Niigata Dent. J. 50（2）：23 － 31,

61

2020

－原著－
某市における施設入所高齢者の身体機能の低下，認知症，栄養摂取形態と全身および口腔の健康状態との関連性について
1）

2）

2）

佐藤夏奈 ，ステガロユ ロクサーナ ，柴田佐都子 ，黒川孝一
1）

新潟大学大学院医歯学総合研究科
2）

口腔生命福祉学専攻博士前期課程（主任：葭原明弘教授）

新潟大学医歯学総合研究科
3）3）

口腔保健学分野（主任：葭原明弘教授）

新潟大学医歯学総合研究科

福祉学分野（主任：葭原明弘教授）

General and oral health factors associated with physical disability, cognitive
impairment, and diet form in an elderly institutionalized Japanese population
1）

2）

2）

3）

Kana Sato , Roxana Stegaroiu , Satoko Shibata , Kouichi Kurokawa
1)2)Master’s Program of Oral Health and Welfare (Chief: Prof. Akihiro Yoshihara), Graduate School of Medical and Dental Sciences, Niigata University

Division of Oral Science for Health Promotion (Chief: Prof. Akihiro Yoshihara), Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata
University3)

Division of Social Welfare (Chief: Prof. Akihiro Yoshihara), Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University
令和２年 10 月 1 日受付

令和２年 11 月９日受理

キーワード：高齢者，咬合支持，障害高齢者の日常生活自立度（寝たきり度），認知症高齢者の日常生活自立度，栄養摂取形態
Key words: elderly people, occlusal support, physical disability/bedridden level, cognitive impairment/dementia
rating, diet form
Abstract
Although several studies investigated the factors associated with physical function, cognitive abilities and dietform, their results are sometimes controversial or inconclusive. This study investigated the relation between oral
and general health of residents of long-term care facilities (LTCF) from a Japanese city and their physicaldisability, cognitive impairment and diet form. Data collected by the local dental association from residents of 18
LTCFs with whom the association had dental examination agreements were used. Three binomial logistic
regression analyses were conducted on 602 full data sets, to investigate the relation between physical disability(bedridden level), cognitive impairment (dementia rating), and diet form and independent variables selected amongresidents’ general and oral health characteristics. The bedridden level was significantly associated with occlusal
support [odds ratio (OR) = 1.88; p = 0.005], swallowing (OR = 3.47; p < 0.001), paralysis (OR = 9.34; p < 0.001), anddementia rating (OR = 2.91; p < 0.001). Dementia rating was significantly associated with occlusal support (OR =3.21; p < 0.001), and the bedridden level (OR = 3.37; p < 0.001). Diet form was significantly associated with occlusal
support (OR = 3.35; p < 0.001), oral moisture (OR = 3.53; p < 0.001), swallowing (OR = 3.50; p < 0.001), bedridden
level (OR = 7.17; p < 0.001), and dementia rating (OR = 1.80; p < 0.01). Lack of bilateral occlusal support on natural
teeth, fixed or removable prostheses was statistically significantly related with physical disability requiring care,dementia requiring care, and soft diet or enteral nutrition.
抄録
本研究は新潟県内某市における施設入所高齢者の全身および口腔の健康に関わる因子のなかで，身体機能の低下，認知症，栄養摂取形態それぞれとの関連のある因子を明らかにすることを目的とした。そこで某市歯科医師会が歯科健診を行った介護保険施設・特定施設（18 施設 602 名）から収集したデータを解析対象とし，障害高齢者の日常生活自立度（寝たきり度），認知症高齢者の日常生活自立度および栄養摂取形態それぞれと全身健康状態の因子，口腔－ 23 －

新潟歯学会誌

6250（2）：2020

健康状態の因子との関連について，3 つの二項ロジスティック回帰分析を用いて検討した。
寝たきり度は，咬合支持（天然歯または義歯を含めた補綴物による両側咬合支持）（オッズ比 (OR) = 1.88; p = 0.005），
嚥下（OR = 3.47; p < 0.001），麻痺（OR = 9.34; p < 0.001）および認知症高齢者の日常生活自立度（OR = 2.91; p<0.001）と有意に関連していた。認知症高齢者の日常生活自立度は，咬合支持（OR = 3.21; p < 0.001）および寝たきり度（OR = 3.37; p < 0.001）と有意に関連していた。栄養摂取形態は，咬合支持（OR = 3.35; p < 0.001），口腔乾燥（OR= 3.53; p < 0.001），嚥下（OR = 3.50; p < 0.001），寝たきり度（OR = 7.17; p < 0.001）および認知症高齢者の日常生活自立度（OR = 1.80; p < 0.01）と有意に関連していた。
以上の結果から，天然歯または義歯を含めた補綴物による両側咬合支持の喪失は，要介護高齢者の身体機能の低下，認知症および経管栄養を含む常食以外の栄養摂取形態と統計的に有意に関連していた。

cognitive impairment 8）. For elders living in theIntroduction

community, impaired glucose tolerance in diabetes wasfound to be a risk factor for the onset of Alzheimer’s

In the fiscal year 2018, 28.1% of Japan populationand vascular dementia 9）. An animal experiment

was aged 65 and above, and 14.2% of the population

showed a decrease in the expression level of genes

was 75 and above1）. Japan’s aging rate is the highest in

related to spatial cognitive ability and memory in rats

the world, and the number of persons who are certified

that lost occlusal support, but restoration of theas requiring long-term care (LTC) and institutional

occlusal support suppressed the decrease in thecare services, such as those who are bedridden, orexpression level of the gene 10）, suggesting thatthose suffering from dementia, are increasing

recovery of occlusal support could improve cognitive

accordingly2）. This became an important social issue

dysfunction. Moreover, in a large-scale cohort study ofand efforts are made to prevent care dependency andolder adults (median age 81)11）, oral health behaviors1）

expand the healthy life years . In Japan, stroke andthat help maintain healthy, functioning teeth wereother cerebrovascular diseases rank first amongassociated with lower risk of dementia. However, othercauses of the most severe LTC level (bedridden

studies did not find a significant correlation between3）

condition) . Paralysis and persistent dysphagia, as

oral health condition and cognitive abilities2,8）.
Malnutrition is another factor that increases caresequelae of stroke, can also cause functional. Similarly,

dependency2）. Energy and nutrient (protein, dietarydementia is a major cause of disability and carefiber, potassium, calcium, vitamins D, K, and B12)

impairment and institutionalization

4, 5）

6）

dependency for elderly people worldwide . Dementia

intakes were significantly higher in the elders withprofoundly affects elders’ everyday life, since cognitive

regular (ordinary) diet than modified diet forms12）.

abilities have a direct effect on activities of daily living

Previous studies showed that ordinary diet for elders

2）(ADL) . Beside comorbid conditions and cognitive

was related with denture wearing, ADL, good oral

ability, nutrition and swallowing were indicated ashygiene13）, and cognitive function14）, but the population

factors directly related to ADL in a study on thesamples were of limited size.

general and oral health of elderly people who were

Although several studies investigated the general

receiving care services at home due to physicaland oral health factors associated with physicaldisabilities2）. Oral health condition (occlusal support7）,

function, cognitive abilities and diet form, their results2）

many teeth and denture wearing ) was another factor

are sometimes controversial or inconclusive. Therefore,

reported to directly 7） or indirectly 2） effect ADL of

we used the results of annual dental examinations atcommunity dwelling elders. However, for

18 LTC facilities (LTCF) of a Japanese city, toinstitutionalized elderly similar studies are scarce.

investigate the relation between oral and general

While edentulous persons not wearing dentures were

health of their residents and their physical disability,

at higher risk for physical disability, the effect of toothcognitive impairment and diet form. The following

loss and lack of dentures for residents with 1-19 teeth

three working hypotheses were tested: 1) certain oral

8）and general health-related factors of the residents areon their physical functions was inconclusive .

Among the characteristics of institutionalized elderly

related with their physical disability, 2) certain oral

people, age and cerebrovascular disorder predicted

and general health-related factors of the residents are－ 24 －