Prevalence of chewing difficulty in older people in long-term care: A systematic review and meta-analysis

Background Many factors can influence chewing, including age. The ageing process causes morphophysiological changes in the body, including in the performance of the stomatognathic system, which directly affect chewing and swallowing. Objective To determine the prevalence of chewing difficulty in older people in long-term care. Methods We searched six electronic databases and the grey literature. Qualitative and quantitative analyses, including risk of bias, were performed on studies that met the inclusion criteria. The meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored by meta-regression. Risk of bias was determined using the Joanna Briggs Institute's Critical Appraisal Checklist. The certainty of evidence was verified using the GRADE tool. Results Twelve articles were included in the meta-analysis. The pooled prevalence estimate was 35% (95% confidence interval, 0.19-0.54). As heterogeneity still persisted even after sensitivity analysis, the predictors of mean sample age and sample size were meta-regressed to assess whether these covariates explained the variance between effect sizes. The covariable sample size of the study included in the analysis explained 84.3% of the heterogeneity existing in the analysis (R-2 = 84.3%; P = .0008). The risk of bias was low in three studies, eight studies had a moderate risk of bias and one study had a high risk of bias. As for the prevalence of chewing difficulty, the GRADE criteria were considered very low. Conclusion About one in three older people in long-term care have difficulty in chewing.