老年人的社会孤立与牙齿较少有关 | 纽约大学护理学院

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Higher levels of social isolation—but not loneliness—associated with faster 

tooth loss in older adults in China

Older adults who are socially isolated are more likely to have missing teeth—

and to lose their teeth more quickly over time—than those with more social interaction, according to a new study of Chinese older adults led by researchers at NYU Rory Meyers College of Nursing. The findings are published in Community Dentistry and Oral Epidemiology.  

“Our study suggests that maintaining and improving social connections may benefit the oral health of older adults,” said Xiang Qi, a PhD student at NYU Meyers and the study’s first author. “The findings align with previous studies demonstrating that structural indicators of social disconnection can have powerful effects on indicators of health and well-being.”

Social isolation and loneliness in older adults are major public health concerns around the world and are risk factors for heart disease, mental health disorders, cognitive decline, and premature death. In some countries, including the United States and China, up to one in three older adults are lonely, according to the World Health Organization. The COVID-19 pandemic has exacerbated these issues among older adults, as many in-person interactions have been interrupted to protect older adults from infection.

Social isolation and loneliness are related but different. Social isolation is an objective measure defined as having few social relationships or infrequent social contact with others, while loneliness is the feeling created by a lack of social connection. 

“While social isolation and loneliness often go hand in hand, it’s possible to live alone and be socially isolated but to not feel lonely, or to be surrounded by people but still feel lonely,” said Bei Wu, Dean's Professor in Global Health at NYU Meyers and the study’s senior author.

Older adults are also at risk for another health concern: losing teeth. In China, older adults aged 65 to 74 have fewer than 23 teeth on average (adults typically have 32 teeth, or 28 if wisdom teeth have been removed) and 4.5% of this age group has lost all of their teeth. Gum disease, smoking, lack of access to dental care, and chronic illnesses like diabetes and heart disease increase the risks of tooth loss. Missing teeth can have a significant impact on one’s quality of life, affecting nutrition, speech, and self-esteem.  

To understand the relationship between social isolation, loneliness, and tooth loss in older adults in China, the researchers used the Chinese Longitudinal Healthy Longevity Survey to analyze data from 4,268 adults aged 65 and up. The participants completed surveys at three different timepoints (2011-12, 2014, and 2018), which captured measures of social isolation and loneliness, how many teeth people had and lost over the 7-year study, and other factors. More than a quarter (27.5%) of the study participants were socially isolated, and 26.5% reported feeling lonely.

The researchers found that higher levels of social isolation were associated with having fewer teeth and losing teeth more quickly over time, even when controlling for other factors such as oral hygiene, health status, smoking and drinking, and loneliness. Older adults who were socially isolated had, on average, 2.1 fewer natural teeth and 1.4 times the rate of losing their teeth than those with stronger social ties.

“Socially isolated older adults tend to be less engaged in social and health-promoting behaviors like physical activity, which could have a negative impact on their overall functioning and oral hygiene, as well as increase their risk for systemic inflammation,” said Wu. “This functional impairment seems to be a major pathway linking social isolation to tooth loss.”

Surprisingly, loneliness was not associated with the number of remaining teeth, nor with the rate of tooth loss.

“While social isolation can result in a lack of support that can affect health behaviors, for older adults who feel lonely, it’s possible that their social networks are still in place and can help them to keep up healthy behaviors,” said Qi.

The findings—which are relevant to countries beyond China, given that social isolation and tooth loss are global issues—highlight the importance of developing interventions to reduce social isolation. Programs could aim to foster intergenerational support within families and improve older adults' peer and social connections within their local communities.  

Additional study authors include Yaolin Pei of NYU Meyers, Katherine Wang of Duke University, and Shuyu Han of Fudan University in China. The research was supported by the National Institute on Aging (1R56AG067619) and the National Institute of Dental and Craniofacial Research (U01DE027512).

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全文翻译（仅供参考）

中国老年人牙齿脱落速度越快，社会孤立程度越高——但与孤独无关

纽约大学罗里迈耶斯护理学院的研究人员领导的一项针对中国老年人的新研究表明，与社会交往较多的老年人相比，与社会隔离的老年人更容易缺牙，而且随着时间的推移，他们会更快地掉牙。. 研究结果发表在《 社区牙科和口腔流行病学》上。 

“我们的研究表明，维持和改善社会联系可能有益于老年人的口腔健康，”纽约大学迈耶斯分校博士生、该研究的第一作者向琦说。“研究结果与之前的研究一致，表明社会脱节的结构性指标可以对健康和福祉的指标产生强大的影响。”

老年人的社会孤立和孤独是全球主要的公共卫生问题，也是心脏病、精神健康障碍、认知能力下降和过早死亡的危险因素。根据世界卫生组织的数据，在包括美国和中国在内的一些国家，多达三分之一的老年人感到孤独 。COVID-19 大流行加剧了老年人的这些问题，因为许多面对面的互动被中断以保护老年人免受感染。

社会孤立和孤独是相关的，但又是不同的。社会孤立是一种客观的衡量标准，定义为很少有社会关系或很少与他人进行社会接触，而孤独感是由于缺乏社会联系而产生的感觉。 

纽约大学全球健康系主任教授吴蓓说：“虽然社会孤立和孤独常常并存，但也有可能独自生活和社会孤立但不会感到孤独，或者被人包围但仍然感到孤独。” 迈耶斯和该研究的资深作者。

老年人还有另一个健康问题的风险：牙齿脱落。在中国，65 至 74 岁的老年人平均有 不到 23 颗牙齿 （成年人通常有 32 颗牙齿，如果拔掉了智齿，则为 28 颗）  ，这个年龄组 中 4.5% 的人牙齿全部脱落。牙龈疾病、吸烟、无法获得牙科护理以及糖尿病和心脏病等慢性疾病会增加牙齿脱落的风险。牙齿缺失会对一个人的生活质量产生重大影响，影响营养、言语和自尊。 

为了了解中国老年人社会孤立、孤独和牙齿脱落之间的关系，研究人员使用中国纵向健康长寿调查分析了来自 4,268 名 65 岁及以上成年人的数据。参与者在三个不同的时间点（2011-12、2014 和 2018 年）完成了调查，这些调查记录了社会孤立和孤独感、在 7 年的研究中人们拥有和失去了多少颗牙齿以及其他因素。超过四分之一（27.5%）的研究参与者在社会上孤立，26.5% 的人表示感到孤独。

研究人员发现，即使在控制口腔卫生、健康状况、吸烟和饮酒以及孤独感等其他因素的情况下，较高程度的社会隔离与牙齿较少和牙齿脱落速度较快有关。与社会联系更紧密的人相比，与社会隔绝的老年人的天然牙齿平均少 2.1 倍，牙齿脱落率是后者的 1.4 倍。

“社会孤立的老年人往往较少参与体育活动等社会和健康促进行为，这可能对他们的整体功能和口腔卫生产生负面影响，并增加他们患全身炎症的风险，”吴说。“这种功能障碍似乎是将社会孤立与牙齿脱落联系起来的主要途径。”

令人惊讶的是，孤独感与剩余牙齿的数量无关，也与牙齿脱落的速度无关。

“虽然社会孤立会导致缺乏支持，从而影响健康行为，但对于感到孤独的老年人来说，他们的社交网络可能仍然存在，可以帮助他们保持健康的行为，”齐说。

鉴于社会孤立和牙齿脱落是全球性问题，研究结果与中国以外的国家相关，强调了制定干预措施以减少社会孤立的重要性。项目可以旨在促进家庭内的代际支持，并改善老年人在当地社区内的同伴和社会联系。 

其他研究作者包括纽约大学迈耶斯分校的 Yaolin Pei、杜克大学的 Katherine Wang 和中国复旦大学的 Shuyu Han。该研究得到了国家老龄研究所 (1R56AG067619) 和国家牙科和颅面研究所 (U01DE027512) 的支持。

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