Oral Health Among Older Adults With Complex Needs Living in the Community and in Aged Residential Care Facilities within New Zealand

ObjectivesTo describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables.DesignSecondary analysis of 2 continuously recruited national cohorts.Setting and ParticipantsAdults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent.MethodsAll community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models.ResultsOverall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Māori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts.Conclusions and ImplicationsHeavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.     

Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial

BackgroundLittle evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls.ObjectiveTo compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality.DesignRandomised experimental trial.SettingA 3000-bed medical centre in northern Taiwan.ParticipantsPatients with hip fracture aged 60 years or older (N = 299).MethodPatients were randomly assigned to three groups: comprehensive care (n = 99), interdisciplinary care (n = 101), and usual care (control) (n = 99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients’ self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission.ResultsThe comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up.ConclusionComprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care.     

Ultrasonographic findings in metatarsophalangeal and talocrural joints in healthy persons

The objective of this study was to establish whether healthy persons have effusions detectable by ultrasonography (US) in metatarsophalangeal (MTP) and talocrural (TC) joints. Fifty consecutive healthy persons without symptoms in ankles and feet were studied. Thirty-eight of them were women, and their mean age was 47.4 (range 23–62) years. Eighteen of the 500 MTP joints studied in nine persons and four of the 100 TC joints in three persons showed effusions upon investigation. One person had effusion in five MTP joints, one in four, two in two, and the remaining five in one MTP joint. None of the studied joints yielded pathological findings in Doppler US examination. These results indicate that the detection of effusion by grayscale US in the absence of Doppler US in MTP and TC joints can be found in healthy persons.     

急性百草枯中毒后MODS患者血清TNF-α和IL-10的变化及意义

目的探讨急性百草枯中毒（APP）后多器官功能障碍综合征（MODS）患者血清TNF-α、IL-10的变化及临床意义。方法应用放射免疫技术测定32例APP后MODS患者与30名健康人血清TNF-α、IL-10水平,分析APP后MODS患者血清TNF-α、IL-10水平和急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分、动脉血氧分压（PaO2）、血尿素氮（BUN）、血肌酐（Scr）等指标的关系。结果APP后MODS患者血清TNF-α、IL-10水平较正常对照组明显升高（P〈0.05）,但死亡组与存活组比较差异无统计学意义（P〉0.05）;血清TNF-α、IL-10水平与APACHEⅡ评分、BUN、Scr呈正相关（P〈0.05）,与Pa02呈显著负相关（P〈0.01）。结论TNF-α、IL-10参与了APP后MODS的发病过程,且与APACHEⅡ评分呈正相关;血清TNF-α、IL-10水平可作为APP后MODS患者多器官功能损害程度评估与预后判断的临床指标之一。     

416例人群牙齿的平均磨耗程度调查

目的:通过调查普通人群牙齿切缘及咬(牙合)面的磨耗情况,研究牙齿磨耗与年龄和性别的关系.方法:分年龄段对抽样人群进行牙齿随机检查,采用Smith 和Knight牙齿磨耗指数TWI分度方法,对416 例受检人群的11 395颗牙齿的切缘和咬(牙合)面进行磨耗度检查. 对各个牙齿的磨耗数据进行统计学分析.结果:测得当代普通人群牙齿平均磨耗度为1.51. 不同年龄段牙齿的磨耗程度有显著性差异(P＜0.05),牙齿的磨耗程度随年龄增加而逐渐加重. 同名牙齿的平均磨耗程度在男女性别中无显著性差异 (P＞0.05).结论:牙齿磨耗呈现增龄性变化,但不存在性别差异.     

Childhood bacterial meningitis: initial symptoms and signs related to age,and reasons for consulting a physician

The relationship of symptoms and signs to age and the reasons for consulting a physician were analyzed in 110 cases of culture-proven childhood bacterial meningitis. H. influenzae caused 74, meningococci 28, pneumococci 6 and streptococci 2 of the cases. Apart from fever (present in 94%), the most common symptoms according to age were as follows: 1–5 months: irritability (85%), 6–11 months: impaired consciousness (79%), 12 months or more: vomiting (82%) and neck rigidity (78%). Absence of neck rigidity at diagnosis was associated with young age (<12 months, P<0.001) and, in older children, to a short duration of symptoms (P<0.01) but not to the degree of CSF pleocytosis. Symptoms of meningitis caused by H. influenzae differed from those of meningococcal meningitis. Meningitis should be suspected in irritable or lethargic febrile children despite absence of neck rigidity. Fever and vomiting were the most frequent reasons for consulting a physician (60% and 31%, respectively). Despite the frequency and alarming character of irritability, impaired consciousness and neck rigidity, their presence led infrequently to a consultation (6%, 22% and 3%, respectively). Parental ignorance of such symptoms or of their importance may cause treatment delay, despite readily available medical services.Abbreviation CSF cerebrospinal fluid     

Smoking cessation in a homeless population: there is a will,but is there a way?

This cross-sectional study sought to determine the prevalence of smoking, readiness to quit, and preferences for smoking cessation treatments among a sample of 236 homeless adults attending 9 sites serving homeless persons (mean age 41.8 years; 73% male). Two thirds (69%) were current smokers, of whom 37% reported readiness to quit smoking within the next 6 months. In bivariate analyses, persons were significantly (P <.05) more likely to be ready to quit if they had tried to quit in the past and if they had social support to quit smoking. Nicotine replacement was the most commonly preferred assistance method (44%), and self-efficacy to quit (10-point scale) was significantly greater if assistance was available (7.3 vs 4.9; P <.001). The findings suggest an urgent need to develop and implement smoking cessation programs for homeless persons.     

Successful program maintenance when federal demonstration dollars stop: the ACCESS program for homeless mentally ill persons

A major issue that has long dogged federal human services demonstration programs is the perception that when federal dollars end, the programs end—regardless of any proven successes. Access to Community Care and Effective Services and Supports (ACCESS) was a 5-year federal demonstration project to foster partnerships between service providers for homeless people with serious mental illness and co-occurring substance abuse disorders; and to identify effective, replicable systems integration strategies. After federal funding ended, research teams visited the ACCESS sites to determine which project elements remained and which strategies were used by the sites to continue ACCESS. This article describes ACCESS services and systems integration activities retained by the sites, new funding streams, and strategies used to obtain continued funding.     

Exercise training for African Americans with disabilities residing in difficult social environments

OBJECTIVE: To examine the feasibility, efficacy, and safety of a structured 12-week exercise training program for a predominantly African-American group of adults with multiple health conditions who reside in difficult social environments. METHODS: A total of 37 females and 7 males (mean age, 54.1 years) participated in an exercise training regimen 3 days per week for 60 minutes per day (cardiovascular, 30 minutes; strength, 20 minutes; and flexibility, 10 minutes). Outcome measures included peak VO(2) (mL min(-1), mL kg(-1) min(-1)); upper and lower body strength (strength); hand-grip strength (GS); body weight (BW); total skin folds (TS); waist-to-hip ratio (WHR); hamstring/low-back flexibility (HLBF); and shoulder flexibility (SF). RESULTS: Compared to the control group, the exercise group showed significant gains in peak VO(2) (p < 0.01); strength (p < 0.01); and body composition (TS, p < 0.01). There was no significant difference between the exercise and control groups on BW, WHR, HLBF, and GS. Of a total 1116 exercise sessions (31 experimental participants x 36 sessions), 87% of the sessions were attended. CONCLUSIONS: A structured exercise-training program can provide substantial improvement in strength and cardiovascular fitness in low-income, sedentary adults with multiple chronic conditions and/or risk factors for chronic conditions. Future research should explore simple home-based and community-based physical activity interventions that provide ongoing support for increasing and maintaining physical activity participation in this cohort.