Influência da reabilitação com próteses totais na qualidade de vida, estado nutricional e função mastigatória de idosos fragilizados e não-fragilizados

Abstract

The current scientific literature lacks clinical studies that contribute to clinical decision-making in the face of frail elderly people. Although frailty is a condition that is associated with dependence on activities of daily living, it appears that free elderly people in the community can also have a profile of frailty. It is suggested that frailty can interfere with the quality of life related to health, nutritional status, among other parameters that can affect the individual's general health status and interfere with the rehabilitation process with conventional complete dentures. This dissertation was divided into two work plans. Initially, we sought to identify the influence of frailty on the health status of free elderly in the community through. A second study was designed to verify the influence of rehabilitation with complete dentures made using the simplified method on the general health status of free elderly people in the community. A non-randomized clinical study was carried out, in which 49 elderly people participated. Among them: 21 frail elderly, 7 pre-frail elderly and 21 non-frail elderly. The classification of the groups was based on the self-reported instrument for identifying the frailty syndrome. Completely edentulous elderly in need of replacement of complete dentures were included based on a clinical examination performed by trained researchers. Elderly people who presented neurological and/or cognitive alterations were excluded, through the application of the Mini Mental State Examination questionnaire. The following parameters were evaluated: Lean mass; BMI; fat percentage; hand strength; assessment of nutritional status with the questionnaire (MNA); and analysis of masticatory efficiency through colorimetric analysis of chewing gum; self-perception of quality of life in relation to health, using the SF-12 questionnaire (Short-Form Health Survey); evaluation of the impact of oral health on the quality of life of edentulous people, using the OHIP EDENT questionnaire (Oral Health Impact Profile);. Differences between frail, pre frail and non-frail groups were investigated in study 1. For study 2, the elderly were rehabilitated and reassessed 90 days after the final adjustment of the new prostheses. In this last analysis, 8 returns were obtained so far. Data were tabulated and analyzed in the Jamovi Desktop software (The Jamovi project, v. 2.3.21, Sydney, Australia). Descriptive and inferential statistical analyzes were performed using Wilcoxon tests, paired t test, ANOVA and Kruskall-Wallis, considering p<0.05. Regarding the influence of frailty on the general state of health, it was found that the general quality of life differed statistically between the frail and non-frail groups (p=0.013). The pre-frail group does not differ statistically from the frail (p=0.137) and non-frail (p= 0.857) groups. There was a difference in MNA between the non-frail and pre-frail groups (p=0.031), as well as between the non-frail and frail groups (p=0.003). The pre-frail and frail groups did not differ from each other (p=0.961). The parameters: hand strength, fat percentage, BMI, lean body mass, impact of oral health on quality of life and masticatory efficiency showed no difference between groups (p>0.05). Regarding the influence of rehabilitation, there was a statistically significant reduction in the percentage of fat (p=0.031 – MD= 2.475), an increase in the MNA score (p=0.010 – MD= -2.375) meaning an improvement in nutritional status, greater impact negative in quality of life related to oral health (p=0.010 – MD= -33.750) and improvement in masticatory efficiency (p=0.014 – MD= 0.261). No differences were observed for variables: lean body mass; BMI and self perception of quality of life in relation to health. This study allows us to conclude that frail elderly people have a worse health-related quality of life and a worse nutritional score. The data obtained in the present study corroborate the findings in the literature, making it possible to identify the improvement in the nutritional status and masticatory efficiency of individuals after rehabilitation. The negative impact on oral health on quality of life may be related to the prosthetic adaptation phase.