Impaired Oral Health in Older Orthopaedic In-Care Patients: The Influence of Medication and Morbidity

Figures & data

Table 1 Baseline Characteristics, Total and in Relation to Gender and Age Groups, 198 Patients, Number of Patients (%)

Variable	Total	Women	Men	p-value	65–79 Years	≥80 Years	p-value
	N=198	N=140 (71)	n=58 (29)		N=82 (41)	N=116 (59)
Comorbidities
Dementia	28 (14)	19 (15)	9 (15.5)	0.721	6 (7)	22 (19)	0.021
Diabetes mellitus	33 (17)	18 (13)	15 (26)	0.025	15 (18)	18 (15.5)	0.606
Heart disease	79 (40)	50 (36)	29 (50)	0.062	23 (28)	56 (48)	0.004
COPD	24 (13)	17 (13)	7 (13)	0.879	8 (10)	17 (15)	0.307
RA	12 (6)	12 (9)	0 (0)	0.021	6 (7)	6 (5)	0.533
CCI >mean, 6.67, age-adjusted	98 (50)	68 (49)	30 (52)	0.686	17 (21)	81 (70)	NA
Medications
Number of drugs^a
Mean (SD)	6.8 (4.5)	6.9 (4.6)	6.7 (4.3)	0.746	6.4 (4.6)	7.2 (4.3)	0.219
Polypharmacy^b 5	130 (66)	91 (65)	39 (67)	0.762	48 (58)	82 (71)	0.076
Polypharmacy^b 10	46 (23)	34 (24)	12 (21)	0.586	18 (22)	28 (24)	0.720
Diuretics	71 (36)	49 (35)	22 (38)	0.746	21 (26)	50 (43)	0.016
Antipsychotics	14 (7)	8 (6)	6 (10)	0.360	4 (5)	10 (9)	0.404
Opioids	19 (10)	14 (10)	5 (9)	0.764	6 (7)	13 (11)	0.360
Anticoagulants	98 (49.5)	65 (46)	33 (57)	0.180	32 (39)	66 (57)	0.013
Antidepressants	48 (24)	38 (27)	10 (17)	0.139	18 (22)	30 (26)	0.527
PPI	57 (29)	43 (31)	14 (24)	0.352	28 (34)	29 (25)	0.161
Inhalation drugs^c	36 (18)	25 (18)	11 (19)	0.854	16 (19.5)	20 (17)	0.683
ACE/ARB	63 (35)	43 (34)	20 (37)	0.681	25 (32)	38 (37)	0.432
Sedatives	52 (29)	38 (30)	14 (26)	0.587	18 (23)	34 (33)	0.120
Anticholinergics^d	20 (10)	15 (11)	5 (9)	0.070	7 (8.5)	13 (11)	0.782
Use of ≥2 drugs with strong anticholinergic effect	14 (7)	13 (9)	1 (2)	0.656	5 (6)	9 (8)	0.539

Notes: ^aUsed on a regular basis, drugs as per needed are not included. ^bPolypharmacy 5, defined as use of 5 or more drugs regularly and severe polypharmacy defined as use of 10 or more drugs regularly. ^cDrugs used for obstructive lung diseases. ^dDrugs with strong anticholinergic effects. P-values of <0.005 are presented in bold text.

Abbreviations: NA, not applicable; COPD, chronic obstructive pulmonary disease; RA, rheumatoid arthritis; CCI, age adjusted Charlson comorbidity index; PPI, proton pump inhibitors; eGFR, estimated glomerular filtration rate; ACE/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker.

Table 2 Oral Health Status in Dentate Patients, Total and in Relation to Gender and Age Groups (n=181).

Variable	Total	Women	Men	p-value	65–79 Years	≥80 Years	p-value
	N=181	N=102	N=54		N=79	N=102
<20 teeth, n (%)	80 (44)	57 (45)	23 (43)	0.777	29 (37)	51 (50)	0.074
Decayed teeth mean (SD)	0.7 (1.9)	0.6 (1.9)	0.9 (2.1)	0.421	0.6 (2.2)	0.7 (1.7)	0.786
Missing teeth mean (SD)	8.8 (6.5)	8.5 (6.3)	9.5 (6.9)	0.319	7.5 (6.5)	9.8 (6.4)	0.020
Filled teeth mean (SD)	14.1 (6.1)	14.7 (5.8)	12.9 (6.6)	0.080	15.0 (6.1)	13.5 (6.1)	0.090
DFT mean (SD)	14.8 (5.8)	15.3 (5.5)	13.8 (6.3)	0.114	15.7 (5.6)	14.2 (5.9)	0.089
Pocket depth ≥4 mm, mean (SD)	5.3 (5.1)	4.8 (4.7)	6.6 (5.8)	0.029	5.5 (5.1)	5.2 (5.1)	0.701

Note: P-values of <0.005 are presented in bold text.

Abbreviations: SD, standard deviation; DFT, Decayed Filled Teeth.

Table 3 Oral Health Status in Dentate Patients, in Relation to Comorbidities and Medications (n=181)

Variable	Number of Teeth	Pocket Depth	DFT
	< 20 Teeth	≥ 4 mm	> Mean 15
	N= 80 (44%)	N= 147 (81%)	N= 94 (52%)
Comorbidities
Diabetes	0.58 (0.25–1.39)	0.68 (0.21–2.22)	0.37 (0.15–0.94)
p-value	0.224	0.520	0.037
Heart disease	1.26 (0.64–2.44)	0.38 (0.15–0.95)	0.99 (0.51–1.94)
p-value	0.505	0.039	0.997
Dementia	0.82 (0.32–2.07)	0.89 (0.27–2.93)	0.75 (0.29–1.96)
p-value	0.673	0.849	0.556
COPD	0.33 (0.13–0.83)	1.03 (0.32–3.35)	0.36 (0.13–0.99)
p-value	0.019	0.961	0.048
Medications
Polypharmacy ≥5^a	0.62 (0.31–1.24)	0.56 (0.24–1.28)	0.40 (0.20–0.81)
p-value	0.176	0.167	0.011
Diuretics	0.62 (0.32–1.20)	0.32 (0.12–0.86)	0.39 (0.20–0.78)
p-value	0.158	0.023	0.007
Anticoagulants	1.13 (0.60–2.12)	0.47 (0.21–1.07)	0.77 (0.41–1.44)
p-value	0.710	0.073	0.414
Inhalation drugs^b	0.29 (0.12–0.67)	1.97 (0.80–4.85)	0.41 (0.18–0.93)
p-value	0.004	0.138	0.032
ACE/ARB	1.65 (0.87–3.14)	0.63 (0.27–1.46)	0.61 (0.32–1.15)
p-value	0.128	0.286	0.127
Sedatives	0.78 (0.39–1.54)	0.67 (0.27–1.65)	0.57 (0.28–1.14)
p-value	0.468	0.382	0.113
Anticholinergics^c	0.49 (0.14–1.64)	0.71 (0.14–3.46)	0.62 (0.19–2.07)
p-value	0.245	0.669	0.440
Use of ≥2 AC drugs^d,*	0.32 (0.15–0.70)	1.76 (0.71–4.34)	0.31 (0.14–0.66)
p-value	0.004	0.149	0.003

Notes: ^aPolypharmacy, defined as use of 5 or more drugs regularly. ^bInhalation drugs used for obstructive lung diseases. ^cDrugs with strong anticholinergic effect. ^dPatients using two or more drugs with strong anticholinergic effect. All variables were adjusted for age, gender, and comorbidity index (CCI), and the variable marked with *was also adjusted for polypharmacy. Values presented as OR (95% CI). P-values of <0.005 are presented in bold text.

Abbreviations: OR, odds ratio; CI, Confidence interval; COPD, chronic obstructive pulmonary disease; RA, rheumatoid arthritis; CCI, Charlson comorbidity index; eGFR, Estimated glomerular filtration rate; ACE/ARB, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers; AC, strong anticholinergic drugs.