Oral status and well-being of home delivered meal recipients

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review

Participation in home-delivered meals programs may contribute to the health and independence of older adults living in the community, especially those who are food insecure or those who are making transitions from acute, subacute, and chronic care settings to the home. The purpose of this study was to conduct a comprehensive and systematic review of all studies related to home-delivered meals in order to shed light on the state of the science. A complete review of articles appearing in PubMed using the keyword "Meal" was conducted; and titles, abstracts, and full-texts were screened for relevance. Included in this review are 80 articles. Most studies are descriptive and do not report on outcomes. Frequently reported outcomes included nutritional status based on self-reported dietary intake. Additionally, most studies included in this review are cross-sectional, have a small sample size, and/or are limited to a particular setting or participant population. More rigorous research is needed to (1) gain insight into why so few eligible older adults access home-delivered meals programs, (2) support expansion of home-delivered meals to all eligible older adults, (3) better identify what home-delivered meals models alone and in combination with other services works best and for whom, and (4) better target home-delivered meals programs where and when resources are scarce.

Significant unmet oral health needs of homebound elderly adults

OBJECTIVES

To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health.

DESIGN

Cross-sectional analysis.

SETTING

Participants' homes in New York City.

PARTICIPANTS

Homebound elderly adults (N = 125).

MEASUREMENTS

A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index.

RESULTS

Participants who reported a high level of unmet oral health needs were more likely to be nonwhite, although this effect was not significant in multivariate analysis. Individual medical diagnoses and the presence of multiple comorbidities were not associated with unmet oral health needs.

CONCLUSION

The oral health status of homebound elderly adults was poor regardless of their medical diagnoses. High unmet oral health needs combined with strong desire to receive dental care suggests there is a need to improve access to dental care for this growing population. In addition to improving awareness of geriatricians and primary care providers who care for homebound individuals, the medical community must partner with the dental community to develop home-based programs for older adults.

Oral health status and needs of homebound elderly in an urban home-based primary care service

OBJECTIVES

This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program.

METHODS

Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team.

RESULTS

Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58).

CONCLUSION

Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.

Oral health in Florida nursing homes

OBJECTIVES

The purpose of this study was to measure the oral health and hygiene status among 265 South Florida nursing home residents aged between 45 and 98 years.

METHODS

The oral health and hygiene status of the residents were assessed by noting the presence of calculus, caries, gingivitis, cheilitis, apthous ulcer, dry mouth and red or white lesions.

RESULTS

The incidence of nursing home residents with calculus was 79.6% and the remaining 20.4% were edentulous. More than half of residents had oral problems (50.6%) the commonest was gingivitis (36.6%), followed by caries (26%) and tooth fracture (15.9%). Almost half the residents wore dentures (47.2%). Statistical analysis was conducted using analysis of variance (P-values). Ageing of the residents was statistically correlated to a worsening of oral hygiene status (P<0.0066), absence and presence of one or two dentures (P<0.0034) and a loss of teeth (P<0.0001).

CONCLUSIONS

The ageing of residents is correlated to increasing oral health problems and the loss of teeth. Oral health neglect affects almost all of the nursing home residents. Care providers should receive education and training from dental hygienists to improve the standard of oral hygiene and health of the elderly.

Developing a schedule of normative denture treatment need

OBJECTIVES

The aim of the study is to assess the reliability and validity of a schedule to determine the normative denture treatment needs of older people.

DESIGN

The design used assessed inter-examiner reliability (criterion validity), test-retest reliability, and content and face validity of the schedule.

SETTING

The inter-examiner reliability study took place in a Department of Prosthetic Dentistry, the remainder of the work took place in a community setting.

RESULTS

The results showed that the schedule in terms of an index performed well with reasonable inter-examiner and test-retest reliability. Difficulties however were encountered with regard to subjective judgements about denture quality and design; consequently, there was modest inter-examiner agreement for stability, retention, and occlusal balance.

CONCLUSIONS

The findings from this preliminary work suggest that the schedule may be useful in the assessment of normative denture treatment need in a community setting. Nevertheless more work will be required to obtain further information on the validity of this new assessment measure.

A comparison of the subjective oral health status of older adults from deprived and affluent communities

A comparative study of the subjective oral health status of 60-65-year-old residents was undertaken in two Liverpool electoral wards, Vauxhall, the most deprived, and Woolton, the most affluent in the city. The measuring instrument used was the Subjective Oral Health Status Indicators (SOHSI) questionnaire devised by Locker. The questionnaire was administered by post to random samples of 250 residents from each ward. The main aim of the study was to compare the reported impact of oral conditions on the lives of individuals living in deprived and affluent communities. Responses of 59.6% for the deprived ward and 77.7% for the affluent ward were achieved. The literature suggested that significant differences could be expected between the wards in the reporting of subjective impact. However, significantly greater impact for only one functional sub-scale and one psycho-social sub-scale was reported by residents from the deprived ward. Further analysis of the relationship between impact and socio-demographic variables revealed a strong association between self-reported general health status and the subjective oral health indicators. Finally, a stepwise regression analysis found that pain and chewing problems were the only significant predictors of psycho-social impact. This finding confirms that the individual's socio-economic circumstances are of secondary importance to pain and functional problems in determining the psycho-social effects of oral conditions, as predicted by the conceptual model on which the measuring instrument is based.