Chewing problems and mortality in older adults in home care: Results from the aged in home care study

OBJECTIVES: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe. DESIGN: Retrospective cohort study. SETTING: Eleven European countries. PARTICIPANTS: Two thousand seven hundred fifty-five older adults (mean age +/- standard deviation 82.2 +/- 7.2) in home care. MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period. RESULTS: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y) = 0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y = 0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR) = 1.45, 95% confidence intervals (CI) = 1.05-1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR = 1.50, 95% CI = 1.03-2.20) and those with unintended weight loss (adjusted HR = 1.62, 95% CI = 1.12-2.34). CONCLUSION: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality.