Investigating the impact of a community-based geriatric dentistry rotation on oral health literacy and oral hygiene of older adults

Interactions between systemic diseases and oral microbiota shifts in the aging community: A narrative review

As a gateway to general health and a diverse microbial habitat, the oral cavity is colonized by numerous microorganisms such as bacteria, fungi, viruses, and archaea. Oral microbiota plays an essential role in preserving oral health. Besides, the oral cavity also significantly contributes to systemic health. Physiological aging influences all body systems, including the oral microbial inhabitants. The cited effect can cause diseases by forming dysbiotic communities. Since it has been demonstrated that microbial dysbiosis could disturb the symbiosis state between the host and the resident microorganism, shifting the condition toward a more pathogenic one, this study investigated how the oral microbial shifts in aging could associate with the development or progression of systemic diseases in older adults. The current study focused on the interactions between variations in the oral microbiome and prevalent diseases in older adults, including diabetes mellitus, Sjögren's syndrome, rheumatoid arthritis, pulmonary diseases, cardiovascular diseases, oral candidiasis, Parkinson's disease, Alzheimer's disease, and glaucoma. Underlying diseases can dynamically modify the oral ecology and the composition of its resident oral microbiome. Clinical, experimental, and epidemiological research suggests the associations of systemic disorders with bacteremia and inflammation after oral microbial changes in older adults.

Relationship between Cognition, Depression, and Oral health status in Older adults: A longitudinal cross-lagged analysis

BACKGROUND

The world's population is aging increasingly, and older adults' physical and mental health needs to be prioritized. Although several studies have explored the relationship between cognition, depression, and oral health in older adults, the exact nature and direction of this relationship are poorly understood. Moreover, most studies to date have been cross-sectional, with fewer longitudinal studies. The current longitudinal study explored the relationship between cognition, depression, and oral health in older adults.

METHODS

We used data from two waves (2018, 2020) of the Korean Longitudinal Study of Aging, which included 4543 older adults aged 60 years and older. General socio-demographic characteristics were analyzed using descriptive analysis, and study variables were described using t-tests. Generalized Estimating Equations (GEE) and cross-lagged models were used to examine the longitudinal associations between cognition, depression, and oral health.

RESULTS

The GEE results suggested that better cognition and less depression over time were associated with better oral health in older adults. Cross-lagged models further validated the effect of depression on oral health over time.

LIMITATIONS

The directionality of the influence of cognition on oral health could not be determined.

CONCLUSIONS

Although there were several limitations, our study provided novel ideas for verifying the effects of cognition and depression on oral health in older adults.

Using the Behaviour Change Wheel to develop an oral hygiene self-care intervention for Punjabi immigrant adults: an illustrative example

BACKGROUND

This article describes the development of an oral hygiene self-care behaviour change intervention (Safeguard Your Smile [SYS]) for Punjabi immigrant adults, using the Behaviour Change Wheel (BCW) theoretical framework.

METHODS

The 3 stages and 8 steps of the BCW were followed to develop the face-to-face SYS intervention. Identification of the problem in behavioural terms was enabled by referring to the results of a qualitative focus group (FG) previously conducted by the research team. Following the BCW method, the sources of behaviour were defined in terms of capability, opportunity, and motivation. Appropriate intervention functions, policy categories, behaviour change techniques (BCTs), and modes of delivery were then identified, selected, and mapped. Concrete strategies were chosen to bring about the desired oral hygiene self-care behavioural change.

RESULTS

Two main barriers to oral hygiene self-care faced by Punjabi immigrant adults were identified from the original FG: 1) inadequate knowledge and 2) inconsistent daily routine. Oral hygiene self-care behaviour was designated as a target behaviour, detailing frequency, duration, and technique. Five intervention functions (education, training, modelling, environmental restructuring, and enablement) and 2 policy categories (communication and service provision) were identified to influence the capability, opportunity, and motivation related to oral hygiene self-care behaviour. Nine BCTs were selected to influence desired oral hygiene self-care behaviour among adults.

CONCLUSION

The development process for this SYS intervention may be employed by researchers to design a behaviour change intervention for other populations. However, additional strategies tailored to each specific context and population must be incorporated.

Impact of an Interprofessional Health Student Education Program on Older Adult Participants

Training health professional students to work with older adults will improve future workforce capacity to meet growing needs. Additionally, older adults may benefit from health education and interactions with health professional students. We analyzed survey responses from older adults who had participated in an interprofessional health student education program regarding their experiences. Qualitative data were summed and averaged, and quantitative survey data were analyzed with Fisher’s Exact Test. At least 60% of participants reported receiving information for health needs or making changes to physical activity, dental care, or diet. The most significant differences in lifestyle modifications were noted among racial and ethnic minorities and among speakers of different primary languages. 64% of the qualitative responses reflected positive affirmation of the program. Our data suggest that interactions with health students are meaningful experiences for older adults, are associated with healthy habit changes, and reflect demographic differences in response to health education.

Migrant Communities at the Center in Co-design of Health Literacy-Based Innovative Solutions for Non-communicable Diseases Prevention and Risk Reduction: Application of the OPtimising HEalth LIteracy and Access (Ophelia) Process

The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.

Association Between Oral Health Literacy and Number of Remaining Teeth Among the Thai Elderly: A Cross-Sectional Study

Purpose

Limited oral health literacy is associated with poor oral health status. This study aimed to determine the association between oral health literacy (OHL) and the number of remaining teeth (NRT) among Thailand’s older population.

Patients and Methods

This cross-sectional study was conducted between July 1, 2020 and September 30, 2020 at the Subdistrict Health Promoting Hospitals in Panare, Pattani, Thailand. A total of 361 independent-living older adults, male and female, participated in the study. OHL data were obtained using the Thai version of Health Literacy in Dentistry (HeLD‐Th) questionnaire. Trained interviewers performed face-to-face interviews for oral health-related behavior information. The NRT was collected through intraoral examination by a trained examiner. Data were analyzed using SPSS version 22. Mann–Whitney U-tests, chi-square tests, and binary logistic regression analysis were performed. A multivariate logistic regression model was developed to test associations between OHL and NRT and other potential covariates. All analyses were two-sided with a 95% confidence interval.

Results

There were significant associations between limited OHL and fewer than 20 remaining teeth (odds ratio [OR]=1.986, P = 0.018), older age (OR=1.743, P = 0.023), and lower educational levels (OR=2.365, P = 0.007).

Conclusion

The significance of this evidence is that OHL influences NRT among older Thai people who have lower education levels. Therefore, OHL intervention is an essential strategy for better oral health-related behaviors to reduce tooth loss and to improve the oral health status of Thai older adults.

Learning programmes and teaching techniques to enhance oral health literacy or patient-centred communication for healthcare providers: A systematic review

OBJECTIVE

To investigate the learning programmes and teaching techniques used in interventions to enhance oral health literacy (OHL) or patient-centred communication (PCC) for healthcare providers.

MATERIALS AND METHODS

A systematic review of OHL and PCC were obtained from four electronic databases (PubMed, ScienceDirect, ProQuest and Scopus) was undertaken. These searches covered the period from January 2008 to December 2017. The quality assessment tool was the Joanna Briggs Institute Critical Appraisal tool for systematic reviews of effectiveness.

RESULTS

The final review included nine studies amongst a total of 1475 studies. They showed three learning programmes (workshops, training and community-based rotation) and 17 related teaching techniques to promote OHL and PCC. The most commonly used learning programmes to enhance OHL and PCC for healthcare providers were workshops, and the teaching techniques included feedback and reflection. The intervention periods of the programmes took 20 minutes to half a day. The three studies did not have a follow-up, whilst the rest showed a follow-up range of 2 months to 3 years. Interestingly, there was one study, which applied double follow-ups to show the effectiveness of the programme.

CONCLUSION

Either workshops or training programmes with a combination of teaching techniques were effective in terms of enhancing their OHL or PCC. The more frequent follow-up might increase the long-term effectiveness of the learning programme.

Application of the Integrated Behavioral Model to oral self-care behavior of community-dwelling middle-aged and older people in Taiwan

OBJECTIVES

This study evaluated the Integrated Behavioral Model and examined oral self-care behavior of community-dwelling middle-aged and older people.

DESIGN

A cross-sectional design was used.

SAMPLE

Purposive sampling was employed to recruit middle and older age community-dwelling individuals, with research locations in public health centers in northern Taiwan.

MEASUREMENTS

Structured questionnaires comprised: participant demographics, oral health literacy, oral self-care attitude, self-efficacy, intention, and behavior, and significant others' perceptions and beliefs as well as environmental constraints. The Model verification was evaluated by path analysis.

RESULTS

Two hundred and sixty-three participants (N = 263) completed the questionnaire survey. Results identified significant direct effects of the independent variables of oral health care literacy, intention of oral self-care, and perception of environmental constraints on the dependent variable of oral self-care behavior; and significant indirect effects on attitude of oral self-care, perception of significant other beliefs, self-efficacy of oral self-care.

CONCLUSION

Public health nurses work with the whole community and can potentially improve the oral self-care behavior of middle-aged and older adults by enhancing their oral health knowledge, maintaining their positive attitudes, assisting acceptance of recognition and support from others, increasing their ability to perform oral self-care, reducing environmental constraints, and thereby enhancing their oral self-care awareness.

Root canal treatment in elderly patients: A review and clinical considerations

Life expectancy has increased as a result of advancements in health care services; thus, maintaining healthy dentition is an important factor in overall health. Furthermore, the growing desire of elderly patients to maintain their teeth has led to an increased need for the performance of complex dental treatment in elderly patients. Root canal therapy is an essential phase of such treatments. Elderly patients may exhibit one or more systemic conditions that require special care, in addition to other changes that occur within the dentition and oral mucosa as a result of aging. These make root canal treatment in elderly patients a great challenge. The aim of this review was to characterize pathologic and physiologic changes in elderly patients that can interfere with root canal treatment procedures, as well as attitudes of elderly patients toward such treatment, guidelines and clinical considerations for management of root canal treatment in elderly patients.

Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia)

BACKGROUND

The need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof-of-concept was defined as successful application of the principles.

METHODS

Nine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own priorities for improvement; collected health literacy data using the Health Literacy Questionnaire (HLQ) within the identified priority groups; engaged staff in co-design workshops to generate ideas for improvement; developed program-logic models; and implemented their projects using Plan-Do-Study-Act (PDSA) cycles. Evaluation included assessment of impacts on organisations, practitioners and service users, and whether the principles were applied.

RESULTS

Sites undertook co-design workshops involving discussion of service user needs informed by HLQ (n = 813) and interview data. Sites generated between 21 and 78 intervention ideas and then planned their selected interventions through program-logic models. Sites successfully implemented interventions and refined them progressively with PDSA cycles. Interventions generally involved one of four pathways: development of clinician skills and resources for health literacy, engagement of community volunteers to disseminate health promotion messages, direct impact on consumers' health literacy, and redesign of existing services. Evidence of application of the principles was found in all sites.

CONCLUSIONS

The Ophelia approach guided identification of health literacy issues at each participating site and the development and implementation of locally appropriate solutions. The eight principles provided a framework that allowed flexible application of the Ophelia approach and generation of a diverse set of interventions. Changes were observed at organisational, staff, and community member levels. The Ophelia approach can be used to generate health service improvements that enhance health outcomes and address inequity of access to healthcare.

Association of parental health literacy with oral health of Navajo Nation preschoolers

Health literacy is 'the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'. Although numerous studies show a link between health literacy and clinical outcomes, little research has examined the association of health literacy with oral health. No large-scale studies have assessed these relationships among American Indians, a population at risk for limited health literacy and oral health problems. This analysis was conducted as part of a clinical trial aimed at reducing dental decay among preschoolers in the Navajo Nation Head Start program. Using baseline data for 1016 parent-child dyads, we examined the association of parental health literacy with parents' oral health knowledge, attitudes, and behavior, as well as indicators of parental and pediatric oral health. More limited health literacy was associated with lower levels of oral health knowledge, more negative oral health attitudes, and lower levels of adherence to recommended oral health behavior. Parents with more limited health literacy also had significantly worse oral health status (OHS) and reported their children to have significantly worse oral health-related quality of life. These results highlight the importance of oral health promotion interventions that are sensitive to the needs of participants with limited health literacy.

A pilot study to assess oral health literacy by comparing a word recognition and comprehension tool

Background

Oral health literacy is important to oral health outcomes. Very little has been established on comparing word recognition to comprehension in oral health literacy especially in older adults. Our goal was to compare methods to measure oral health literacy in older adults by using the Rapid Estimate of Literacy in Dentistry (REALD-30) tool including word recognition and comprehension and by assessing comprehension of a brochure about dry mouth.

Methods

75 males and 75 females were recruited from the University of Connecticut Dental practice. Participants were English speakers and at least 50 years of age. They were asked to read the REALD-30 words out loud (word recognition) and then define them (comprehension). Each correctly-pronounced and defined word was scored 1 for total REALD-30 word recognition and REALD-30 comprehension scores of 0–30. Participants then read the National Institute of Dental and Craniofacial Research brochure “Dry Mouth” and answered three questions defining dry mouth, causes and treatment. Participants also completed a survey on dental behavior.

Results

Participants scored higher on REALD-30 word recognition with a mean of 22.98 (SD = 5.1) compared to REALD-30 comprehension with a mean of 16.1 (SD = 4.3). The mean score on the brochure comprehension was 5.1 of a possible total of 7 (SD = 1.6). Pearson correlations demonstrated significant associations among the three measures. Multivariate regression showed that females and those with higher education had significantly higher scores on REALD-30 word-recognition, and dry mouth brochure questions. Being white was significantly related to higher REALD-30 recognition and comprehension scores but not to the scores on the brochure.

Conclusions

This pilot study demonstrates the feasibility of using the REALD-30 and a brochure to assess literacy in a University setting among older adults. Participants had higher scores on the word recognition than on comprehension agreeing with other studies that recognition does not imply understanding.

eHealth literacy interventions for older adults: a systematic review of the literature

Background

eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources.

Objective

This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults.

Methods

A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles.

Results

Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design.

Conclusions

Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population.