Orofacial Pain Symptoms Among Chinese Older Adults in the Last Year of Life

Abstract The aims of this study were to examine the prevalence of orofacial pain symptoms and its associated factors in Chinese older adults in the last year of life. We retrospectively followed 1,646 participants (60 years or older) in the last year of life to death from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The 6-month prevalence of toothache and jaw joint pain or facial pain for older adults in the last year of life to death were 14.1% and 4.5%, respectively. Older adults who had lower socioeconomic status, were smokers, and had any chronic disease tended to have orofacial pain symptoms. This study generated interesting but counterintutive findings that Chinese older adults who brusehed their teeth at least daily and those who had at least one natural teeth were more likely to have orofacial pain. It is important to include dental care as a part of end-of-life medical treatment.

Oral health is a global public health concern. The four papers in this symposium capture various understudied risk and protective factors in oral health and dental care among older adults in China. The first paper examined the relationship between social isolation, loneliness, and tooth loss among Chinese older adults, using the Chinese Longitudinal Healthy Longevity Survey. The findings suggest that higher levels of social isolation, rather than loneliness, were associated with fewer remaining teeth and accelerated tooth loss over time. The second paper investigated urban-rural disparities in dental care utilization among Chinese adults aged 18 to 65 years old, using the 2019 New Era and Living Conditions in Megacities Survey. The findings demonstrate urban residents were more likely to visit dentists than rural residents. Besides socioeconomic status, health attitudes/behaviors, and oral health needs, health insurance coverage was considered an important enabling factor to promote dental care use in this population. The third paper examined the relationship between denture use and cognitive decline among Chinese older adults, using data from the Chinese Longitudinal Healthy Longevity Survey. The findings indicate that denture use is protective against cognitive decline over time in later life. The fourth paper examined the prevalence of self-reported orofacial pain symptoms and their correlates at the last year of life among Chinese older adults. Low socioeconomic status, smoking, chronic conditions, oral hygiene practice, and natural teeth condition were associated with such symptoms. This symposium offers valuable insights to improve oral health and dental care in older adults in China.

SOCIAL ISOLATION AND ACCELERATED TOOTH LOSS AMONG CHINESE OLDER ADULTS
Xiang Qi, 1 Yaolin Pei, 2 Katherine Wang, 3 Shuyu Han, 4 and Bei Wu, 2 1. Rory Meyers College of nursing,New York,New York,United States,2. New York University,New York,New York,United States,3. Duke University,Durham,North Carolina,United States,4. Fudan University,Shanghai,Shanghai,China (People's Republic) Social isolation and loneliness in older adults are major global public health concerns. Tooth loss is also a common problem in this population. This study examined the effects of social isolation and loneliness on the number of remaining teeth and the rate of tooth loss among Chinese older adults. We included 4,268 older adults age 65+ from three waves of the Chinese Longitudinal Healthy Longevity Survey (2011/2012, 2014, 2018). Linear mixed-effect models showed higher levels of social isolation were associated with fewer remaining teeth (β = -1.59, P < 0.05) and accelerated tooth loss (β=-0.10, P<0.05) controlled for socio-demographic, lifestyle, oral hygiene behavior, and health status. Loneliness was neither associated with the number of remaining teeth (β=0.64, P>0.05) nor with the rate of tooth loss (β=-0.09, P>0.05) before and after controlling for covariates. These findings expand our knowledge regarding the correlation between social connection and tooth loss in non-Western populations.  New York,New York,United States,3. New York University,New York,New York,United States Using data from the '2019 New Era and Living Conditions in Megacities Survey' that included 4,049 residents aged 18-65, we examined the urban-rural disparities in dental visits among adults living in China's 10 megacities. All of China's megacities are metropolitan regions that include urban, periurban and rural land, and all have rural populations within the city boundaries. The results show that 43.3% (n=595) rural and 23.8% urban (n=637) residents had never visited dentists. Urban residents were more likely to visit dentists than rural residents after controlling for covariates (OR=1.57, 95%CI=1.30 to 1.91). The rates of visits were similar across age groups. Higher socioeconomic status, having urban insurances, having positive attitudes towards healthy diets and visited physicians regularly, and having poorer oral health was associated with higher odds of visiting dentists (P<0.05). These findings can help develop policies to increase dental care access to underserved populations in Chinese megacities. Using data from the Chinese Longitudinal Healthy Longevity Survey (2011 to 2018), we examined the effect of denture use on cognitive decline (assessed by the Mini-Mental State Examination [MMSE]) among 1,316 cognitively normal older adults with severe tooth loss (≤9 remaining teeth) at baseline. We generated propensity scores for weighted and matched analyses using 18 covariates, classified as socio-demographics, health-related behaviors, health status, and oral health conditions. The results show that non-denture users had worse cognitive decline than denture users. In the kernel-based matched data, the difference in the declined score of cognitive function between denture and non-denture users was 2.25 (95%CI=1.37 to 3.13). In the weighted data, the difference in cognitive function score was 2.14 (95% CI=1.35 to 2.94). Using dentures is beneficial for cognitive health in older adults with severe tooth loss, suggesting that prosthodontic rehabilitation with dentures might have benefits beyond restoring oral functioning. The aims of this study were to examine the prevalence of orofacial pain symptoms and its associated factors in Chinese older adults in the last year of life. We retrospectively followed 1,646 participants (60 years or older) in the last year of life to death from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The 6-month prevalence of toothache and jaw joint pain or facial pain for older adults in the last year of life to death were 14.1% and 4.5%, respectively. Older adults who had lower socioeconomic status, were smokers, and had any chronic disease tended to have orofacial pain symptoms. This study generated interesting but counterintutive findings that Chinese older adults who brusehed their teeth at least daily and those who had at least one natural teeth were more likely to have orofacial pain. It is important to include dental care as a part of end-of-life medical treatment.

PRESIDENTIAL SYMPOSIUM: PHYSIOLOGICAL VS. MOLECULAR CLOCKS, STUDIES FROM MICE TO HUMANS Chair: Blanka Rogina
Aging is associated with a functional decline in metabolic, physiological, proliferative, and tissue homeostasis leading to deterioration at the organismal level, and an increased risk for disease and death. Genetic, pharmacological and nutritional interventions have been successfully used to preserve metabolic health, which leads to preserved healthspan and extended longevity. However, the rate at which animals in a population become impaired by age-related frailty and disease is highly variable and several aging clocks that measure different age-modulated processes in the organism are being use as potential markers of the rate of aging. These molecular clocks allow to a more accurate quantification of the biological age of animals. Nevertheless, there is still room for further discussion in terms of the strengths and weaknesses of these biomarkers, in order to probe their biological significance, cellular mechanisms, and epidemiological potential to further explore their long-term benefit of increasing healthspan. This symposium will discuss new approaches to delineate physiological versus molecular clocks based on studies in mice and humans. We will also discuss species-specific metabolic mechanisms based on longitudinal studies in mice, monkeys and humans.

INTEGRATIVE ANALYSIS OF MOLECULAR AND PHYSIOLOGICAL DATA TO QUANTIFY BIOLOGICAL AGING Daniel Belsky, Columbia University Mailman School of Public Health, New York, New York, United States
Development of reliable and valid measurements to quantify biological aging is a critical frontier geroscience. Originating in accumulations of molecular changes, biological aging undermines resilience within cellular networks and organ systems, driving disease, disability, and mortality. Measurements of biological aging have been proposed at several molecular and physiological levels of analysis. But agreement between measures implemented at different levels of analysis is low. The timing at which aging processes manifest at different levels of biological organization may vary, with the result that signs of aging manifest in one level of analysis are not yet observable in another. And different aging processes may be most apparent in different molecular levels of analysis. In midlife humans, aging-related changes are manifest at multiple molecular and physiological levels, making this population ideal for development of measurements that integrate information across levels of analysis to more precisely quantify the state and pace of biological aging.

AGING ACROSS THE LIFESPAN: RETHINKING THE DAVID BARKER HYPOTHESIS
Luigi Ferrucci, National Institute on Aging, Baltimore, Maryland, United States For many years, the scope of geriatric medicine has been the care of older persons affected by multiple disease with the aim of improving their functional status and optimize quality of life. As our knowledge of the mechanisms of aging grows rapidly, it is becoming clear that accomplishing this scope requires taking a life-course perspective. Research have failed to establish a clear-cut distinction between normal aging and pathology leading to the hypothesis that aging is at the root of chronic diseases, and difference in health can be ascribed to different aging rates. Research in model organisms, suggest that aging can be modified with consequent changes on healthspan and longevity. Interventions that modulate aging may ultimately prevent most-age-associated diseases and their consequences. From this perspective, geriatric medicine is the leading and most promising branch of biomedical science. Challenges remain: first, demonstrating that certain interventions slow down the aging rate requires the valid measure of aging, and while many tools were developed, "epigenetic clocks" being the most promising, the underline mechanism that drive their changes with aging and validity in clinical applications are unclear. We do not know whether variability in the rate of biological aging assessed in old age are already detectable in younger individuals and person-specific rates remain constant during life. In 1986, David Barker stated the hypothesis that the period of gestation, characterized by a strong epigenetic imprinting, affects health and wellbeing across life, perhaps by setting the aging rate. Perhaps pediatric and geriatric medicine are more connected than previously believed.

EVOLUTION OF NATURAL LIFESPAN VARIATION AND MOLECULAR STRATEGIES OF EXTENDED LIFESPAN Alaattin Kaya, Virginia Commonwealth University, Richmond, Virginia, United States
To understand the genetic basis and the selective forces acting on longevity, it is useful to employ ecologically diverse individuals of the same species, widely different in lifespan. This way, we may capture the experiment of Nature that modifies the genotype arriving at different lifespans. Here, we analyzed 76 ecologically diverse wild yeast isolates and discovered wide diversity of lifespan. We sequenced the genomes of these organisms and analyzed how their replicative lifespan is shaped by nutrients and transcriptional and metabolite patterns. By identifying genes, proteins and metabolites that correlate with longevity across these isolates, we found that long-lived strains elevate intermediary metabolites, differentially regulate genes involved in NAD metabolism and adjust control of epigenetic landscape through conserved, rare histone modifier. Our data further offer insights into the evolution and mechanisms by which caloric restriction regulates lifespan by modulating the availability of nutrients without decreasing fitness. Susan Howlett, Dalhousie University, Halifax, Nova Scotia, Canada People age at different rates. This heterogeneity in aging has led to the concept of "frailty", a state of heightened