Validation of a Dutch version of the Geriatric Oral Health Assessment Index (GOHAI-NL) in care-dependent and care-independent older people

Psychometric Properties of General Oral Health Assessment Index Across Ages: COSMIN Systematic Review

OBJECTIVES

To systematically review the psychometric properties of the Geriatric Oral Health Assessment Index (GOHAI) across age groups using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

METHODS

Data: English peer-reviewed articles reporting studies of the development, translation, or validation of GOHAI.

SOURCES

PubMed, Web of Science, and EMBASE from Jan 1990 until December 31, 2023. Methodological evaluation: based on COSMIN methodology. The results are presented overall and for 4 age groups (≥60 years, all ages, <60 years, ≤45 years). Structural validity was summarized qualitatively. Internal consistency and reliability were synthesized via random-effects meta-analysis of T-transformed Cronbach α values, and Fisher's Z transformed correlation coefficients. Construct validity and responsiveness were assessed using effect sizes.

RESULTS

Four hundred ninety-seven records were identified, 72 underwent full-text assessment, resulting in 60 included reports. Structural validity was inconsistent across all age groups and overall. Internal consistency was sufficient with overall α = 0.81, and high evidence quality. Test-retest reliability was consistently sufficient across age groups with overall r = 0.84. For construct validity 361 hypotheses were assessed (37.4% for convergent-, 62.6% for known-groups validity). The percentage of confirmed hypotheses in ≥60-years, all ages, <60-years and ≤45-years were 75.5%, 66.7%, 78.9%, and 88.9%, respectively. Responsiveness was not assessed in the <60-years and ≤45-years age groups, leading to indeterminate overall rating with very low evidence quality.

CONCLUSIONS

This review affirms that GOHAI has sufficient psychometric properties as an oral health-related quality of life instrument in various age groups, but its responsiveness is scarcely researched and its utility for individual-level follow-up is limited. The measurement properties of oral health-related quality of life tools must be scrutinized in the changing demands of personalized and value-based dental care. (PROSPERO registration: CRD42022384132).

Dry mouth in patients with a life-limiting condition or frailty: a study protocol for two intervention studies and a nested qualitative sub-study (the Dry mOuth Project, DROP)

BACKGROUND

Despite its prevalent and impactful nature, dry mouth remains an underexposed and undertreated symptom in patients with a life-limiting condition or frailty. The main contributing factors are a lack of awareness and knowledge amongst both healthcare professionals and patients, and a scarcity of effective, evidence-based interventions. In the DRy mOuth Project (DROP), we address these factors by investigating both a non-pharmacological and a pharmacological intervention: a nurse-led patient education program and locally applied pilocarpine.

METHODS

This intervention-based research project consists of two parallel studies. The non-pharmacological study is a cluster non-randomized controlled trial in 228 palliative nursing home and hospital patients, investigating the effect of structured use of guidelines and of patient education on dry mouth symptoms. This intervention, a nurse-led patient education program (the Mouth Education Program, MEP), will be compared to care as usual, the control. The pharmacological study is a double-blind placebo-controlled randomized trial that examines the effect of locally applied pilocarpine drops in 120 patients with dry mouth symptoms. Both studies use the same mixed-methods study design, in which the primary outcome is the clinical response to the intervention at 4 weeks, as measured by a dry mouth severity score (numeric rating scale from 0 to 10). Other outcomes, as measured by questionnaires over a 12-week follow-up period, include durability of the effect, impact on quality of life and, adherence and acceptability of the intervention. In addition, the feasibility and cost-effectiveness are evaluated by means of questionnaires and focus groups with healthcare professionals, and interviews with patients.

DISCUSSION

This study investigates the effectiveness and feasibility of two interventions for dry mouth symptoms in patients with life-limiting conditions or frailty. Due to the large-scale and mixed-method nature of the study, this study will also improve our understanding of dry mouth and its relating factors and of the patients' and healthcare professionals' experiences with symptoms, care and guidelines of dry mouth, including any perceived barriers and facilitators.

TRIAL REGISTRATION

NCT05964959 & NCT05506137.

Psychometric Properties of the Brazilian Version of GOHAI among Community-Dwelling Elderly People

This study assessed the psychometric properties of the Brazilian version of the Geriatric Oral Health Assessment Index (GOHAI). A representative sample of 613 community-dwelling elderly people aged from 65 to 74 years was selected. Sociodemographic data, GOHAI and self-perceived oral health measures were collected. Dental clinical measures were obtained through oral examinations. The dimensional structure and adequacy of components were assessed using Confirmatory Factor Analysis (CFA), inter-item correlations and item-scale correlations. Reliability was evaluated by internal consistency and Intraclass Correlation Coefficients. Correlations between GOHAI scores and self-reported oral health measures were conducted to assess convergent validity. The relationship between dental clinical measures and GOHAI was tested through Poisson Regression to examine discriminant validity. The link between GOHAI items and dimensions was supported by CFA. Item 12 showed a poor factor loading. The inter-item correlations varied from 0.047 to 0.442, and item-scale correlations ranged from 0.305 to 0.612. Cronbach's alpha was 0.704. The test-retest correlation for GOHAI was 0.882. GOHAI scores were correlated by self-rated oral health measures. Poor dental clinical measures were associated with GOHAI. The Brazilian version of GOHAI showed adequate psychometric properties. However, the weak dimensional structure of GOHAI suggests the need to perform cross-cultural adaptation of GOHAI for Brazilian elderly people.

Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study

OBJECTIVES

To assess the oral health of older people who visit the community dental practice from both the dentists' and the patients' perspective.

MATERIALS AND METHODS

In this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI]. Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman's rank correlation coefficient (rho) and an ordinal regression model.

RESULTS

In total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis. Older people's assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication.

CONCLUSIONS AND CLINICAL RELEVANCE

Chronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health. Older patients themselves assess their oral health differently, mostly more positive, than their dentist.

Oral hygiene in patients with motor neuron disease requires attention: A cross-sectional survey study

Aims

Motor Neuron Disease (MND) is a progressive neurodegenerative neuromuscular disease, which can progressively impair arm‐hand function. Needs and barriers of MND patients and their caregivers in performing oral hygiene were studied.

Methods

An online survey was sent to 706 MND patients. The questions of the survey included self‐reliance, self‐reported oral health, and oral hygiene. The oral health‐related quality of life (GOHAI‐NL) and the subjective well‐being (ALSAQ‐5) were also measured.

Results

A total of 259 patients responded (36.7%), of which 71.9% stated not to be informed about the importance of maintaining good oral health by their MND treatment team. Moreover, 40.4% would like to receive help concerning oral hygiene from a dental professional. 19.8% were not satisfied about oral care as conducted by themselves or their caregivers. Patients who do not ask for support with their daily oral care had a significantly worse oral health‐related quality of life compared to patients who do ask for support.

Conclusions

The support for daily oral hygiene of MND patients and their barriers to requesting support needs more attention from both MND‐treatment teams and general dental professionals.

Oral Health and Related Quality of Life in Older People: A Systematic Review and Meta-Analysis

Background

Of the most important implications and complaints in the elderly group of the population, is oral and dental health problems. This study aimed to assess oral health- related quality of life in older people.

Methods

To data collection, databases were searched including PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Central Register of Controlled Trials and scholar google The keywords were "older adults", "Geriatric" Elderly", "Older", "Aged", "Ageing", "Oral health", "Oral hygiene" and "Quality of life", "QOL. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Studies from 1st Jan 2000 to 30^th Jan 2017 were included. Studies were subjected to meta-analysis to calculate indexes, using CMA:2 (Comprehensive Meta-Analysis) software.

Results

Totally, 3707 articles were searched that 48 of them were subjected to the oral and dental health-related quality of life in 59 groups of the elderly population with the mean age of 73.57+6.62 in the 26 countries. The obtained percentage values of dental and oral health were 80.2% (0-60), 14.8% (0-12), 16.4% (0-70), 22% (0-14 or 0-59) and 19.2% (0-196) for GOHAI with the additive method, GOHAI with Simple Count Method, OHIP-14 with the additive method, OHIP-14 with Simple Count method and OHIP-49 with additive method indexes, respectively.

Conclusion

The elderly group of the population had no proper oral health-related quality of life. Regarding the importance and necessity of oral and dental health and its effect on general health care in the target group, it is recommended to improve dental hygiene in the mentioned group of population.

The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review

BACKGROUND

Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties.

METHODS

This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines.

RESULTS

Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria.

CONCLUSIONS

None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.

Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study

OBJECTIVE

The dental and periodontal impact of GH/IGF-1 hypersecretion has been poorly investigated until now. Our aim is to precisely describe the oro-dental state of acromegalic patients and to study the impact of GH/IGF-1 hypersecretion on patients' reported oral health-related quality of life (OHRQoL).

METHODS

After collecting characteristics of their disease, acromegalic patients answered the GOHAI questionnaire assessing their OHRQoL, the AcroQoL questionnaire and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam CT if necessary).

RESULTS

In total, 29 patients aged 59.1 ± 16.0 years were included. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0 ± 7.8. 16/29 patients had a gingivitis and 18/29 a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis was found, probably because the frequency of a protective thick gingival biotype was increased (9/29). No case of generalized gingival hypertrophy or diffuse hypercementosis was observed. According to the Add-GOHAI score, only 8/26 patients had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11/29 patients had bulky oral bony outgrowths (OBO), such as large maxillary or mandibular tori and multiple vestibular exostosis.

CONCLUSIONS

The unsatisfactory OHRQoL reported by acromegalic patients contrasts with a rather good objective oro-dental state and annual oral examination seems relevant in this population. Finally, we report that huge OBO could be helpful signposts for the diagnosis of acromegaly.

Validation of a modified version of the Spanish Geriatric Oral Health Assessment Index (GOHAI-SP) for adults and elder people

Background

The Geriatric Oral Health Assessment Index (GOHAI) was developed and validated in 1990 and translated into Spanish in 1999. Since then, the original version has been used in numerous studies, but it has not been re-evaluated in terms of language in the new generations of older adults. The purpose of this study is to confirm the validity of the Spanish version of the Geriatric Oral Health Assessment Index (GOHAI-SP) after three decades to be used as part of an ongoing field trial.

Methods

The GOHAI-SP was pilot tested in a focus group to confirm linguistic comprehension. A version with minor language changes was administered to individuals with metabolic syndrome aged 55–75 years from one health care district in southern Spain as part of an ongoing field trial (PREDIMED-Plus). Clinical evaluation included assessment of dental and periodontal status. The psychometric properties of the GOHAI-SP were evaluated through stability and internal consistency measures, and concurrent and discriminant validity were assessed.

Results

The new version of the GOHAI-SP was administered to 100 individuals. The application time was reduced by 7 min. The alpha value for reliability was 0.87. The item-scale correlation coefficients ranged from 0.54 to 0.75, and the test–re-test correlation for the total score was 0.75. There were inverse correlations between GOHAI-SP scores and the number of lost teeth and the decayed-missing-filled teeth index (p < 0.001).

Conclusions

The GOHAI-SP questionnaire remains a valid and useful tool to assess oral health-related quality of life in primary health care settings. A linguistic update of the questionnaire brought improvements to the instrument application.

Trial registration

The PREDIMED-Plus trial is registered in the ISRCTN registry with reference number ISRCTN89898870. Registration date: 4th July 2014.

Objective and perceived oral health status of elderly nursing home residents: a local survey in southern France

Objective

The aim of this study was to compare the perceived oral health of elderly persons and the clinical reality of their oral status.

Background

Persons aged over 60 have considerable need for oral health care; a need that increases over time. However, this population appears to be unaware of their state of oral health, and this may be a further obstacle to professional management. We thought it useful to examine the objective and the perceived oral health of these patients. Understanding what may influence their perception can help us to improve their management.

Methods

The data analyzed in this work are the findings of a field survey carried out in elderly nursing home residents. Their objective oral health was evaluated by using two variables: oral profile, determined by clinical examination, and the oral health index determined using the Oral Health Assessment Tool (OHAT). Perceived oral health was evaluated using the various categories and fields of the General Oral Health Assessment Index (GOHAI).

Results

Our clinical study showed a discrepancy between perceived oral health and the clinical reality: although a significant association can be demonstrated between the OHAT and the GOHAI, there are considerable variations. It also appeared that the number of teeth and total edentation considerably influence perceived oral health and that findings vary according to different situations.

Conclusion

Numerous factors influence elderly persons' perception of their true oral health. In order to improve our elders' quality of life, the necessary measures must be taken for the follow-up and regular monitoring of their oral health. At the same time, all possible means should be used and awareness should be raised to improve the health behavior and perception of patients and their entourage.

Cultural adaptation and validation of the Geriatric Oral Health Assessment Index - GOHAI - Colombian version

Objective

This study aims to carry out the cultural adaptation and the validation of the GOHAI scale for the Colombian population.

Methods

Translation process, cultural adaptation, and content and face validity were carried out with a sample of 63 participants as a pretest. The validation counted with a sample of 7,200 subjects, divided into two groups: a work sample (WS) with 3,628 subjects and a confirmatory sample (CS) with 3,572 subjects. Construct, criterion validity and internal consistency were performed for both samples. Test-retest reliability was assessed with a sub-sample of 75 participants.

Results

The GOHAI showed an appropriate face and content validity, the pre-test revealed an understandable questionnaire, the scale showed a unidimensional factorial structure and a Cronbach's Alpha of 0.8. Convergent validity with a self-perception on general health scale pointed to a significant correlation (p= 0.0001), while discriminant validity showed significant differences regarding groups according to age group, skin color, educational level, socio-economic level, healthcare affiliation and self-perception about need of dental prostheses. Gender groups did not show significant differences among groups within either sample. The CS showed similar results, differences existed among factorial structures of 2 and 3 factors, and for discriminant validity, the CS showed statistically significant differences for the Area variable not in the WS. Kendall's test-retest analysis's correlation is 0.85 (p= 0.0000).

Conclusions

The GOHAI scale is valid and reliable enough to be used as a measure of Oral-Health-Related Quality of Life in the Colombian elderly population, also could be applied for other Latin-American populations.

Effectiveness of the implementation project 'Don't forget the mouth!' of community dwelling older people with dementia: a prospective longitudinal single-blind multicentre study protocol (DFTM!)

BACKGROUND

The oral health of community dwelling frail older people is poor, and depends on the oral health care provisions available within their own community. The implementation project 'Don't forget the mouth!' (i.e., the intervention) was created with the aim of maintaining and improving the oral health and the general health of community dwelling frail older people, with education and interdisciplinary collaborations of health care professionals and informal caregivers. Critical scientific assessment of the intervention will be described in this study protocol, focused on community dwelling older people with dementia.

METHODS

This protocol describes a prospective longitudinal single-blind multicentre study, which will take place in 14 towns, each with an intervention and a control group receiving oral health care as usual. Assessment will take place four times during 12 months (i.e., at baseline, after 3, 6, and 12 months). Participants are 65 years and older, community dwelling, and suspected of dementia by their home care worker. The home care organizations will inform, and approach their clients about the study, before the researcher will reach out. The effectiveness of the intervention will be determined with the primary outcome variable 'oral hygiene', assessed through the presence of dental plaque (DP) or dental prosthetic plaque (DPP). The secondary outcome variables are: 'oral health', 'oral health related quality of life', 'oral health care behaviour', 'general health and care dependency', and 'compliance of the health care professionals'.

DISCUSSION

This protocol aims to assess the effectiveness of the implementation project 'Don't forget the mouth!' focused on community dwelling older people with dementia. The strengths of the current study are the national roll-out of the intervention, interdisciplinary collaborations and education, and the scientific evaluation over the course of 12 months. The threats and weaknesses are in the recruitment procedure, and the adherence and compliance of the health care professionals to the project.

TRIAL REGISTRATION

The Netherlands Trail Register NTR6159 .

Oral Health-related Quality of Life among Patients after Complete Denture Rehabilitation: A 12-month Follow-up Study

Introduction:

Complete edentulism is an eventual oral health outcome and results from the combined pathology of dental caries, periodontal disease, or faulty method of rehabilitation due to reduced cost. Complete edentulism has a significant concern and leads to reduced quality of life (QoL) along with impact on general health. However, it has been observed that due to wider and better oral health services globally, edentulism rate is decreasing every decade. Edentulism is directly related to masticatory and nutritional problems, and some authors regard it as a good mortality indicator.

Methodology:

The sample population consisted of 100 individuals comprising 63 males and 37 females who fulfilled the inclusion criteria. Geriatric oral health assessment index (GOHAI) was administered by a single investigator at baseline (preinsertion) and also 6 and 12 months postdenture insertion. Sociodemographic data, including age and gender, were also collected.

Results:

It was observed that the overall oral health-related QoL (OHRQoL) scores of the sample improved significantly at 6 and 12 months postinsertion (P < 0.001) when compared to baseline scores. When GOHAI scores were compared individually for males and females (pre- and post-insertion), it was observed that there was statistically significant improvement in OHRQoL (male – pre = 25.02 ± 1.34 and post-12 months = 8.84 ± 1.26, P < 0.001, female – pre = 25.19 ± 0.88 and post-12 months = 9.05 ± 1.20, P < 0.001) postinsertion of denture in both the groups.

Conclusion:

OHRQoL in patients improved after complete denture rehabilitation. There was an upward shift in score for each item in GOHAI from preinsertion to 6 and 12 months postinsertion of dentures, reflecting improvement in OHRQoL of the sample.

Frequency of Fruit and Vegetable Consumption and the Oral Health-Related Quality of Life among Japanese Elderly: A Cross-Sectional Study from the Kyoto-Kameoka Study

OBJECTIVE

Many previous studies have reported that fruit and vegetable consumption is associated with a reduced risk of various disease, but whether or not their consumption is associated with the oral health-related quality of life (OHRQoL) is unclear. The objective of this study was to examine the association between the frequency of fruit and vegetable consumption and the OHRQoL in elderly subjects by sex.

METHODS

We analyzed cross-sectional data from a population-based Kyoto-Kameoka Study in 2012 of 3112 men and 3439 women (age ≥ 65 years). The frequencies of fruit and vegetable consumption were assessed using a validated food frequency questionnaire. We evaluated the OHRQoL using the General Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems in old adults.

RESULTS

After adjusting for age, body mass index, alcohol, smoking, education, socioeconomic status, history of disease, medication use, mobility disability, and total energy intake, a higher frequency of combined fruit and vegetable consumption showed a significant positive association with the GOHAI score in both men and women (p-trend < 0.001 in both sexes). These associations remained significant after adjustment for poor mastication and denture use (p-trend all < 0.05 in both sexes). We observed a significant positive association even when the frequencies of fruit or vegetable consumption were analyzed separately (all p-trend < 0.05 in both sexes).

CONCLUSIONS

A higher frequency of fruit and/or vegetable consumption independently showed a strong positive association with the OHRQoL in both men and women. Further prospective studies are needed to confirm these findings.

Magnifying the Senescence: Impact of Oral Health on Quality of Life and Daily Performance in Geriatrics: A Cross-Sectional Study

OBJECTIVE

The objective of the study is to study the behavior of the GOHAI as well as the OIDPs as potent measures in oral health related to quality of life in senior citizens.

MATERIALS AND METHODS

An outreach program-based cross-sectional study conducted in Modinagar, Uttar Pradesh, India. A total of 340 study participants aged >60 years were selected from outreach program which were held between January 2017 and April 2017 based on inclusion and exclusion criterion. The dental health status and its influence on the self-perceived value of life was assessed using GOHAI and OIDP index among the participants. The data were estimated using Statistical Package for the Social Sciences version 21.0 (SPSS Inc., Chicago, IL, USA). Chi-square analysis and Pearson correlation were used to test the significance of the independent variables and the distinct the overall oral impact scores in groups with different dental status.

RESULTS

OIDP shows that most of the patients are suffering from eating food (57.74) and speaking clearly (45.96). GOHAI shows that most of the geriatric population with a lowest mean score of 2.12 and 2.13 were difficulty in chewing food and sorrowful with the condition of mouth and teeth. Similarly, a lower number of population of 3.68 had difficulty in swallowing food.

CONCLUSION

The prevalence of OIDPs in this geriatric population was high. Oral impact mainly effect their quality or value of life leading to difficulty in eating and verbal communication.