SHARED DECISION MAKING: A FUNDAMENTAL COMPONENT OF PATIENT-CENTERED CARE FOR DENTAL PATIENTS.

The rapidly growing population of older adults (≥ 65 years old) puts major pressure on the healthcare system []. Older adults are at higher risk of chronic diseases, including gastrointestinal (GI) disorders [, ]. Maintaining a well-functioning gut has been recognized as an important part of overall health and quality of life in this age group []. The ageing process is associated with several alterations along the GI tract that may negatively affect its function and increase the risk of GI symptoms, such as abdominal pain and constipation [, ]. Emerging evidence also suggests that advancing age is associated with loss of beneficial gut microbes and gut-related metabolites, including short-chain fatty acids (SCFAs), resulting in dysbiosis of the gut microbiota []. Gut dysbiosis has recently been associated with impaired gut barrier integrity, which may result in harmful substances entering the bloodstream, potentially triggering systemic low-grade inflammation, known as “” []. Inflammaging is characterized by elevated levels of pro-inflammatory markers suggested to contribute to an unhealthy ageing process []. There is a substantial variation in the prevalence of GI symptoms in community-dwelling older adults when comparing findings from different countries [, ]. The identification of GI symptoms in older adults also remains challenging. However, it is well recognized for its multifactorial aetiology, including low dietary fibre intake, lack of physical activity, and use of medications, as well as disturbances in swallowing function, reduced gastric emptying, and loss of colon motility []. Additionally, overweight, obesity and female gender have been associated with increased risk of GI symptoms []. It has also been demonstrated that alterations in the concentrations of SCFAs, produced by the gut microbiota, might influence GI health and increase the risk of disorders of gut-brain interaction, including irritable bowel syndrome (IBS) []. IBS is diagnosed based on symptom-based criteria (Rome criteria) and characterized by chronic relapsing abdominal pain associated with altered bowel habits, without any organic lesions []. The global prevalence ranges from 3.8–9.2% in the general population, depending on criteria used []. To date, few studies have assessed the prevalence of IBS in older adults [], and to the best of our knowledge, no study have used the latest Rome criteria (Rome IV). The association between dietary intake and GI symptoms is widely accepted, and more than two out of three individuals with IBS report postprandial exacerbation of GI symptoms after a meal []. Notably, dietary intake is one of the major factors that influence the levels of the SCFAs []. The SCFAs are suggested to promote the gut barrier function and to have anti-inflammatory effects, indicating that they are key players in maintaining GI homeostasis []. To date, we have limited knowledge about the concentrations of faecal SCFAs in older adults []. Identifying how faecal SCFAs, dietary factors, and BMI relate to GI symptoms and IBS could be a future target for preventive and therapeutic intervention to promote gut health in the older population [].