Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity

Domiciliary dental care among homebound older adults: A nested case-control study in Japan

AIM

Improving the availability of dental care is essential to maintain older adults' general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home-dwelling dependent older adults.

METHODS

A retrospective nested case-control study was carried out. We identified long-term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long-term care service claim database. One-to-one case-control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care.

RESULTS

We identified 3 377 998 eligible homebound long-term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93-2.06), exemption from out-of-pocket payment (OR 1.35, 95% CI 1.32-1.39]), living in a group home (OR 7.93, 95% CI 7.71-8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08-3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70-1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62-0.66) and dementia (OR 0.89, 95% CI 0.88-0.91).

CONCLUSIONS

Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679-683.

Health State Utilities in Edentulous Patients: A Time Trade-off Approach

BACKGROUND

Health is generally regarded as a very high good, and oral health may substantially affect the quality of life of patients. Oral health-related quality of life has usually been investigated by means of disease-specific descriptive instruments, such as the Oral Health Impact Profile and the General Oral Health Assessment Index. These instruments, however, do not enable a comparison of oral health-related quality of life with other medical diseases. Economic methods, such as the time trade-off technique, enable a comparison of the impact of oral health with other medical diseases and thus provide a means to build a bridge in quality-of-life assessments between medicine and dentistry.

METHODS

We included in our study a total of 58 patients who received a complete denture in our clinic in the last 10 y (between January 2001 and May 2012) and who were ≥65 y old. Patient preferences for the edentulous and poorest imaginable oral health state were assessed via the time trade-off method.

RESULTS

Edentulous patients rated their current oral health state as 0.73 (SD, 0.25) and the poorest oral health state as 0.43 (SD, 0.33) on a scale between 0 (death) and 1 (best possible health state). These results are comparable to patient preferences for other serious diseases, such as breast cancer (0.75), asymptomatic HIV infection (0.69), depression (0.44), and osteoarthritis of the hip (0.44).

CONCLUSION

In conclusion, our results suggest that oral health may substantially affect quality of life no less than other medical diseases.

KNOWLEDGE TRANSFER STATEMENT

Health is generally considered the highest good of humankind. In the present article, we show that oral health substantially affects quality of life. In particular, we show that loss of teeth (i.e., being edentulous) reduces quality of life no less than other systemic diseases. Treatment modalities for the edentulous patient may therefore substantially improve the patient's well-being and should be a research priority.

Significant unmet oral health needs of homebound elderly adults

OBJECTIVES

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

DESIGN

Cross-sectional analysis.

SETTING

Participants' homes in New York City.

PARTICIPANTS

Homebound elderly adults (N = 125).

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

Cognitive function and oral health-related quality of life in older adults

OBJECTIVES

To examine the relationship between cognitive function and self-reported oral health-related quality of life (HRQoL) in community-dwelling older adults.

DESIGN

Cross-sectional.

SETTING

Community in West Virginia.

PARTICIPANTS

Two hundred twenty-six community-dwelling older adults.

MEASUREMENTS

Oral HRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI) (range 12-60), and cognitive function was assessed using a comprehensive neuropsychological test battery. Dental professionals performed oral health examinations.

RESULTS

Participants with normal cognitive function had higher GOHAI total scores (mean 55.1), indicating better oral HRQoL, than participants with cognitive impairment without dementia (CIND) (mean 52.3) and mild dementia (mean 51.0). The difference remained significant after controlling for sociodemographic, health status, comorbidity, and clinical dental status covariates.

CONCLUSION

Oral HRQoL, as measured using the GOHAI, was better in participants with normal cognitive function than in those with CIND of mild dementia in the population studied.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Exploring the role of peer density in the self-reported oral health outcomes of older adults: a kernel density based approach

Previous research has documented that oral health is inextricably linked with overall health and is an important component of successful aging. Additionally, peer social interactions are known to improve older adults' general well-being by increasing social opportunities and knowledge of local resources. This study examines the relationship between peer density of participants aged 50 and older in the ElderSmile program and self-reported oral health in northern Manhattan. Results from logistic regression models found that higher peer kernel density estimation values are associated with better self-reported oral health. This reinforces the need for place-based health interventions, and provides new evidence of the importance of peer communities for older adults.

The concept of validity in sociodental indicators and oral health-related quality-of-life measures

BACKGROUND

Most of the psychometric instruments used to measure quality of life associated with oral impairment and disability from the perspectives of older adults focus on negative experiences, and pay little attention to the possibility of positive reactions to disablement. This oversight challenges the validity of the instruments in current use, and raises questions about the process used to validate them.

OBJECTIVES

In this study, we consider the general attributes of psychometric validity, and how they have been applied to oral health-related instruments.

CONCLUSIONS AND RECOMMENDATIONS

The psychometric characteristics and predictive validity of existing dental instruments are still weak, probably because the instruments fail to address the broad range of personal variables that influence oral health, disability and quality of life. We recommend, therefore, that a continuous process of validation be adopted to include: (1) assessments of the theoretical framework supporting the instruments; (2) evaluations of the focus and structure of the questions used; and (3) enhancements of the prediction value of instruments applicable to oral health-related beliefs and behaviours.

Revisiting the concept of malnutrition in older people

AIM

The aim of this study is to revisit the concept of malnutrition in older people, trace the new development and test the use of refined framework with empirical data.

BACKGROUND

Malnutrition in older people is a common and significant problem worldwide. Continuing Chen's earlier work in 2001, a refinement was conducted and a prospective study was designed to test the use of this refined framework.

DESIGN

A cohort study of 114 hospitalized older patients in Northern Taiwan.

METHODS

The sample consists of 114 older patients aged 65 years and older, who were admitted for the cardiac and orthopaedic services at a tertiary 2300-bed hospital. From March to August 2004, assessed by one trained nurse, participants completed a structured face-to-face interview evaluating their age, visual/hearing impairments, oral health, cognitive status, comorbidities, medication use, social economic status, functional status, social support, depressive symptoms and nutritional status within 48 hours of admission. Participants who stayed >5 days were reassessed before discharge (n = 70). The data from admission were the main focus of this report.

RESULTS

Regression analysis revealed that that more medication taken, female gender, lower functional status (beta = 0.34, P < 0.001) and higher depressive symptoms were independent predictors of poor nutritional status, with the full model accounting for 48.2% of the variance. The result is in-line with the original theoretical underpinnings and it suggests that this refined framework detailing sub-concepts and measurable indices appears to fit the empirical data and suitable for clinical use.

CONCLUSION

The findings lend support to the use of this framework in managing malnutrition in older people.

RELEVANCE TO CLINICAL PRACTICE

Nurses have an essential role in providing care for older people a framework like this would provide a road map guiding the intervention efforts.

Oral health-related quality of life: a critical appraisalof assessment tools used in elderly people

OBJECTIVE

The purpose of this study was to undertake a critical appraisal of oral health-related quality of life (OHRQoL) measurements used for research in the elderly.

BACKGROUND

A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person's quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly.

MATERIALS AND METHODS

Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative-qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions).

RESULTS

In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative-qualitative criteria.

CONCLUSION

Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile-49, Dental Impact on Daily Living, Oral Health Impact Profile-14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.

The oral hygiene and denture status among residential home residents

The aim of this study was to investigate the oral hygiene practices and denture status of elderly people living in a residential home. One hundred one elderly people living in Gurcesme Zubeyde Hanim Residential Home, Izmir-52 women (mean age 75.5 +/- 7.8) and 49 men (mean age 75.3 +/- 8.8)-participated in an interview. Their oral hygiene practices, self-perceived oral health, denture status, and needs of denture were noted down. Self-perceived oral health was very bad in 9.9%, bad in 47.5%, good in 33.7%, and very good in 8.9%. From 69 people who reported maintaining oral hygiene, the incidence of oral hygiene practice was 36.2% once a day, 31.9% three times a day, 21.8% once a week, and 10.1% seldom. The majority, 60 people (59.4%), were dentate. Among the dentate, 47 people (78.3%) had full denture, 4 (6.6%) removable partial denture, 2 (3.3%) fixed/removable partial denture, 5 (8.3%) full/removable partial denture, and 2 (3.3%) one or more fixed partial dentures. By gender, 57.6% female and 61.2% male subjects were dentate. The relationship between having a social security and having a denture was significant (p = 0.02); having a denture and needing a denture was also significantly related (p = 0.00). The high prevalence of needs for denture pointed to the requirement for frequent dental check ups. The most important need within the residents of the residential home was daily oral hygiene. Nurses trained on this subject are required.

Factors associated with oral health-related quality of life in institutionalized elderly

OBJECTIVE

The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany.

MATERIAL AND METHODS

One-hundred-and-fifty-eight subjects from old people's homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n = 128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable.

RESULTS

In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R2 = 0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC.

CONCLUSIONS

In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.

Impact of dry mouth conditions on oral health-related quality of life in older people

OBJECTIVE

The aim of the present study was to evaluate the impact of dry mouth conditions on oral health-related quality of life in frail old people, residents at community care centers. Further, reliability and validity of a visual analogue scale (VAS) for dry mouth symptoms were determined within the study cohort.

BACKGROUND

In old people functional, social and psychological impacts of oral conditions are associated with an overall sense of well being and general health. Subjective dry mouth and reduced saliva flow are common disorders in old people caused by disease and medication. Thus, dry mouth conditions may be determinants for compromised oral health-related quality of life in old people.

METHOD

In total, 50 old people living at service homes for the old people were asked to answer questionnaires on subjective dry mouth (VAS) and Oral Health Impact Profile (OHIP14) for oral health-related quality of life. Saliva flow was estimated by absorbing saliva into a pre-weighed cotton roll.

RESULTS

The final study cohort comprised 41 old people (aged 83-91 years). Significant associations were identified between both objective and subjective dry mouth and overall or specific aspects of oral health-related quality of life.

CONCLUSION

Dry mouth (objective and subjective) is significantly associated with oral health-related quality of life strengthening the value of monitoring dry mouth conditions in the care of frail old people.

Impact of new prostheses on the oral health related quality of life of edentulous patients

OBJECTIVE

A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI).

BACKGROUND

Oral health quality of life indicators can be used to evaluate the effects of dental treatments.

MATERIAL AND METHODS

The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients' satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group.

RESULTS

At baseline, the impact of oral health problems was apparent; the mean GOHAI-Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI-Add scores was negatively correlated with the initial GOHAI-Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants' satisfaction with the new dentures and change in GOHAI scores (p < 0.05).

CONCLUSION

The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.

Oral hygiene care for adults with dementia in residential aged care facilities

OBJECTIVE

The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: INCLUSION CRITERIA: This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to:1 quantify the oral health status of older adults living in residential aged care facilities;2 quantify the oral health status of adults with dementia living in the community and in residential aged care facilities;3 evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities;4 evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and5 evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities.Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics.

SEARCH STRATEGY

The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents.

METHODOLOGICAL QUALITY

All selected studies were critically appraised by two reviewers prior to inclusion in the review.

RESULTS

In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions.

CONCLUSIONS

This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

Validation of an oral health quality of life index (GOHAI) in France

Oral health has traditionally been defined in terms of disease. Today, health is seen in a wider context: taking into account its impact on everyday living. Several indices attempt to capture this dimension. The Geriatric Oral Health Assessment Index (GOHAI) has been adapted for general use and tested on adult samples, mainly in North America. Language, cultural norms and the health care system in France are different and this raises the need to validate the GOHAI in France before it receives widespread use.

OBJECTIVES

The purpose of this study was to test the validity of a French version of the GOHAI.

METHODS

The GOHAI is based on responses to a 12-item self-administered questionnaire. The items were translated into French, back-translated and compared with the original. After pilot testing and minor modifications, the French version was administered to a group of low-income persons benefiting from the national health insurance system (n = 260, 18-45 years). Measures for stability and internal consistency were calculated. Concurrent and discriminant validity were assessed.

RESULTS

Cronbach's alpha (0.86) showed a high internal consistency and homogeneity between items. Item-scale correlations varied between 0.40 and 0.78. Repeat administration of the GOHAI to 32 participants gave weighted kappa coefficients from 0.51 to 0.87 and a Pearson's correlation coefficient of 0.87. Low GOHAI scores were associated with perceptions of poor oral and general health, low satisfaction with oral health and a perceived need for dental care. There were significant relationships between the GOHAI score and most objective measures of dental status except FT. Younger, well-educated and higher income respondents were more likely to have a high GOHAI score.

CONCLUSION

The French version of the GOHAI exhibits satisfactory psychometric properties but two items (one about swallowing, the other with complex sentence structure) had poor stability.

Translation and validation of the Chinese version of GOHAI

OBJECTIVE

To translate and validate the Chinese version of General Oral Health Assessment Index (GOHAI) for elderly in Hong Kong and to investigate factors that possibly may influence the GOHAI scores.

METHODS

The English version of GOHAI was translated into Chinese. Persons aged 60-80 years were interviewed by two trained interviewers and clinically examined by a dentist. Information on subjects' demographic background and oral health conditions was collected.

RESULTS

Altogether 1,023 elderly were interviewed and clinically examined. The mean GOHAI score was 48.9 (SD = 7.2). Cronbach's alpha of the translated GOHAI was 0.81; item-scale correlation ranged from 0.28-0.61. It was found that the mean GOHAI scores were lower for subjects with poorer perceived oral health (rs = 0.57, P < .001). Elderly who had perceived dental treatment need had a lower mean GOHAI score than those who did not (P < .001). It was also found that elderly who lived in elderly homes, those who received social welfare assistance, those who had recent dental visits, and those with higher DMFT scores had higher mean GOHAI scores.

CONCLUSION

The translated Chinese version of GOHAI demonstrated acceptable reliability and validity. It is available for use by researchers in oral health-related quality of life studies on Chinese elderly population.