Factors associated with negative self-perception of oral health among institutionalized elderly

Wasting syndrome and associated factors in hospitalized older people

Wasting syndrome (WS) is characterized by clinically important unintentional weight loss >5 % in six to 12 months. This syndrome is responsible for a significant portion of hospitalizations throughout the world and is an important indicator of serious diseases, especially in individuals with 60 years of age or older. The aim of the present study was to investigate WS and associated factors in hospitalized older people. An observational cross-sectional study was developed at a university hospital in Brazil with male and female patients ≥60 years of age. WS was considered in the occurrence of unintentional weight loss of 10 % in 12 months, 7.5 % in six months or >5 % in three months. Data were collected on sociodemographic, clinical, lifestyle, nutritional and biochemical characteristics. This study received approval from the local institutional review board and all participants signed a statement of informed consent. The sample was composed of 178 older people with a mean age of 70.0 ± 8.0 years. The prevalence of WS was 45.5 %. WS was associated with the following clinical variables: conservative CKD (p = 0.007), dysphagia (p = 0.035), dementia (p = 0.017), anorexia (p < 0.001), fatigue (p = 0.001), functional dependence (measured using the Barthel Index) (p = 0.001) and medications that cause malabsorption (p = 0.020); the following nutritional variables: body mass index (p < 0.001), low calf circumference (p < 0.001), low muscle strength (p = 0.001), low muscle mass (p < 0.001) and undernourishment or risk of malnutrition (evaluated using the Mini Nutritional Assessment); and the following biochemical variables: high CRP (p = 0.027), hypoalbuminemia (p = 0.005) and anemia (p < 0.001). The prevalence of WS was high among the hospitalized older people in the present sample and was associated with clinical and biochemical aspects as well as all nutritional variables analyzed. In contrast, lifestyle and sociodemographic characteristics were not associated with wasting syndrome.

Association between clinical oral health status and perceived oral health in different age groups

Objective

The perceived oral health refers to the very own perception of a person's oral health (OH). This study aims to explore the association of perceived oral health status (PSR-OHS) with clinically determined OHS in three age groups: young adults, adults and older adults. This study also aims to identify demographic, socio-economic and/or clinical factors that influence PSR-OHS.

Methods

A cross-sectional study was conducted in ten different dental hospitals of Pakistan. The one-way ANOVA test was used to analyze patient's demographic distribution with PSR-OHS and oral functions. The complex sample general linear model was used to determine association between clinical OH and PSR-OHS. Analyses of each age group were conducted separately.

Results

A total of 1,804 outdoor patients participated in the study, out of which 660 were young adults, 685 adults and 459 were older adults. Overall self-perception of all age groups about their oral health was 'good' (mean = 3.71). Female gender and education status were a significant factor in young adults and adults. Family income affected PSR-OHS of only the adult age group. Frequent visit to dental clinic and preventive reason of dental attendance were associated with good PSR-OHS. DMFT score, prosthesis score and periodontal score also affected the PSR-OHS of individuals. Association between PSR-OHS and clinical examination was confirmed by complex general linear model.

Conclusion

There are differences in the perceived oral health status of young adults, adults and older adults. The variables, age, education, family income, DMFT score, prosthesis score and periodontal score directly influence the self-perception of individuals.

Relationship between Knowledge and Attitude toward Oral Function in Middle-Aged and Older Adults

Oral hypofunction is the stage at which recovery can be expected with proper diagnosis, management, and motivation before oral dysfunction occurs. The knowledge and attitude toward oral function can influence the maintenance and improvement of oral function. However, whether middle-aged and older adults with declining oral function have knowledge of their oral function and how this knowledge and their attitude affect their oral function are unclear. Therefore, we aimed to examine (1) the relationship between knowledge and attitude toward oral function and hypofunction in individuals with suspected oral hypofunction and (2) changes in knowledge and attitude toward oral function through evaluation and education. Participants aged ≥50 years were enrolled during their first community dental clinic visit. A questionnaire assessment of knowledge and attitudes before and after oral function evaluation was performed. The oral function was initially assessed with seven criteria: oral hygiene; oral dryness; occlusal force; tongue pressure; tongue-lip motor, masticatory, and swallowing function. Associations between knowledge and attitudes and their changes were statistically analyzed. Fifty-nine participants (93.7%) were unaware of “oral hypofunction.” Associations between knowledge and attitudes and their changes in the negative to positive response groups, from 86.4% and 61.0% to 6.8% and 25.4%, respectively, after oral function evaluation, indicated that participants understood their oral function and the need for training. Middle-aged and older individuals with poor knowledge and attitudes were more likely to have a worse oral function; however, their knowledge and attitudes toward oral function could be improved through oral function assessment and education.

Impact of oral health on nutritional status, self-perception of oral health and quality of life of institutionalized elderly

Background

This study aimed to investigate the influence of oral health on nutritional status, self-perception of oral health and health related quality of life of institutionalized elders.

Material and Methods

A cross-sectional study was conducted with 193 institutionalized elders living in the metropolitan region of João Pessoa (Brazil). The independent variables included were: 1) caries experience (DMFT index and its components); 2) use and need of dental prostheses; and 3) type of edentulism. The dependent variables included were related to nutritional status, self-perception of oral health and health-related quality of life. Data were submitted to a descriptive and comparative analysis, through correlation, association and difference tests, considering a significance level of 5% (p<0.05).

Results

No statistical significant correlations or associations between the oral health status and nutritional status and quality of life were found (p>0.05). Individuals who did not need prosthesis had higher scores for nutritional status. Self-perception of oral health and health-related quality of life did not vary significantly according to the studied variables.

Conclusions

The oral health status has a limited impact on the nutritional status, and does not impact the self-perception of oral health and quality of life of the institutionalized elders. Key words:Nursing homes, oral health, quality of life.

Society of Behavioral Medicine position statement: Society of Behavioral Medicine supports oral cancer early detection by all healthcare providers

In response to the increasing incidence of certain oral and oropharyngeal cancers, the Society of Behavioral Medicine (SBM) calls on healthcare providers and legislators to expand awareness of oral and oropharyngeal cancer risk factors, increase early detection, and support policies that increase utilization of dental services. SBM supports the American Dental Association's 2017 guideline for evaluating potentially malignant oral cavity disorders and makes the following recommendations to healthcare providers and legislators. We encourage healthcare providers and healthcare systems to treat oral exams as a routine part of patient examination; communicate to patients about oral/oropharyngeal cancers and risk factors; encourage HPV vaccination for appropriate patients based on recommendations from the Advisory Committee on Immunization Practices; support avoidance of tobacco use and reduction of alcohol consumption; and follow the current recommendations for evaluating potentially malignant oral cavity lesions. Because greater evidence is needed to inform practice guidelines in the primary care setting, we call for more research in collaborative health and dental services. We encourage legislators to support policies that expand Medicaid to cover adult dental services, increase Medicaid reimbursement for dental services, and require dental care under any modification of, or replacement of, the Affordable Care Act.

Clinical and self-perceived oral health assessment of elderly residents in urban, rural, and institutionalized communities

OBJECTIVES

This study aims to evaluate the self-perception of oral health according to the physical, psychosocial and pain/discomfort dimensions related to clinical conditions and orofacial pain of elderly people living in three different environments.

METHODS

This was an observational, cross-sectional, quantitative study with a population-based approach and nonprobabilistic convenience sampling that included 81 elderly people: 27 resided in institutional homes for elderly individuals, 27 resided in an urban area and 27 resided in a rural area in the interior of Paraíba (PB) in northeastern Brazil.

RESULTS

The Geriatric Oral Health Assessment Index (GOHAI) was used to assess self-perception of oral health, while the Questionnaire for Screening of Patients with Temporomandibular Disorders (QST/TMD) was used to assess the influences of orofacial pain and the biofilm indexes of teeth and prostheses. There was a statistically significant difference in the GOHAI scores among the places of residence, with the worst values associated with the rural area. According to the QST/TMD, the majority of individuals were affected by TMDs, with statistical differences for both sex and income.

CONCLUSION

The biofilm analysis showed a higher incidence of clinical conditions in the rural population. The place of residence also influenced self-perception and the clinical oral health condition of elderly people; the rural population presented the worst results.

Protocol for the evaluation of chewing among older adults

Abstract Objectives : To evaluate the functional and physiological structures of the stomatognathic system of the oral cavity of older adults based on self-perception, comparing the same with a professional clinical evaluation, and investigating the difficulties encountered when chewing. Method : An analytical cross-sectional study with a quantitative approach was conducted with a sample of 53 older adults aged 60 to 90 years. A protocol consisting of three questionnaires was used: a sociodemographic evaluation, a self-perception based interview with 19 questions on the chewing of the older adults and a clinical evaluation containing 30 questions covering aspects of the oral cavity tissue. The self-perception and clinical evaluation scores were compared using the Mann-Whitney test and the proportions observed for each item were compared by the binomial test. Results : It was found that the self-perception of older adults did not correspond to the result of the clinical evaluation. While 31 (58.5%) reported satisfaction with chewing, 16 (30.2%) had high/very high impairment and 14(26.4%) moderate impairment, based on the results of the clinical evaluation found. Conclusion : It was found that the chewing analysis process cannot be exclusively based on the answers provided by the older adults, and assessment proved to be more accurate when combined with a clinical evaluation performed by a professional.

Factors associated with the hospitalization of the elderly: a national study

Abstract Objective :to analyze the factors associated with hospitalization among the Brazilian elderly based on multidimensional methodology. Method: a cross-sectional, quantitative study was performed with data from the National Health Survey (2013) population-based study. The sample was composed of 23,815 individuals over the age of 60 years. Hospitalization was considered the outcome variable and 53 independent variables were included, relating to: sociodemographic characteristics; limitations and illness; difficulties in performing basic and instrumental activities of daily living; use of health services and medical emergencies. Results: it was found that 10% of the elderly were hospitalized in the previous year. This event was related to: a negative self-perception of health (OR = 1.35); stopping performing any of their usual activities due to health reasons (OR = 2.14); difficulty going to the doctor (OR = 1.65) or walking alone (OR = 1.55); a recent search for a site, service or health professional for health-related care (OR = 1.47); increased frequency of annual medical visits (OR = 2.93) and household emergency (OR = 5.40). Conclusion: the results reinforce the fact that multiple factors are associated with the hospitalization of the elderly. The analysis of these associations has the potential to make health professionals and administrators aware of the need to improve health care for the elderly and to assist in the organization and planning of the actions of the entire health service network.

Halitosis and associated factors in institutionalized elderly persons

Abstract Objective: to evaluate the prevalence of halitosis and associated factors in institutionalized elderly persons. Methods: a sectional study was performed with 268 elderly persons from 11 long-term care institutions in Natal in the northeast of Brazil. Data collection included an oral epidemiologic examination and questions about self-perception of oral health, as well as a consultation of medical records and the application of a questionnaire to the directors of the institutions. Halitosis was measured using the organoleptic test. The independent variables were oral, sociodemographic, institutional, general health and functional conditions. Bivariate analysis was performed using the Pearson chi-square test and Fisher's exact test, and the magnitude of effect was verified by the prevalence ratio for the independent variables in relation to the outcome, with a 95% confidence level. Results: the prevalence of halitosis was 26.1%, which was exhaled by the mouth in 98.57% of cases and by the nose in 10% of cases. Prevalence was 43% higher among non-white individuals (p=0.006); 65% higher among those living in non-profit institutions (p=0.039); 52% higher in elderly persons with oriented cognitive status (p=0.047); 41% higher in elderly persons with root caries (p=0.029); 62% higher in those who did not use dentures (p=0.046); 57% lower in edentulous persons (p<0.001); and 73% higher in elderly individuals with tongue biofilm (p=0.001). Conclusion: The occurrence of halitosis in institutionalized elderly persons was similar to other studies, but there was an expressive number of extrabuccal cases and an association with oral health problems, as well as sociodemographic, institutional and functional factors.