Oral health trajectories in community-dwelling older adults in the last 3 years of life

Background Systemic health and physical, cognitive, and social function gradually decline at the end of life. How oral health change at the end of life in community-dwelling older adults remains unknown, increasing the difficulty in treatment planning for these individuals. Methods Results A total of 250 community-dwelling decedents of a longitudinal study were included in the analysis. Decedents' clinical and interview data collected at baseline, 18, 36, 60, and 84 months were linked to their death dates and plotted on an inverted time scale to study their oral health changes in the 3 years prior to death. Mixed effect models with random intercepts and slopes of months from death and sociodemographic variables were used to model the subjective and objective oral health trajectories in the last 3 years of life. The association of the change in the outcomes with a linear trend of months from death were assessed using the F-test. Number of missing teeth was significantly associated with a linear trend of months from death. With every month in proximity to death, the expected number of missing teeth increased by 0.03 (SE = 0.004; p < 0.001), resulting in an average of 1.08 missing teeth in 3 years. Among subjective outcomes, the odds of good versus poor or neither self-rated systemic health (p = 0.009) and mouth appearance (p = 0.008) significantly decreased as death approached. Conclusion Although other oral health measures remained relatively stable, tooth loss and dissatisfaction with mouth appearance steadily increased in community-dwelling older adults as death approached. These changes were gradual and parallel the end-of-life general health decline.