Oral health and oral health-related quality of life among older adults receiving home health care services: A scoping review

Self-reported oral health and oral health-related quality of life among older adults receiving home care services in South-eastern Norway

OBJECTIVE

To map self-reported oral health status, oral health-related quality of life (OHRQoL), and associated factors among older adults receiving home care services (HCS) in south-eastern Norway.

MATERIAL AND METHODS

For this cross-sectional study, older adult users of HCS, aged ≥ 65 years were interviewed using an interviewer-administered questionnaire. Information about demographics, number of medicines, and Activity of Daily Living (ADL-score) was obtained. Self-reported oral health status and subjective dry mouth (Summated Xerostomia Inventory-Duch version, SXI-D) were assessed. OHRQoL was measured using Oral Health Impact Profile-14 (OHIP-14).

RESULTS

Of 116 participants (mean age 83 years), 52.6% were female. Half of the participants reported missing < 5 of their natural teeth and 6.9% were edentulous. Pain and discomfort were reported by 16.4%, and subjective dry mouth was common (40.7%). Poor oral health status was reported by 8.6%, and experiencing problems or discomfort fairly often or very often was reported by 20.7%. Good self-perceived oral health was reported by 61%. Younger (< 75 years) and less dependent (ADL < 2) individuals and those missing ≥ 5 natural teeth reported a negative impact on OHRQoL more often.

CONCLUSIONS

Half of older adults receiving HCS in Norway retain most of their natural teeth, few are edentulous and xerostomia is common. Younger and less dependent individuals and those missing ≥ 5 natural teeth reported a negative impact on OHRQoL more often.

Assessment of Oral Health-Related Quality of Life of the United Arab Emirates' Elderly Population: Observational Prospective Cross-Sectional Study

Background/Objectives: The current study aimed to evaluate the oral health self-perception on quality of life in the elderly using the Geriatric Oral Health Assessment Index (GOHAI) to assess the impact of demographic and oral health factors on oral health-related quality of life. Methods: An observational prospective cross-sectional study for the entire six-month period was conducted in a dental health care center in the United Arab Emirates. The principal inclusion criterion is being aged 60 and over. The GOHAI questionnaire is composed of 4 domains of 12 items that address functional limitation, pain and discomfort, psychological impacts, and behavioral impacts. Patients were questioned about the frequency at which they experience any of the 12 listed problems. Results: A total of 318 respondents participated in the study and completed the whole questionnaire. Among these participants, 63.5% (n = 202) were male and 86.8% (n = 276) were ≤70 years. The average GOHAI score was 13.25, with a 95% confidence interval (CI) [12.4%, 14%], indicating a low self-perception of oral health by the allocated sample. Statistical modeling identified dry mouth (OR = 2.21, 95% CI 1.40-3.48) and chewing problems (OR = 1.87, 95% CI 1.09-3.20) as the strongest determinants of poor oral health-related quality of life (OHRQoL) in the elderly population. Conclusions: Healthcare professionals should develop targeted strategies to address the specific needs of this population, ensuring sustained improvements in their quality of life.

The Association Between Cognitive Function and Oral Health in Home Dwellers and Nursing Home Residents: The HUNT Study

OBJECTIVES

To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population.

METHODS

This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as 'having oral problem' if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

RESULTS

The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function.

CONCLUSIONS

NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.

Dental caries and related factors in the elderly of the Azar cohort population: A cross-sectional study

OBJECTIVE

Oral health is often overlooked among the elderly due to the numerous comorbidities prevalent in this population. However, oral health significantly influences quality of life by affecting both general health and psychological well-being. The present study aimed to assess dental caries in elderly individuals using the DMFT index (decayed, missing, and filled teeth) and to explore its relationship with various factors based on data from the Azar cohort study in Iran.

MATERIALS AND METHODS

In this cross-sectional study, data from the initial phase of the Azar cohort study, which involved 2629 elderly individuals (aged 60 years and older), were statistically analyzed. The Azar cohort study evaluated demographic factors, the history of chronic diseases, and behavioral habits using a well-designed questionnaire administered through face- to -face interviews. The DMFT index was evaluated through oral examination. A negative binomial regression analysis with a log link function was employed to investigate the relationship between the DMFT and related variables, including gender, age, marital status, level of education, socioeconomic status, chronic diseases, smoking, alcohol consumption, and body mass index.

RESULTS

The mean (SD) age of elderly individuals was 64.15±2.91 years. The mean (SD) DMFT was 28.42±6, and the mean (SD) number of missing teeth was 26.58±8.36. Approximately 70.8% of elderly individuals were edentulous. Women exhibited a higher mean DMFT score and a greater number of missing teeth compared to men. The mean DMFT score and its components significantly differed based on the level of education and socioeconomic status. However, no significant relationship was found between the DMFT index and the variables in the multiple regression analysis.

CONCLUSION

The high prevalence of edentulism and the elevated DMFT scores in the elderly population of the Azar cohort indicate a poor oral health status among older individuals. Providing the dental services within the primary health care system for the adults, can be beneficial in improving oral health in old age.

Significant association of oral health-related quality of life with mental depression in middle-aged and older Taiwanese adults

Background/purpose

With the gradual aging of the population, oral health has emerged as a critical concern alongside mental well-being. This study endeavored to investigate the relationship between oral health-related quality of life (OHRQoL) and mental depression in middle-aged and older population.

Materials and methods

Based on the Taiwan Longitudinal Study on Aging in 2015, 7631 participants were enrolled. OHRQoL was assessed utilizing the Taiwan version of the Oral Health Impact Profile questionnaire, stratifying individuals into five categories (excellent, good, fair, poor, and very poor). The excellent OHRQoL group was regarded as the reference group. Depression status was evaluated using the 10-item Center for the Epidemiological Studies of Depression Short Form questionnaire. Descriptive statistics and Pearson's chi square test were applied to elucidate the demographic characteristics and the differences among the five OHRQoL groups, respectively. Multivariable logistic regression was applied to elucidate the association of OHRQoL with depression after controlling for confounding factors.

Results

After controlling for covariates such as age, sex, marital status, living status, residency status, religion, level of physical activity, and pressures arising from personal or familial concerns, the adjusted ORs of experiencing mental depression were 1.45 (95% CI: 1.198-1.760, P < 0.001), 2.25 (95% CI: 1.791-2.829, P < 0.001), 3.88 (95% CI: 2.730-5.525, P < 0.001), and 6.87 (95% CI: 3.116-15.129, P < 0.001) for the good, fair, poor, and very poor OHRQoL groups, respectively, which demonstrated a gradually increased relationship.

Conclusion

Oral health-related quality of life was negatively associated with mental depression in middle-aged and older adults.

Root caries in older adults: A co-citation network analysis (1980-2023)

BACKGROUND

Root caries affect the oral health and quality of life of older adults. This study examines the breadth of global research on this topic, aiming to clarify its expansive scope and to shed light on pertinent trends for new researchers in the field.

OBJECTIVE

To identify key advances in root caries research as highlighted in high-quality articles from the Social Science Citation Index (SSCI) as well as to explore emerging trends and perspectives.

MATERIALS AND METHODS

Using the Web of Science (WoS) database, we conducted a comprehensive review of articles related to root caries in older adults. Our focus was on finding high-quality SSCI articles, identifying major contributors, journals and research trends and exploring areas such as dentistry, oral surgery and medicine for potential future research.

RESULTS

Our analysis included 192 articles, each of which was subjected to bibliometric and VOS viewer evaluations. The results revealed a concentration of studies in dentistry, oral surgery and medicine, with gaps identified in areas like anthropology, biochemistry, molecular biology and chemistry. A notable deficiency was found in root caries management.

CONCLUSION

We discuss research gaps and propose future directions based on our findings, emphasising interdisciplinary research approaches.

Assessing oral health-related quality of life among older people in home-based care - survey results of the InSEMaP study in Germany

BACKGROUND

Older people receiving home-based care (HBC) often face barriers to access preventive oral health care (OHC) and dental treatments. Leading to deterioration of their oral healthcare. It is further deteriorated by factors such as increasing burden of systemic diseases, medicinal side effects, limited mobility, financial constraints and lack of professional OHC at home. Older people also struggle to maintain necessary daily oral hygiene, leading to malnutrition, weight loss, and a risk of a further health degradation. This cross-sectional survey aimed to investigate the oral health-related quality of life (OHRQoL) and their associated factors in HBC recipients.

METHODS

5,280 older people (≥ 60 years) living in Hamburg, who were in need of care and insured with statutory health insurance DAK-Gesundheit received the questionnaire, which included the German version of the Oral Health Impact Profile (OHIP G-14) and, the EQ-5D health-related quality of life (HRQoL) measure as well as further questions regarding the extent of informal social support, subjective oral health status, oral health behaviour, subjective cognitive status, and socio-demographic variables.

RESULTS

The participants (n = 1,622) had a median age of 83.2 years, with 72.0% of the sample being female. Nearly two thirds of the sample reported that their independence or abilities were significantly impaired (care level 2). Regarding oral health impacts, 40.0% of the participants reported experiencing at least one of the fourteen possible prevalent impacts of the OHIP-G14 fairly often or very often. A multivariate regression model on the severity of oral health impacts revealed, that a better HRQoL, a positive perception of one's own dental status, fewer visits to dental practices, and no need for support in OHC were associated with better OHRQoL. Conversely, respondents with a negative perception of their oral health status, more frequent visits to a dental practice, a need for support in OHC, and subjective memory impairment showed poorer OHRQoL.

CONCLUSIONS

The results highlight the risk for poor oral health among older people in HBC. We conclude that there is an urgent need to prioritise oral health, especially as poor oral health can further compromise the systemic wellbeing of these already care dependent population.

A Holistic Approach for Ethics and Sustainability in the Food Chain: The Gateway to Oral and Systemic Health

Food production is a complex matter, affecting people's lives, organizations' profits, and the well-being of the whole planet, and has multifaceted ethical considerations surrounding its production, distribution, and consumption. This paper addresses the pressing need to confront ethical challenges within the food system, encompassing issues such as environmental sustainability, food security, and individual food choices for better oral and systemic health of all individuals around the globe. From agricultural practices to global trade and food waste, ethical implications are addressed across various domains, highlighting the interconnectedness of ethical decision-making in the food industry. Central themes explored include the ethical dimensions of food production methods, the impact of global trade on food ethics, and the role of individuals in making ethically informed food choices. Additionally, this paper considers the spiritual and physical significance of food, particularly through the lens of oral health as a gateway to holistic well-being. Recognizing the complexity of the food and mouth ecosystem, this paper calls for serious interventions in legislation and economics to promote ethical protocols and techniques for sustainability reasons. It emphasizes the importance of ethical considerations in food safety management systems, regulatory frameworks, and quality standards. Moreover, this paper underlines the need for a comprehensive approach to address ethical dilemmas and moral values inherent in the food industry and oral health policies, adopting the precautionary principle and ethical decision-making frameworks. This article finally aims to serve as a call to action for stakeholders across the food industry and the healthcare sector, to prioritize ethical practices, promote transparency, rearrange economic parameters, and work towards a more sustainable and equitable food system for inner and outer oral and systemic health and human sustainability for all.

Synthesis and evaluation of the antifungal activity of 5-hydroxy-3-phenyl-1H-pyrazole-1-carbothioamide for use in the oral environment

Background and aim

Candida albicans and Candida tropicalis, can cause superficial infections of the oral mucosa as well as disseminated bloodstream and deep-tissue infections. The most frequently employed class of antifungals used for Candida infection treatment are the azole antifungals. Their low price, low toxic qualities, and availability for oral use make fluconazole and similar azole antifungals the preferred treatment for various infections caused by Candida. Nevertheless, developed and intrinsic resistance to antifungals of the azole family has been widely documented in association with various species of Candida. Candida infection management requires synthesizing new compounds to improve azole class antifungals, as Candida isolates resistant to azole are increasingly encountered in the clinical setting. This study aimed to synthesize a new azole compound and investigate its antifungal activity.

Methods

In this experimental study, 5-hydroxy-3-phenyl-1H-pyrazole-1-carbothioamide was synthesized by the reaction between thiosemecarbazide and ethylbezoylacetate. The structure of the synthesized compound was characterized by different techniques such as Fourier transform infrared (FT-IR) and nuclear magnetic resonance (NMR) spectra and its antifungal activity against Candida albicans and Candida tropicalis was investigated by the Spread Plat method to determine its minimum fungicidal concentration (MFC) and minimum inhibitory concentration (MIC).

Results and discussion

The Spread Plat test demonstrated that with the increase in 5-hydroxy-3-phenyl-1H-pyrazole-1-carbothioamide concentration, colonies of fungi were increasingly eliminated at a significant level(p < 0.001). At a concentration of 1000 ppm, all Candida albicans and Candida tropicalis colonies were destroyed.

Conclusions

The results indicate that the synthesized compound showed a promising antifungal effect. On the other hand, it had a suitable spectrum of effect, because it showed antifungal effects on both Candida albicans and Candida tropicalis strains.

Denture care and oral health-related quality of life among complete denture wearers in Eastern Province of Saudi Arabia

INTRODUCTION

This study aimed to evaluate denture care and hygiene and oral health-related quality of life (OHRQoL) among complete denture (CD) wearers in the Eastern Province of Saudi Arabia.

METHODOLOGY

This cross-sectional study was conducted on CD wearers in the Eastern Province of Saudi Arabia. A pre-tested questionnaire was administered among study participants. Questionnaire was divided in three sections: (1) patients' demographic data, (2) awareness and maintenance of CD and (3) OHRQoL. Independent sample t-test and one-way ANOVA test were performed.

RESULTS

The study included data of 300 participants with 71% of males and 28% of females. Majority of participants (82.7%) cleaned CD daily, removed CD while sleeping (88.0%) and knew that unhygienic dentures can cause oral infection (92.7%). Only 19.3% used denture cleansing tables, 41% used toothpaste, and 60.7% rinsed CD with water. Regarding OHIP-DENT domains, highest score was for functional limitation domain (2.20 ± 1.67) and the lowest for handicap domain (0.94 ± 1.09). The mean OHIP-DENT score of the sample was 12.02 ± 8.52. Females (p = 0.006), participants below 65 years of age (p = 0.029), non-Saudis (p = 0.042), those with university education (p = 0.030) and low monthly income (p = 0.045) and participants who visited dentist due to problem with CD (p = 0.041) demonstrated significantly higher mean OHIP-DENT score.

CONCLUSION

Majority of participants demonstrated appropriate denture care behaviours because they were aware of the importance of denture care and hygiene. Female gender, age below 65 years, non-Saudi nationality, university education, low monthly income and visiting dentist due to problem were related to poor OHRQoL.

Establishing an empirical conceptual model of oral health in dependent adults: Systematic review

AIM

This qualitative evidence synthesis was performed to establish a conceptual model of oral health in dependent adults that defines the construct of oral health and describes its interrelationships based on dependent adults' and their caregivers' experiences and views.

METHODS

Six bibliographic databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, OATD, and OpenGrey. Citations and reference lists were manually searched. A quality assessment of included studies was conducted independently by two reviewers using the Critical Appraisal Skills Programme (CASP) checklist. The 'best fit' framework synthesis method was applied. Data were coded against an a priori framework and data not captured by this framework were thematically analyzed. To assess the confidence of the findings from this review, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used.

RESULTS

Twenty-seven eligible studies were included from 6126 retrieved studies. Four themes were generated to further understand oral health in dependent adults: oral health status, oral health impact, oral care, and oral health value.

CONCLUSION

This synthesis and conceptual model offer a better understanding of oral health in dependent adults and subsequently provide a starting point to guide establishment of person-centred oral care interventions.

Factors influencing home health care providers' performance of oral health care for older people: A qualitative study

AIM

To examine factors that affect the performance of oral health care (OHC) for older people receiving nursing care at home.

BACKGROUND

Oral health is often neglected by health care providers caring for older people. Research shows that health care providers' provision of OHC may be influenced by various factors (barriers and facilitators). When this research was conducted, health care providers from home healthcare services (HHCS) and nursing homes were grouped together despite setting differences; therefore, this study focuses on the performance of OHC by home health care providers (HHCPs) as a single group.

DESIGN

Explorative design with a qualitative approach.

METHODS

The managers of four HHCS units recruited 17 HHCPs to participate in focus group interviews. One interview was conducted per unit, and there were four to five participants in each interview. The analysis of interviews was based on theoretical thematic analysis and the PRECEDE constructs in the PRECEDE-PROCEED model. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used in reporting this study.

FINDINGS

The analysis resulted in two themes with predisposing factors (HHCPs' professional responsibilities, older people's attitude), five themes with enabling factors (knowledge and skills, older people/carer trust, available time, available equipment and collaboration with public dental service (PDS)), and two themes with reinforcing factors (routines and OHC focus on the workplace) that affect the provision of OHC. The factors were categorised as individual, organisational and collaboration factors.

CONCLUSIONS

In addition to individual factors found in previous studies, factors related to the organisation of services and communication between HHCPs and PDS seem to affect HHCPs' provision of OHC for adults receiving HHCS.

IMPLICATIONS FOR PRACTICE

This study provides in-depth knowledge that can contribute to increasing HHCPs' provision of OHC and thereby prevent oral and dental disease among older people receiving HHCS.

The Relationship between Oral Health-Related Quality of Life and Body Mass Index in an Older Population from Southern Italy: The Salus in Apulia Study

BACKGROUND

The assessment of oral health-related quality of life (OHRQoL) evaluated the impact of an individual's oral health on the patient's physical and psychosocial status. We evaluated the association between subjective OHRQoL, measured with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and unfavorable body mass index (BMI) (i.e., too high or too low) in a large population-based study on older adults from Southern Italy. Moreover, we assessed which of the seven OHIP-14 domains was the most strongly associated with an unfavorable BMI.

METHODS

We used data on a subpopulation of the Salus in Apulia Study, including 216 older adults. BMI < 18.4 kg/m2 and >30 kg/m2 were classified as unfavorable, while values between 18.5 and 30 kg/m2 were classified as ideal.

RESULTS

A higher OHIP-14 total score increased the risk of an unfavorable BMI (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.15). In the model adjusted for age, sex, education, hypertension, carbohydrate consumption, and alcohol consumption, this finding was confirmed with a higher OHIP-14 total score increasing the risk of an unfavorable BMI (OR: 1.10, 95% CI: 1.01-1.22), and higher age linked to a decreased risk of an unfavorable BMI (OR: 0.89, 95% CI: 0.82-0.97). In a random forest regression model, the most important predictive domains/sub-scales of OHIP-14 in the mean decrease in the Gini coefficient for unfavorable BMI were, in order of decreasing importance, physical pain, functional limitation, psychological discomfort, physical disability, social disability, psychological disability, and handicap.

CONCLUSIONS

In older age, negative OHRQoL, particularly linked to the physical pain domain, increased the risk of being underweight or overweight and obesity.

Dental care for older adults in home health care services - practices, perceived knowledge and challenges among Norwegian dentists and dental hygienists

BACKGROUND

Providing dental services to dependent older adults might be challenging because of physical and cognitive decline. The present study aimed to explore current practices, knowledge, and experienced challenges related to the treatment of older adults in home health care services (HHCS) among dentists and dental hygienists in Norway.

METHODS

An electronic questionnaire survey was distributed to Norwegian dentists and dental hygienists, inquiring about background characteristics, current practices, self-perceived knowledge, and challenges when providing oral health care for older HHCS patients.

RESULTS

Four hundred and sixty-six dentists and 244 dental hygienists treating older HHCS patients responded to the survey. The majority were female (n=620; 87.3%) and worked in the public dental service (PDS) (n=639; 90%). When older HHCS adults attended the dental practice, the treatments provided were most frequently aimed at relieving acute oral problems, although dental hygienists reported to focus on improving oral health more often than dentists. Dentists reported to have more self-perceived knowledge than dental hygienists regarding patients with complex treatment needs, cognitive or physical impairment. Exploratory Factor Analysis (EFA) was carried out on the 16 items related to challenges, three factors were extracted and Structural Equation Models (SEMs) were performed. Challenges related to dental care for older HHCS adults were related to time, practical organization and communication. Variation within these categories was associated with sex, graduation year and country, as well as time used per patient and work sector, but not with professional status.

CONCLUSIONS

The results indicate that dental care for older HHCS patients is time-demanding and more often aimed at relieving symptoms than improving oral health. A substantial proportion of dentists and dental hygienists in Norway lack confidence when providing dental care for frail elderly.

Increased Oral Dryness and Negative Oral Health-Related Quality of Life in Older People with Overweight or Obesity

This cross-sectional study was to evaluate the association between the oral health-related quality of life (OHRQoL) of older Thai people with obesity and oral health indicators. General and oral conditions were assessed. Oral dryness was determined using the Xerostomia Inventory-11 (XI-11) and clinical oral dryness score (CODS). OHRQoL was evaluated by the oral health impact profile (OHIP-14). Participants were aged 60-86 years; 73 (59.3%) were overweight or obese, and 50 (40.7%) were normal weight. Older patients with obesity had almost four times the rate of hypertension (OR = 3.59; 95%CI:1.34-9.60; p = 0.002), more missing teeth (p = 0.025), and higher CODS (p = 0.014) than those without obesity. The total XI-11 scores were positively associated with the total CODS, after adjusting for BMI (r = 0.267, p = 0.003). Those with obesity had almost three times the tendency for a negative OHRQoL compared with the non-obese (OR = 2.73; 95%CI:1.12-6.71; p = 0.04). After adjusting for all related factors, the chances of predicting an OHIP-14 score of four based on obesity and total XI-11 score were 4.42 (95%CI:1.57-12.47; p = 0.005) and 1.11 (95%CI:1.02-1.20; p = 0.013), respectively. Obesity had an increasingly undesirable negative impact on the OHRQoL of older Thai people and was influenced by BMI and oral dryness.