Factors influencing eating ability of old in-patients in a rehabilitation hospital in Japan

Objectives: This study was designed to determine the factors influencing eating ability of old in‐patients in a rehabilitation hospital. Design: Cross‐sectional investigation. Setting: Forty‐six in‐patients in the rehabilitation ward of Hashimoto Hospital in Kagawa Prefecture in Japan were investigated using a multi‐disciplinary approach. Main outcome measures: Age, gender, state of dentition, muscle activity of lip, cheek and tongue, biting force, salivary flow rate per a minute (SFR), masticatory ability for gummy jelly, swallowing ability, texture of meal, independency of walking (Functional Independence Measure=FIM) and ability to communicate. Results: Bivariate analysis for the relationship between surveyed items and masticatory ability (chi‐square test) identified that better masticatory ability for gummy jelly was associated with age (<85 years), gender (male), state of dentition (dentate), SFR (high), activity of lip (good), biting force (high), swallowing ability (good) and activity of communication (high). Among these items, SFR (p=0.001), gender (p=0.004), ability to communicate (p=0.005) and age (p=0.012) were found having an influence on the masticatory ability (logistic regression analysis). On the other hand, age (<85years), gender (male), SFR (high), activity of lip (good), activity of cheek (good), biting force (high), masticatory ability (good) and swallowing ability (good) had a relationship with normal texture of meal. In regression analysis, only two items, activity of lip (p=0.003) and swallowing ability (p=0.024) emerged as factors on texture of meal. Conclusions: Masticatory ability for gummy jelly was influenced by cognitive function and was excluded from the factors on the state of meal. These results suggested the limitation of evaluation using test food, so dentists should observe eating behaviour of in‐patients. In addition, dentists should pay attention to the activity of the lip and swallowing ability as well as dentition and prostheses in the rehabilitation of eating ability. As SFR was the most significant factor on masticatory ability, this emphasizes the necessity of care for dry mouth caused by side effects of multi‐medication