Oral health of aged inpatients

Objectives: The proportion of the population aged 65 years and over in Australia is expected to increase substantially, and more people in this age group are retaining their teeth and will require dental care. The objective of this study was to assess the oral health status of inpatients over the age of 65. Methods: Dental examinations were performed on inpatients at Fremantle Hospital. Standardised assessment forms were used to investigate factors related to medical history, hospital admission and oral health needs. Results: A total of 104 persons were examined, 56% were dentate. The dentate participants had an average decayed, missing and filled (DMF)‐index of 21.6 (SD 7.1). All edentulous participants had dentures and the estimated average age of their dentures was 18.1 years. Although the majority of participants (70.2%) were satisfied with their oral health status, 76.6% were professionally assessed to be in need of immediate dental care. Among the edentulous participants, 47.1% needed new dentures. Among all the participants, 75.3% also needed improved oral hygiene. Conclusion: There is a need to fully assess availability, appropriateness and effectiveness of models of oral health care delivery among the older population. This study clearly indicates a current problem and high levels of unmet need. With an increasing ageing population and higher retention levels of natural dentitions, this will result in higher levels of oral disease and need for prevention and care.     

Diabetes care in rest homes in Christchurch, New Zealand.

AIM: To determine the prevalence and describe the management of known diabetes in a group of New Zealand rest homes. METHODS: A random sample of 54 rest homes in Christchurch were studied. Residents with known diabetes were identified by rest home staff and interviewed. Selected staff members of all rest homes were also interviewed using structured questionnaires. The medical and nursing records and laboratory results of all residents with known diabetes were reviewed and all information pertaining to diabetes management recorded. RESULTS: The prevalence of known diabetes in Christchurch rest homes was 11.7%. Residents with known diabetes had a mean of five other comorbidities and were prescribed a mean of 7.5 medications. Of residents with diabetes, 45% were taking oral glucose-lowering agents, 28% were on a diet alone and 27% on insulin treatment. The mean blood pressure was 134/73 mmHg. The mean HbA(1c) was 7.3%. Routine blood glucose monitoring was performed often but residents with possible hypoglycaemic episodes frequently did not have their blood glucose level checked. CONCLUSIONS: The prevalence of known diabetes in Christchurch rest homes is similar to that found in British studies but less than that found in studies from the USA. Indicators of quality of care in residents with diabetes in this study appeared to be satisfactory, in contrast to other studies. There was poor recognition by staff of the necessity of checking acutely blood glucose levels in residents with diabetes who became unwell.     

Nursing home resident and facility characteristics associated with pneumococcal vaccination: national nursing home survey, 1995-1999

Objectives: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination. Design: Cross‐sectional national sample surveys of nursing homes and nursing home residents with a two‐stage probability design, stratified on size and Medicare and Medicaid certification status. Setting: U.S. nursing homes during 1995, 1997, and 1999. Participants: Six current residents were randomly selected from each facility (n=approximately 8,000 each year). Measurements: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: “Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?” Vaccination status was coded as yes, no, and unknown. Results: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999. Conclusion: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.     

Variation in nursing home antipsychotic prescribing rates

BACKGROUND: Excessive prescribing of antipsychotic therapy is a concern owing to their potential to cause serious adverse events. We explored variation in the use of antipsychotic therapy across nursing homes in Ontario, Canada, and determined if prescribing decisions were based on clinical indications. METHODS: A point-prevalence study of antipsychotic therapy use in 47 322 residents of 485 provincially regulated nursing homes in December 2003. Facilities were classified into quintiles according to their mean antipsychotic prescribing rates. Residents were grouped into those with a potential clinical indication or no identified clinical indication for antipsychotic therapy. RESULTS: A total of 15 317 residents (32.4%) were dispensed an antipsychotic agent. The mean rate of antipsychotic prescribing by home ranged from 20.9% in the quintile of facilities with the lowest mean prescribing rates (quintile 1) to 44.3% in facilities with the highest mean prescribing rates (quintile 5). Compared with individuals residing in nursing homes with the lowest mean antipsychotic prescribing rates, those residing in facilities with the highest rates were 3 times more likely to be dispensed an antipsychotic agent (adjusted odds ratio [AOR], 3.0; 95% confidence interval [CI], 2.74-3.19). Similar rates were observed among residents with psychoses with or without dementia (AOR, 2.7; 95% CI, 2.35-3.09) and residents without psychoses or dementia (AOR, 2.9; 95% CI, 2.19-3.81) who had no identifiable indication for an antipsychotic therapy. CONCLUSION: Residents in facilities with high antipsychotic prescribing rates were about 3 times more likely than those in facilities with low prescribing rates to be dispensed an antipsychotic agent, irrespective of their clinical indication.     

Atypical presentation of scabies among nursing home residents.

BACKGROUND: Scabies epidemics are not uncommon in nursing homes. Effective treatment is enhanced by prompt clinical diagnosis and early intervention. The clinical presentation of scabies may vary in older, immunocompromised or cognitively impaired persons. METHODS: We performed a retrospective study of all residents diagnosed with scabies in a multilevel long-term care geriatric facility. The duration of the outbreak was from May to September 2000. RESULTS: Fifteen residents contracted scabies during the outbreak. All affected residents had predominantly truncal lesions. Twelve residents had diffuse erythematous, papulosquamous lesions. Pruritus occurred in only 5 residents. Three residents with severe dementia and notably impaired functional status failed to respond to Permethrin cream (5%). All 3 residents responded to treatment with oral Ivermectin. CONCLUSION: Older nursing home residents with scabies may present with atypical skin lesions. Residents with cognitive impairment and restricted mobility may be treatment resistant. The diagnosis of scabies should be considered in any nursing home resident with an unexplained generalized rash. Residents with dementia and severe functional impairment that fail to respond to Permethrin cream (5%) may benefit from treatment with oral Ivermectin.     

Prevalence of Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff in Nursing Homes in Northern Ireland

OBJECTIVES: To determine the prevalence of, and factors associated with, methicillin-resistant Staphylococcus aureus (MRSA) colonization in residents and staff in nursing homes in one geographically defined health administration area of Northern Ireland.
DESIGN: Point prevalence study.
SETTING: Nursing homes.
PARTICIPANTS: Residents and staff in nursing homes.
MEASUREMENTS: Nasal swabs were taken from all consenting residents and staff. If relevant, residents also provided urine samples, and swabs were taken from wounds and indwelling devices.
RESULTS: A total of 1,111 residents (66% of all residents) and 553 staff (86% of available staff) in 45 nursing homes participated. The combined prevalence rate of MRSA in the resident population was 23.3% (95% confidence interval (CI)=18.8–27.7%) and 7.5% in staff (95% CI=5.1–9.9%). Residents who lived in nursing homes that were part of a chain were more likely to be colonized with MRSA (odds ratio (OR)=1.91, 95% CI=1.21–3.02) than those living in independently owned facilities. Residents were also more likely to be colonized if they lived in homes in which more than 12.5% of all screened healthcare staff (care assistants and nurses) were colonized with MRSA (OR=2.46, 95% CI=1.41–4.29) or if they lived in homes in which more than 15% of care assistants were colonized with MRSA (OR=2.64, 95% CI=1.58–4.42).
CONCLUSION: The findings suggest that there is substantial colonization of MRSA in nursing home residents and staff in this one administrative health area. Implementation of infection control strategies should be given high priority in nursing homes.     

ETHNO-SPECIFIC AND MAINSTREAM NURSING HOMES: A SURVEY OF RESIDENTS FROM NON-ENGLISH SPEAKING BACKGROUNDS

A survey compared the experiences of 47 NESB residents in mainstream and 46 residents in ethno-specific nursing homes and the experiences of their family carers. Residents were more satisfied with ethno-specific homes, particularly the food and companionship. They had better relationships with staff. Carers were more satisfied with ethno-specific homes, particularly the food. Both groups of residents had similar patterns of reaction to placement as did their carers. The aged in ethno-specific homes had migrated at a younger age and their carers seemed better informed regarding services.     

Mobiler geriatrischer Konsiliardienst für Pflegeheime

Background

Hospital admissions are frequent among long-term residents of nursing homes and can result in detrimental complications affecting the patients?? somatic, psychological, and cognitive status. In this prospective controlled study, we investigated the effects of a mobile geriatric consultant service (GECO) offered by specialists in internal medicine on frequency of hospitalizations in nursing home residents.

Methods

During a 10-month observation period, residents in a control nursing home received medical attendance by general practitioners as is common in Austrian nursing homes. Residents in the intervention nursing home also received the medical service of GECO.

Results

Within the group of rest home residents receiving GECO support, a statistically significant lower frequency of acute transports to hospitals was observed in comparison to residents of the control nursing home (mean number of acute transports to hospitals/100 residents/month: 6.1 versus 11.7; p?<?0.01). The number of planned non-acute hospital and specialist office presentations was also lower in the intervention nursing home (mean number of hospital and specialist office presentations/100 residents/month: 14.4 versus 18.0); however, this difference did not reach statistical significance.

Conclusion

This study shows that a mobile medical geriatric consultant service based on specialists in internal medicine can improve medical care in nursing homes resulting in a statistically significant reduction of acute transports to hospitals.     

Effectiveness of conservative urinary incontinence management among female nursing home residents—A cluster RCT

BackgroundGuideline-compliant conservative management of urinary incontinence (UI) is the first step of the initial management for UI and is recommended for long-term care in older persons. Recent studies have focused on the effects of guideline-compliant UI management. However, most of these studies were tested in another setting than nursing homes and were not focused on conservative management.AimsTo measure the effectiveness of 29 evidence-based nursing recommendations regarding the conservative management of UI in Austrian nursing homes.MethodsThe study is a cluster randomized intervention trial with institution as the unit of randomization. Twelve nursing homes in two Austrian provinces (Styria, Carinthia) were randomly allocated to the intervention group (IG) and control group (CG). Data were collected from participating residents over a three-month period. The intervention consisted of the implementation of recommendations for the conservative management of UI among female nursing home residents. The primary outcome variable was the daily UI experienced by the participating residents.ResultsResidents in the (IG n = 216) had a lower risk (OR = 0.14, p = 0.02) of experiencing daily UI and were less likely to receive absorbent products (OR = 0.01, p = 0.01) than residents in the CG (n = 165). Residents in the IG (OR = 5.16, p = 0.00) were five times more likely to receive recommended interventions (e.g., bladder training) than residents in the CG.ConclusionIntroducing guideline-compliant management into nursing practice can increase the likelihood of evidence-based interventions for the conservative management of UI. The intervention in this study targeted on nurses/nurse managers and can be recommended for the nursing home setting.     

Dental health and oral health‐related quality of life in children with congenital bleeding disorders

The purpose of this study was to investigate the dental and some other aspects of oral health status of young patients with congenital bleeding disorders (CBD) and the impact of these on their quality of life (OHR‐QoL) compared with controls. DMFS‐dmfs (Decayed, Missed, Filled Tooth surfaces in permanent and primary teeth) scores, Simplified oral hygiene index, occurance of hypoplasia of first permanent molars, Temporomandibular joint dysfunction and occlusion of 46 CBD patients at the age range of 2–15 years and 46 of other children as control were compared, and the impact of their oral health situation on quality of life was also investigated. Data were analysed by chi–square, t‐test and Pearson correlation. Patients were significantly more caries‐free with less decayed teeth in primary‐permanent dentition (P = 0.03, t = ?2.17).The mean scores of OHR‐QoL of CBD patients and controls were not significantly different. Oral Bleeding was the significant variable in relation to ‘oral health‐related quality of life’ in CBD groups (Pearson correlation, r = ?0.56, P = 0.000). OHR‐QoL in the control group was related to dmfs score (r = ?0.392, P = 0.011) and male gender (r = ?0.329, P = 0.026). Congenital bleeding disorder CBD patients were found to have a better dental health situation in primary dentition compared with controls; however, their ‘oral health‐related quality of life’ was similar. Oral bleeding was the only significant factor related to OHR‐QoL in CBD. It shows an overall importance of development of comprehensive care centres for CBD as the main cause of this achievement.     

Obesity in nursing homes: an escalating problem

OBJECTIVES: To estimate trends in the prevalence of obesity in nursing homes, to characterize the obese nursing home population, and to evaluate the extent to which estimates of the prevalence of obesity varied by facility and geographic location. DESIGN: Cross-sectional. SETTING: One thousand six hundred twenty-five nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota from 1992 to 2002; 16,110 nursing homes in the United States in 2002. PARTICIPANTS: Newly admitted residents between 1992 and 2002 (n=847,601) in selected states and 1,448,046 residents newly admitted to a U.S. nursing home in 2002 with height and weight documented on the Minimum Data Set (MDS) assessment. MEASUREMENTS: Data were from the Systematic Assessment of Geriatric Drug Use via Epidemiology database. Residents were classified as having a body mass index of less than 18.5 kg/m2, 18.5 to 24.9 kg/m2, 25.0 to 29.9 kg/m2, 30 to 34.9 kg/m2, or 35.0 kg/m2 or greater. RESULTS: Adjusting for sociodemographics, in Kansas, Maine, Mississippi, New York, and South Dakota, fewer than 15% of newly admitted residents were obese in 1992, rising to more than 25% in 2002. In U.S. nursing homes, the distribution of obese residents is not shared equally across facilities. Nearly 30% of residents with a BMI of 35 kg/m2 or greater are younger than 65, and a disproportionate percentage of obese residents are non-Hispanic black. Residents identified as obese had a higher likelihood of comorbid conditions (e.g., diabetes mellitus, arthritis, hypertension, depression, and allergies). CONCLUSION: Increasing prevalence of obesity in nursing homes and substantial variation of obesity prevalence within facilities raise concerns about nursing home preparedness and access.     

Evaluation of oral health in different types of diabetes mellitus: A cross-sectional retrospective study

ObjectiveIt was aimed to compare the relationship between oral health and two types of diabetes mellitus (DM) using laboratory findings and oral health parameters.Material and methodThis retrospective study was conducted between 2021 and 2022. Type-I and Type-II diabetic patients who had laboratory findings and panoramic radiograph taken on the same day was included to the study. HbA1c, glucose, urea, LDL, HDL, AST, ALT, triglyceride, creatinine, positive and negative microalbuminuria levels on laboratory tests and, the number of root canal treated, missing, filled and decayed tooth on the panoramic radiograph were recorded. The obtained data were compared statistically to evaluate the association between diabetes type and oral health.ResultsA total of 101 patients, 51.5 % (n = 52) with Type-I diabetes and 49.5 % (n = 49) with Type-II diabetes, were included. The number of males (53.8 %) in Type-I DM group and the number of females (67.3 %) in Type-II DM group were statistically higher. The mean age of Type-II diabetic patients was higher than Type-I diabetic patients (p < 0.05). While the average number of teeth with caries per patient in the Type-1 diabetes group was 5, the average number of tooth loss per patient in the Type 2 group was 9.ConclusionsWhile Type-I diabetes could be a predisposing factor for dental caries, Type-II diabetes could be a predisposing factor for tooth loss.     

Need fulfillment in the nursing home: resident and observer perspectives in relation to resident well-being

Self-reports in nursing homes generally show highly satisfied residents, whereas observational studies provide more nuanced results. In this study, which is based on self-determination theory, the perspective of nursing home residents (self-reports) is compared to the perspective of trained “neutral” observers (video-observations). The experiences of physically frail older residents are measured with regard to the fulfillment of their needs for relatedness, autonomy, and competence. Self-reports of need fulfillment in general, in the caring relationship, and during a caregiving episode recorded on videotape of 36 residents (64 % female, mean age 80 years) were compared with observer ratings of resident need fulfillment during the latter caregiving episode. Furthermore, it was investigated which measure relates best to residents’ self-reported well-being. The results show that residents rate their need fulfillment higher than observers. There is weak to moderate agreement between resident and observer ratings. Furthermore, only residents’ self-reported need fulfillment in general is related with self-reported well-being. Different explanations are provided, including the “barrier of happiness,” the use of cognitive strategies, a change in identity and existing power relations. There seems to be a paradox in caregiving: Residents and their needs should be central, but because residents might adapt their needs and wishes it is hard to assess these. Suggestions for practical applications are given.     

Relationship between oral health and nutrition in very old people.

OBJECTIVE: To evaluate the relationship between oral health status and nutritional deficiency. DESIGN: Cross-sectional clinical study. SUBJECTS: 324 institutionalized frail older adults (mean age 85). MEASUREMENTS: Structured oral examination including an evaluation of mucosa, periodontal state, caries prevalence and denture quality. The nutritional status was assessed using serum albumin concentration and the body mass index. Physical dependence was assessed using the Barthel index. To identify oral health disorders associated with markers of malnutrition we performed the Pearson chi2 test separately for edentulous and dentate patients. Subjects with at least one of the identified oral disorders were classified as having compromised oral functional status. RESULTS: About two-thirds of the subjects were functionally dependent and half had either a body mass index <21 kg/m2 or serum albumin <33 g/l. Among the edentulous, wearing dentures with defective bases or not wearing dentures at all were the factors most associated with malnutrition. In dentate subjects, corresponding identifiers were the number of occluding pairs of teeth (five or fewer, either natural or prosthetic), the number of retained roots (four or more), and the presence of mobile teeth. According to these criteria, 31% of the subjects had a compromised oral functional status. This was more frequently found in dependent subjects (37%) than semi-dependent subjects (18%; odds ratio, 2.6; 95% confidence interval, 1.4-4.8). Those with compromised oral functional status had a significantly lower body mass index and serum albumin concentration. CONCLUSION: Specific detrimental oral conditions are associated with nutritional deficiency in very old people.     

The impact of legislation on psychotropic drug use in nursing homes: a cross-national perspective

OBJECTIVES: To quantify the impact of legislation on nursing home residents, psychotropic drug use, and the occurrence of falls in the US compared with five countries with no such regulation. DESIGN: A retrospective cross-sectional study SETTING: Nursing homes in five US states and selected nursing homes in Denmark, Iceland, Italy, Japan, and Sweden. PARTICIPANTS: Residents in nursing homes in five US states and the aforementioned countries during 1993-1996. MAIN OUTCOME MEASURES: Using data collected using the Minimum Data Set, logistic regression provided estimates of the legislative effects on the use of antipsychotics and antianxiety/hypnotics while simultaneously adjusting for potential confounders. The occurrence of falls was evaluated similarly. RESULTS: Prevalence of antipsychotic and/or antianxiety/ hypnotic use varied substantially across countries. After adjustment for differences in age, gender, presence of psychiatric/neurologic conditions, and physical and cognitive functioning, residents in Denmark, Italy, and Sweden were at least twice as likely to receive these drugs (Denmark Odds Ratio (OR)=2.32; 95% Confidence Intervals (CI), 2.15-2.51; Italy OR=2.05; 95% CI, 1.78-2.34; Sweden OR=2.50; 95% CI, 2.16-2.90); in Iceland, the risk was increased to greater than 6 times (OR=6.54; 95% CI, 5.75-7.44) that of the US. Residents were less likely to fall in Italy, Iceland, and Japan compared with the US, despite more extensive use of psychotropic medication, whereas residents in Sweden and Denmark were more likely to fall. CONCLUSIONS: Policy has had an impact on the prescribing of psychotropic medication in US nursing homes compared with other countries, but it is unclear if this is translated into better outcomes for residents.     

Disruptive Behaviors in Veterans Affairs Nursing Home Residents: How Different Are Residents with Serious Mental Illness?

OBJECTIVES: To determine the prevalence and correlates of behavior problems of residents of Veterans Affairs (VA) nursing homes and to compare residents with serious mental illness (SMI) with other resident groups. DESIGN: This study combined cross-sectional resident assessments with administrative data for all residents in VA nursing homes. Multivariate ordinal logistic regression was used to evaluate associations between resident characteristics and problem behaviors. SETTING: Nursing home care units in the VA healthcare system. PARTICIPANTS: A total of 9,618 nursing home residents assessed as part of the VA's April 2001 national resident census. MEASUREMENTS: The Patient Assessment Instrument assessed each resident's verbally disruptive, physically aggressive, and socially inappropriate behaviors in the prior 4 weeks. Functional limitations in eating, mobility, toileting, and transfer were assessed. Diagnoses were evaluated for the stay and up to 6 months before assessment. RESULTS: Almost one-fifth (17.9%) of residents received a diagnosis of SMI. Residents with SMI or dementia had greater behavior problems than residents with neither condition. Residents with SMI (and without dementia) exhibited more verbal disruption than residents with dementia (and without SMI), but the two subgroups did not differ in physically aggressive or socially inappropriate behavior. CONCLUSION: Many VA nursing home residents have SMI. Their level of behavior problems is comparable with that of residents with dementia. Clinical practice and nursing home staff training must encompass geriatric mental health and behavior management to meet the needs of residents with SMI.     

Trends in the Prevalence and Comorbidities of Diabetes Mellitus in Nursing Home Residents in the United States: 1995–2004

OBJECTIVES: To estimate trends in the prevalence and comorbidities of diabetes mellitus (DM) in U.S. nursing homes from 1995 to 2004. DESIGN: SAS callable SUDAAN was used to adjust for the complex sample design and assess changes in prevalence of DM and comorbidities during the study period in the National Nursing Home Surveys. Trends were assessed using weighted least squares linear regression. Multiple logistic regressions were used to calculate predictive margins. SETTING: A continuing series of two‐stage, cross‐sectional probability national sampling surveys. PARTICIPANTS: Residents aged 55 and older: 1995 (n=7,722), 1997 (n=7,717), 1999 (n=7,809), and 2004 (n=12,786). MEASUREMENTS: DM and its comorbidities identified using a standard set of diagnosis codes. RESULTS: The estimated crude prevalence of DM increased from 16.9% in 1995 to 26.4% in 2004 in male nursing home residents and from 16.1% to 22.2% in female residents (all P<.05). Male and female residents aged 85 and older and those with high functional impairment showed a significant increasing trend in DM (all P<.05). In people with DM, multivariate‐adjusted prevalence of cardiovascular disease increased from 59.6% to 75.4% for men and from 68.1% to 78.7% for women (all P<.05). Prevalence of most other comorbidities did not increase significantly. CONCLUSION: The burden of DM in residents of U.S. nursing homes has increased since 1995. This could be due to increasing DM prevalence in the general population or to changes in the population that nursing homes serve. Nursing home care practices may need to change to meet residents' changing needs.