施設高齢者の低栄養と口腔：系統的レビュー

施設入所高齢者の低栄養と口腔健康状態に関する系統的レビューを紹介します。これは重要論文だと思います。

Aurélie Van Lancker, et al: The association between malnutrition and oral health status in elderly in long-term care facilities: A systematic review. International Journal of Nursing Studies, Available online 27 April 2012 http://dx.doi.org/10.1016/j.ijnurstu.2012.04.001

結果ですが、16論文をレビューしています。9論文は口腔健康状態と低栄養に関連を認めました。4論文は咀嚼障害と低栄養に関連を認めました。5論文は低栄養と歯の状態、口腔問題の数、舌の変化、唾液流量の問題、カンジダ症に関連を認めました。

これより施設入所高齢者の口腔健康状態と低栄養には独立した関連があるといえそうです。ただ、低栄養と口腔健康状態を定義、評価するゴールドスタンダードが欠落していて、研究に方法論の限界があるため、解釈には注意が必要という結論です。

系統的レビューで施設入所高齢者の低栄養と口腔健康状態に関連があるとされたことは、インパクトが大きいと考えます。栄養を考えずに口腔をみるのはもはや時代遅れといえるかもしれません。もちろん、栄養を考えないリハも時代遅れです。

Abstract
Objectives
Malnutrition is a common problem in the elderly. It is not clear if oral health is associated to malnutrition in this population. The aim of this systematic review is to determine whether an association exists between oral health and malnutrition in the elderly in a long-term care facility.

Design
Systematic review.

Data source
Medline, Cochrane and Cinahl were systematically searched for to identify articles published between January 1985 and May 2011. Reference lists were checked for additional publications.

Review methods
Publications were included if they explored the association between oral health status and malnutrition. As no consensus about terminology was found, a sensitive filter was developed. The methodological quality of the studies was assessed. Two independent reviewers performed all methodological steps.

Results
Sixteen studies met the criteria for inclusion. Eleven studies used a multivariate approach; nine of these found an association between oral health status and malnutrition. Four studies found a relationship between masticatory problems and malnutrition. Five studies found an association between malnutrition and dental condition, number of oral problems, tongue alteration, problems with saliva flow, and candidiasis. Overall, the methodological quality of the studies was medium.

Conclusions
Tentative evidence indicates an independent association between oral health status and malnutrition in the elderly residing in a long-term care facility. Caution is needed for the interpretation of these results because of the absence of a gold standard to define and assess malnutrition and oral health status and the presence of methodological limitations throughout the studies.