臼歯の不正咬合は、重症高齢者の日常生活動作の喪失とせん妄に関連する

Malocclusion of Molar Teeth Is Associated with Activities of Daily Living Loss and Delirium in Elderly Critically Ill Older Patients.

• Yoshihisa Fujinami
• Toru Hifumi
• Yuko Ono
• Masafumi Saito
• Tomoya Okazaki
• Natsuyo Shinohara
• Kyoko Akiyama
• Misa Kunikata
• Shigeaki Inoue
• Joji Kotani
• Yasuhiro Kuroda

抄録

単一施設のレトロスペクティブコホート研究で，急性期患者のICU入室時の臼歯不正咬合状態と退院時の日常生活動作（ADL）の喪失との関連を検討した．患者を両側性咬合群または不正咬合群（＝それぞれ227名，93名）に割り付けた。電子カルテから，年齢，性別，入院時のCFS（Clinical Frailty Scale），APACHE（Acute Physiology and Chronic Health Evaluation）Ⅱスコア，確定診断（神経疾患など），退院時のCFS，咬合状態などのデータを収集した。入院時に虚弱であった患者（CFS＞5）は解析から除外し、ADL低下は退院時にCFS＞5と定義した。多変量解析の結果、不正咬合はADL低下と独立して関連していた[OR, 2.03; 95% CI, 1.13-3.64; = 0.02]。65歳以上では、不正咬合はADL低下（OR, 3.25; 95% CI, 1.44-7.32; < 0.01）およびせん妄の発生（OR, 2.61; 95% CI, 1.14-5.95; = 0.02）の両方と有意に関連していた。ICU入室時の不正咬合は、重症患者のADL低下と関連し、高齢者のADL低下とせん妄の発生率と関連していた。口腔衛生状態の悪さは、重症患者の予後を悪くする要因であった。

A single-center retrospective cohort study examined the association between molar malocclusion status at ICU admission and loss of activities of daily living (ADL) at hospital discharge among acutely ill patients. Patients were assigned to the bilateral occlusion group or malocclusion group ( = 227 and 93, respectively). The following data were collected from electronic medical records: age, sex, Clinical Frailty Scale (CFS) on admission, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, confirmed diagnosis (neurological disorders or others), CFS at hospital discharge, and occlusion condition. Patients who were frail at admission (CFS > 5) were excluded from analysis, and ADL loss was defined as CFS > 5 at hospital discharge. Multivariate analysis showed malocclusion was independently associated with ADL loss [OR, 2.03; 95% CI, 1.13-3.64; = 0.02]. For those aged 65 and older, malocclusion was significantly associated with both ADL loss [OR, 3.25; 95% CI, 1.44-7.32; < 0.01] and the incidence of delirium [OR, 2.61; 95% CI, 1.14-5.95; = 0.02]. Malocclusion on ICU admission was associated with ADL loss in critically ill patients, and was associated with ADL loss and the incidence of delirium in the elderly. Poor oral health was a poor prognostic factor among critically ill patients.