Comparative Study of the Oral Health Profile of Institutionalized Elderly Persons in Brazil and Barcelona, Spain

Prevalence of chewing difficulty in older people in long-term care: A systematic review and meta-analysis

BACKGROUND

Many factors can influence chewing, including age. The ageing process causes morphophysiological changes in the body, including in the performance of the stomatognathic system, which directly affect chewing and swallowing.

OBJECTIVE

To determine the prevalence of chewing difficulty in older people in long-term care.

METHODS

We searched six electronic databases and the grey literature. Qualitative and quantitative analyses, including risk of bias, were performed on studies that met the inclusion criteria. The meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored by meta-regression. Risk of bias was determined using the Joanna Briggs Institute's Critical Appraisal Checklist. The certainty of evidence was verified using the GRADE tool.

RESULTS

Twelve articles were included in the meta-analysis. The pooled prevalence estimate was 35% (95% confidence interval, 0.19-0.54). As heterogeneity still persisted even after sensitivity analysis, the predictors of mean sample age and sample size were meta-regressed to assess whether these covariates explained the variance between effect sizes. The covariable sample size of the study included in the analysis explained 84.3% of the heterogeneity existing in the analysis (R²  = 84.3%; P = .0008). The risk of bias was low in three studies, eight studies had a moderate risk of bias and one study had a high risk of bias. As for the prevalence of chewing difficulty, the GRADE criteria were considered very low.

CONCLUSION

About one in three older people in long-term care have difficulty in chewing.

Factors associated with oral health-related quality of life of institutionalized elders

This study aimed to evaluate the correlation between two Oral Health-Related Quality of Life (OHRQoL) questionnaires (the Oral Health Impact Profile (OHIP-14) and the Geriatric Oral Health Assessment Index (GOHAI)) and to investigate the factors associated with the OHRQoL of institutionalized elderly individuals. A cross-sectional multicenter study was performed with 344 institutionalized elderly individuals residing in two Brazilian cities. Six trained researchers interviewed the elderly individuals. Sociodemographic data were collected from medical records. Dental caries experience and the use of and need for dentures were recorded through oral examination performed by two trained examiners. A Likert scale (1-5 points) was used to assess general health and self-perceived oral health. The number of chewing cycles needed to chew a portion of peanuts was used to assess the swallowing threshold. The OHIP-14 and GOHAI were used to evaluate OHRQoL, and statistically significant correlations were assessed using Spearman's correlation test (p < 0.05). Poisson regression (p < 0.05) was used to investigate the association of OHRQoL with independent variables. Scores on the OHIP-14 (7.57 ± 8.63) and GOHAI (32.46 ± 3.85) were strongly and inversely correlated (r2 = -0.671, p < 0.001), although these measures were associated with different factors. A higher OHIP-14 total score (worse OHRQoL) was associated with female gender, a greater number of healthy teeth, worse self-perceived general health and oral health, and a lower swallowing threshold (p < 0.05). A higher GOHAI total score (better OHRQoL) was associated with a greater number of filled teeth, better self-perceived oral health and a greater swallowing threshold (p < 0.05). In conclusion, worse OHRQoL among institutionalized elderly individuals is associated with worse self-perceived oral health and a greater swallowing threshold.

Oral health profile of participants of an elderly cohabitation program in the state of Santa Catarina, Brazil

Abstract Introduction Cohabitation and social interaction programs have been shown to enhance several aspects of the quality of life of the elderly. Objective This observational study assessed the oral health and oral health perception of participants of an elderly cohabitation program in the state of Santa Catarina, Brazil. Material and method Calibrated dental students examined/interviewed 235 participants of the program. The oral examination considered Decayed, Missing, and Filled Teeth (DMFT) index, Community Periodontal Index (CPI), Periodontal Attachment Loss (PAL), use and need of prostheses, and presence of oral mucosal lesions. Oral health perception was verified with the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. Data were analyzed with descriptive statistics and chi-square test (α=0.05). Result The mean DMFT index was 24.3 teeth, with emphasis on the ‘Missing’ category. Upper and lower prosthetic needs were 53.6 and 71.1%, respectively. Fifty-five per cent of participants presented oral mucosal lesions. Moderate oral health perception prevailed (43%), with mean GOHAI score of 29.9. The negative perception on physical and pain/discomfort dimensions was statistically associated with lower prosthetic need (p<0.05). Conclusion The participants of the cohabitation program presented poor oral health and prevalence of moderate oral health perception. Lower prosthetic need was associated with negative perception.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Ações desenvolvidas por cuidadores de idosos institucionalizados no Brasil

Objetivo: analizar las acciones realizadas por cuidadores de ancianos dirigidas a residentes de instituciones de larga estancia para ancianos (ILEA) en Brasil.Metodología: estudio de naturaleza cualitativa con análisis de datos cuantitativo, clasificado como observacionaly analítico, desarrollado en 36 ILEA seleccionadas en 11 municipios brasileños de medio y gran porte, distribuidas en las 5 regiones geográficas.Se realizaron entrevistas a los cuidadores en el periodo 2008-2011. El análisis del material discursivo (corpus) fue mediado por el software de análisis cuantitativo de datos textualesAnalyse Lexicale par Contexte d’un Ensemble de Segments de Texte (ALCESTE), la versión 4.9 para Windows.Resultados: los participantes fueron 117 cuidadores de ancianos de las ILEA estudiadas. La mayoría de los cuidadores son mujeres y trabajan en ILEA sin ánimo de lucro (filantrópicas). El material textual originó 5 clases semánticas que se dividieron en dos ejes fundamentales. El primer eje se denominó “asistencia a la salud de ancianos institucionalizados” y el segundo eje “actividades habituales de cuidadores en las ILEA”.Conclusiones: los discursos evidenciaron que las principales acciones realizadas están relacionadas con el cuidado directo al anciano, como la alimentación, higiene personal –bucal y general– y administración de medicamentos. Además, la alud bucal ocupa un lugar de relevancia para los cuidadores, a pesar de que relaten dificultades para realizar esta práctica. 

Dental Functionality: construction and validation of an oral health indicator for institutionalized elderly persons in the city of Natal, Rio Grande do Norte

Abstract Objective: to suggest a composite indicator that identifies the oral health condition of institutionalized elderly persons. Method: an observational and cross-sectional study was performed. A total of 315 elderly persons were investigated in long-stay care facilities for the elderly in the city of Natal, Rio Grande do Norte, Brazil. Such individuals underwent an epidemiological evaluation of their oral health conditions, based on the DMFT index, CPI and the PAL (periodontal attachment loss) index. Factor analysis was used to identify a relatively small number of common factors by principal component analysis. Results: five oral health variables were included in factor analysis, and using the Kaiser criterion, which considers the percentage of variance explained by the factors, a single factor which together explained 79.7% of the total variance of the variables included in the analysis model was selected. This factor was analyzed and interpreted according to the dimension to which it related, and was entitled the factor of Dental Functionality. Conclusion: this factor generated an objective indicator to characterize the oral health of the elderly in long-term care facilities for the elderly of Natal, Rio Grande do Norte, and represents a parameter for studies of the oral health outcomes of this elderly population. It also revealed a change in the dental profile of this population with more teeth present in the mouth and a reduction in edentulism.