Dysphagia and Oral Health in Older Adults: Examining Demographic and Clinical Associations.

Oral health is a modifiable risk factor with significant implications for general health, particularly in the geriatric patient population. Poor oral hygiene has been linked to respiratory disease, aspiration pneumonia, and systemic conditions such as diabetes and cardiovascular disease. Oral health is a critical component of clinical care for elderly patients with dysphagia; however, limited literature exists to guide clinicians in describing the patient characteristics associated with inadequate oral health in this population. This retrospective study aimed to identify associations between patient characteristics and inadequate oral health in a geriatric population with dysphagia. Data were collected from 29,302 patients aged 65 and older referred to a regional mobile medical practice providing MBSS services across multiple residential and health care settings in the northeastern United States between 2013 and 2019. Inadequate oral health was coded as a binary variable based on documented findings related to oral secretions, oral hygiene, mucosa, and dentition. A multivariable logistic regression model was used to analyze the relationship between oral health status and both demographic and clinical factors. The multivariable regression analysis included 18,395 complete cases. Results indicated that the demographic variables significantly associated with inadequate oral health included being male (AOR = 1.21; 95% CI: 1.12, 1.31), Black (AOR = 1.42, 95% CI = 1.15, 1.76), and residing in a skilled nursing facility (AOR = 1.17, 95% CI: 1.02, 1.35). Observed disparities may reflect inequities in access to oral healthcare and other structural factors rather than inherent patient characteristics. Clinical characteristics associated with inadequate oral health included moderate-to-severe (AOR = 3.05, 95% CI: 1.83, 5.06), severe oral dysphagia (AOR = 3.98, 95% CI: 2.35, 6.75), profound pharyngeal dysphagia (AOR = 1.92, 95% CI: 1.14, 3.23), non-ambulatory status (wheelchair AOR = 1.47, 95% CI: 1.19, 1.82); chair/bed bound AOR = 1.34, 95% CI: 1.07, 1.67)) dependence for feeding (required assistance AOR = 1.45, 95% CI: 1.30, 1.61; dependent for feeding AOR = 1.44, 95% CI: 1.22, 1.71), and dietary modifications (IDDSI 3 AOR = 1.29, 95% CI: 1.13, 1.47; IDDSI 4 AOR = 1.27, 95% CI: 1.14, 1.43; IDDSI 5 AOR = 1.19, 95% CI: 1.06, 1.34; IDDSI 6 AOR = 1.17, 95% CI: 1.06, 1.31). Among dietary categories, patients classified as nil per os (NPO) had the highest odds of inadequate oral health (AOR = 2.03, 95% CI: 1.62, 2.53). The study identified demographic and clinical characteristics associated with inadequate oral health in this geriatric dysphagia population, offering a first step in guiding preventive efforts, institutional protocols, and interdisciplinary approaches to oral health management.