Longitudinal associations between oral and general health indicators among nursing home residents: an open cohort study based on interRAI assessments

Regular health assessments using interRAI instruments, including the Oral Health Screener (OHS), may help identify care needs and improve nursing home residents' oral health. This study explored longitudinal associations between oral health (OH) and general health (GH) indicators.

InterRAI assessments from Flemish and Dutch nursing home residents aged ≥ 65 years (October 2020-February 2024) were included. OH was derived from the OHS and GH from Activities of Daily Living Hierarchy (ADLH), Depression Rating Scale (DRS), Cognitive Performance Scale (CPS) and Changes in Health, End-stage Disease, and Signs and Symptoms (CHESS). A joint model explored overall associations between indicators. Bivariate autoregressive models examined cross-lagged associations conditional on prior status.

In total, 12,586 assessments from 5450 residents were analyzed. Mean baseline age was 85.8 years (SD 7.7); 76.0% were women. All OH items were significantly interrelated, although correlations were mostly weak (< 0.4). Several cross-lagged associations between OH and GH indicators were observed, but effect sizes were small. Bidirectional associations were found between chewing function-ADLH, and discomfort/pain-both ADLH and CHESS. ADLH-problems were associated with poorer subsequent OH (teeth, tongue, palate-cheeks-lips). Depressive symptoms and higher CPS-scores were associated with later chewing difficulties and poorer denture hygiene, with depressive symptoms also linked to discomfort/pain. Chewing difficulties and poor gum and palate-cheeks-lips conditions were associated with subsequent health instability. Dry mouth was negatively associated with cognitive impairment.

The findings suggest that OH and GH are interrelated and support considering OH as an integral part of general care rather than a separate domain.