Relationship between clinical dental status and eating difficulty in an old Chinese population

This study investigated the relationship between clinical dental status and eating difficulty in a sample of older Chinese people in Guangxi, China. Sample was selected from people aged 55 years and older who had routine annual health check-ups at a large hospital health centre. The sample consisted of 1,196 dentate people who had clinical oral examinations and face-to-face interviews. Different measures, namely the Index of Eating Difficulty, dissatisfaction with chewing ability and ease of eating certain foods were used to measure eating difficulty. Multiple logistic regression analysis showed that after controlling for the effects of age, sex, occupation, self-assessed social class and self-perceived general health, increased eating difficulty was significantly related with having fewer teeth, fewer posterior and anterior occluding pairs of teeth (both natural teeth only and natural plus replaced teeth), more unfilled posterior spaces, more unfilled anterior spaces, mobile teeth, decayed teeth and roots. In conclusion, clinical dental status was strongly related with eating difficulty in a sample of older Chinese dentate people.     

Preference for dentist's home visits among older people

Komulainen K, Ylöstalo P, Syrjälä A‐M, Ruoppi P, Knuuttila M, Sulkava R, Hartikainen S. Preference for dentist’s home visits among older people. Community Dent Oral Epidemiol 2012; 40: 89–95. © 2011 John Wiley & Sons A/S Abstract – Objectives: To investigate factors associated with older people’s preference for a dentist’s home visit. Methods: This is a report on 321 home‐dwelling participants (mean age 81.6) in the population‐based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004–2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health‐related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Of the study subjects, 25.9% preferred a dentist’s home visit. The preference for choosing a dentist’s home visit was associated with a low score (≤24) in the Mini‐Mental State Examination, OR 6.1 (CI: 2.9–13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6–18.6). It was also associated with living alone, OR 5.9 (CI: 2.7–13.0), and high use of home care services, OR 9.3 (CI: 4.6–19.0). Conclusions: The findings of this study emphasize the need to organize dentists’ home visits in order to increase equality in the use of dental health care services among the older people with disabilities.     

Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain

OBJECTIVE: The objective was to assess the prevalence, in a British population aged 65 years and older, of oral health related impacts and the effects they had on the quality of daily life and in particular on eating. METHODS: 753 free living and 202 institutionalised subjects aged 65 years and over, participating in the oral health survey of the British National Diet and Nutrition Survey (NDNS), had a dental examination and interview. Data on the impact of dental and oral disorders on the activities of daily living based upon the modified Oral Impacts on Daily Performance (OIDP) indicator were collected. RESULTS: 17% of the free living edentate participants reported that their mouth affected their pattern of daily living on a regular basis. Oral impacts levels were lowest in dentate subjects with the greatest number of teeth. For the dentate, the most common oral impacts were on eating and speaking. Impacts relating to emotional stability, sleeping, relaxing, carrying out physical activity and social contact were very infrequent, but were severe when they did occur. Among those with an impact on eating, 25% said it was severe and 42% had the impact nearly every day or in a spell of 3 or more months. Oral impacts were more prevalent among the institution sample, particularly the dentate. The impacts were associated with the inability or difficulty to eat a range of 16 common foods. CONCLUSION: This survey has shown that the oral status of older people fairly frequently affects the quality of life of older people, and in particular, the ability to eat several common types of foods.     

Relationship between dental status and Oral Impacts on Daily Performances in older Southern Chinese people

Objective: The objective of this study was to assess the relationship between different clinical indicators of dental status and an Oral Health‐Related Quality of Life (OHRQoL) measure, the Oral Impacts on Daily Performances (OIDP) index, using different scoring formats, among older Southern Chinese people. Methods: A total of 1,196 dentate people aged 55 years and older, attending routine annual health checkups at Guangxi Medical University Hospital Health Centre in Guangxi, China, participated in the study. They had a face‐to‐face structured interview and a clinical dental examination. The OIDP index was used to assess the impacts of oral conditions on quality of life. Spearman and Pearson as well as partial correlation coefficients were used to assess, respectively, the unadjusted and adjusted associations of 14 clinical indicators with the overall OIDP score, OIDP intensity, and OIDP extent. Results: All clinical indicators, except number of filled teeth, were significantly correlated with the OIDP index, after controlling for covariates. However, correlations were weak, ranging between 0.07 and 0.26. The strongest correlation was for the relationship between the number of natural plus replaced teeth and the OIDP index, irrespective of whether the overall OIDP score, OIDP intensity, or OIDP extent was used to measure OHRQoL. Conclusions: Clinical dental status indicators were related to OIDP, regardless of the scoring format used to calculate the OIDP index. Clinical indicators that included natural plus replaced teeth were more strongly associated with the OIDP index than their corresponding indicators that included only natural teeth.     

Development of an educational pamphlet on postoperative delirium management in older people receiving hip fracture surgery

BackgroundIn recent decades, POD has gradually attracted the attention of healthcare professionals. A preliminary literature search revealed very few results on the understanding of POD by the general public. To the authors’ knowledge, no educational material on POD has been developed by healthcare professionals in Hong Kong.AimThe aim of this study was to design and develop a validated pamphlet on POD for older people receiving hip fracture surgery.MethodsPamphlet development involved a literature search for previous studies undertaken to develop a predictive tool and preventive protocol for POD in orthopaedic settings. This study used self-reported questionnaires to obtain feedback from the carers of a selected group of patients and orthopaedic nurses on a draft educational pamphlet.ResultsNo difference was found in the rating results of the nurses and carers regarding Content Validity Index. Data were analysed and used to produce the final version of the pamphlet.ConclusionThe study revealed the differing perspectives of nurses and carers on the design and content of the pamphlet. The nurses and carers who participated in this study gained valuable information and knowledge about POD. It is hoped that this pamphlet will be very useful for nurses, patients and carers in understanding POD management.     

Determinants for preventive oral health care need among community‐dwelling older people: a population‐based study

The aim was to study the determinants of preventive oral health care need among community‐dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty‐five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co‐morbidity (measured by means of the Modified Functional Co‐morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0–1.5), being pre‐frail or frail, OR 2.5 (CI 1.2–5.1), presence of natural teeth, OR 4.8 (CI 2.2–10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4–114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.     

The oral health of older people: general dental practitioners' beliefs and treatment experience

The purpose of this study was to examine New Zealand general dentists' beliefs about older people's oral health and to identify the important barriers that prevent dentists from treating institutionalized older adults. A postal survey was distributed nationwide to a representative sample of 700 dentists (response rate 64.5%). Dentists' beliefs were mostly consistent with current epidemiological knowledge, although most (81.5%) mistakenly believed that the root surface caries increment was greater than that for coronal caries. One in four had visited a long‐term care (LTC) facility during the previous 2 years. Over threequarters cited the inconvenience of leaving their practices as a barrier, and the lack of a financial incentive was cited by almost half. The results suggested that the areas most in need of attention were the LTC staff's oral health knowledge and attitudes, as well as government policies. Although dentists' beliefs, practices, and attitudes occasion some optimism, the increase in the dentate older population means that policymakers will need to examine efficient, dentist‐acceptable ways of delivering care. The profession will need to develop and sustain an appropriate workforce.     

Examiner reliability for an invasive gingival bleeding index

This investigation was undertaken to determine the intra- and inter-examiner reliability of the method of stimulation for bleeding used in the Eastman interdental bleeding index. 26 subjects were examined twice, 1 h apart, by either a single examiner or 2 examiners in each half of their mouths, for the presence bleeding after stimulation with a wooden interdental cleaner. Scores were tabulated and intra- and inter-examiner % agreements and kappa-coefficients calculated. Z-tests were performed on the pairs of agreement statistics to check for significant differences. Overall, intra-examiner agreement statistics were high (91.3% to 93.1% agreement; 0.79 to 0.86 kappa-coefficient). Further breakdowns of the data into facial and lingual sites by arch and location (anterior or posterior) resulted in similar levels of reliability, with no significant differences within examiners. The overall inter-examiner agreement statistics were good (82.8% to 87.6% agreement; 0.62-0.75 kappa coefficient). When inter-examiner data were analyzed at facial or lingual sites by arch and location, a significant difference existed in reliability for mandibular posterior lingual sites, but reliability was high in all other areas. These data demonstrate a high level of reproducibility for this method, which suggests that the Eastman interdental bleeding index is suitable for clinical trials and epidemiologic studies of interdental gingivitis.     

Life‐course social influences on tooth loss and oral attitudes among older people: evidence from a prospective cohort study

This study examined the relationship of trajectories in social condition with oral attitudes and major tooth loss, using the social mobility and accumulation life‐course models in a cohort. Whether social‐condition inequalities remained stable or changed from 65 yr of age to 70 yr of age was investigated. In 1992, 6,346 inhabitants born in 1942 and residing in two Swedish counties agreed to participate in a prospective survey. Of the participants in 1992, 3,585 (47.6% men) completed questionnaires in 1997, 2002, 2007, and 2012. In line with the social‐mobility model, the prevalence of negative oral attitudes and major tooth loss in participants at 65 and 70 yr of age showed a consistent gradient according to social‐condition trajectory, whereby it was lowest among those who were persistently high and highest among those who were persistently low, with the upwardly and downwardly mobile categories being intermediate. A linear graded association between the number of periods with disadvantaged social condition and oral health supported the accumulation model. Both the social mobility and accumulation life‐course models were supported. Social‐condition differentials in negative oral attitudes and tooth loss seem to remain stable or to narrow weakly after the usual age of retirement.     

The impact of educational level on oral health-related quality of life in older people in London

There are socioeconomic inequalities in oral health, but the relationship between education and oral health-related quality of life (OHRQoL) among older adults has not been adequately studied. This study assessed whether there is an educational gradient in OHRQoL among older people in London. We employed secondary analysis of baseline data ( n  = 1,090) from a randomized controlled trial of health-risk appraisal on community-dwelling non-disabled people 65 yr of age and older, registered with three group medical practices in suburban London. Multiple linear regressions were used to analyze the association between OHRQoL [measured using the Geriatric Oral Health Assessment Index (GOHAI)] and education, adjusted for age, gender, pension status, and denture wearing. Overall, 30.6% reported low levels of OHRQoL. Eating discomfort was the most frequent problem (24% reported 'often/always'), while concerns about appearance were also prevalent. Significant variations in OHRQoL existed between socioeconomic groups. In adjusted analyses, there was a clear education gradient in OHRQoL, with worse perceptions at each lower level of education. Low educational level has an independent negative impact on OHRQoL in older people, which is not explained by differences in income or in denture wearing between educational groups. Policies targeting lower educated groups should be complemented with whole-population strategies for the reduction of oral health inequalities.     

Development of the Chinese version of the Dentine Hypersensitivity Experience Questionnaire

The aim of this study was to evaluate the reliability and the validity of the Chinese version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ). After translation and cross-cultural adaptation following international guidelines, 110 patients with dentine hypersensitivity were recruited to complete the questionnaire. The reliability of the Chinese version of the DHEQ was evaluated using internal consistency and test-retest methods. Construct validity was determined based on factor analysis, discriminative validity (by comparing the subscale scores difference in the degree of sensitivity being investigated), and convergent validity (by analyzing the correlation between DHEQ subscale scores and the global rating of oral health question). Cronbach's alpha value (internal reliability) for the total DHEQ score was 0.95 and the intraclass correlation coefficient (ICC) value (test-retest reliability) was 0.85. Construct validity was determined by factor analysis, extracting eight factors, accounting for 74% of the variance. All items had factor loadings of >0.40. In addition, the Chinese version of the DHEQ was found to be valid for distinguishing patients with varying degrees of dentine hypersensitivity. In terms of convergent validity, the impact scale was significantly highly correlated to the global oral health rating. The results suggest that the Chinese version of the DHEQ has satisfactory psychometric properties and is applicable for patients with dentine hypersensitivity in China.