Preventing Falls: The Surprising Link Between Walking and Dentures in Older Adults
Written by: 藤巻 弘太郎 (Dentist)
For older people and their families, a fall is a serious accident that can lead to being bedridden. It is important to know the risks in advance and take precautions.
With age, various factors such as weaker muscles, walking difficulties and failing eyesight combine to make it harder to keep one’s balance. In later old age, illness and medication add to these factors and raise the risk of falling further, and accidents can happen in unexpected places.
In this column, I’ll discuss fall prevention in older people from a dental perspective.
After 50, walking speed gradually declines
Did you know? After the age of 50, walking speed gradually declines. From age 60 onward, the decline is said to average about 1 percent a year. Don’t dismiss it as a mere 1 percent.
The age-related decline in walking speed is said to be driven more by shorter strides than by fewer steps per minute (Reference 1). And when trying to walk faster, young people tend to lengthen their stride, whereas middle-aged and older people have been found to respond mainly by taking more steps (Reference 2).
Because middle-aged and older people spend a larger share of each stride supported on both feet (Reference 3), the older they get, the less time their feet spend lifted off the ground while walking, and their walk increasingly looks like a shuffle compared with when they were young.
In recent years, active research has focused on step-to-step variability while walking, that is, variability in walking speed, stride length, foot placement and the time spent supported on both feet. This variability grows with age and is thought to be linked to the risk of falling (References 4 and 5).
The link between dental status and falls
So how can dentistry help with these problems of walking and falls?
Study 1: Number of teeth, denture use, and balance and walking ability
One study examined 205 community-dwelling older adults (mean age 74.1 ± 4.5 years; 49.8% men) to see how dental status (the number of remaining teeth and whether dentures were used) related to physical function and history of falls (Reference 6).
It reported that the physical function of community-dwelling older adults differed by dental status, that dental status appeared to be related to a history of falls, and in particular that older adults with 19 or fewer remaining teeth who did not use dentures had reduced balance and walking ability and might be at higher risk of falling.
In a little more detail, the participants were divided into three groups for comparison:
19 or fewer remaining teeth, no dentures
19 or fewer remaining teeth, with dentures
20 or more remaining teeth
Among other findings, group 1 showed more body sway than group 3, took longer to walk 5 meters than group 2, and had a higher proportion of people who had fallen in the past than groups 2 and 3.
Put simply, people with 19 or fewer teeth who don’t use dentures have up to about 2.5 times the risk of falling of people who have 20 or more teeth.
Study 2: Occlusion and falls in older people with dementia
Another study focused on older people with dementia, who are at high risk of falling. It examined the relationship between their falls over the previous year and their occlusion (how the upper and lower teeth meet), to see whether maintaining or restoring occlusion could help prevent falls (Reference 7).
The participants were 146 hospitalized older people with dementia who could walk unaided. With no differences in cognitive assessment results, the proportion with Alzheimer’s disease, or medication use, they were divided into three groups based on how their left and right premolars and molars met: occlusion maintained by natural teeth, occlusion maintained by dentures, and no occlusion. Forty-one people had fallen two or more times, and 105 had fallen once or not at all.
Those who had fallen two or more times were more often in the no-occlusion group. Remarkably, of the 10 people who were able to receive denture treatment, everyone except three who had become unable to walk a year later had fewer falls.
Occlusion and power, speed and balance
In fact, in my own research, too, the consistency of walking differed depending on whether the occlusion had been adjusted. In the field of sports dentistry, there have also been conference reports that differences in the contact area of the bite affected power, speed and balance: the larger the occlusal contact area, the better the scores for power, speed and balance.
Unfortunately, these studies involved young people and athletes, so their findings cannot all be applied to older people, whose muscle strength and physical fitness are different.
Keep your teeth, and replace lost ones with dentures
Still, based on the two studies described above, I think we can say the following:
The more teeth you keep, the better
If you lose teeth, get properly fitted dentures or similar replacements as a precaution against falls
Wearing dentures properly when eating of course also affects chewing efficiency and nutrition. If there is someone around you who isn’t wearing dentures, please talk to a dentist.
References
Elble RJ, et al. J Neurol. 238: 1-5, 1991.
Larish DD, et al. Ann NY Acad Sci. 585: 18-31, 1988.
Winter DA, et al. Phys Ther. 70: 340-347, 1990.
Grabiner PC, et al. Arch Phys Med Rehabil. 82: 31-35, 2001.
Callisaya ML, et al. Age Ageing. 39: 191-197, 2010.
Kitano N, Tsunoda K, Okura T, et al. Journal of Health and Welfare Statistics (Kosei no Shihyo). 62(11): 9-14, 2015. (in Japanese)
Yoshida M, Morikawa H, et al. Osteoporosis Japan. 14(1): 114-115, 2006. (in Japanese)
About the author: 藤巻 弘太郎 (Dentist)
Specializes in sports dentistry and dental sleep medicine. Certified sports dentist of the Japan Sports Association (now the Japan Sport Association), and certified by Japanese professional societies in sports dentistry, occlusion (as an occlusion specialist), oral clinical examination and dry mouth (all as of the time of writing).
This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
About Next Co., Ltd. We are a Tokyo-based company working in Japan’s senior care and end-of-life planning field. Alongside these expert columns, we publish professional training textbooks and support businesses entering Japan’s eldercare market. More expert columns | Our English textbook | Contact us
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