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Yang Y, Liang L, Cai J, You J, Liao X. Improving oral hygiene for better cognitive health: Interrelationships of oral hygiene habits, oral health status, and cognitive function in older adults. J Adv Nurs 2024; 80:275-286. [PMID: 37403198 DOI: 10.1111/jan.15769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/09/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To explore the interrelationships between oral hygiene habits, oral health status and cognitive function in older adults. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A total of 371 participants (age 76.79 [7.99] years) were enrolled from June 2020 to November 2021 in an aged care facility. METHODS Cognitive function was screened using the mini-mental state examination (MMSE) with adjusted cut-off points for age and education. Periodontal status (Biofilm-Gingival Interface index based on periodontal probing depth and bleeding on probing), dental status (plaque, calculus, and caries), and tooth loss were assessed through full-mouth examination. Oral hygiene habits were based on self- or informant-reporting. RESULTS Poor periodontal status was an associated factor for MCI (OR = 2.89, 95% CI = 1.20-6.95), while multiple tooth loss (OR = 4.90, 95% CI = 1.06 ~ 22.59), brushing teeth less than once a day (OR = 2.88, 95% CI = 1.12 ~ 7.45) and delayed dental visits (OR = 2.45, 95% CI = 1.05 ~ 5.68) were associated factors for cognitive impairment. An indirect effect of brushing teeth ≥2 daily on MMSE score through periodontal status was observed only in older adults without cognitive impairment (Bootstrap-corrected B = 0.17, 95%CI = 0.03 ~ 0.36, SE = 0.08, β = 0.08). CONCLUSIONS AND IMPLICATIONS Adequate toothbrushing might prevent cognitive decline indirectly by improving periodontal health only in older adults without cognitive impairment. Multiple tooth loss, infrequent toothbrushing, and delayed dental visits were associated factors for cognitive impairment. Nursing professionals and health care policymakers should advocate for the improvement of basic oral hygiene in older adults, and provide regular professional oral hygiene care for older adults with cognitive impairment. PATIENT OR PUBLIC CONTRIBUTION The information on oral health habits of this study was based on an interview with the participants or their caregivers during the study period.
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Affiliation(s)
- Yajie Yang
- Nursing Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
- Dental Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lizhu Liang
- Nursing Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jinfen Cai
- Dental Department, the home of aged Guangzhou, Guangzhou, China
| | - Jie You
- Dental Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Liao
- Nursing Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
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Souza EDO, Pedreira LC, Silva RS, Góes RP, Cavaleiro AJBG. Oral hygiene self-care: Concept analysis for the development of a new nursing diagnosis. Int J Nurs Knowl 2023. [PMID: 38044331 DOI: 10.1111/2047-3095.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE This study aims to analyze the concept of oral hygiene self-care and develop a new problem-focused nursing diagnosis (ND) based on the NANDA-I terminology. METHOD A concept analysis was performed based on the Walker and Avant framework, including a scoping review phase according to the Joanna Briggs Institute guidelines. Searches were performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Virtual Health Library, and specific gray literature databases. The development of the diagnostic structure followed the NANDA-I guidelines with a focus on Orem's self-care theory. RESULTS Including 51 studies, the analysis facilitated the formulation of attributes, antecedents, and consequences of oral hygiene self-care. The ND "Oral hygiene self-care deficit" was created and included 17 defining characteristics, 9 related factors, 5 associated conditions, and 5 high-risk populations. Two cases were constructed to illustrate the use of key terms. CONCLUSIONS The conceptual analysis provided insight into the concept of oral hygiene self-care and supported the structure of a new ND. IMPLICATIONS FOR NURSING PRACTICE This study contributes to the implementation of the nursing process by focusing on the identification of individuals with oral hygiene self-care deficit. It will facilitate the promotion of oral health, thereby impacting the individual's quality of life. In addition, it will aid in the development of public policy for the prevention of oral diseases.
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Affiliation(s)
| | - Larissa Chaves Pedreira
- RN, Nursing and Health Graduate Program, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rudval Souza Silva
- RN, Nursing and Health Graduate Program, Federal University of Bahia, Salvador, Bahia, Brazil
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Wang DH, Tsai FT, Tu HF, Yang CC, Hsu ML, Huang LJ, Lin CT, Hsu WE, Lin YC. Profiles of oral microbiome associated with nasogastric tube feeding. J Oral Microbiol 2023; 15:2200898. [PMID: 37063979 PMCID: PMC10101675 DOI: 10.1080/20002297.2023.2200898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Background Dysbiosis of oral microbiome causes chronic diseases including dental caries and periodontitis, which frequently affect older patient populations. Severely disabled individuals with impaired swallowing functions may require nutritional supply via nasogastric (NG) tubes, further impacting their oral condition and possibly microbial composition. However, little is known about the effect of NG tube on oral microbes and its potential ramification. Methods By using 16S rRNA amplicon sequencing, we characterized the tongue microbiome of 27 patients fed with NG tubes and 26 others fed orally. Results The microbial compositions of NG-tube and oral-feeding patients were substantially different, with more Gram-negative aerobes enriched in the presence of NG tube. Specifically, NG-tube patients presented more opportunistic pathogens like Pseudomonas and Corynebacterium associated with pneumonia and lower levels of commensal Streptococcus and Veillonella. Co-occurrence analysis further showed an inverse relationship between commensal and pathogenic species. Conclusion We present a systematic, high-throughput profiling of oral microbiome with regard to long-term NG tube feeding among the older patient population.
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Affiliation(s)
- Ding-Han Wang
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Tzu Tsai
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsi-Feng Tu
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Dentistry, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan
| | - Cheng-Chieh Yang
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Stomatology, Oral & Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Lun Hsu
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Lin-Jack Huang
- Department of Dentistry, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan
| | - Chiu-Tzu Lin
- Department of Dentistry, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan
| | - Wun-Eng Hsu
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yu-Cheng Lin
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- CONTACT Yu-Cheng Lin Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Turnbull N, Cherdsakul P, Chanaboon S, Hughes D, Tudpor K. Tooth Loss, Cognitive Impairment and Fall Risk: A Cross-Sectional Study of Older Adults in Rural Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16015. [PMID: 36498085 PMCID: PMC9735973 DOI: 10.3390/ijerph192316015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Tooth loss is associated with both cognitive impairment and fall risk. However, the relationships between these variables are complex and bidirectional. Observed associations have been reported in separate studies but data on rural-dwelling older adults remain sparse. This cross-sectional study investigated socioeconomic and dental factors affecting cognitive functions, and the association between tooth loss, cognitive functioning, and fall risk. Two hundred and thirty-one rural-dwelling older adults (60−74 years old) were recruited from a single Dental Service Unit. Cognitive function and fall risk were assessed with the Mini-Mental State Examination and the Morse Fall Scale, respectively. Oral examinations were performed by a dentist using the Community Periodontal Index of Treatment Needs form. 38.1%, had >16 tooth loss. Socioeconomic data and health status were obtained from a questionnaire and interviews. Age, Activities of Daily Living (ADL) score, and the number of teeth lost was significantly associated with impaired cognitive function. Chi-square analysis showed that cognitive function was also associated with fall risk. Past research suggests that much cognitive impairment and fall risk is induced by tooth loss. Service planners need to be aware of the complex bidirectional relationships between these variables and give higher priority to dental services that can improve the general health status and social functioning of older rural adults.
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Affiliation(s)
- Niruwan Turnbull
- Faculty of Public Health, Mahasarakham University, Maha Sarakham 44150, Thailand
- Public Health and Environmental Policy in Southeast Asia Research Unit (PHEP-SEA), Mahasarakham University, Maha Sarakham 44150, Thailand
| | | | - Sutin Chanaboon
- Sirindhorn College of Public Health Khon Kaen, Khon Kaen 40000, Thailand
| | - David Hughes
- Faculty of Medicine, Health & Life Science, Swansea University, Swansea SA2 8PP, UK
| | - Kukiat Tudpor
- Faculty of Public Health, Mahasarakham University, Maha Sarakham 44150, Thailand
- Public Health and Environmental Policy in Southeast Asia Research Unit (PHEP-SEA), Mahasarakham University, Maha Sarakham 44150, Thailand
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Memory decline in older individuals predicts an objective indicator of oral health: findings from the Sydney Memory and Ageing Study. BMC Oral Health 2022; 22:93. [PMID: 35346157 PMCID: PMC8962025 DOI: 10.1186/s12903-022-02128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Growing evidence suggests that there is an association between poor oral health and cognitive function in late adulthood. However, most studies to date have relied on cross-sectional research methods that do not permit inferences about the temporality of any association. Moreover, the few longitudinal studies that do exist have typically relied on small samples and quite limited cognitive or oral health assessments. The aim of the present study was therefore designed to provide the first direct evaluation of whether cognitive function is predictive of poor oral health in older adults. Methods This longitudinal research included data from 339 participants aged 70 years or older from The Sydney Memory and Ageing Study (MAS), a large cohort of healthy community-dwelling older adults. Cognitive function was assessed using a battery of tests at baseline (Wave 1) in 2005 and six years later (Wave 4) in 2011. In 2015 (Wave 6), participants were assessed for oral health using the Oral Health Assessment Tool (OHAT), number of functional occluding pairs of natural teeth and sublingual resting saliva pH (SRSpH). Ordinal least squares regression analysis was used to model the effect of cognitive function on total OHAT score, and binomial logistic regression used for SRSpH and occluding pairs of functional teeth. Results Two models were tested. In the partially adjusted model, age, gender and years of education were included. The fully adjusted model additionally included medical conditions, general health, depression, smoking, alcohol consumption, functionality, and dental care utilization. The key finding to emerge was that a six-year change in memory (from Wave 1 to Wave 4) was associated with lower sublingual resting saliva pH at Wave 6 in partially (Odds Ratio (OR) = 0.65) and fully adjusted model (OR = 0.63). Conclusions This longitudinal study provides further evidence that a relationship between cognitive function and oral health exists, and also points to this relationship potentially being bi-directional, as previous evidence suggests. The findings from the study also suggest that older adults who present with greater than normal memory decline at an earlier point in life were more likely to experience poor oral health when this was evaluated at a later time-point, four years later. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02128-y.
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Kc S, Aulakh M, Curtis S, Scambler S, Gallagher JE. Perspectives of community-dwelling older adults with dementia and their carers regarding their oral health practices and care: rapid review. BDJ Open 2021; 7:36. [PMID: 34811365 PMCID: PMC8608883 DOI: 10.1038/s41405-021-00091-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022] Open
Abstract
AIM To review evidence on oral health practices, beliefs/views and experiences of community-dwelling older adults living with dementia, including their carers. MATERIALS AND METHODS A search of key terms across six databases including Pubmed, Web of Science and OVID (Embase, MEDLINE [R] and PsycINFO) and Google Scholar was conducted, supplemented by reference screening. The Mixed Methods Appraisal Tool (MMAT) 2018 was used to assess the methodological quality. RESULTS Eighteen studies reported across 19 papers were included in the review. Papers largely focused on normative needs (n = 13), whilst also reporting oral health-related experiences (n = 2), practices (n = 7), and beliefs/views (n = 9), of community dwellers with dementia. Generally, people living with dementia presented with poor oral and dental health, the exception being one study where dental care was integrated with memory clinic services. Maintenance of oral health focused only on toothbrushing. Overall, people living with dementia have reduced capacity for self-performed oral hygiene and high reliance on caregivers. There was a paucity of evidence on their perceptions of oral health and quality of life, the findings of which were equivocal, with weak evidence suggesting possible difficulty in identifying and communicating their needs. Experiences of accessing dental care, when explored, appear to be system dependent. CONCLUSION There was limited research evidence on oral health-related practices, beliefs/views and experiences of people with dementia. Recommendations for future research are presented.
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Affiliation(s)
- S Kc
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - M Aulakh
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - S Curtis
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - S Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK.
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Severity of Dementia Is Associated with Increased Periodontal Inflamed Surface Area: Home Visit Survey of People with Cognitive Decline Living in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211961. [PMID: 34831719 PMCID: PMC8618461 DOI: 10.3390/ijerph182211961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Abstract
No studies have measured the periodontal inflamed surface area in people with dementia, although periodontal disease is a major health issue in this group. This study aimed to determine the relationship between dementia severity and periodontal inflamed surface area. An interdisciplinary team, including a dentist and psychiatrist, conducted an in-home survey of older people living in the community. This cross-sectional study was designed as part of a larger cohort study. The interdisciplinary team visited 198 individuals with cognitive decline. We surveyed the clinical dementia rating, periodontal inflamed surface area, number of teeth, and other health issues. We used multiple linear regression analysis to assess the 75 people who were able to take part in all the visits. Number of teeth (Beta = 0.479, p < 0.001), clinical dementia rating (Beta = 0.258, p = 0.013), and age (Beta = 0.250, p = 0.017) were independently associated with periodontal inflamed surface area after adjusting for biological sex, depression, diabetes, collagen disease, visual disorder, and osteoporosis medication. To make communities more dementia-friendly, we must protect older people with dementia from developing poor oral health, which may require home visits for dental assessment.
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Cognitive function and oral health in relapsing-remitting multiple sclerosis. Clin Oral Investig 2021; 26:2899-2907. [PMID: 34773142 DOI: 10.1007/s00784-021-04272-1] [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: 08/11/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is often associated with reduced cognitive function, and there is also emerging evidence of a heightened vulnerability to oral health problems. However, although links between cognitive function and oral health have been identified in other special populations, it remains to be established whether this relationship is also evident for people with MS. The aim of this study was to provide the first empirical test of whether there is a relationship between cognitive function and oral health in people diagnosed with relapsing-remitting multiple sclerosis (RRMS). METHODS One hundred and eleven individuals were evaluated: 56 people diagnosed with RRMS and 55 demographically matched healthy controls. All participants completed an objective oral health assessment as well as a standardized battery that assessed six distinct neurocognitive domains. RESULTS Relative to controls, people with RRMS presented with higher rates of decayed teeth and mild gingivitis, and also performed more poorly in three of the six neurocognitive domains assessed (language, complex attention, and executive function). However, for the RRMS group, no associations emerged between oral health with performance on any of the six neurocognitive domains. CONCLUSIONS These data cross-validate previous research which shows people with RRMS are more likely to present with both reduced cognitive function and poorer oral health, but also extends this literature in a meaningful way by additionally showing for the first time that these clinical features are unrelated in RRMS. CLINICAL RELEVANCE The findings emphasize the need for early assessment of both oral health and cognitive function in people with RRMS so that appropriate interventions and support can be put in place for each of these clinical symptoms.
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Gibney JM, Naganathan V, Lim MAWT. Oral health is Essential to the Well-Being of Older People. Am J Geriatr Psychiatry 2021; 29:1053-1057. [PMID: 34246517 DOI: 10.1016/j.jagp.2021.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023]
Abstract
Although the highest attainable standard of health is a fundamental human right, oral health is often not considered an important component of overall health. Older people experience poorer quality of life due to discomfort and uncleanliness of their mouth and there continue to be barriers within health systems that contribute to this poor oral health. This paper advocates for oral health to be considered part of the basic human right to good health care and discusses how stakeholders can collaborate and work together to begin to meet the needs of this population, proposing solutions and recommendations to bring about change.
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Affiliation(s)
- Jennifer Mary Gibney
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, New South Wales, Australia; Nepean Hospital, Sydney, New South Wales, Australia.
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, New South Wales, Australia
| | - Mathew Albert Wei Ting Lim
- Dental Services, Alfred Health, Melbourne, Victoria, Australia; Maxillofacial and Dental Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Mun SJ, Jeon HS, Choi ES, Lee R, Kim SH, Han SY. Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26880. [PMID: 34397904 PMCID: PMC8360428 DOI: 10.1097/md.0000000000026880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.
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Affiliation(s)
- So Jung Mun
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Hyun Sun Jeon
- Department of Dental Hygiene, Yeoju Institute of Technology, Yeoju, Republic of Korea
| | - Eun Sil Choi
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Ree Lee
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sun Young Han
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
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Kumar S, Jha PC, Negi BS, Haidry N, Kulkarni P, Gulati S, Muttu J. Oral Health Status and Treatment Need in Geriatric Patients with Different Degrees of Cognitive Impairment and Dementia: A Cross-Sectional Study. J Family Med Prim Care 2021; 10:2171-2176. [PMID: 34322409 PMCID: PMC8284228 DOI: 10.4103/jfmpc.jfmpc_2481_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background Health can be defined as more than an absence or lack of disease. It is generally related to personal, physical, social, along with spiritual wellness. However, the importance of good health is comparable with a progressive physical and cognitive limitations due to aging and hence, its clear definition is not possible. Hence, most of the important aims or goals in aging are unrelated to finding a cure but rather toward achieving an optimal function. Thus, a healthy aging process that encompasses physical, mental, psychological, and spiritual well-being is always much desired. Aim and Objectives The aim and objective of this study is to assess the oral health status and degree of cognitive impairment along with dementia, if present. Materials and Methods This is a prospective and cross-sectional analysis comprising of 300 study participants of which 150 are males while 150 are females. Cognitive ability is assessed using the Standardized Mini-Mental State Examination (SMMSE) scoring test. A score value lesser than or equal to 23 is considered as low, whereas a score of 24 and above represents normal cognitive abilities. Subjects with low score are selected for the study. Oral health status is assessed by examining a) total numbers of teeth present; b) presence or absence of denture use; and c) capacity for masticatory or chewing ability (recorded as yes or no). Demographic variables parameters include age, gender, and presence of smoking habit. Clinical parameters or variables are analyzed by employing the independent t-test and Chi-square test. Pearson's correlation analysis is used to test a correlation between impairment of cognitive capacity, oral health status, masticatory capability, and use of dentures, if present. Two-tailed t-test is used to derive a P value for significance. Results The total numbers of teeth present are significantly correlated with a lower SMMSE score (R = + 0.56; P = 0.03) while a significant association is noted between ability for mastication and lower SMMSE score (P = 0.05). Conclusion This study concluded that loss of cognition or dementia is closely related to a poor oral health status.
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Affiliation(s)
- Santosh Kumar
- Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
| | - Prakash C Jha
- Department of Dentistry, Nalanda Medical College Hospital Agamkuan, Patna, Bihar, India
| | - Bhupender S Negi
- Department of Dentistry (MDS, Oral Medicine and Radiology, GDC Calicut), Consultant and Dental Surgeon, Shree Balaji Hospital, Kangra, Himachal Pradesh, India
| | - Nazia Haidry
- Private Dental Practitioner, Patna, Bihar, India
| | | | - Saakshi Gulati
- Department of Oral Medicine and Radiology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Jayalakshmi Muttu
- Private Practitioner and Consultant Oral Surgeon Thandalam, Chennai, Tamil Nadu, India
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Balasubramaniam A, Diwakar MKP, Vaitheswaran S, Santhosh Kumar MP, Sushanthi S, Pandiyan I. Determining Association Between Cognitive Function and Oral Health Status among Rural Community Dwelling Geriatrics. J Int Soc Prev Community Dent 2021; 11:281-286. [PMID: 34268190 PMCID: PMC8257007 DOI: 10.4103/jispcd.jispcd_394_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/08/2021] [Accepted: 03/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Numerous prospective studies worldwide investigated the association between oral health status and dementia or cognitive decline. No clear agreement has emerged on the association. This study aimed to determine the association of cognitive function and oral health status among community dwelling geriatrics in rural South India. MATERIALS AND METHODS A cross-sectional study was conducted among community dwelling geriatrics in rural South India by recruiting 211 individuals aged above 60 years. Their cognitive function was assessed using pre-validated community screening instrument for dementia (CSI-D) which has informant and cognitive scale. The data on cognitive function was collected by community health workers in electronic version (Web app). Their oral health status was assessed by World Health Organization (WHO) oral health assessment form in electronic version (Web app). RESULTS From the logistic regression analysis, it was observed that cognitive impairment showed an association with 1.6- and 1.9-times risk for root caries and a greater number of missing teeth (P ≤ 0.05). No association of other oral health parameters such as gingivitis, periodontitis, dental erosion, and dental trauma with cognitive impairment exhibited. CONCLUSION From the results, it can be concluded that cognitive impairment has an association with root caries and number of missing teeth which increases the risk for the same and vice versa.
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Affiliation(s)
- Arthi Balasubramaniam
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Chennai, India
| | | | - Sridhar Vaitheswaran
- Consultant Psychiatrist, Schizophrenia Research Foundation (SCARF), Chennai, India
| | - M P Santhosh Kumar
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College & Hospital, Chennai, Tamil Nadu, India
| | - S Sushanthi
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Chennai, India
| | - Indumathy Pandiyan
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Chennai, India
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Cinquanta L, Varoni EM, Barbieri C, Sardella A. Patient attitude and habits regarding removable denture home hygiene and correlation with prosthesis cleanliness: A cross-sectional study of elderly Italians. J Prosthet Dent 2021; 125:772.e1-772.e7. [PMID: 33648795 DOI: 10.1016/j.prosdent.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
STATEMENT OF PROBLEM With the aging population, an increasing number of patients will require removable dental prostheses. Despite the recent public efforts to improve oral healthcare, knowledge of hygiene procedures for removable dental prostheses is sparse. PURPOSE The purpose of this cross-sectional study was to determine, through questionnaires, the level of awareness and education of home hygiene procedures among elderly Italian individuals wearing removable dental prostheses and to correlate self-reported hygiene habits and prosthesis cleanliness, as determined by a clinical examination. MATERIAL AND METHODS A cross-sectional study was performed by questionnaires administered by a dental hygienist to patients attending the dental clinics (prosthodontic and periodontology clinical units) at San Paolo Hospital of Milan from January 2014 to October 2015 and who volunteered to participate. The questionnaire included demographic data and oral hygiene habits. Each participant received an intraoral and prosthesis examination performed by the same dental hygienist. The cleanliness of the removable dental prosthesis was classified according to a 3-point scoring system. Categorical variables were expressed as a percentage of study participants and compared by using the χ2 test, while, for the statistical correlations between continuous and categorical variables, the point-biserial correlation calculator was used (α=.05). RESULTS Questionnaires were collected from 161 study participants: 92 women (mean ±standard deviation age: 76 ±7.59 years; range: 65-93 years) and 69 men (mean ±standard deviation age: 74 ±6.31 years; range: 65-86 years). A total of 239 prostheses were considered. A significant correlation was found between older participants, older removable dental prostheses, and reduced prosthesis cleanliness, correlating age ranges of participants as well as of removable dental prostheses with the degrees of prosthesis cleanliness (P=.001 and P=.004, respectively). Half the study participants (n=81; 50.3%) reported prosthesis removal during the night, while the others reported sleeping with the prosthesis in place. Some study participants (n=32; 19.9%) reported that they had never received instructions about how to clean the prosthesis. Mechanical brushing with toothbrush and toothpaste was the most common cleaning method (n=47; 29.2%), while the recommended combined cleaning method based on both mechanical brushing and immersion in dental cleanser was applied by 34 (21.1%) study participants. A similar number (n=25; 15.5%) reported at least 1 episode of denture-related stomatitis. CONCLUSIONS In the analyzed cohort, patient attitude and habits toward home procedures for denture hygiene resulted in poor prosthesis cleanliness. Most individuals used a toothbrush and toothpaste to clean their device, although combining mechanical and chemical cleaning is typically reported to be the optimal method.
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Affiliation(s)
- Lucrezia Cinquanta
- Lecturer on contract, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Elena Maria Varoni
- Associate Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Christian Barbieri
- Lecturer on contract, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Andrea Sardella
- Full Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Cognitive Performance and Its Associations with Dental Caries: Results from the Dental, Oral, Medical Epidemiological (DOME) Records-Based Nationwide Study. BIOLOGY 2021; 10:biology10030178. [PMID: 33670936 PMCID: PMC7997282 DOI: 10.3390/biology10030178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022]
Abstract
Relatively few studies have analyzed the association between cognitive performance and dental status. This study aimed to analyze the association between cognitive performance and dental caries. Included were data from the dental, oral, medical epidemiological (DOME) study; cross-sectional records-based research, which integrated large socio-demographic, medical, and dental databases of a nationally representative sample of young to middle-aged military personnel (N = 131,927, mean age: 21.8 ± 5.9 years, age range: 18-50). The cognitive function of draftees is routinely measured at age 17 years using a battery of psychometric tests termed general intelligence score (GIS). The mean number of decayed teeth exhibited a gradient trend from the lowest (3.14 ± 3.58) to the highest GIS category (1.45 ± 2.19) (odds ratio (OR) lowest versus highest = 5.36 (5.06-5.68), p < 0.001). A similar trend was noted for the other dental parameters. The associations between GIS and decayed teeth persisted even after adjusting for socio-demographic parameters and health-related habits. The adjustments attenuated the OR but did not eliminate it (OR lowest versus highest = 3.75 (3.38-4.16)). The study demonstrates an association between cognitive performance and caries, independent of the socio-demographic and health-related habits that were analyzed. Better allocation of resources is recommended, focusing on populations with impaired cognitive performance in need of dental care.
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Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect. Healthcare (Basel) 2021; 9:healthcare9020226. [PMID: 33670706 PMCID: PMC7922918 DOI: 10.3390/healthcare9020226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.
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16
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Manchery N, Nangle MR, Grainger SA, Haines S, Pradhan A, Rendell PG, Henry JD. Event-Based but Not Time-Based Prospective Memory Is Related to Oral Health in Late Adulthood. Gerontology 2021; 67:112-120. [PMID: 33429388 DOI: 10.1159/000511607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most evidence now indicates that cognitive function is related to poorer oral health in late adulthood, but that this relationship is not invariant across specific cognitive domains. Prospective memory (PM) is a core memory skill that refers to memory for future intentions and is known to be related to the formation of habits such as tooth flossing. However, the relationship between PM and oral health has been subject to only limited empirical study. OBJECTIVE The two studies reported in this paper were designed to test whether PM is related to oral health in older adults of varying vulnerability status. METHODS Study 1 sampled community-dwelling older adults (N = 172) living independently in the community; Study 2 sampled older adults living in a retirement village (N = 32). Participants in both studies were asked to complete a behavioural measure of PM, with their oral health indexed via self-report (Study 1) or an objective oral health exam (Study 2). RESULTS In both studies, relationships emerged between event-based PM and oral health, with Study 2 showing that these relationships were specific to oral health measures of plaque and calculus. CONCLUSIONS Older adults are particularly vulnerable to dental pathology, with important implications for their broader health and well-being. By showing that there is a relationship between oral health and a particular type of PM, this work will have potential implications for the development of more effective interventions focused on enhancing oral health outcomes in this group, such as those focused on strengthening habit formation.
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Affiliation(s)
- Nithin Manchery
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia,
| | - Matthew R Nangle
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah A Grainger
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Haines
- Lincoln Centre for Research on Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Archana Pradhan
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter G Rendell
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Julie D Henry
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Curtis SA, Scambler S, Manthorpe J, Samsi K, Rooney YM, Gallagher JE. Everyday experiences of people living with dementia and their carers relating to oral health and dental care. DEMENTIA 2020; 20:1925-1939. [PMID: 33345612 PMCID: PMC8361472 DOI: 10.1177/1471301220975942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Little is known about how community-dwelling people with dementia, as well as their carers, look after their oral health and use dental care. This exploratory study aimed to explore the beliefs, experiences and practices about oral health of people living with dementia and their carers. We used an ethnographic qualitative approach conducting face-to-face interviews at home with people living with dementia and/or carers. Interview data and field notes were analysed thematically using framework methods. We approached volunteers registered with the online UK. Join Dementia Research network from whom a total of 17 participants were recruited in 2018. Five interviews were conducted with carers alone, two with a person living with dementia alone, and five with a carer and person with dementia jointly. Three main themes emerged: oral health is not prioritised; access to dental care is shaped by increasing disability; and the importance of continuity of care. While people living with dementia and their carers may view oral health important once prompted, many reported difficulties in undertaking or assisting with daily self-care and accessing dental services, particularly as dementia progresses. We draw out implications for the organisation and delivery of public and private dental services.
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Affiliation(s)
- Sarah A Curtis
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, UK
| | - Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce and NIHR Applied Research Collaborative (ARC) South London, The Policy Institute, King's College London, UK
| | - Kritika Samsi
- NIHR Policy Research Unit in Health and Social Care Workforce and NIHR Applied Research Collaborative (ARC) South London, The Policy Institute, King's College London, UK
| | - Yvonne M Rooney
- Department of Community Special Care Dentistry; King's Dental Institute, London, UK; Teddington Community Dental Clinic, London, UK; Kingston Community Dental Clinic, Princess Alexandra Wing, Kingston Hospital, London, UK
| | - Jennifer E Gallagher
- Global Envoy, King's College London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
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Badr F, Sabbah W. Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8523. [PMID: 33212971 PMCID: PMC7698597 DOI: 10.3390/ijerph17228523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022]
Abstract
The growing geriatric population is facing numerous economic challenges and oral health changes. This study explores the relationship between affordability of dental care and untreated root caries among older American adults, and whether that relationship is independent of ethnicity and socioeconomic factors. Data from 1776 adults (65 years or older) who participated in the National Health and Nutrition Examination Survey (NHANES) were analyzed. The association between affordability of dental care and untreated root caries was assessed using logistic regression models. Findings indicated that untreated root caries occurred in 42.5% of those who could not afford dental care, and 14% of those who could afford dental care. Inability to afford dental care remained a statistically significant predictor of untreated root caries in the fully adjusted regression model (odds ratio 2.79, 95% confidence interval: 1.78, 4.39). Other statistically significant predictors were gender (male), infrequent dental visits, and current smoking. The study concludes that the inability to afford dental care was the strongest predictor of untreated root caries among older Americans. The findings highlight the problems with access to and use of much needed dental services by older adults. Policy reform should facilitate access to oral healthcare by providing an alternative coverage for dental care, or by alleviating the financial barrier imposed on older adults.
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Affiliation(s)
- Fatma Badr
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia;
- Faculty of Dentistry, Oral & Craniofacial Sciences, Dental Public Health, King’s College London, Denmark Hill Campus, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London SE5 9RS, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, Dental Public Health, King’s College London, Denmark Hill Campus, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London SE5 9RS, UK
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19
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Aagaard K, Meléndez‐Torres GJ, Overgaard C. Improving oral health in nursing home residents: A process evaluation of a shared oral care intervention. J Clin Nurs 2020; 29:3392-3402. [DOI: 10.1111/jocn.15373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/25/2020] [Accepted: 05/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Karin Aagaard
- Department of Health Science and Technology, Public Health and Epidemiology Group Aalborg University Aalborg Øst Denmark
| | - G. J. Meléndez‐Torres
- Peninsula Technology Assessment Group College of Medicine and Health University of Exeter Exeter England
| | - Charlotte Overgaard
- Department of Health Science and Technology, Public Health and Epidemiology Group Aalborg University Aalborg Øst Denmark
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20
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Schüler IM, Kurtz B, Heinrich-Weltzien R, Lehmann T, Kwetkat A. Testing the ability for autonomous oral hygiene in hospitalized geriatric patients-clinical validation study. Clin Oral Investig 2020; 25:1059-1068. [PMID: 32577831 PMCID: PMC7878223 DOI: 10.1007/s00784-020-03402-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/10/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to evaluate if the Timed Test for Money Counting (TTMC) complemented with testing the range of shoulder motion by griping the backside of the neck (NG) predicts the ability of geriatric inpatients to perform effective plaque reduction by autonomously conducted oral hygiene. MATERIAL AND METHODS This clinical validation study involved 74 hospitalized geriatric inpatients, 48 (64.9%) females, aged between 66 and 98 years (mean age 84.1 years). Oral health status was examined. Dental plaque was assessed with the Turesky modified Quigley-Hein Index (TI) on teeth and the Denture Hygiene Index (DHI) on removable dentures. The performance and duration of TTMC and NG were recorded. After autonomous tooth brushing and denture cleaning by the patient, dental plaque was scored again with the TI and DHI. Geriatric assessment data were collected from medical records. RESULTS Forty-nine (66.2%) geriatric inpatients completed the TTMC&NG successfully. Passing the TTMC&NG was significantly associated with better plaque removal on teeth and dentures by autonomously conducted oral hygiene. The sensitivity of the TTMC&NG for above average plaque reduction was 86.4% on teeth and 77.8% on dentures. The test revealed a negative predictive value of 75.0% to detect below average plaque reduction on teeth and 72.7% on dentures. CONCLUSIONS The TTMC&NG served as a suitable predictor for the ability of geriatric inpatients to perform autonomously effective tooth brushing and denture cleaning. CLINICAL RELEVANCE This simple and short test might help the medical staff to identify geriatric inpatients unable to perform effective oral hygiene by themselves.
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Affiliation(s)
- Ina Manuela Schüler
- Section of Preventive and Pediatric Dentistry, Department of Orthodontics, Jena University Hospital, Bachstraße 18, D -, 07743, Jena, Germany.
| | - Barbara Kurtz
- Section of Preventive and Pediatric Dentistry, Department of Orthodontics, Jena University Hospital, Bachstraße 18, D -, 07743, Jena, Germany
| | - Roswitha Heinrich-Weltzien
- Section of Preventive and Pediatric Dentistry, Department of Orthodontics, Jena University Hospital, Bachstraße 18, D -, 07743, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - Anja Kwetkat
- Department of Geriatric Medicine, Jena University Hospital, Jena, Germany
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21
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Orr ME, Reveles KR, Yeh CK, Young EH, Han X. Can oral health and oral-derived biospecimens predict progression of dementia? Oral Dis 2020; 26:249-258. [PMID: 31541581 PMCID: PMC7031023 DOI: 10.1111/odi.13201] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022]
Abstract
Growing evidence indicates that oral health and brain health are interconnected. Declining cognition and dementia coincide with lack of self‐preservation, including oral hygiene. The oral microbiota plays an important role in maintaining oral health. Emerging evidence suggests a link between oral dysbiosis and cognitive decline in patients with Alzheimer's disease. This review showcases the recent advances connecting oral health and cognitive function during aging and the potential utility of oral‐derived biospecimens to inform on brain health. Collectively, experimental findings indicate that the connection between oral health and cognition cannot be underestimated; moreover, oral biospecimens are abundant and readily obtainable without invasive procedures, which may help inform on cognitive health.
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Affiliation(s)
- Miranda E Orr
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Geriatric Research, Education & Clinical Center and Research Service, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Medicine, UT Health San Antonio, San Antonio, Texas.,Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas.,Gerontology and Geriatric Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, Texas.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas
| | - Chih-Ko Yeh
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Geriatric Research, Education & Clinical Center and Research Service, South Texas Veterans Health Care System, San Antonio, Texas.,Comprehensive Dentistry, School of Dentistry, UT Health San Antonio, San Antonio, Texas
| | - Eric H Young
- College of Pharmacy, The University of Texas at Austin, Austin, Texas.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas
| | - Xianlin Han
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Department of Medicine, UT Health San Antonio, San Antonio, Texas
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22
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Kwan RYC, Kwan CW, Bai X, Chi I. Cachexia and Cognitive Function in the Community-Dwelling Older Adults: Mediation Effects of Oral Health. J Nutr Health Aging 2020; 24:230-236. [PMID: 32003416 DOI: 10.1007/s12603-019-1303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive impairment and poor oral health are common problems in older adults and are associated with malnutrition. However, it is unclear how they are related to cachexia in community-dwelling older adults. The aim of this study was to examine the relationships among cachexia, cognitive function, and oral health in community-dwelling older adults. METHODS This study is a secondary analysis of a data-set. Data were collected in the community setting on older adults who applied for government-funded long-term care services in Hong Kong in 2017. Subjects were community-dwelling and aged ≥60 years. The outcome variable was cachexia. The predictors were cognitive function and oral health. The covariates included demographics and comorbidities associated with cachexia or malnutrition. Path analysis was employed to examine the associations among cachexia, cognitive function, and oral health using the software SAS/STAT and Mplus. RESULTS This analysis included 12,940 subjects. The prevalence of cachexia was 1.3%. Cognitive function was also found to have a direct effect on the oral health indicators of chewing problems (OR=1.073, p<0.001), brushing teeth problems (OR=1.349, p<0.001), and swallowing problems (coeff.=0.177, p<0.001). Oral health indicators with a direct effect on cachexia included dry mouth (OR=1.250, p<0.001), brushing teeth problems (OR = 1.185, p<0.01), and swallowing problems (OR=1.231, p<0.001). Cognitive function had no significant direct effect, but had a significant indirect effect on cachexia (OR=1.100, p<0.001) which is mediated by brushing teeth problems (OR=1.052, p<0.001) and swallowing problems (OR=1.038, p<0.001). CONCLUSION Cognitive impairment causes cachexia indirectly through poor oral health. This study recommends adding cognitive function when screening community-dwelling older adults for cachexia. Health policymakers should stress regular oral health screening and interventions, and encourage increased utilization of oral health services by community-dwelling older adults with cognitive problems.
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Affiliation(s)
- R Y C Kwan
- Professor Iris Chi, 669 W. 34th Street, Los Angeles, CA 90089-0411, , Tel: 1-213-8211360
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Liu W, Chen X, Yuan D, Guo C, Wang Y, Zhang Q, Song D. Dental-related function in individuals with stroke: A confirmatory factor analysis of the dental activities test. SPECIAL CARE IN DENTISTRY 2019; 40:71-78. [PMID: 31858622 DOI: 10.1111/scd.12438] [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: 07/23/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
Abstract
AIMS The dental activities test (DAT), designed to assess individuals' ability to perform oral health-related activities, was initially tested among 90 assisted living residents with normal to severely impaired cognition. This study aimed to examine the reliability (internal consistency), convergent validity, and structural validity of DAT among individuals with stroke. METHODS AND RESULTS This study was a secondary analysis of data collected for a cross-sectional study that aimed to understand oral disease patterns among 207 individuals with stroke from three hospitals in China. Convergent validity was examined using Spearman's Correlation coefficient (rs ) for correlation between DAT scores and the assessments of physical function and cognition. Structural validity was examined using Confirmatory Factor Analysis (CFA). The DAT demonstrated good estimates for internal consistency (Kuder Richardson-20 = 0.85, 95% confidence of interval [CI] = 0.82, 0.88), convergent validity (rs range: 0.43-0.61, all P < .001), and good structural validity with a one-factor structure. CONCLUSION Findings supported the reliability and validity of DAT as a unidimensional construct in measuring the ability to perform oral health-related activities in persons with stroke. Further testing among different patient populations and care settings is needed to accumulate evidence and expand the use of the test.
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Affiliation(s)
- Wen Liu
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Xi Chen
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - Dong Yuan
- Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Cui Guo
- Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Yue Wang
- Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Qianqian Zhang
- Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Dandan Song
- Beijing Hospital of Integrated Traditional and Western Medicine, Beijing, China
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Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224558. [PMID: 31752149 PMCID: PMC6888624 DOI: 10.3390/ijerph16224558] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 12/15/2022]
Abstract
Background. The world population is aging. This phenomenon is accompanied by an increase in the number of elderly with dementia, whose oral hygiene care is a challenge. Objective. This paper presents a literature review of oral health status and the need for oral care in people with dementia, as compared to people without dementia and also of the relationship between periodontal disease and cognitive impairment. Methods. A systematic review was conducted in PubMed, CINAHL, and the Cochrane Library. Fifty-six articles met the inclusion criteria and were consequently included for quality assessment and data extraction. Results. No significant differences were found between both groups with regard to the number of present teeth, DMFT Index, edentulousness/use of denture, and orofacial pain. Coronal/root caries and retained roots were more common in people with dementia than in those without dementia. Most of the participants with dementia presented gingival bleeding or inflammation and they suffered from the periodontal disease more than people without dementia. Conclusions. Poor oral health is a common condition among the elderly with dementia. The education process of caregivers might improve the oral health status of people with dementia. Finally, periodontal disease might contribute to the onset or progression of dementia.
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Liu W, Shaw C, Chen X. Dental-related function and oral health in relation to eating performance in assisted living residents with and without cognitive impairment. SPECIAL CARE IN DENTISTRY 2019; 39:497-504. [PMID: 31287185 DOI: 10.1111/scd.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 12/23/2022]
Abstract
AIMS Despite the physiologic relationship, there is a lack of evidence on how dental-related function and oral health impact eating performance. This study aims to examine the association of eating performance with dental-related function and oral health among assisted living residents. METHODS AND RESULTS This study was a secondary analysis of observational data collected from an instrument development study. Participants included 90 residents with normal to severely impaired cognition from three assisted livings. Multilevel mixed-effects ordered logistic models were used. The dependent variable was eating performance measured by the single "eating" item (scored from 0 to 4 on level of dependence). Independent variables were resident age, gender, dental-related function, and oral health. The resident and facility clustering effects accounted for 88% of variance in eating performance, among which 84% was explained by dental-related function and oral health. Eating performance was associated with dental-related function (coefficient = -0.10, 95% CI = -0.19, -0.01, P = .025), and was not associated with other characteristics. CONCLUSION Eating performance is influenced by the complex relationship with dental-related function and oral health. Novel interventions using interdisciplinary partnerships are needed to maintain dental-related function and oral health to optimize eating performance.
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Affiliation(s)
- Wen Liu
- College of Nursing, The University of Iowa, Iowa City, Iowa
| | - Clarissa Shaw
- College of Nursing, The University of Iowa, Iowa City, Iowa
| | - Xi Chen
- Department of Preventive & Community Dentistry, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, Iowa
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Krausch-Hofmann S, De Almeida Mello J, Declerck D, Declercq A, De Lepeleire J, Tran TD, Lesaffre E, Duyck J. The oral health-related section of the interRAI: Evaluation of test content validity by expert rating and assessment of potential reasons for inaccurate assessments based on focus group discussions with caregivers. Gerodontology 2019; 36:382-394. [PMID: 31274218 DOI: 10.1111/ger.12421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/21/2019] [Accepted: 05/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To explore the failure of the oral health-related section of the interRAI (ohr-interRAI), this study investigated test content validity (A.) and reasons for inaccurate assessments (B.). BACKGROUND Poor oral health negatively affects quality of life and is associated with a number of systemic diseases. The interRAI instruments, internationally used for geriatric assessment, should accurately detect oral conditions that require care. Previous research showed that the ohr-interRAI and related precursor versions do not achieve this goal. MATERIALS AND METHODS (A.) A group of 12 experts rated completeness, relevance, clarity of wording and feasibility of the ohr-interRAI. Content validity indices were calculated per item (threshold 0.78). (B.) Focus group discussions with 23 caregivers were organized. A semi-structured question guide made sure that all topics of interest were covered. Qualitative content structuring analysis was applied after transcription. RESULTS (A.) Experts agreed on the relevance of the items on chewing, pain, gingival inflammation and damaged teeth. They regarded none of the items as worded clearly and only prosthesis use and pain were considered to be assessable by untrained caregivers. All experts agreed that the ohr-interRAI was incomplete. (B.) Focus group discussions revealed that in the care environment oral health had low priority. Aspects related to the ohr-interRAI itself and aspects related to the assessment situation impeded the oral health assessment. The approach of the caregivers to complete the ohr-interRAI was inappropriate to accurately detect oral care needs. CONCLUSIONS Findings challenge test content validity of the ohr-interRAI and reveal reasons for inaccurate assessments.
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Affiliation(s)
- Stefanie Krausch-Hofmann
- Department of Oral Health Sciences, KU Leuven Population Studies in Oral Health, Leuven, Belgium
| | | | - Dominique Declerck
- Department of Oral Health Sciences, KU Leuven Population Studies in Oral Health, Leuven, Belgium
| | - Anja Declercq
- Centre for Care Research and Consultancy, KU Leuven LUCAS, Leuven, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven Academic Centre for General Practice, Leuven, Belgium
| | - Trung Dung Tran
- Department of Public Health and Primary Care, KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Emmanuel Lesaffre
- Department of Public Health and Primary Care, KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Biomaterials/BIOMAT, Leuven, Belgium
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Cheng YM, Ping CC, Ho CS, Lan SJ, Hsieh YP. Home-care aides’ self-perception of oral health-care provision competency for community-dwelling older people. Int Dent J 2019; 69:158-164. [DOI: 10.1111/idj.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nangle M, Riches J, Grainger S, Manchery N, Sachdev P, Henry J. Oral Health and Cognitive Function in Older Adults: A Systematic Review. Gerontology 2019; 65:659-672. [DOI: 10.1159/000496730] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
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Chen X, D'Souza V, Yu L. The oral health status of residents with different cognitive and dental-related functions in three North Carolina assisted living facilities. Gerodontology 2019; 36:142-148. [PMID: 30724388 DOI: 10.1111/ger.12391] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 11/03/2018] [Accepted: 12/08/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of the study was to describe the oral health status of persons with different cognition and dental-related functions (DRFs). METHODS The present study was a secondary analysis of data collected for a cross-sectional study of residents in three assisted living facilities in North Carolina. The participants were aged 50 years or older, had normal to severely impaired cognition and spoke English. Upon obtaining informed consent, an oral assessment was completed by a trained geriatric dentist. A research team member who was blind to the oral examination outcomes then used the Minimum Data Set Cognition Scale to assess participants' cognition and the dental activities test to evaluate oral self-care and other DRFs. Descriptive statistics were used to describe the demographic, cognitive, functional and oral health status of the study participants. The impacts of cognitive and functional status on oral health measures were examined using simple linear regression models, negative binomial and zero-inflated negative binomial models. RESULTS A total of 91 long-term residents from three long-term care facilities participated in the study. Oral hygiene and gingival health were significantly associated with cognition (P = 0.056 and P = 0.017, respectively) and DRFs (P = 0.013 and P = 0.008, respectively). Residents with poor cognitive and dental-related function also presented with poor oral hygiene and gingival health. CONCLUSION The study results suggest that oral hygiene and gingival health were significantly associated with cognition and DRFs.
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Affiliation(s)
- Xi Chen
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - Violet D'Souza
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - Lixi Yu
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
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Psychometric Properties of the Dental Activities Test: An Exploratory Factor Analysis in Older Adults with Cognitive Impairment. Behav Neurol 2019; 2018:8625916. [PMID: 30651893 PMCID: PMC6311855 DOI: 10.1155/2018/8625916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/05/2018] [Indexed: 11/17/2022] Open
Abstract
Objective The Dental Activities Test (DAT) was developed to be used by dental, nursing, and other health professionals to assess the ability of persons with dementia to perform oral health-related activities and aid care planning. The instrument was designed as a unitary scale and has excellent internal consistency, test-retest reliability, interrater reliability, and construct validity. This study examines the underlying factor structure of the DAT among older adults in assisted living settings. Methods In a secondary analysis of the data from the original study, the results of testing of 90 older adults with normal to severely impaired cognition from three assisted living communities in North Carolina from March 2013 to February 2014 were studied. An exploratory factor analysis was used to assess the dimensionality of the presumed unitary assessment scale. Results Two-factor structures were explored. A one-factor model demonstrated acceptably mixed model fit, and a two-factor model had good model fit with moderate correlation between the two factors (r = 0.667, p < 0.05). All the items in the one-factor model demonstrated significant factor loadings (loadings ≥ 0.39, all p < 0.05), while the loadings of some items in the two-factor model (nonsignificant or cross-loadings, loadings < 0.40) did not meet the criteria of factor selection. The one-factor structure was preferred based on the criteria of Scree Plot, eigenvalue, and factor interpretability in relation to clinical relevance. Conclusions The study provided preliminary evidence that the Dental Activities Test has a unidimensional construct among older adults with cognitive impairment. It suggested that this instrument can be used as a unitary scale to assess dental-related function in persons with dementia. Future testing, including using a confirmatory factor analysis, in a new sample is needed to further assess the usefulness and psychometric properties of this instrument.
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Chen X, Xie XJ, Yu L. The pathway from cognitive impairment to caries in older adults: A conceptual model. J Am Dent Assoc 2018; 149:967-975. [PMID: 30205901 DOI: 10.1016/j.adaj.2018.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/08/2018] [Accepted: 07/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Caries significantly increases in people with cognitive impairment (PWCI). However, the interrelationships among cognitive impairment, dentally related function (DRF), oral hygiene, and caries remain unclear, increasing difficulties to care appropriately for PWCI. In this study, the researchers tested a conceptual model in which impaired DRF acts as a mediator between cognitive impairment and poor oral hygiene, which then leads to caries. METHODS The researchers recruited 68 older adult dentate participants with normal to severely impaired cognition from 3 assisted-living communities in North Carolina. Within 1 week of a calibrated oral examination performed by a geriatric dentist, a trained examiner blinded to the oral examination results conducted cognitive and functional assessments. The researchers conducted statistical analyses to examine the mediating effect of DRF on the relationship between cognitive impairment and oral hygiene or caries. RESULTS Cognitive impairment (β = 0.05; standard error [SE], 0.02; P = .017) and DRF (β = -0.07; SE, 0.02; P = .005) were significantly associated with oral hygiene. However, the association between cognitive impairment and oral hygiene was greatly reduced and became nonsignificant after controlling for DRF (β = 0.01; SE, 0.03; P = .430), suggesting that the effect of cognitive impairment on oral hygiene was mediated by DRF. DRF accounted for 80% of the total effect of cognitive impairment on oral hygiene. The ratio of the indirect effect to the total effect was .8. Associations between either cognitive impairment or DRF and caries were not significant, but oral hygiene was significantly associated with caries (β = 0.87; SE, 0.28; P < .001). CONCLUSIONS DRF mediated the association between cognitive impairment and oral hygiene. It accounted for 80% of the total impact of cognitive impairment on oral hygiene, which was associated with increased caries in PWCI. PRACTICAL IMPLICATIONS As a result of cognitive impairment, impaired DRF plays a critical role in the pathway from cognitive impairment to oral health decline. Therefore, DRF assessment should be a standard component of geriatric dental assessment. A functionally-tailored oral hygiene intervention is essential to improve oral health for persons with cognitive impairment.
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Effects of tooth loss on brain structure: a voxel-based morphometry study. J Prosthodont Res 2018; 62:337-341. [DOI: 10.1016/j.jpor.2017.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/24/2017] [Accepted: 12/26/2017] [Indexed: 11/18/2022]
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The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents. PLoS One 2018; 13:e0198910. [PMID: 29894494 PMCID: PMC5997339 DOI: 10.1371/journal.pone.0198910] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/29/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess the impact of an oral healthcare program in nursing homes on the initial treatment backlog and residents' oral health stability. MATERIALS AND METHODS The study is a longitudinal cohort study in nursing home residents in Flanders, Belgium, to evaluate the oral healthcare programme Gerodent. The program consisted of: (1) the introduction of an oral healthcare team, (2) oral health education, (3) the implementation of oral health guidelines and protocols, and (4) regular visits of a mobile dental team. Data were extracted from the oral health records of 381 residents from 21 nursing homes who received treatments from the mobile dental team between October 2010 and March 2014 (mean follow-up period of 22.5 months). Oral health and treatment need between baseline and follow-up were compared. RESULTS The mean age at baseline was 82.4 years and the mean number of consultations per resident was 3.61 during the follow-up period. The proportion of residents with an oral treatment need was reduced from 65.9% to 31.3%. Among residents with natural teeth, there was significantly lower prevalence of caries (from 70.5% at baseline to 36.5% at follow-up; p<0.001), residual roots (from 54.2% to 25.1%; p<0.001), and need for fillings (from 31.9% to 17.1%; p<0.001) or extractions (from 64.3% to 31.6%; p<0.001). In the group with partial or full dentures (n = 223), 38.1% needed a repair, rebasing or renewal of their existing dentures at baseline and the respective figure at follow-up was 9.0% (p<0.001). In terms of oral health stability, 53% of the residents had no incident restorative and prosthetic treatment need throughout the follow-up period. A lower number of natural teeth at baseline (p<0.001) and a shorter follow-up period (p = 0.002) were associated with higher chances of oral health stability. CONCLUSION The oral healthcare program Gerodent significantly reduced the treatment backlog and contributed to a considerable proportion of residents being stable in terms of oral health without any incident treatment needs.
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Petti S. Elder neglect-Oral diseases and injuries. Oral Dis 2018; 24:891-899. [PMID: 29029370 DOI: 10.1111/odi.12797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022]
Abstract
Elder neglect (EN) is the failure of a designated caregiver to meet the needs of a dependent older person. World EN prevalence, meta-analyzed in this study, is 1.0% or 1.8% according to different statistical methods. Referring alleged EN cases to Adult Protective Services (APSs) by healthcare workers (HCWs) is mandatory in many countries. However, only few claims are substantiated, as EN could be confused with Self-Neglect, and neglect could be unintentional or due to caregiver unawareness. Screening tools are inaccurate, and their use is discouraged by public health organizations, because they lead to too many false positives, which engulf the already overwhelmed APSs. HCWs need effective tools with objective judgments, which do not hamper the HCW-caregiver-patient rapport and prevent lawsuits when allegations are unfounded. Orofacial EN manifestations (poor oral/denture hygiene, lack of needed/improper dentures, dry mouth, skin/mucosal rashes) are essential Forensic Markers of EN. I classified EN-associated oral diseases according to the unmet needs into four groups: (1) traumatic injuries due to lack of caregiver vigilance (e.g., maxillofacial fractures); (2) diseases due to oral hygiene deficiency (e.g., root caries); (3) diseases typical of the elderly with late/no diagnosis (e.g., oral cancer); and (4) diseases typical of the elderly exacerbated by psychological distress (e.g., oral lichen planus).
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Affiliation(s)
- S Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues. Clin Oral Investig 2018; 22:93-108. [PMID: 29143189 PMCID: PMC5748411 DOI: 10.1007/s00784-017-2264-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. OBJECTIVE To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues. METHODS A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list. RESULTS The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia. CONCLUSIONS The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow. SCIENTIFIC RATIONALE FOR STUDY With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia. PRINCIPAL FINDINGS Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow. PRACTICAL IMPLICATIONS The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.
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Affiliation(s)
- Suzanne Delwel
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Faculty of Medicine, Department of Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands
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The Effect of Number of Teeth and Chewing Ability on Cognitive Function of Elderly in UAE: A Pilot Study. Int J Dent 2017; 2017:5732748. [PMID: 29348749 PMCID: PMC5734010 DOI: 10.1155/2017/5732748] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/16/2017] [Accepted: 09/24/2017] [Indexed: 12/31/2022] Open
Abstract
Cognitive decline is one of the major causes of disability among the aging population. The aim of this study was to explore the relationship between oral health parameters (number of teeth, chewing ability, and presence of a denture) and cognitive function in the elderly across the UAE. Fifty persons (age ≥ 60; 71.26 ± 10.23) were enrolled in the study. Cognitive status was assessed using the standardized mini-mental state examination (SMMSE) and accordingly, cognitively normal subjects scoring ≥24 were considered as the control group and cognitively impaired individuals scoring ≤23 were considered as the low scoring group. Chewing ability was examined, number of teeth was noted, and demographical data was collected. The results of this pilot study showed that individuals with low SMMSE scores were significantly less educated (P < 0.01) and had fewer number of remaining teeth (P < 0.05) and impaired chewing ability (P < 0.05). These results demonstrate a significant link between the number of teeth, chewing ability, and cognitive function. However, this pilot study had its limitations and was the first of its kind in the UAE and Gulf region; therefore, future research addressing the limitations is needed to further explore this association.
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Steel BJ. Oral hygiene and mouth care for older people in acute hospitals: part 1. Nurs Older People 2017; 29:26-31. [PMID: 29124917 DOI: 10.7748/nop.2017.e947a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 12/24/2022]
Abstract
The oral health of older people in acute hospitals has rarely been studied. Hospital admission provides a prime opportunity for identification and rectification of problems, and oral health promotion. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presents the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. Searches of electronic databases and the websites of relevant professional health service bodies in the UK were undertaken to identify articles and guidelines. The literature shows a high prevalence of oro-dental disease in this population, with many known detrimental effects, combined with suboptimal oral hygiene and mouth care provision in acute hospitals. Several guidelines exist, although the emphasis on oral health is weaker than other aspects of hospital care. Older adults admitted to acute hospitals have a high burden of oro-dental disease and oral and mouth care needs, but care provision tends to be suboptimal. The literature is growing, but this area is still relatively neglected. Great potential exists to develop oral and mouth care in this context. The second part of this article explores clinical recommendations.
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Affiliation(s)
- Ben J Steel
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
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Almomani FM, Bani-issa W. The incidence of depression among residents of assisted living: prevalence and related risk factors. Clin Interv Aging 2017; 12:1645-1653. [PMID: 29070943 PMCID: PMC5640406 DOI: 10.2147/cia.s147436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study aims to recognize and estimate the prevalence of depression and its risk factors among residents of assisted living facilities (ALs) in Jordan. BACKGROUND Depression is commonly experienced by residents of ALs. The condition is, however, often misunderstood as a part of normal aging and may be overlooked by health care professionals. Little is known about the extent of depression and its risk factors among AL residents in Jordan. SUBJECTS AND METHODS A national representative sample of 221 residents selected from all AL units across Jordan was recruited to the study. Data on expected risk factors for depression were collected, including sociodemographics; smoking status; number of roommates; number of family members; assessments for cognitive functioning, for lower limb functioning, for hand, shoulder, and arm impairments; and oral health status. Levels of depression among the sample respondents were also assessed. RESULTS The study found that around 60% of the participants reported depressive manifestations, with 48.0% of AL residents exhibiting impaired cognitive functions, one-third (33.2%) having >50% upper limb disability, two-thirds (63.2%) being at moderate risk of falls, and 69.7% having fair to poor oral health status. Being female, and having a higher level of education, disability of the upper limbs, and impairment of cognitive functions were found to be independent risk factors for depression in participants. CONCLUSION Depression is relatively common among residents of AL units in Jordan. Health care professionals, nurses, physiotherapists, and dentists working in these facilities need to work cooperatively to identify the manifestations of depression in residents and collaboratively implement the best practice in the treatment of depression and circumvent its long-term impacts on the health of residents.
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Affiliation(s)
- Fidaa M Almomani
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan Bani-issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Fereshtehnejad SM, Garcia-Ptacek S, Religa D, Holmer J, Buhlin K, Eriksdotter M, Sandborgh-Englund G. Dental care utilization in patients with different types of dementia: A longitudinal nationwide study of 58,037 individuals. Alzheimers Dement 2017; 14:10-19. [DOI: 10.1016/j.jalz.2017.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/10/2017] [Accepted: 05/14/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Neurology and Neurosurgery; McGill University; Montreal QC Canada
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Internal Medicine; Section for Neurology; Södersjukhuset Stockholm Sweden
| | - Dorota Religa
- Department of Geriatric Medicine; Karolinska University Hospital; Stockholm Sweden
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
| | - Jacob Holmer
- Division of Periodontology, Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Kåre Buhlin
- Division of Periodontology, Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Geriatric Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Gunilla Sandborgh-Englund
- Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
- Academic Center for Geriatric Dentistry; Stockholm Sweden
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Tiisanoja A, Syrjälä AM, Komulainen K, Hartikainen S, Taipale H, Knuuttila M, Ylöstalo P. The association of medications with sedative properties with oral health behaviour in community-dwelling older people. Int J Dent Hyg 2017; 16:e17-e22. [PMID: 28467020 DOI: 10.1111/idh.12285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether drugs with sedative properties are related to oral health behaviour-such as frequency of toothbrushing, using toothpaste and dental visits-and oral hygiene, measured by the number of teeth with dental plaque, among community-dwelling older people. METHODS The study population consisted of 159 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study (Geriatric Multidisciplinary Strategy for the Good Care of Older People study). The data were collected by interviews and clinical examinations during 2004-2005. Sedative properties of drugs were assessed using the sedative load (SL) model. Logistic and Poisson regression models were used to estimate odds ratios/relative risks (OR/RR) and 95% confidence intervals (CI). RESULTS After adjusting for confounding factors, SL associated with infrequent toothbrushing (OR 1.72, CI: 0.61-4.89), toothpaste use less than twice a day (OR 3.34, CI: 1.39-8.12), non-regular dental visits (OR 2.28 CI: 0.91-5.30) and the number of teeth with dental plaque (RR 1.20 CI: 1.04-1.39) compared to participants without a SL. CONCLUSIONS The results of this study suggest that use of drugs with sedative properties indicates poor oral health behaviour among older people.
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Affiliation(s)
- A Tiisanoja
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - A-M Syrjälä
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Dental Training Clinic, Social and Health services, Oulu, Finland
| | - K Komulainen
- Social and Health Centre of Kuopio, Kuopio, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - S Hartikainen
- Kuopio Research Center of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - H Taipale
- Kuopio Research Center of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - M Knuuttila
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P Ylöstalo
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
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Chen X, Zimmerman S, Potter GG, Sloane PD, Cohen LW, Reed D. Assessment of Dentally Related Function in Individuals with Cognitive Impairment: The Dental Activities Test. J Am Geriatr Soc 2017; 65:580-585. [PMID: 28152161 DOI: 10.1111/jgs.14772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To develop and validate the Dental Activities Test (DAT), a clinical tool for measuring dentally related function in cognitively impaired older adults. DESIGN Cross-sectional study design. SETTING Three assisted living residences in North Carolina. PARTICIPANTS Assisted living residents with normal to impaired cognition aged 50 and older; not blind, deaf, or severely physically disabled; and English speaking (N = 90). MEASUREMENTS Items for the DAT were developed based on focus group discussions, literature review, and clinical relevance. Cronbach alpha, interrater reliability, and test-retest reliability were examined, and construct validity was assessed in relation to correlations with cognitive and functional assessments. Correlations between the DAT and oral health measures were also analyzed to evaluate the concurrent validity of the DAT. RESULTS The DAT has excellent internal consistency reliability (Cronbach alpha 0.90), test-retest reliability (correlation coefficient (r) = 0.84), and interrater reliability (r = 0.90). In terms of construct validity, higher DAT scores were significantly associated with better cognitive function, as well as better activity of daily living and instrumental activity of daily living function. Finally, the DAT was significantly associated with oral hygiene and gingival health. CONCLUSION The DAT is a reliable and valid instrument to measure dentally-related function in older adults with cognitive impairment.
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Affiliation(s)
- Xi Chen
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, Iowa
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.,School of Social Work, University of North Carolina, Chapel Hill, North Carolina
| | - Guy G Potter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.,Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren W Cohen
- Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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Warmling AMF, Santos SMAD, Mello ALSFD. Home-based oral healthcare strategies of elderly people with Alzheimer's disease. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.160026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify strategies used in the oral health care of elderly persons with Alzheimer's disease in the home. Method: an exploratory, descriptive study with a qualitative approach to collecting and analyzing data was performed. Data was collected through interviews with 30 caregivers and analyzed by the content analysis technique. Results: The majority of subjects were female, daughters of the elderly person, university graduates and aged 32-77 years. The strategies identified were grouped into categories according to the participation of the caregiver: does not participate in care actions or oral health assessments; reminds the elderly person about oral hygiene, demonstrates movements and assists with some procedures; directly carries out actions of care. Conclusion: The strategies employed are related to the degree of dependence of the elderly person, as the caregiver acts based on the need for oral health care and the difficulties in carrying out such care.
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Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F. Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues. Clin Oral Investig 2016; 21:17-32. [PMID: 27631597 PMCID: PMC5203832 DOI: 10.1007/s00784-016-1934-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/03/2016] [Indexed: 01/04/2023]
Abstract
Objective The aim of this review was to provide a systematic overview including a quality assessment of studies about oral health and orofacial pain in older people with dementia, compared to older people without dementia. Methods A systematic literature search was performed in PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. The quality assessment of the included articles was performed using the Newcastle-Ottawa Scale (NOS). Results The search yielded 527 articles, of which 37 were included for the quality assessment and quantitative overview. The median NOS score of the included studies was 5, and the mean was 4.9 (SD 2.2). The heterogeneity between the studies was considered too large to perform a meta-analysis. An equivalent prevalence of orofacial pain, number of teeth present, decayed missing filled teeth index, edentulousness percentage, and denture use was found for both groups. However, the presence of caries and retained roots was higher in older people with dementia than in those without. Conclusions Older people with dementia have worse oral health, with more retained roots and coronal and root caries, when compared to older people without dementia. Little research focused on orofacial pain in older people with dementia. Clinical relevance The current state of oral health in older people with dementia could be improved with oral care education of caretakers and regular professional dental care.
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Affiliation(s)
- Suzanne Delwel
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands. .,Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology, EMGO+ Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Faculty of Medicine, Department of Elderly Care Medicine, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
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Aguayo C, Nass L. Estereotipos sociales como amenaza a la inserción de adultos mayores. Revisión narrativa. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2013.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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