Common Precipitating Factors of Xerostomia in Elderly

Abstract

Xerostomia is a subjective sign of dry mouth t may or may not be accompanied by objective signs of hyposalivation. The condition of xerostomia has been associated with increasing age in line with the aging process, with a global prevalence of 30%. in the elderly aged 65 years and above. This can have an impact on the health and quality of life of the elderly. Also, xerostomia is the most common symptom in patients during periods of anxiety, stress, depression, radiotherapy, chemotherapy, and systemic diseases, as well as in individuals who have a history of polypharmacy or who use certain drugs. This study aimed to review the most recent available evidence regarding the most common causes of xerostomia in the elderly. The PCC strategy (population, context, and concept) was used as a guide for retrieving the relevant articles for this scoping review. Two databases were systematically searched using PubMed and Scopus. The draft of the scoping review and assessment of the methodological quality of the trials was carried out following the criteria of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A total of 12 trials were identified that met the previously defined selection and quality criteria; 9 related to medicine, and 4 included populations in which xerostomia was a systemic disease, rheumatic disease, radiation therapy to the head or neck region, nutrition, and psychological factors. The common precipitating factor of xerostomia in the elderly is medicine. Drugs that are more commonly found to cause xerostomia are gastrointestinal drugs, psychotropic drugs, and antihypertensive drugs.

Keywords

dry mouth - xerostomia - elderly - geriatric - human and health

Authors’ Contributions

The authors alone are responsible for the content and writing of the article.

Publication History

Article published online:
14 April 2023

• References

• 1 Kamińska-Pikiewicz K, Bachanek T, Chałas R. The incidence of oral dryness in people over 65 years living in Lublin. Curr Issues Pharm Med Sci 2015; 28: 250-253
• 2 Kessler AT, Bhatt AA. Review of the major and minor salivary glands, part 1: anatomy, infectious, and inflammatory processes. J Clin Imaging Sci 2018; 8: 47
• 3 Tanasiewicz M, Hildebrandt T, Obersztyn I. Xerostomia of various etiologies: a review of the literature. Adv Clin Exp Med 2016; 25 (01) 199-206
• 4 Mortazavi H, Baharvand M, Movahhedian A, Mohammadi M, Khodadoustan A. Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann Med Health Sci Res 2014; 4 (04) 503-510
• 5 Barbe AG. Medication-induced xerostomia and hyposalivation in the elderly: culprits, complications, and management. Drugs Aging 2018; 35 (10) 877-885
• 6 Agostini BA, Cericato GO, Silveira ERD. et al. How common is dry mouth? systematic review and meta-regression analysis of prevalence estimates. Braz Dent J 2018; 29 (06) 606-618
• 7 Tanigawa T, Yamashita J, Sato T. et al. Efficacy and safety of pilocarpine mouthwash in elderly patients with xerostomia. Spec Care Dentist 2015; 35 (04) 164-169
• 8 Archibald D, Patterson R, Haraldsdottir E, Hazelwood M, Fife S, Murray SA. Mapping the progress and impacts of public health approaches to palliative care: a scoping review protocol. BMJ Open 2016; 6 (07) e012058
• 9 Ohara Y, Hirano H, Yoshida H, Suzuki T. Ratio and associated factors of dry mouth among community-dwelling elderly Japanese women. Geriatr Gerontol Int 2011; 11 (01) 83-89
• 10 Fornari CB, Bergonci D, Stein CB, Agostini BA, Rigo L. Prevalence of xerostomia and its association with systemic diseases and medications in the elderly: a cross-sectional study. Sao Paulo Med J 2021; 139 (04) 380-387
• 11 Fernandes MS, Castelo PM, Chaves GN. et al. Relationship between polypharmacy, xerostomia, gustatory sensitivity, and swallowing complaints in the elderly: a multidisciplinary approach. J Texture Stud 2021; 52 (02) 187-196
• 12 Leal SC, Bittar J, Portugal A, Falcão DP, Faber J, Zanotta P. Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth. Gerodontology 2010; 27 (02) 129-133
• 13 Diep MT, Jensen JL, Skudutyte-Rysstad R. et al. Xerostomia and hyposalivation among a 65-yr-old population living in Oslo, Norway. Eur J Oral Sci 2021; 129 (01) e12757
• 14 Persson RE, Izutsu KT, Treulove EL, Persson R. Differences in salivary flow rates in elderly subjects using xerostomatic medications. Oral Surg Oral Med Oral Pathol 1991; 72 (01) 42-46
• 15 Viljakainen S, Nykänen I, Ahonen R. et al. Xerostomia among older home care clients. Community Dent Oral Epidemiol 2016; 44 (03) 232-238
• 16 Tiisanoja A, Syrjälä AM, Komulainen K. et al. Sedative load and salivary secretion and xerostomia in community-dwelling older people. Gerodontology 2016; 33 (02) 177-184
• 17 Lee KA, Park JC, Park YK. Nutrient intakes and medication use in elderly individuals with and without dry mouths. Nutr Res Pract 2020; 14 (02) 143-151
• 18 Mao W, Chen Y, Wu B. et al. Perceived stress, social support, and dry mouth among US older Chinese adults. J Am Geriatr Soc 2019; 67 (S3): S551-S556
• 19 Lima DLF, Carneiro SDRM, Barbosa FTS, Saintrain MVL, Moizan JAH, Doucet J. Salivary flow and xerostomia in older patients with type 2 diabetes mellitus. PLoS One 2017; 12 (08) e0180891
• 20 Tan ECK, Lexomboon D, Sandborgh-Englund G, Haasum Y, Johnell K. Medications that cause dry mouth as an adverse effect in older people: a systematic review and metaanalysis. J Am Geriatr Soc 2018; 66 (01) 76-84
• 21 Kapourani A, Kontogiannopoulos KN, Manioudaki AE. et al. A review on xerostomia and its various management strategies: the role of advanced polymeric materials in the treatment approaches. Polymers (Basel) 2022; 14 (05) 850
• 22 Shetty SR, Bhowmick S, Castelino R, Babu S. Drug induced xerostomia in elderly individuals: An institutional study. Contemp Clin Dent 2012; 3 (02) 173-175
• 23 Einhorn OM, Georgiou K, Tompa A. Salivary dysfunction caused by medication usage. Physiol Int 2020; 107 (02) 195-208
• 24 Karthik R, Karthik KS, David C, Ameerunnisa Keerthi G. Oral adverse effects of gastrointestinal drugs and considerations for dental management in patients with gastrointestinal disorders. J Pharm Bioallied Sci 2012; 4 (Suppl (Suppl. 02) S239-S241
• 25 Tiisanoja A, Syrjälä AH, Kullaa A, Ylöstalo P. Anticholinergic burden and dry mouth in middle-aged people. JDR Clin Trans Res 2020; 5 (01) 62-70
• 26 Usman NA, Hernawan I. Tata Laksana Xerostomia Oleh Karena Efek Penggunaan Amlodipine: Laporan Kasus. Insisiva Dent J 2017; 6 (02) 15-23
• 27 Wishart JM, Hodge JL, Greig DE. Systemic treatment of psoriasis with an oral retinoic acid derivative (Ro-10-9359) Tigason. N Z Med J 1981; 94 (694) 307-308
• 28 Luppa M, Sikorski C, Luck T. et al. Age- and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis. J Affect Disord 2012; 136 (03) 212-221
• 29 Husna F, Ariningtyas N. Tingkat Kecemasan Lansia Berdasarkan Depression Anxiety Stress Scale 42 (Dass 42) Di Posyandu Lansia Mekar Raharja Dusun Lemah Dadi Bangunjiwo, Kasihan Bantul. J Kesehat Samodra Ilmu 2019; 10 (01) 36-44
• 30 Bulthuis MS, Jan Jager DH, Brand HS. Relationship among perceived stress, xerostomia, and salivary flow rate in patients visiting a saliva clinic. Clin Oral Investig 2018; 22 (09) 3121-3127
• 31 Cappetta K, Beyer C, Johnson JA, Bloch MH. Meta-analysis: risk of dry mouth with second generation antidepressants. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84 (Pt A): 282-293
• 32 Cockburn N, Pradhan A, Taing MW, Kisely S, Ford PJ. Oral health impacts of medications used to treat mental illness. J Affect Disord 2017; 223: 184-193
• 33 Khoury C, Samot J, Helmer C. et al. The association between oral health and nutritional status in older adults: a cross-sectional study. BMC Geriatr 2022; 22 (01) 499
• 34 Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a mediator in the relation between oral and systemic disease: associations between specific measures of adult oral health and nutrition outcomes. Crit Rev Oral Biol Med 2002; 13 (03) 291-300
• 35 Jelinek MJ, Howard AS, Haraf DJ, Vokes EE. Management of early head and neck cancer in elderly patients. J Oncol Pract 2018; 14 (09) 541-546
• 36 Pinna R, Campus G, Cumbo E, Mura I, Milia E. Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage. Ther Clin Risk Manag 2015; 11: 171-188