Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease

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.

Oral healthcare beliefs among home care services personnel; a cross-sectional study in south-eastern Norway

BACKGROUND

There is little knowledge about home care services personnel competencies and beliefs concerning oral healthcare for home-dwelling, dependent older adults. This study aims to map oral healthcare beliefs among home care services personnel, and have the following question: How do the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs?

METHODS

A cross-sectional study among home care services personnel working with older people receiving home care services was conducted across four municipalities in south-eastern Norway. The questionnaire consisted of background information (gender, education level, years of work experience, training in oral healthcare, employment status) and the nursing Dental Coping Beliefs scale. Ethics approval for this study was obtained from the Norwegian Centre for Research Data.

RESULTS

Two hundred and sixty-two homecare services personnel responded to the questionnaire, 16.5% males and 83.5% females; 40.5% had had training in oral healthcare. Home care services personnel believed that gum diseases and cavities can be prevented by dental flossing (61.4%) and toothbrushing (98.4%). 59% disagreed that preventing sickness and medicines from destroying teeth is impossible. However, the majority of the home care services personnel were uncertain about how oral mucosal disorders can be treated. Having more than three years of higher education was positively associated with being in higher quartiles of oral healthcare beliefs, and external locus of control, and having training in oral healthcare was positively associated with being in the lower quartiles of internal locus of control and self-efficacy dimensions. Males were more likely to be in the lower quartile of oral healthcare beliefs, which wasn't positive.

CONCLUSION

In the population studied, the home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that home care services personnel need more education and training in oral healthcare.

Oral status of older adults receiving home medical care: A cross-sectional study

AIM

This study examined the oral status and the presence of teeth requiring treatment among older adults receiving home medical care.

METHODS

This cross-sectional study was conducted at a Japanese dental clinic specializing in geriatric treatment. We recruited older adults receiving home medical care in the community who had begun to receive domiciliary dental care. The Japanese version of the Oral Health Assessment Tool (OHAT-J), as well as the presence of teeth requiring extraction and the need for assistance in maintaining oral hygiene were used to evaluate the participants' oral health and its association with other items.

RESULTS

Ninety-three participants (44 male and 49 female, median age: 87.0 years) were surveyed. The median OHAT-J score was 6. The duration since the previous dental visit was 23 months. Sixty-two (73.8%) of 84 participants with ≥1 natural tooth had severe caries or teeth with severe mobility that required extraction. Logistic analysis revealed that requiring assistance in maintaining oral hygiene, mild dementia, severe dementia, and depression were significantly associated with an OHAT score of ≥6.

CONCLUSIONS

Older adults receiving home medical care had poor oral health, with approximately 70% of them requiring tooth extraction. The need for assistance in maintaining oral hygiene and poor mental status contribute to poor oral health. Geriatr Gerontol Int 2024; 24: 706-714.

Impaired Oral Health in Older Orthopaedic In-Care Patients: The Influence of Medication and Morbidity

Introduction

Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.

Material and Methods

The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.

Results

Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.

Conclusion

The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.

Older people's experiences of oral health and assisted daily oral care in short-term facilities

Background

Older people’s oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

Method

A descriptive, qualitative study was performed through interviews with 14 older people (74–95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

Results

The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff’s knowledge.

Conclusions

The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff’s attention towards older peoples’ oral health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02281-z.

Oral health among older adults in nursing homes: A survey in a national quality register, the Senior Alert

Aim

To investigate the extent to which the Revised Oral Assessment Guide–Jönköping (ROAG‐J) is used by nursing staff routinely in nursing homes in Sweden and to describe oral health status of the residents.

Design

An observational, retrospective register‐based study.

Methods

Data from different validated health assessments instruments, including ROAG‐J, for the period 2011–2016 were obtained from the Web‐based national quality register Senior Alert. The basis for the analyses was 190,016 assessments.

Results

About half of all residents had underwent at least one annual ROAG‐J assessment (2014–2016). During the period 2011–2016, 42% of the residents (n = 92,827) were registered to have oral health problems. Significantly more oral health problems were found for men and for those with younger age, poorer physical condition, neurophysiological problems, underweight, impaired mobility and many medications. In conclusion, poorer oral health was found for more care‐dependent individuals, which shows a need of preventive actions.

Physical ability and comorbidity and oral health among home-dwelling older people in the Finnish population

AIM

To examine how physical ability and comorbidity associate with oral health.

METHODS AND RESULTS

The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self-perceived oral health (pain/discomfort in mouth). Physical ability was determined by measuring limitations in daily activities (activities of daily living [ADL] and instrumental activities of daily life [IADL]) and the number of comorbidities with Functional Comorbidity Index (FCI). Poisson's multivariate regression model was used to estimate prevalence rate ratio (PRR) and their 95% confidence intervals (CI). The physical ability or number of comorbidities did not associate consistently with oral diseases, but ADL, IADL and FCI associated all with self-perceived oral discomfort (PRR: 1.74, CI: 1.01-3.03; PRR: 1.20, CI: 1.06-1.35; PRR: 1.20, CI: 1.05-1.36, respectively). Furthermore, IADL associated also with poor self-perceived oral health (PRR: 1.27, CI: 1.03-1.57).

CONCLUSION

Older people with impaired physical ability and comorbidities are more likely to have oral discomfort and have poorer self-perceived oral health.

Oral health and oral care in short-term care: prevalence, related factors and coherence between older peoples' and professionals' assessments

Background

Oral health is important for well‐being and overall health. Older peoples′ oral health is well described in the residential care context, but remains understudied in short‐term care.

Objective

The aim of this study was to describe oral health, daily oral care and related factors among older people in short‐term care and to compare self‐perceived oral health with professional assessment.

Materials and methods

This cross‐sectional study included 391 older people in 36 short‐term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self‐perceived oral health. Self‐care ability was assessed with Katz Index of Activities of Daily Living (Katz‐ADL).

Results

Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self‐care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self‐perceived oral health.

Conclusion

Professionals’ assessments of oral health differed considerably from the older peoples′ own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self‐care (ADL). This study indicates that in order to improve older peoples′ oral health and oral care we need to provide person‐centred oral care and to develop a close collaboration between nursing and dental staff.

Perceptions of older people's oral health care among nurses working in geriatric home care

OBJECTIVES

This study investigates nurses' self-reported experiences and perceptions of older people's oral health care using a qualitative method.

METHODS

We interviewed 10 nurses working in geriatric home care who regularly visit and take care of older people in their homes. The interviews consisted of semi-structured questions. The interviews were then transcribed and analysed.

RESULTS

All nurses were aware of the connection between oral health and general health, but more detailed knowledge about oral health was lacking and confidence in oral health care practices was limited. Many of the interviewees noted the cleaning of removable dentures and problems related to them, but did not mention anything about periodontal diseases. Oral health education among the nurses was rare. The nurses reported lack of time to take care of their clients' oral health. As possible development steps, the interviewees suggested that including oral health care in the daily treatment plan would improve oral health care practices.

CONCLUSIONS

The nurses' lack of knowledge about oral health care and uncertainty in oral health practices among older people are major problems in daily geriatric home care. Oral health education and confidence in oral health practices should be improved in both basic and on-the-job education.

Oral inflammation and infection, and chronic medical diseases: implications for the elderly

Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.

Experience of dental care, knowledge and attitudes of older immigrants in Sweden-A qualitative study

OBJECTIVES

Knowledge about the oral health and dental care habits of older immigrants is limited. The aim of this study was to explore dental service utilization, oral care habits, and attitudes to and knowledge about oral diseases and their prevention among older immigrants in Sweden.

METHODS

A qualitative research method was used, and data were collected in individual interviews to gain a deeper understanding of the immigrants' views. Thirteen immigrants, seven women and six men, recruited from meeting places for older immigrants, participated, all aged between 59 and 88 (median 72 years). Interviews were tape-recorded and transcribed verbatim. Eight interviews were carried out with the help of an authorized interpreter.

RESULTS

In the analytical process, performed using the content analysis method, meaning units were identified and condensed into codes which were labelled and grouped into subcategories and categories. The interview analysis resulted in four categories: Experiences of dental care, Attitudes, Barriers and Prevention of oral diseases. The elderly immigrants described a mix of regular and acute dental care and were often not satisfied with the outcome of the treatments. They stated that oral health was important and that they were responsible for their own teeth. Barriers to dental care were costs, language problems and lack of confidence in dental services. Daily oral hygiene routines were performed using a traditional chewing stick and/or regular toothbrush.

CONCLUSION

The participants stated that, despite the barriers to treatment described above, they valued good oral health and visited dental services when they needed to.

Preventive oral health intervention among old home care clients

Background

poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene.

Aim

to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over.

Patients and methods

the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months.

Results

the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene.

Conclusions

the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.

Effect of 12-month weekly professional oral hygiene care on the composition of the oral flora in dentate, dependent elderly residents: A prospective study

OBJECTIVE

To study the effect of weekly professional oral hygiene care on the proportion of micro-organisms associated with good oral health, caries, and periodontal and soft tissue diseases in oral biofilms in dentate, dependent elderly residents.

BACKGROUND

Assisted oral hygiene care reduces the plaque score and number of micro-organisms in the oral biofilms in elderly residents. Less is known about the effect on the quality/composition of the remaining oral flora.

MATERIALS AND METHODS

Participants comprised 33 residents in the study and 35 in the control group. Dental status (≥10 natural teeth and no removable dentures to be included), plaque score, salivary secretion rate and prescription medicines were recorded. Duplicate samples, collected from supragingival plaque and tongue, were analysed using cultivation technique. Differences between and within groups were analysed using one-way and two-way ANOVA, respectively.

RESULTS

At the baseline, the number of teeth in the participants (mean age, 83.7 ± 7.4 years) was 22.0 ± 4.5. The number of prescription medicines was 9.4 ± 4.5. Seventy-six per cent had low salivary secretion rate. Fifty per cent had "visible thick" supragingival plaque. At the 12-month registration, "no visible" or "visible but thin" plaque was recorded in 92% in the study group. The proportions of bacteria associated with good oral health and periodontal diseases were decreased over time, while the frequency and proportions of micro-organisms associated with caries and soft tissue infection were unaffected or increased.

CONCLUSION

The results indicate that assisted oral hygiene care alone is not sufficient to regain an oral microbial flora associated with good oral health in dentate, dependent elderly residents.

Quality of life and oral health in elderly

Background

We want to assess quality of life in elderly patients in relation to the number of remaining teeth, the number of ingested drugs and xerostomía and to determine the correlation between an increased intake of drugs and a greater feeling of dry mouth and to know the most commonly used measures to control xerostomia.

Material and Methods

30 subjects aged between 65 and 95 years (14 males, 16 females) completed the OHIP questionnaire to determine quality of life. For oral status, the number of remaining teeth according to WHO criteria and xerostomia using the xerostomia index (XI) were studied. In cases of dry mouth sensation, the measures to alleviate it were asked.

Results

The average quality of life according to the OHIP rate is 19.23 (Dt = 10.58), being 56 the worst quality of life. The Pearson correlation coefficient indicates that quality of life is not related to the number of remaining teeth (r = -0.046; p = 0.810) nor the number of ingested drugs (r = 0.226; p = 0.23) but a greater sensation of dry mouth is related to a poorer quality of life (r = 0.678; p = 0.230). There is no association between the number of ingested drugs and the xerostomia index (r = 0.144; p = 0.447). The most frequently measures used against dry mouth were drinking water (21 subjects) and sugarless candies (15 subjects).

Conclusions

Quality of life is not related to the number of remaining teeth nor the number of ingested drugs. However, a higher level of xerostomia was significantly associated with a poorer quality of life. There is no association between the number of drugs ingested and xerostomia index. Sugarless candies and drinking water are the more frequently used measures to alleviate dry mouth.

Key words:Quality of life, oral health, elderly.

Older people's description of factors that facilitate and impede regular dental care - a qualitative interview study

OBJECTIVES

The aim of this study was to achieve an understanding of older people's view of the benefits of regular dental care and investigate factors that facilitate and impede regular dental care.

METHODS

A qualitative research method was used. To gain a deeper understanding of the elderly people's views, individual interviews were conducted. Fifteen respondents, eleven women and four men aged between 65 and 95, participated, all recruited from senior social centres. All interviews were tape-recorded and transcribed verbatim, and the content analysis method was then used. Meaning units were identified and condensed into codes which were labelled and grouped into categories and subcategories.

RESULTS

Findings were grouped into three categories: experiences of dental care, obstacles and facilitators to dental care and about oral health and responsibility. The elderly had experience of both regular and irregular dental care. Obstacles to visiting dental services included high costs and complicated dental insurance, other practical obstacles, lack of confidence in dentistry and seeing no benefits of dental care at their age. Views of the importance of oral health varied, and some people thought poor teeth were shameful. Some expressed that oral health was your own responsibility, while others thought that oral health was the responsibility of the dental services.

CONCLUSIONS

Several factors which hamper regular dental care have been identified, and taken together, these obstacles often became unsurmountable. However, individuals taking their own responsibility for their dental status and dental services making certain adaptations, both encourage people to seek regular dental care.

Oral health status in older immigrants in a medium-sized Swedish city

AIM

The aim of the study was to investigate oral health and oral care habits among older immigrants to Sweden from countries outside the Nordic region.

METHOD

Participants ≥60 years of age from senior social centers for immigrants were invited to attend oral examinations. Data was collected on the number of teeth, dentures, caries, periodontal status, saliva secretion, and plaque scores. Participants also described their general health and oral care habits.

RESULTS

Fourteen men and 28 women, median age 71.5 years, participated. Seventeen percent were edentulous, women often than men. Three out of four had caries and 63% had gingival bleeding. Two-thirds brushed their teeth twice per day and 60% had visited dental services in the last 2 years.

CONCLUSION

The group had a high prevalence of oral diseases and discomfort. They used dental services and brushed their teeth less frequently than Swedish populations of the same age.

Self-reported changes in using fluoride toothpaste among older adults in Sweden: an intervention study

OBJECTIVE

The aim of the study was to investigate the possibility of increasing knowledge about the caries-reducing effects of fluoride (F) toothpaste and to increase the use of F toothpaste among older adults through an intervention.

MATERIALS AND METHODS

63-67-year-olds in Sweden, who 2 years earlier had answered a questionnaire about their knowledge of F toothpaste, toothbrushing and toothpaste habits and who had shown less favourable habits with regard to toothpaste use, were invited to participate. The 20-min intervention, performed at a Public Dental Clinic, was implemented by a dental hygienist (author OJ) and consisted of individual information and instruction on the use of F toothpaste. The questionnaire was repeated 4 months after the intervention and a population in another city in Sweden served as control.

RESULTS

In the intervention group, 68 individuals responded and 151 in the control group. Knowledge of the benefits of F toothpaste in the intervention group had improved between the times of the first and second questionnaires, but the same effect was also noted in the control group. After the intervention, a clear improvement concerning the use of F toothpaste was reported: the individuals brushed for a longer time, used more toothpaste and used less water during and after brushing. In the control group, there were no changes of habits between the first and second occasions.

CONCLUSION

Individually-based interventions performed by a dental hygienist had a positive effect on changing the way older adults used F toothpaste.

Factors contributing to tooth loss among the elderly: A cross sectional study

BACKGROUND

The present study evaluates the influence of several demographic, health, personal, and clinical factors on the number of missing teeth in old age sample.

METHODS

The number of patients included was 259; they received a full mouth examination and answered a questionnaire provided by one examiner. All the variables related to teeth loss based on the literature were included. These variables focused on age, gender, race, marital status, clinical attachment level, pocket depth, year of smoking, number of cigarettes smoked per day, number of medications, root decay, coronal decay, health status, and year of education. Statistical analysis involved stepwise multivariate linear regression.

RESULTS

Teeth loss was statistically associated with clinical attachment level (CAL)(p value 0.0001), pocket depth (PD) (0.0007) and education level (0.0048). When smoking was included in the model, age was significantly associated with teeth loss (0.0037). At least one of these four factors was also related to teeth loss in several specific groups such as diabetes mellitus, male, and White. The multiple linear regressions for all the proposed variables showed that they contributed to teeth loss by about 23%.

CONCLUSIONS

It can be concluded that less education or increased clinical attachment level loss may increase number of missing teeth. Additionally, age may cause teeth loss in the presence of smoking.

Oral health-related quality-of-life in homebound elderly dependent on moderate and substantial supportive care for daily living

OBJECTIVES

To describe the oral health-related quality-of-life in homebound elderly dependent on moderate and substantial supportive care for daily living.

MATERIALS AND METHODS

A total of 302 selected persons in three counties in Sweden over 65 years of age and in need of daily support from society participated in the study. Half of the participants had moderate needs of support, defined as supportive care of 15-50 h per month and half had substantial needs of supportive care, i.e. 3-times a day with a night overview. An oral examination was performed and structured questions were asked about general health and living conditions, medication, oral care routines and quality-of-life, using the instrument GOHAI (Geriatric Oral Health Assessment Instrument).

RESULTS

Cardiovascular disease was common and an average of seven prescription drugs was used. More than half of the participants had dentures. The strongest correlation with GOHAI was the total number of teeth. There was a significant difference between individuals with moderate and substantial needs according to GOHAI, irrespective of gender. More elderly people with substantial needs of support had low GOHAI values. Decayed teeth, DT/T, root remnants and dry mouth were negatively correlated to GOHAI among individuals with substantial needs.

CONCLUSIONS

This study found that elderly homebound individuals with substantial needs of supportive care had a lower quality-of-life than elderly homebound individuals with moderate needs of supportive care, although both medical and odontological variables were similar in the groups.