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Geddis-Regan A, Wassall RR, Abley C, Exley C. Exploring dental treatment decision-making experiences of people living with dementia and family carers. Gerodontology 2024; 41:83-93. [PMID: 37036039 DOI: 10.1111/ger.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION People living with dementia can have complex dental care needs. Dentists and patients should make treatment decisions together, yet some people living with dementia may be unable to make their own decisions about their dental care. Dental treatment decision-making and patients' experiences of this process have not been comprehensively researched. OBJECTIVE This study aimed to explore the dental treatment decision-making perspectives and experiences of people living with dementia and their family members. METHODS Semi-structured interviews were undertaken with 8 people living with dementia and 17 family caregivers. A constructivist grounded theory approach was adopted, using a maximum variation sample. Qualitative data collection and analysis occurred concurrently. Data underwent initial open coding followed by more focused coding, supported by reflexive memo writing, which supported data categorisation. RESULTS People living with dementia reported wanting to be understood as unique individuals with specific needs. All participants described wanting to be actively involved in dental treatment decisions. However, many felt that they were insufficiently involved in treatment decision-making. This perceived underinvolvement meant that some people living with dementia and family members felt the treatment outcomes they sought were neither discussed nor considered. CONCLUSION People living with dementia and carers had specific expectations of dental care yet felt passive in decision-making despite their desire to be involved in this process. Dentists should seek to actively establish patients' preferences, regardless of mental capacity and consider these in discussions and decisions about dental treatment.
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Affiliation(s)
- Andrew Geddis-Regan
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle Dental Centre, Carlisle, UK
| | - Rebecca R Wassall
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Dental Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Clare Abley
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Matsuda S, Yoshimura H. Dental decision-making for persons with dementia: A systematic narrative review. Medicine (Baltimore) 2024; 103:e36555. [PMID: 38241530 PMCID: PMC10798713 DOI: 10.1097/md.0000000000036555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/17/2023] [Indexed: 01/21/2024] Open
Abstract
Dental decision-making represents the establishment of a common understanding between the dental professional and the recipient of the intervention, which determines oral healthcare and dental treatment policies. Dental decision-making for persons with dementia can be challenging, and there have been no systematic reviews on this topic. Therefore, this systematic narrative review aimed to identify the current state of dental decision-making in persons with dementia. Literature search was performed using PubMed, Web of Science, Cochrane Library, CINAHL, and Google Scholar databases. Through the process of research selection, 7 articles with a high risk of bias were included in this study. This review clarified that there is limited information on the dental decision-making processes for persons with dementia. In conclusion, although this may be difficult due to different medical and socioeconomic conditions, the dilemma between the need to establish evidence for dental decision-making and medical ethics that prioritize a patient-centered position should be discussed globally in the future.
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Affiliation(s)
- Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Robbins-Welty GA, Gallo JJ. A Pound of Prevention and an Ounce of Palliative Care: Commentary on "Pneumonia Risk Increased by Dementia-Related Daily Living Difficulties" by Funayama et al. Am J Geriatr Psychiatry 2023; 31:886-888. [PMID: 37407383 DOI: 10.1016/j.jagp.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Gregg A Robbins-Welty
- Department of Medicine, Duke University School of Medicine (GAR-W), Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (GAR-W), Durham, NC.
| | - Joseph J Gallo
- Johns Hopkins University School of Medicine (JJG), Baltimore, MD
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de Siqueira Mendes FDCC, de Almeida MNF, Falsoni M, Andrade MLF, Felício APG, da Paixão LTVB, Júnior FLDA, Anthony DC, Brites D, Diniz CWP, Sosthenes MCK. The Sedentary Lifestyle and Masticatory Dysfunction: Time to Review the Contribution to Age-Associated Cognitive Decline and Astrocyte Morphotypes in the Dentate Gyrus. Int J Mol Sci 2022; 23:ijms23116342. [PMID: 35683023 PMCID: PMC9180988 DOI: 10.3390/ijms23116342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
Abstract
As aging and cognitive decline progresses, the impact of a sedentary lifestyle on the appearance of environment-dependent cellular morphologies in the brain becomes more apparent. Sedentary living is also associated with poor oral health, which is known to correlate with the rate of cognitive decline. Here, we will review the evidence for the interplay between mastication and environmental enrichment and assess the impact of each on the structure of the brain. In previous studies, we explored the relationship between behavior and the morphological features of dentate gyrus glial fibrillary acidic protein (GFAP)-positive astrocytes during aging in contrasting environments and in the context of induced masticatory dysfunction. Hierarchical cluster and discriminant analysis of GFAP-positive astrocytes from the dentate gyrus molecular layer revealed that the proportion of AST1 (astrocyte arbors with greater complexity phenotype) and AST2 (lower complexity) are differentially affected by environment, aging and masticatory dysfunction, but the relationship is not straightforward. Here we re-evaluated our previous reconstructions by comparing dorsal and ventral astrocyte morphologies in the dentate gyrus, and we found that morphological complexity was the variable that contributed most to cluster formation across the experimental groups. In general, reducing masticatory activity increases astrocyte morphological complexity, and the effect is most marked in the ventral dentate gyrus, whereas the effect of environment was more marked in the dorsal dentate gyrus. All morphotypes retained their basic structural organization in intact tissue, suggesting that they are subtypes with a non-proliferative astrocyte profile. In summary, the increased complexity of astrocytes in situations where neuronal loss and behavioral deficits are present is counterintuitive, but highlights the need to better understand the role of the astrocyte in these conditions.
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Affiliation(s)
- Fabíola de Carvalho Chaves de Siqueira Mendes
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
- Curso de Medicina, Centro Universitário do Estado do Pará, Belém 66613-903, PA, Brazil
| | - Marina Negrão Frota de Almeida
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - Manoela Falsoni
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - Marcia Lorena Ferreira Andrade
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - André Pinheiro Gurgel Felício
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - Luisa Taynah Vasconcelos Barbosa da Paixão
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - Fábio Leite do Amaral Júnior
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - Daniel Clive Anthony
- Laboratory of Experimental Neuropathology, Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK;
| | - Dora Brites
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-004 Lisbon, Portugal;
- Department of Pharmaceutical Sciences and Medicines, Faculty of Pharmacy, Universidade de Lisboa, 1649-004 Lisbon, Portugal
| | - Cristovam Wanderley Picanço Diniz
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
| | - Marcia Consentino Kronka Sosthenes
- Laboratório de Investigações em Neurodegeneração e Infecção, Instituto de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém 66073-005, PA, Brazil; (F.d.C.C.d.S.M.); (M.N.F.d.A.); (M.F.); (M.L.F.A.); (A.P.G.F.); (L.T.V.B.d.P.); (F.L.d.A.J.); (C.W.P.D.)
- Correspondence:
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