Did you know oral candidiasis, a fungal infection in the mouth, is more prevalent in older people? This condition is commonly known as oral thrush and is characterised by a white patch on the tongue. It is caused by Candida, often referred to as 'white fungus'. We spoke to our expert Dr Dhiraj Bhattad, Consultant - Internal Medicine, Sir HN Reliance Foundation Hospital, Girgaon, Mumbai, who explained the causes of oral candidiasis in older people.
Causes Of Oral Candidiasis In Older People
According to a 2023 study, oral candidiasis usually arises due to immune suppression, which can be either local or systemic. This contains factors, such as age extremes (both newborns and the elderly), immunocompromising conditions like HIV/AIDS, and prolonged use of systemic steroids and antibiotics.
According to StatPearls, oral thrush can last for months or even years without treatment. In individuals with very weakened immune systems, the fungi might invade deeper tissues and potentially cause severe complications like sepsis, though such occurrences are rare.
Immunosenescence
“As people age, their immune system weakens, reducing their ability to control Candida growth in the oral cavity. This weakened immune response allows the yeast to proliferate, leading to infection,” said Dr Bhattad.
Comorbidities
Elderly individuals often have higher rates of diabetes and cancer. Diabetes, in particular, increases the likelihood of Candida infections due to elevated blood sugar levels that promote yeast growth. Cancer and its treatments, such as chemotherapy, can also weaken the immune system, further predisposing individuals to oral candidiasis.
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Polypharmacy
The elderly frequently take multiple medications, which can alter the oral environment, making it more favourable for Candida growth. “Antibiotics, for example, disrupt normal oral flora, reducing competition for Candida and facilitating its overgrowth. Corticosteroids, commonly used for chronic conditions in the elderly, can suppress immune function, increasing susceptibility to fungal infections,” said Dr Bhattad.
Poor Oral Hygiene
Physical and cognitive impairments in the elderly can hinder proper oral hygiene practices. Reduced dexterity may make it difficult to clean the mouth effectively, leading to plaque buildup and an increased risk of infection.
Cognitive decline can also result in neglect of oral care. Reduced saliva production, a common issue among the elderly, further contributes to the risk of oral candidiasis.
“Medications, such as antihistamines and diuretics, commonly used by seniors, can exacerbate dry mouth, creating an environment conducive to yeast growth. Ill-fitting dentures or inadequate denture hygiene can also promote Candida colonisation,” added Dr Bhattad.
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Nutritional Deficiencies
Elderly individuals often experience nutritional deficiencies due to reduced appetite, chewing difficulties, and changes in dietary habits. “Insufficient intake of essential nutrients weakens the immune system, making the body less capable of fighting infections like oral candidiasis. Malnutrition can also lead to oral mucosal atrophy, increasing susceptibility to Candida colonisation,” said Dr Bhattad.
According to a 2015 study, iron deficiency is the most frequent nutritional deficiency contributing to Candida colonisation, as it weakens the fungistatic effects of transferrin and iron-dependent enzymes. Chronic candidiasis often involves deficiencies in essential fatty acids, folic acid, vitamins A and B6, magnesium, selenium, and zinc.
Bottomline
Dr Bhattad concluded, “Addressing the risk factors of oral thrush in elderly people through improved medical management, adequate nutrition, proper oral hygiene practices, and regular dental care is crucial in reducing the incidence of oral candidiasis among the elderly population.”
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your own professional if you are dealing with any health issues to avoid complications.]