Impaired oral health status on admission is associated with poor clinical outcomes in post-acute inpatients: A prospective cohort study

Abstract

Background & aims: Oral health is an integral part of nutrition and rehabilitation. The purpose of this study was to investigate the impact of impaired oral health status on clinical and functional outcomes in post-acute in-hospital rehabilitation.

Methods: We conducted a prospective cohort study of hospitalized patients undergoing rehabilitation at a 225-bed post-acute rehabilitation hospital in Japan. All newly admitted patients were eligible to enroll during the two-year research period. Oral health status was evaluated on admission using the Revised Oral Assessment Guide (ROAG). Nutritional status, assessed using the Mini Nutritional Assessment-Short Form; activities of daily living, assessed by Functional Independence Measure motor scores; home discharge; all-cause in-hospital mortality; and length of hospital stay were measured as clinical and rehabilitation outcomes. Multivariate analyses were used to determine whether the ROAG score on admission was associated with these outcomes at discharge.

Results: Of the 1066 patients enrolled, 1056 were included in the final analysis. The mean age was 70 ± 17 years. Fifty-two percent of patients were women. Stroke (21.7%) and musculoskeletal disorders (30.5%) were the most common reasons for admission. Slight or moderate to severe oral health problems were detected in 609 (57.7%) and 163 (15.4%) patients, respectively. Eighteen patients died during hospitalization. The ROAG score at admission was independently associated with Functional Independence Measure motor scores at discharge (P = 0.022), home discharge (P = 0.005), in-hospital mortality (P = 0.039), and length of hospital stay (P = 0.045), after adjusting for potential confounders.

Conclusions: Impaired oral health status may be associated with rehabilitation outcomes in hospitalized patients. Early detection of oral health problems and treatment by dental professionals, or through cooperation between medical and dental professionals, should be implemented in these patients.

Keywords: Home discharge; In-hospital mortality; Length of hospital stay; Oral health; Physical activity; Rehabilitation.