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The Relationship between Oral Health-Related Factors and Grip Strength in the Elderly
J Dent Hyg Sci 2022;22:37-43
Published online March 31, 2022;  https://doi.org/10.17135/jdhs.2022.22.1.37
© 2022 Korean Society of Dental Hygiene Science.

Ki-Eun Kim

Department of Dental Hygiene, Daejeon Institute of Science and Technology, Daejeon 35408, Korea
Correspondence to: Ki-Eun Kim, https://orcid.org/0000-0002-5989-9503
Department of Dental Hygiene, Daejeon Institute of Science and Technology, 100, Hyechon-ro, Seo-gu, Daejeon 35408, Korea
Tel: +82-42-580-6449, Fax: +82-42-580-6301, E-mail: uri4rang@dst.ac.kr
Received December 21, 2021; Revised February 15, 2022; Accepted February 21, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Among the health problems in old age, oral health is closely related to nutrition intake and digestion, so although it is an important factor in the well-being of the elderly along with general health, studies examining the relationship between oral health-related factors and grip strength of the elderly are insufficient. Therefore, this study intends to examine the relationship between oral health-related factors and grip strength, which are closely related to the general health of the elderly.
Methods: This study used data from the 7th period of Korea National Health and Nutrition Survey (2016∼2018) approved by the Research Ethics Review Committee of the Korea Centers for Disease Control and Prevention. Complex sample frequency analysis and descriptive statistics were performed, and general linear model analysis was performed to confirm the relationship between demographic characteristics, oral health -related factors and grip strength. The statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23.0, and the significance test was based on type I error level of 0.05.
Results: Grip strength was higher in the case of no discomfort than in the case of discomfort in relation to mastication discomfort and grip strength (B=0.927, p<0.001). In addition, the grip strength was decreased by 1.348 times when not using dental floss (p<0.001) and when not using mouth wash was 1.480 times (p<0.001).
Conclusion: In this study, in the relationship between oral health-related factors and grip strength, grip strength was found to be high in the absence of mastication discomfort. and in the case of using dental floss and mouthwash the elderly showed high grip strength. Therefore, it is suggested to present a lifestyle to improve hand function and grip strength in the elderly and develop a program to increase grip strength and provide them at the same time during oral health education.
Keywords : Elderly, Grip strength, Oral health
Introduction

It is a global trend that the elderly population is increasing due to the improvement of living standards, the development of medical technology, and the increase in interest in health. Due to the rapid aging of Korea, it is expected that the population aged 65 years or over will account for 16.5% in 2021, 20.3% in 2025, and 43.9% in 2060 of the total population1).

An increase in age is inevitably accompanied by aging, and aging is a physical, mental, and social change that appears in humans, resulting in a decrease in physical strength and overall physical functions2). Usually, it is known that physical performance gradually decreases after reaching its peak in the late 20s, and muscle strength and muscle mass decrease to about 20% to 25% of the peak at the age of 65 years3). In this sense, muscle strength among the physical strength of the elderly is recognized as very important4), and in particular, hand grip strength is known as a representative physical strength indicator that can grasp the strength of the body5).

It is known that the grip strength gradually decreases after reaching a peak in the 30s5), sharply decreasing after the age of 50 years6). According to a previous study, those with grip strength in the lower tercile compared to those with grip strength in the upper tercile of all subjects in middle age experienced more physical dysfunction such as walking speed, getting up from a chair, changing clothes, eating, bathing, and using toilets7). As such, grip strength is also an indicator of physical activity, and it can be said that it is related to independence in daily life activities. In addition, it is reported that high grip strength not only prevents various chronic diseases, but also plays a positive role in reducing the risk of premature death due to chronic diseases8).

There were many studies mainly related to general health such as grip and cardiovascular disease8), differences in physical strength according to grip strength9), dietary and exercise habits according to grip strength10), correlation between lower strength of extremity and balance ability according to grip strength11), and the effect of muscle strengthening exercise on grip strength12), and the relationship between body function index and grip strength13). Although oral health is an important factor for the well-being of the elderly along with general health as it has a deep relationship with nutrition intake and digestion, studies investigating the relationship between oral health factors and grip strength in the elderly are insufficient. In addition, although there has been a study on the relationship between oral health-related factors and grip strength in adults among the previous studies, it seems to be weak to represent the characteristics of the elderly.

Therefore, this study intends to find oral health-related factors that affect the grip strength of the elderly by using the data of the 7th period (2016∼2018) of the Korea National Health and Nutrition Examination Survey and provide them as basic data for improving the oral health of the elderly.

Materials and Methods

1. Research subject

This study used data from the 7th period of Korea National Health and Nutrition Survey (2016∼2018) approved by the Research Ethics Review Committee of the Korea Centers for Disease Control and Prevention (2018-01-03-P-A), and 3,426 out of a total of 16,489 elderly people aged 65 years or older were selected as subjects.

2. Research tool

1) Demographic & sociological characteristics

Sex was classified into ‘male’ and ‘female’, and income level was classified into ‘low’, ‘middle-low’, ‘middle-high’, and ‘high’.

Marital status was divided into ‘married’ and ‘single’. Educational level was divided into ‘less than elementary school’, ‘middle school graduate’, ‘high school graduate’, and ‘university graduate or higher’, and the mainly used hand was reclassified into ‘right hand’ and ‘left hand’.

2) Oral health-related factors

Whether or not there was mastication discomfort was classified as ‘yes’ or ‘no’, and subjective oral health status was reclassified as ‘bad’, ‘normal’, and ‘good’. The experience of toothache for one year was divided into ‘yes’ and ‘no’. The number of toothbrush per day was reclassified into ‘0∼2 times’ and ‘3 or more times’, and floss, interdental toothbrushes, mouth wash, and electric toothbrushes were classified into ‘yes’ and ‘no’.

3) Grip strength

The grip strength was measured using a digital grip strength dynamometer (T.K.K 5401; Takei, Tokyo, Japan), and the grip strength value was the maximum value of the predominant hand among the two-handed grip strength values measured three times. In this study, the average value of right hand grip strength was used due to the high proportion of right hand use.

3. Statistical method

Since the Korea National Health and Nutrition Survey was data collected using the complex sample design method, a complex sample analysis was performed after applying weight, stratification variable (kstrata), and survey group (psu). Complex sample frequency analysis and descriptive statistics were performed, and general linear model analysis was performed to confirm the relationship between demographic characteristics, Oral health-related factors and grip strength. The statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA), and the significance test was based on type I error level of 0.05.

Results

1. General characteristics of study subjects

The general characteristics of the study subjects are shown in Table 1. Of the 3,426 seniors aged 65 years or older, 57.6% were female and 99.3% were married, in the level of education, ‘below elementary school graduate’ was found to be the highest at 57.6%. As for the hand mainly used, ‘right hand’ accounted for 94.3%, and ‘right hand grip strength’ was found to be 22.9 kg on average.

General Characteristics

Characteristic Division Value
Sex Male 1,465 (42.4)
Female 1,961 (57.6)
Age (y) 72.9±0.1
Marital status Married 3,398 (99.3)
Single 28 (0.7)
Income quartile Low 871 (26.0)
Middle-low 881 (24.9)
Middle-high 840 (24.2)
High 814 (24.9)
Education level ≤Elementary school 1,906 (57.6)
Middle school 476 (15.3)
High school 532 (16.8)
≥College 302 (10.3)
Use of hands Right hand 3,004 (94.3)
Left hand 175 (5.7)
Grip strength (kg) Right hand (kg) 22.9±0.2

Values are presented as number (weighted %) or mean±standard deviation.

The discrepancy in the frequency count was due to missing values.



2. Relationship with grip strength according to demographic and sociological characteristics

As age increased, grip strength decreased statistically significantly, and male grip strength was 11.735 times higher than that of females (p<0.001). As for the grip strength according to the educational level, the grip strength of the elderly with elementary school education or less decreased by 1.489 times compared to those with a college degree or higher (p=0.001). When the economic level was ‘low’ than ‘high’, the grip strength decreased by 0.942 times (p=0.001) and the grip strength was 1.453 times higher in the right hand than in the left p=0.001) (Table 2).

Relationship between Grip Strength and Socio-Demographic Characteristics

Variable Estimate SE 95% Confidence interval t p-value

Lower Upper
Age −0.511 0.022 −0.555 −0.468 −23.235 <0.001
Sex
Male 11.735 0.263 11.219 12.252 44.691 <0.001
Female Reference
Marital status
Married 2.001 1.096 −0.153 4.156 1.826 0.069
Single Reference
Education level
≤Elementary school −1.489 0.455 −2.383 −0.596 −3.276 0.001
Middle school −0.266 0.496 −1.242 0.710 −0.535 0.593
High school 0.355 0.520 −0.668 1.377 0.682 0.496
≥University Reference
Income level
Low −0.942 0.343 −1.616 −0.268 −2.749 0.001
Middle-low −0.619 0.342 −1.291 0.053 −1.811 0.071
Middle-high −0.212 0.325 −0.851 0.427 −0.652 0.515
High Reference
Use of hands
Right hand 1.453 0.561 0.349 2.557 2.588 0.001
Left hand Reference


3. Relationship between grip strength and oral health-related factors

According to the results including the correction variable, grip strength was higher in the case of no discomfort than in the case of discomfort in relation to mastication discomfort and grip strength (B=0.927, p< 0.001). In addition, the grip strength was decreased by 1.348 times when not using dental floss (p<0.001), and when not using mouth wash was 1.480 times (p<0.001) (Table 3).

Relationship between Grip Strength and Oral Health-related Factors

Variable Estimate SE 95% Confidence interval t p-value

Lower Upper
Mastication problems
No 0.927 0.249 0.438 1.416 3.726 <0.001
Yes Reference
Oral health condition
Good 0.001 0.449 −0.882 0.884 0.002 0.999
Fair −0.061 0.286 −0.624 0.502 −0.213 0.832
Poor Reference
Toothache
No −0.982 0.263 −1.499 −0.464 −3.730 0.900
Yes Reference
Dental floss
Unuse −1.348 0.390 −2.113 −0.582 −3.459 <0.001
Use Reference
Interdental brush
Unuse −0.254 0.349 −0.941 0.433 −0.728 0.467
Use Reference
Mouth wash
Unuse −1.480 0.309 −2.088 −0.872 −4.787 <0.001
Use Reference
Electric toothbrush
Unuse −1.029 0.709 −2.422 0.365 −1.451 0.147
Use Reference
Tooth brushing/day
0∼2 −0.252 0.246 −0.736 0.233 −1.022 0.307
≥3 Reference

R2=0.561, adjusted for age, sex, income, education level, use of hands.


Discussion

Oral health in old age is a very important and essential element for maintaining good health as if the oral condition is not good it adversely affects the overall health, such as poor chewing of food, and lowering the digestive function. This study was conducted to confirm the relationship between oral health-related factors and grip strength in the elderly, and the results of this study are as follows.

In this study, male grip strength was higher than that of female, and the average grip strength was 22.9 kg, which was lower than 30.6 kg and 30.4 kg in the adult study14,15), showing the same result as previous study that the grip strength decreases with age. As for the grip strength according to the level of education, the grip strength of the elderly with elementary school education or less was statistically significantly reduced by 1.489 times compared to those with a college degree or higher, so it can be estimated that the subjects with elementary school education or less are older, and this was a result similar to Kang’s study14). When the economic level was ‘low’ rather than ‘up’, the grip strength decreased by 0.942 times. In the case of the elderly with economic stability, it is presumed that the muscle strength is high due to active physical activity or leisure activities for health management. The result that the grip strength of the right hand was higher than that of the left hand was found to be 94.3% of right-handed users of the study subjects, which can be said to be the result of more developed muscle strength in the right hand, which is frequently used. The results were the same as those of Kang’s study14) targeting Korean adult population over 20 and Jung et al.’s study11) targeting the elderly over 70 years of age in Korea.

In the relationship between oral health-related factors and grip strength, grip strength was found to be high in the absence of mastication discomfort, which was similar to the study of lectures for adults14). Judging from the results of previous studies16) that complaints about author discomfort cause systemic problems, continuous management is required17) and the possibility of lowering the will to participate in society should be considered. It is presumed that discomfort from mastication not only affects overall health, but also reduces physical activity and health behaviors related to grip strength. In addition, when the masticatory function is lowered, it is thought that malnutrition is caused, which leads to a decrease in muscle strength18), and thus affects the grip strength. The use of interdental toothbrushes and electric toothbrushes did not have any relationship with grip strength, and in the case of using dental floss and mouthwash the elderly showed high grip strength. This is a slightly different result from Kang’s study14) for adults over 20 years old, but the use of dental floss, which requires repeated movements with the act of grasping is closely related to grip strength, so it is not expected that the use of dental floss will be particularly easy for the elderly with weak grip strength. In the case of a person with weak muscle strength, oral disease occurs19) due to neglect of oral health management, and nutrient intake is restricted due to inconvenient mastication, which appears to continuously repeat a vicious cycle of decreased muscle strength.

In addition, considering the results of previous studies20) that hand function, grip strength, and instrumental daily life were improved after simple hand function training for the elderly, it can be inferred that hand skills training is necessary to help the elderly properly use tooth brushing and oral care products.

Currently, in Korea, a variety of community-based and individualized oral health care programs are being provided with the goal of promoting oral health for the elderly in the local community. However, in order to effectively manage oral health, individual oral health behaviors and practices must be combined. Therefore, it is suggested to present a lifestyle to improve hand function and grip strength in the elderly and develop a program to increase grip strength and provide them at the same time during oral health education. These efforts are considered to be an alternative to coordinating the oral health problems for the elderly caused by oral care, which is neglected due to aging and weakening of physical strength, and will help them to cope effectively without incurring a large cost.

The limitation of this study is that oral health-related factors using the 7th Korea National Health and Nutrition Examination Survey may have been underestimated or overestimated as a self-reported questionnaire rather than an objective measurement, so it is somewhat difficult to generalize. In addition, there is a limitation in not considering the basic health status of the elderly, so additional research is needed.

However, in order to expand the previous studies, which have mostly been related to grip strength and general health such as muscle strength, physical function, and chronic disease, the relationship between oral health-related factors and grip strength in old age was confirmed, and it is thought that it is meaningful in that it can be used as basic data to find an effective method for oral health management in old age.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Ethical Approval

This study was approved by the Institutional Review Board of Daejeon Institute of Science and Technology (IRB No. 1044342-20210428-HR-020-02).

Author contributions

This study was carried out with the support of academic research fund from Daejeon Institute of Science and Technology in the academic year of 2021.

References
  1. Gauchard GC, Gangloff P, Jeandel C, Perrin PP: Physical activity improves gaze and posture control in the elderly. Neurosci Res 45: 409-417, 2003.
    https://doi.org/10.1016/s0168-0102(03)00008-7.
    Pubmed CrossRef
  2. Andersen-Ranberg K, Christensen K, Jeune B, Skytthe A, Vasegaard L, Vaupel JW: Declining physical abilities with age: a cross-sectional study of older twins and centenarians in Denmark. Age Ageing 28: 373-377, 1999.
    https://doi.org/10.1093/ageing/28.4.373.
    Pubmed CrossRef
  3. Lim JH, Lee JO: The relationship between body composition change and muscle strength and endurance depending on aging at the senescence. Korea Gerontolog Soc 21: 15-24, 2001.
  4. Bohannon RW: Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther 31: 3-10, 2008.
    https://doi.org/10.1519/00139143-200831010-00002.
    Pubmed CrossRef
  5. Dodds RM, Syddall HE, Cooper R, et al.: Grip strength across the life course: normative data from twelve British studies. PLoS One 9: e113637, 2014.
    https://doi.org/10.1371/journal.pone.0113637.
    Pubmed KoreaMed CrossRef
  6. Guralnik JM, LaCroix AZ, Abbott RD, et al.: Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol 137: 845-857, 1993.
    https://doi.org/10.1093/oxfordjournals.aje.a116746.
    Pubmed CrossRef
  7. Kim GR, Sun J, Han M, Park S, Nam CM: Impact of handgrip strength on cardiovascular, cancer and all-cause mortality in the Korean longitudinal study of ageing. BMJ Open 9: e027019, 2019.
    Erratum in: BMJ Open 9: e027019corr1, 2019.
    Pubmed KoreaMed CrossRef
  8. Sung BJ, Lee WY: Difference in a physical fitness level according to grip strength and age group in Korean older adults. J Wellness 14: 361-370, 2019.
    https://doi.org/10.21097/ksw.2019.11.14.4.361.
    CrossRef
  9. Lee OH: Relationship between fat-free mass and grip strength, nutrient intakes, exercise behavior in middle- and old-aged women. J Nutr Health 34: 449-457, 2001.
  10. Jeong JY, Yoon JH, Oh JK: The correlation between hand grip strength and knee strength, proprioception and balance in elderly. Sport Sci 34: 55-62, 2016.
  11. Lee SG, Park SK: The effects of a video strength exercise on grip strength, balance, TUG in the frail elderly women. JKSPM 8: 91-98, 2013.
    https://doi.org/10.13066/kspm.2013.8.1.091.
    CrossRef
  12. Chung JY, Lee JW, Im JY, Lee DC: Hand grip power is independently associated with physical function in community dwelling elderly. Korean J Clin Geri 11: 315-323, 2010.
  13. Kang HK: Association between oral health-related factors and grip strength using the 6th Korea National Health and Nutrition Examination Survey data. J Korean Soc Dent Hyg 19: 743-752, 2019.
    https://doi.org/10.13065/jksdh.20190063.
    CrossRef
  14. HongSon GR, Lee YK, Park YS, Oh EM: The impacts of difficulty on daily activities, grip strength, and activities of daily living on perceived health in community-living older adults. J Muscle Joint Health 17: 192-202, 2010.
    https://doi.org/10.5953/JMJH.2010.17.2.192.
    CrossRef
  15. Richmond S, Chestnutt I, Shennan J, Brown R: The relationship of medical and dental factors to perceived general and dental health. Community Dent Oral Epidemiol 35: 89-97, 2007.
    https://doi.org/10.1111/j.1600-0528.2007.00296.x.
    Pubmed CrossRef
  16. Back J, Park MH: Ability for chewing a social activity and connection with the life function of a senior citizen. J Korean Acad Deny Technol 29: 87-103, 2007.
  17. Sheiham A, Steele JG, Marcenes W, et al.: The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res 80: 408-413, 2001.
    http://doi.org/10.1177/00220345010800020201.
    Pubmed CrossRef
  18. Padilha DM, Hugo FN, Hilgert JB, Dal Moro RG: Hand function and oral hygiene in older institutionalized Brazilians. J Am Geriatr Soc 55: 1333-1338, 2007.
    https://doi.org/10.1111/j.1532-5415.2007.01278.x.
    Pubmed CrossRef
  19. Kim HY: The effects of hand function program on hand function and instrumental activities of daily living. JOTAD 2: 1-12, 2008.


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