline in oral function, particularly in chewing and swallowing, is associated with greater dependency over time. These findings underscore the need for targeted oral health management strategies to support functional independence and the overall quality of life in older populations. Future research should explore the bidirectional causality and broader demographic representations to further substantiate these results.

Keyword

Elderly health; Oral function; Physical activities; Physical functions

Reference

References

1. Ministry of Economy and Finance (MOEF). [Internet]. Available from: https://www.moef.go.kr/sisa/main/main. cited 2024 Nov 21.

2. World Health Organization (WHO), Statistics DB. World report on ageing and health [Internet]. Available from: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.\pdf?ua=1. cited 2024 Nov 21.

3. Han SH, Ko PC, Pinazo-Hernandis S, Sanchez M. 2023; Introduction to the special issue on productive aging in honor of Frank Caro. Res Aging. 45:3–7. DOI: 10.1177/01640275221135901. PMID: 36269793.

4. Oblak L, Van der Zaag J, Higgins-Chen AT, Levine ME, Boks MP. 2021; A systematic review of biological, social, and environmental factors associated with epigenetic clock acceleration. Ageing Res Rev. 69:101348. DOI: 10.1016/j.arr.2021.101348. PMID: 33930583.

5. John WR, Robert LK. 1987; Human aging: Usual and successful. Science. 237:143–149. DOI: 10.1126/science.3299702. PMID: 3299702.

6. Sun Y, Wang Z, Sun S, Cui L, Zhu X, Ho SY, et al. 2023; Cognitive activities, lifestyle factors, and risk of cognitive impairment: An analysis of the Apolipoprotein Epsilon 4 genotype. Gerontology. 69:1137–1146. DOI: 10.1159/000531109. PMID: 37276850.

7. Fieo RA, Austin EJ, Starr JM, Deary IJ. 2011; Calibrating ADL-IADL scales to improve measurement accuracy and to extend the disability construct into the preclinical range: A systematic review. BMC Geriatr. 11:42. DOI: 10.1186/1471-2318-11-42. PMID: 21846335. PMCID: PMC3201016.

8. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. 1963; Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 185:914–919. DOI: 10.1001/jama.1963.03060120024016. PMID: 14044222.

9. Spector WD, Katz S, Murphy JB, Fulton JP. 1987; The hierarchical relationship between activities of daily living and instrumental activities of daily living. J Chronic Dis. 40:481–489. DOI: 10.1016/0021-9681(87)90004-X. PMID: 3597653.

10. Phelan EA, Williams B, Penninx BWJH, LoGerfo JP, Leveille SG. 2004; Activities of daily living function and disability in older adults in a randomized trial of the Health Enhancement Program. J Gerontol A Biol Sci Med Sci. 59:M838–M843. DOI: 10.1093/gerona/59.8.M838. PMID: 15345735.

11. Nakamura K, Ogata T. 2016; Locomotive Syndrome: Definition and Management. Clin Rev Bone Miner Metab. 14:56–67. DOI: 10.1007/s12018-016-9208-2. PMID: 27375370. PMCID: PMC4906066.

12. Inui A, Takahashi I, Sawada K, Naoki A, Oyama T, Tamura Y, et al. 2016; Teeth and physical fitness in a community-dwelling 40 to 79-year-old Japanese population. Clin Interv Aging. 11:873–878. DOI: 10.2147/CIA.S108498. PMID: 27418813. PMCID: PMC4933564.

13. Qiao Y, Liu S, Li G, Lu Y, Wu Y, Shen Y, Ke C. 2021; Longitudinal follow-up studies on the bidirectional association between ADL/IADL disability and multimorbidity: Results from two national sample cohorts of middle-aged and elderly adults. Gerontology. 67:563–571. DOI: 10.1159/000513930. PMID: 34182559.

14. Xia X, Yang Z, Xu Z, Tang J, Zhang G, Dong B, et al. 2024; Nutrition status plays a partial mediation role in the relationship between number of teeth and frailty: A cross-sectional multicenter study. Gerontology. 70:572–584. DOI: 10.1159/000538181. PMID: 38461811.

15. Robinson TL, Gogniat MA, Miller LS. 2022; Frailty and cognitive function in older adults: A systematic review and meta-analysis of cross-sectional studies. Neuropsychol Rev. 32:274–293. DOI: 10.1007/s11065-021-09497-1. PMID: 33886024.

16. Fei Y, Niu S, Xi X, Tang W, Zhao Y, Zhang G, et al. 2024; Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, especially for females: A cross-sectional study. BMC Geriatr. 24:468. DOI: 10.1186/s12877-024-05056-4. PMID: 38811863. PMCID: PMC11134949.

17. National Evidence-based Healthcare Collaborating Agency (NECA). 2024. Development of Korean oral frailty diagnostic criteria and efficient management strategies. NECA;Seoul: p. 1–128.

18. National Evidence-based Healthcare Collaborating Agency (NECA). 2022. Domestic oral senescence diagnosis criteria and treatment. NECA;Seoul: p. 1–5.

19. Baek J, Baldina E, Sung K, Lee SH, Christakis NA, Bearman P, et al. 2023; A prospective sociocentric study of two entire traditional Korean villages: The Korean Social Life, Health, and Aging Project (KSHAP). Am J Epidemiol. 193:241–255. DOI: 10.1093/aje/kwad190. PMID: 37759338.

20. Won CW, Yang KY, Rho YG, Kim SY, Lee EJ, Yoon JL, et al. 2002; The development of Korean Activities of Daily Living (K-ADL) and Korean Instrumental Activities of Daily Living (K-IADL) scale. J Korean Geriatr Soc. 6:107–120.

21. Won CW, Rho YG, Kim SY, Cho BR, Lee YS. 2002; The validity and reliability of Korean Activities of Daily Living (K-ADL) scale. J Korean Geriatr Soc. 6:98–106.

22. Won CW, Rho YG, SunWoo D, Lee YS. 2002; The validity and reliability of Korean Instrumental Activities of Daily Living (K-IADL) scale. J Korean Geriatr Soc. 6:273–280.

23. Shin ES. 2024; Relationship between physical function (ADL, IADL) and frailty level in community-dwelling older adults. J Korea Acad Ind Coop Soc. 25:346–354. DOI: 10.5762/KAIS.2024.25.6.346.

24. Kwon J, Kim J, Jeong H, Lee J. 2023; Relationship between nutritional status, health status, and functional ability in community-dwelling older people in long-term care. J Long-Term Care. 11:65–86. DOI: 10.32928/TJLTC.11.1.3.

25. Lee SB, Heo NM. 2021; A Study on the Determinants of the Elderly's ADL/IADL: Focused on the Comparison of Urban and Rural Areas. Journal of the Korea Academia-Industrial cooperation Society. 22:419–429.

26. Jun NR, Kim JH, Park JT, Jang JH. 2022; Association of number of teeth with ADL/IADL in Korean middle-aged and older adults: An analysis of the 7th Korean Longitudinal Study of Aging. Int J Environ Res Public Health. 19:12840. DOI: 10.3390/ijerph191912840. PMID: 36232142. PMCID: PMC9566546.

27. Korea Health Statistics. 2013. Korea National Health and Nutrition Examination Survey 6th [Internet]. Ministry of Health and Welfare. http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=337254. cited 2022 Mar 10.

28. Yin Z, Yang J, Huang C, Sun H, Wu Y. 2020; Eating and communication difficulties as mediators of the relationship between tooth loss and functional disability in middle-aged and older adults. J Dent. 96:103331. DOI: 10.1016/j.jdent.2020.103331. PMID: 32251697.

29. Kato Y, Kikutani T, Sagawa K, Tamura F. 2022; Association between masticatory movement and oral and physical function in healthy older women. J Prosthodont Res. 66:416–421. DOI: 10.2186/jpr.JPR_D_20_00285. PMID: 34789608.

30. Togashi S, Wakabayashi H, Ohinata H, Nishioka S, Kokura Y, Momosaki R. 2022; Sensitivity and specificity of body mass index for sarcopenic dysphagia diagnosis among patients with dysphagia: A multi-center cross-sectional study. Nutrients. 14:4494. DOI: 10.3390/nu14214494. PMID: 36364757. PMCID: PMC9655070.

31. Wakabayashi H, Takahashi R, Murakami T. 2019; The prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation. J Nutr Health Aging. 23:84–88. DOI: 10.1007/s12603-018-1117-2. PMID: 30569074.

32. Kurosu A, Osman F, Daggett S, Peña-Chávez R, Thompson A, Myers SM, et al. 2021; Factors associated with self-reported dysphagia in older adults receiving meal support. J Nutr Health Aging. 25:1145–1153. DOI: 10.1007/s12603-021-1700-9. PMID: 34866141. PMCID: PMC8653989.