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[Dental treatment in old age-When and what is indicated?]. Z Gerontol Geriatr 2021; 54:517-528. [PMID: 33900419 DOI: 10.1007/s00391-021-01893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
In the past few years the oral health of seniors has improved and more seniors retain their natural teeth until old age; however, the prevalence of oral diseases among seniors is still very high and a serious problem. Good oral health is, however, relevant for seniors as it influences the chewing function, the nutritional status and general satisfaction. In addition, diseases of the oral cavity show interactions with general health. The current article therefore provides an evidence-based overview of the oral health of seniors and highlights important relationships (nutritional status, oral health-related quality of life, general health). It also gives advice on when dental treatment may be indicated. Furthermore, instruments for assessing oral health, chewing function and oral health-related quality of life are presented and explained.
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Development of a German version of the Oral Health Assessment Tool. Aging Clin Exp Res 2020; 32:165-172. [PMID: 30847843 DOI: 10.1007/s40520-019-01158-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Limited assessment tools for estimating the oral health of nursing home residents are available in the German language. AIMS To develop a German version of the Oral Health Assessment Tool (OHAT) and to evaluate test-retest and inter-examiner reliability in use for the assessment of nursing home residents' oral health by caregivers before and after dental training. METHODS The original English version of the OHAT was translated into German by a forward-backward translation process. Reliability assessments were conducted in a nursing home (n = 18) by independent application of the OHAT by two trained dentists and four professional caregivers. After receiving dental training, the caregivers repeated the OHAT with the same participants. Reliability analyses of single items were performed using Cohen's kappa statistics. Intra-class correlations were compiled to assess reliability of the total scores. T tests were used to compare percentage agreement, and under- and overestimation of findings between a reference dentist and the caregivers before and after the training unit. RESULTS Specificity and sensitivity of the German OHAT were 87% and 86%. Test-retest reliability of the total OHAT score as estimated by the dentists was excellent (ICC 0.910; 95% CI 0.776-0.965). Before training, mean κ values between the reference dentist and caregivers ranged between 0.155 and 0.912, whereas the inter-examiner reliability of most items was only fair. After training, overall agreement between the dentist and the caregivers improved significantly from 62.1 to 83.1% (p < 0.001), as well as satisfying inter-examiner agreement for the single items. CONCLUSIONS The German version of the OHAT is a reliable and valid tool for the assessment of oral health conditions of nursing home residents. When used by caregivers, instruction on the tool and practical training are mandatory to ensure reliable estimations. However, further studies with a larger sample size are encouraged to verify the outcomes of this study.
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Klotz AL, Hassel AJ, Schröder J, Rammelsberg P, Zenthöfer A. Oral health-related quality of life and prosthetic status of nursing home residents with or without dementia. Clin Interv Aging 2017; 12:659-665. [PMID: 28442895 PMCID: PMC5396830 DOI: 10.2147/cia.s125128] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The objective of this cross-sectional study was to evaluate the effect of prosthetic status on the oral health-related quality of life (OHRQoL) of nursing home residents with or without dementia. Methods The study was performed in 14 nursing homes across the federal state of Baden-Württemberg, Germany. All eligible participants were included, and general and medical information and information about their dental and prosthetic statuses were collected. The Geriatric Oral Health Assessment Index (GOHAI) was administered to evaluate OHRQoL. The Mini-Mental State Examination (MMSE) served to classify participants into living or not living with dementia according to the established cutoff value for dementia (MMSE <24). Parametric bivariate statistics and logistic regression models were used to analyze data at P<0.05. Results A total of 169 participants were included in this study. The mean age of the participants was 82.9 years. A total of some 70% of the sample was living with dementia. The mean GOHAI score along the sample was 49.1 (8.3), and 41% of the sample reported substantially compromised OHRQoL (GOHAI <50). OHRQoL was statistically similar for people with or without dementia (P=0.234); objective oral health was also similar in both groups (P>0.05). The number of teeth (odds ratio [OR]: 2.0), the type of prosthetic status (OR: 6.5), and denture-related treatment needs (OR: 2.4) were the major factors significantly affecting OHRQoL (P<0.05). Conclusion The OHRQoL of elderly nursing home residents is substantially compromised. Several prosthetic treatment needs for residents living with or without dementia were identified. Edentulism without tooth replacement and having <5 teeth resulted in an increased risk of substantially compromised OHRQoL. Further studies should be conducted to determine whether improvements in prosthetic status can increase OHRQoL.
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Affiliation(s)
| | | | - Johannes Schröder
- Institute of Gerontology.,Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
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Zenthöfer A, Cabrera T, Rammelsberg P, Hassel AJ. Improving oral health of institutionalized older people with diagnosed dementia. Aging Ment Health 2016; 20:303-8. [PMID: 25677603 DOI: 10.1080/13607863.2015.1008986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Previous research has revealed poor oral hygiene and health among older people suffering from dementia. To evaluate the oral health and denture hygiene of older people with and without dementia, six months after carer have followed a dental education programme. METHOD Ninety-three older people living in four long-term care homes in south-western Germany were included in this longitudinal cohort study. All participants were allocated into two groups on basis of the medical dementia diagnosis extracted from the medical records in the care documentation: suffering from dementia (n = 33) or not (n = 60). For each participant plaque control record, gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN), and denture hygiene index (DHI) were assessed at baseline and six months after carer have followed a dental education programme, and after use of ultrasonic devices for denture cleaning. Differences between all target variables from baseline to follow-up, and between participants with and without dementia, were evaluated by bivariate and multivariate testing. RESULTS In bivariate testing, participants with dementia had a significantly lower DHI (p < 0.001), a lower GBI (p < 0.05), and a lower CPITN (p < 0.01) at follow-up. In participants without dementia, only for DHI (p < 0.001) a significant improvement was observed. In multivariate analyses, the significant association could not be reproduced (p > 0.05). CONCLUSIONS Use of ultrasonic baths can be a successful means for improving denture hygiene among older people in long-term care with and without dementia. Education for carer in order to improve oral hygiene, however, seems to be of minor significance and to be more effective for people with dementia.
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Affiliation(s)
- Andreas Zenthöfer
- a Department of Prosthodontics, Dental School , University of Heidelberg , Heidelberg , Germany
| | - Tomas Cabrera
- a Department of Prosthodontics, Dental School , University of Heidelberg , Heidelberg , Germany
| | - Peter Rammelsberg
- a Department of Prosthodontics, Dental School , University of Heidelberg , Heidelberg , Germany
| | - Alexander Jochen Hassel
- a Department of Prosthodontics, Dental School , University of Heidelberg , Heidelberg , Germany
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Zenthöfer A, Meyer-Kühling I, Hufeland AL, Schröder J, Cabrera T, Baumgart D, Rammelsberg P, Hassel AJ. Carers' education improves oral health of older people suffering from dementia - results of an intervention study. Clin Interv Aging 2016; 11:1755-1762. [PMID: 27942206 PMCID: PMC5137930 DOI: 10.2147/cia.s118330] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of this study was to evaluate the effectiveness of carers’ education on improvements in oral health and denture hygiene of care-dependent and cognitively impaired older people in nursing homes compared to those without intervention. Methods A total of 219 seniors living in 14 nursing homes in southwest Germany (intervention: n=144; control: n=75) were enrolled in this study. For each participant, Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Denture Hygiene Index (DHI) and Community Periodontal Index of Treatment Needs (CPITN) were assessed at baseline and six months following the interventions. In addition, demographic parameters such as age, sex, chronic diseases, permanent medications, level of dependency and cognitive state were recorded. In the intervention homes, education for caregivers was provided and ultrasound baths for denture cleaning were implemented. Changes in the dental target variables PCR, GBI, CPITN and DHI during the six-month study period were compared between subjects in the intervention and the control groups as well as between subjects with and without dementia. Additionally, multivariate models were compiled for each dental index to evaluate possible confounders. Results In the intervention group, PCR and DHI significantly improved during the study period (P<0.001). Oral health and denture hygiene improved likewise in subjects with and without dementia. In the control group, no significant improvements were observed (P>0.05). Conclusion Carers’ education improves oral health of people in nursing homes over a clinically relevant period of time. Implementation of ultrasound baths is a simple and effective measure to improve denture hygiene of both institutionalized elderly people and seniors with dementia and in severe need of care. From a clinical standpoint, it is noteworthy that the respective interventions can be easily implemented in everyday care routine.
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Affiliation(s)
| | - Inga Meyer-Kühling
- Institute of Gerontology, University of Heidelberg; Section of Geriatric Psychiatry, Center of Psychiatry, University of Heidelberg, Heidelberg, Germany
| | | | - Johannes Schröder
- Institute of Gerontology, University of Heidelberg; Section of Geriatric Psychiatry, Center of Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Tomas Cabrera
- Department of Prosthetic Dentistry, University of Heidelberg
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Shiraishi A, Yoshimura Y, Wakabayashi H, Tsuji Y. Poor oral status is associated with rehabilitation outcome in older people. Geriatr Gerontol Int 2016; 17:598-604. [DOI: 10.1111/ggi.12763] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/13/2016] [Accepted: 01/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Ai Shiraishi
- Department of Dental Surgery; Kumamoto Rehabilitation Hospital; Kumamoto Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine; Kumamoto Rehabilitation Hospital; Kumamoto Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
| | - Yuri Tsuji
- Department of Dental Surgery; Kumamoto Rehabilitation Hospital; Kumamoto Japan
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Zenthöfer A, Rammelsberg P, Cabrera T, Schröder J, Hassel AJ. Determinants of oral health-related quality of life of the institutionalized elderly. Psychogeriatrics 2014; 14:247-54. [PMID: 25495087 DOI: 10.1111/psyg.12077] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 08/19/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index (GOHAI). MATERIALS AND METHODS Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini-Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants. RESULTS The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups (P = 0.030) and were affected by care level (P = 0.008) and type of dentures worn (P = 0.006). CONCLUSIONS Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health.
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Affiliation(s)
- Andreas Zenthöfer
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
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Zenthöfer A, Rammelsberg P, Cabrera T, Hassel AJ. Increasing dependency of older people in nursing homes is associated with need for dental treatments. Neuropsychiatr Dis Treat 2014; 10:2285-90. [PMID: 25506220 PMCID: PMC4259561 DOI: 10.2147/ndt.s71184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To determine relationships between the need for dental treatments of institutionalized elderly people and cognitive impairment and the general level of care needed. Two hundred and sixty-eight residents of long-term care facilities in Germany were included in this study. Age, sex, diseases, number of frequently taken drugs, and location of the long-term care facility of the participants were recorded. For each participant, the need for care was assessed by use of the Barthel index (BI). Cognitive impairment was evaluated by use of the mini-mental state examination (MMSE). To assess dental treatment needs, the revised oral assessment guide (ROAG) was applied for different oral health conditions, which were rated "healthy" or "treatment needed". Spearman correlations were performed to evaluate associations between BI and MMSE and dental treatment needs. Statistical analysis revealed significant associations of BI (P<0.001) and MMSE (P=0.015) with the ROAG score. Increasing dependency and decreasing cognitive ability worsen oral health and increase the need for dental treatment.
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Affiliation(s)
- Andreas Zenthöfer
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
| | - Tomas Cabrera
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
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Tannen A, Schütz T, Smoliner C, Dassen T, Lahmann N. Care problems and nursing interventions related to oral intake in German Nursing homes and hospitals: A descriptive mulitcentre study. Int J Nurs Stud 2012; 49:378-85. [DOI: 10.1016/j.ijnurstu.2011.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 09/10/2011] [Accepted: 09/16/2011] [Indexed: 11/26/2022]
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Nitschke I, Majdani M, Sobotta BAJ, Reiber T, Hopfenmüller W. Dental care of frail older people and those caring for them. J Clin Nurs 2010; 19:1882-90. [DOI: 10.1111/j.1365-2702.2009.02996.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jäger S, Köster-Schmidt A, Schade M, Heudorf U. Mundhygiene und Mundgesundheit bei Bewohnern von Altenpflegeheimen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:927-35. [DOI: 10.1007/s00103-009-0940-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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