Factors associated with oral health-related quality of life in community-dwelling elderly persons with disabilities

OBJECTIVES: To examine, in community‐dwelling elderly persons with disabilities, the association between oral health—related quality of life (OHRQOL) as measured using the 14‐item Oral Health Impact Profile (OHIP‐14) and specific oral health, health, and disability status variables; life satisfaction; living alone; and low income. DESIGN: Observational cross‐sectional. SETTING: A Medicare demonstration conducted in 19 counties in three states. PARTICIPANTS: Six hundred forty‐one disabled, cognitively intact, community‐dwelling individuals aged 65 and older. MEASUREMENTS: The subjects' OHRQOL was assessed using the OHIP‐14, which was scored using three different methods. Data on oral health, health and functional status, life satisfaction, prior health services use, and sociodemographics were collected using interviewer‐administered questionnaires. RESULTS: The participants' mean age was 79.1, and they were dependent in an average of 1.8 activities of daily living (ADLs); 43.1% were edentulous, 77.4% wore a denture, 40.4% felt that they were currently in need of dental treatment, and 64.7% had not had a dental examination in the previous 6 months. Seven of the 16 variables of interest had significant bivariate relationships using three OHIP scoring methods. Logistic regression analysis found that poor OHRQOL was significantly associated with perceived need for dental treatment (odds ratio (OR)=2.61), poor self‐rated health (OR=2.29), poor (OR=2.00) and fair (OR=1.73) mental health, fewer than 17 teeth (OR=1.74), and relatively poor cognitive functioning (OR=1.52). CONCLUSION: OHRQOL is associated with some (perceived need for dental treatment, poor self‐rated health, worse mental health, fewer teeth, and relatively poor cognitive status) but not all (e.g., ADL and instrumental ADL dependence) measures of oral health, health, and disability status and not with life satisfaction, living alone, or low income.     

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.     

Factors associated with self‐reported use of oral health services among older Melbournians

Objectives: This paper discusses the utilisation of oral health‐care services by older adults in Melbourne, Australia, and factors associated with their use. Methods: The study involved 993 older adults who participated in the Melbourne Longitudinal Studies on Healthy Ageing baseline data collection. Results: Nearly 38% of respondents had used oral health services in the previous year. Another 4% had not visited a dentist for more than 5 years. Recent use of dental services was associated with five predictors: higher level of education, non‐pension sources of income, lower age, more social support and higher levels of depression. Conclusion: This study provides important information about dental utilisation by older Melbournians. Lack of information on dentition status, and type of dental visits limits the interpretation of the data, highlighting the need to collect relevant information that would inform the design of longitudinal studies aimed at determining predictors of use of oral health services by older Australians.     

A study investigating the travel habits and preferences of older Australian adults with a falls risk

Aim: To investigate the travel habits and preferences of city‐dwelling older Australians with a falls risk, and factors influencing outings. Methods: A retrospective cross‐sectional survey was conducted with 96 community‐dwelling adults with a falls risk. Results: The mean age of participants was 78.2 years (SD 5.33). The majority were women (77%). Most (75%) went on five or more outings per week (mean 6.9 outings). Men drove more than women (41% vs 31%). Shopping was the most common reason for outings. Walking was the most frequent mode of travel, and buses were both the easiest and most difficult. Factors that enabled bus travel included bus stop location, good services and cheap fares. Primary reasons for restricting outings were poor health, transport barriers, neighbourhood safety and personal motivation. Conclusion: These older adults went out nearly every day. Findings can be used to improve transport services for older people.     

Palestinian women's oral health status,knowledge, practices,and access to dental care during pregnancy: a cross-sectional study

Background

No data exist about the oral health status, beliefs, and practices of women living in the occupied Palestinian territory generally and in pregnant women in particular. The aim of this study was to investigate pregnant women's oral health status, beliefs, and practices and the barriers to access to dental care.

Risk factor profile in Chinese‐Australian stroke patients living in Sydney

Aim: To examine and compare stroke risk factors and their management in stroke patients of Chinese descent versus English‐speaking background (ESB)‐Australian patients. Methods: Cohort study. Fifty‐one Chinese‐Australians and 119 ESB‐Australians who were admitted to hospitals within Sydney metropolitan area with a recent acute ischaemic or haemorrhagic stroke were recruited. Results: Chinese‐Australian patients tended to have a favourable smoking (0% current smokers vs 15%, P = 0.036) and drinking (5% current medium/heavy drinkers vs 17%, P = 0.005) pattern compared with the Australian patients. The prevalence of diabetes mellitus was higher in Chinese‐Australians (31% vs 10%, P = 0.003). The management of hypertension and atrial fibrillation (AF) in Chinese‐Australians was suboptimal (19% untreated hypertension vs 8%, P = 0.102; 78% AF not on Warfarin vs 51%, P = 0.264). Conclusion: The findings of this study suggest that targeting specific stroke prevention strategies may be useful for Chinese‐Australians. Larger‐scale studies need to be conducted to confirm these findings.     

Prevalence of tooth loss and dental service use in older Mexican Americans

OBJECTIVES: To describe the prevalence of tooth loss, to examine risk factors for having fewer teeth or no teeth, and to describe the use of dental services in an older Mexican-American population. DESIGN: Data from the baseline phase of the Hispanic Established Population for the Epidemiological Study of the Elderly survey conducted from 1993 to 1994, a cross-sectional survey of older Mexican Americans. SETTING: Five southwestern states: Texas, California, Arizona, New Mexico, and Colorado. PARTICIPANTS: 3,050 noninstitutionalized Mexican Americans age 65 to 99. RESULTS: Twenty-seven percent of the sample was completely edentulous and 22% reported visiting or speaking with a dental care professional in the preceding year. Logistic regression analyses showed that being older or being female was significantly associated with tooth loss, adjusting for education, income, smoking status, and diabetes mellitus. Current smokers (odds ratio (OR) = 1.69; 95% CI = 1.31-2.20) and diabetics (OR = 1.53; 95% CI = 1.27-1.84) were more at risk for tooth loss, as were persons of lower socioeconomic status. CONCLUSIONS: The prevalence of tooth loss and use of dental services in this population of older Mexican Americans is lower than what has been previously found among older people in the general population.     

Spirituality,religion, social support and health among older Australian adults

Aim: To examine the impact of perceived importance of spirituality or religion (ISR) and religious service attendance (RSA) on health and well‐being in older Australians. Methods: A cross‐sectional survey of 752 community‐dwelling men and women aged 55–85 years from the Hunter Region, New South Wales. Results: Overall, 51% of participants felt spirituality or religion was important in their lives and 24% attended religious services at least 2–3 times a month. In univariate regression analyses, ISR and RSA were associated with increased levels of social support (P < 0.001). However, ISR was also associated with more comorbidities (incidence–rate ratio= 1.2, 95% confidence interval 1.08–1.33). There were no statistically significant associations between ISR or RSA and other measures such as mental and physical health. Conclusion: Spirituality and religious involvement have a beneficial impact on older Australians' perceptions of social support, and may enable individuals to better cope with the presence of multiple comorbidities later in life.     

Oral health of Adelaide nursing home residents: longitudinal study

Objective: The Adelaide Dental Study of Nursing Homes aimed to quantify oral disease experience, incidence and increments in Adelaide nursing home residents. Methods: Questionnaires and dental inspections were completed at baseline and at 1‐year for residents from randomly selected Adelaide nursing homes. Results: The residents were very functionally dependent, cognitively impaired and behaviourally difficult older adults with complex oral problems and dental treatment needs. The prevalence of edentulism (total tooth loss) (63%) decreased and more residents were retaining natural teeth. Existing residents had a mean of 10.8 teeth present and new residents had a mean of 12.7 teeth present. Residents’ previous experiences of caries (decay) were high – existing residents had a mean of 1.2 decayed teeth and new residents had a mean of 0.8 decayed teeth. Residents’ caries increments (new decay) over the 1‐year period were high (coronal = 2.5 surfaces; root = 1.0 surfaces), especially in those who had lost weight and who could eat fewer food types. These levels of caries were many times greater than had been reported for community‐dwelling older adults. Large accumulations of plaque, calculus and debris (food) were evident on residents’ natural teeth and dentures, especially those with dementia. Up to 25% of residents owned dentures that were not worn. Residents with dementia gave their carers complex and challenging oral hygiene care problems. Existing and new residents had similar general health and oral health characteristics, with the exceptions that new residents had significantly more filled tooth surfaces, and fewer decayed retained roots. Conclusion: New residents were being admitted to the nursing homes with a compromised oral health status or developed severe oral diseases and conditions within several months of their admittance. Residents’ oral diseases, especially coronal and root caries, rapidly progressed during their stay in residential care.     

Dietary and health supplement use among older Australians: results from a national survey

Objectives: To measure the extent of dietary and health supplement use among older Australians and to contrast older supplement users from older non‐supplement users. Method: Survey participants (n= 1,263) provided information related to demographic, health and lifestyle features. The target population were Australians aged 65 years and over, randomly chosen from the Australian Electoral Commission. Data was obtained using a 12‐page self‐administered, mail questionnaire. Results: Forty‐three percent (n=548) of the sample reported using at least one dietary and health supplement, 52% of females and 35% of males. Supplement use was significantly related to several demographic and lifestyle features including: gender, educational level, smoking status and number of visits to complementary health therapists. Conclusions: Clearly, supplements were chosen more for their perceived ability to attenuate or modify ailments, rather than their role in correcting nutritional deficiencies. Older Australians appear intent on taking health matters in their own hands. Approximately one third of them rarely inform their doctor about the supplements they use, which raises concerns about the safety and appropriateness of this action.     

Referral patterns to a palliative care service in rural Australia servicing indigenous Australians

Background: Territory palliative care (TPC) of the Northern Territory covers a population of 150 000 over 400 000 km² in urban, rural and remote settings. Thirty‐two per cent of the population are indigenous Australians. There is little documentation of palliative services to the indigenous Australians. Methods: We retrospectively reviewed the referral characteristics of patients who died in or were discharged from the TPC over 6 months in order to define unique characteristics of palliative care of such a population. Results: The records of 151 consecutive patients were analysed, with a mean age 63 ± 17 years, 62% male, 59% non‐indigenous, 70% urban dwellers and 71% referred for malignancies. Median time to separation was 69 days, with 33% discharged within 30 days, while 28% survived beyond 6 months. Eighty‐two per cent of patients died, and of these 52% in the hospice. indigenous patients were more likely to be younger (54 vs 70 years), female (52% vs 29%), living rurally (52% vs 12%) and to die at home (47% vs 11%). Conclusion: These data showed major differences from the largest Australian study published so far, based on a population of predominantly non‐indigenous Australians. This study identifies for the first time how TPC needs to have an encompassing service plan and delivery model to cater for indigenous patients and people in remote locations.     

Patterns of tooth loss in older adults with and without dementia: a retrospective study based on a Minnesota cohort

OBJECTIVES: To study tooth loss patterns in older adults with dementia. DESIGN: Retrospective longitudinal study. SETTING: A community‐based geriatric dental clinic in Minnesota. PARTICIPANTS: Four hundred ninety‐one older adults who presented to the study clinic as new patients during the study period, remained dentate after finishing the initial treatment plan, and returned for care at least once thereafter were retrospectively selected. One hundred nineteen elderly people with International Classification of Diseases, Ninth Revision, codes 290.x, 294.1, or 331.2 or a plain‐text diagnosis of dementia, Alzheimer's disease, or chronic brain syndrome in the medical history were considered having dementia. INTERVENTION: All existing dental conditions were treated before enrollment. Dental treatment was continually provided for all participants during follow‐up. MEASUREMENTS: Tooth loss patterns, including time to first tooth loss, number of tooth loss events, and number of teeth lost per patient‐year were estimated and compared for participants with and without dementia using Cox, Poisson, and negative‐binomial regressions. RESULTS: Participants with dementia arrived with an average of 18 and those without dementia with an average of 20 teeth; 27% of remaining teeth in the group with dementia were decayed or retained roots, higher than in the group without dementia (P<.001). Patterns of tooth loss did not significantly differ between the two groups; 11% of participants in both groups had lost teeth by 12 months of follow‐up. By 48 months, 31% of participants without dementia and 37% of participants with dementia had lost at least one tooth (P=.50). On average, 15% of participants in both groups lost at least one tooth each year. Mean numbers of teeth lost in 5 years were 1.21 for participants with dementia and 1.01 for participants without dementia (P=.89). CONCLUSION: Based on data available in a community‐based geriatric dental clinic, dementia was not associated with tooth loss. Although their oral health was poor at arrival, participants with dementia maintained their dentition as well as participants without dementia when dental treatment was provided.     

Using the health belief model to explore nursing students’ relationships between COVID-19 knowledge,health beliefs,cues to action,self-efficacy,and behavioral intention: A cross-sectional survey study

Nursing educators should equip nursing students with sufficient knowledge about coronavirus disease 2019 (COVID-19), perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and behavioral intention in order to prevent the spread of COVID-19.The purpose of this study was to use the health belief model to elucidate nursing students’ relationships between knowledge about COVID-19, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and behavioral intention.A cross-sectional survey design was adopted and purposive sampling was utilized. A total of 361 nursing students participated in the study. Quantitative analysis was employed for all data analysis.The findings showed that the nursing students had the following mean scores on knowledge of COVID-19 9.43 [standard deviation (SD)1.19], perceived susceptibility 19.41 (SD2.68), perceived severity 20.31 (SD 4.09), perceived benefits 26.52 (SD 4.08), perceived barriers 15.17 (SD5.88), cues to action 3.30 (SD1.70), self-efficacy 17.68 (SD2.83), and behavioral intention 18.46 (SD2.33). Nursing students’ demographic background, knowledge of COVID-19, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy explained 58.1% of the variance in behavioral intention (R² = 0.581, F = 29.775, P < .001).Nursing educators can increase nursing students’ knowledge of COVID-19, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy as effective means of health promotion to improve their behavioral intention to prevent the spread of COVID-19.     

Overcoming preconceptions and perceived barriers to medical communication using a 'dual role-play' training course

Background: Communication is a core component of clinical competence. We introduced a dual role‐play (DRP) course, in which participants role‐played both the doctor‐candidate and the standardized patient. The aim of the study was to assess the usefulness of a DRP communication course for physicians and to identify factors that inhibit effective medical communication. Methods: We conducted four medical communication skills courses from 2004 to 2006. A questionnaire was administered before and after completion of each course. We assessed respondents’ confidence levels before and after the course and sought to identify perceived barriers to effective communication among medical trainees in Singapore. Finally, we asked if they found participation in the course and its DRP nature to be useful. Results: Twenty‐six participants, 20 men, 6 women, of mean age 30.2 years (standard deviation (SD) 2.01) completed the survey. The pre‐course confidence levels (rated on a scale of 1–10) of 6.23 (SD 1.18) rose significantly to 7.58 (SD 0.95) on completion of the course (P = 0.001, Wilcoxon signed rank test). All respondents felt that they had benefited from participation in the medical communication skills course. 24 (92.3%) respondents deemed it useful to have role‐played both the doctor and standardized patient in the exercise. We identified respondents with language difficulties to have benefited the most from the course (P = 0.031, odds ratio 2.906 (95%CI 0.292–5.519), linear regression analysis). Conclusion: DRP is an effective way to train doctors in medical communication.     

Blood lead levels in iron‐deficient and noniron‐deficient adults

Iron deficiency (ID) has been reported to increase lead absorption. This relationship has been investigated in detail in children but not in adults. This study was designed to investigate whether blood lead levels are significantly higher in iron‐deficient adults. ID‐parameters (haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin, serum iron, total iron‐binding capacity, iron‐binding saturation, soluble transferrin receptors, washed zinc protoporphyrin and ferritin) together with whole blood lead were measured in three different adult groups – blood donors (n = 73), pregnant women (n =74) and haemodialysis patients (n = 72). Of a total of 219 subjects tested, 7.7% was found to have a lead level above 10 μg/dl (maximum 16 μg/dl). No association was found between blood lead level and ID [iron‐deficient subjects (n: 139), mean: 5.6 μg/dl (SD: 3 μg/dl) and noniron‐deficient subjects (n: 80), mean: 5.4 μg/dl (SD: 3 μg/dl)]. The results suggest that the inverse association between blood lead and serum iron in studies carried out on children does not occur in adults.     

Caregiver and noncaregiver attitudes toward dementia screening

OBJECTIVES: To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving. DESIGN: A cross‐sectional study. SETTING: Primary care clinics in Indianapolis, Indiana. PARTICIPANTS: Eighty‐one participants with dementia caregiving experience (CG) and a random sample of 125 participants without dementia caregiving experience (NCG). MEASUREMENTS: Attitudes of dementia screening, including acceptance of dementia screening and its perceived harms and benefits, as determined according to the Perceptions Regarding Investigational Screening for Memory in Primary Care questionnaire. RESULTS: After adjusting for age, race, sex, and education, CGs had a lower dementia screening acceptance mean score (53.9 vs 60.6; P=.03) and a higher perceived suffering score (61.6 vs 55.9, P=.04) than NCGs, but there were no differences in perceived benefits of dementia screening (72.8 vs 69.0; P=.50), perceived stigma (32.9 vs 37.5; P=.12), and perceived negative effect on independence (47.6 vs 54.0; P=.20). The top three barriers to screening identified by both groups were emotional suffering by the family (86% of CGs and 75% of NCGs), loss of driving privileges (75% of CGs and 78% of NCGs), and becoming depressed (64% of CGs and 43% of NCGs). CONCLUSION: The experience of being a dementia caregiver may influence one's own attitude about accepting dementia screening for oneself.     

The effect of mental health screening and referral on symptoms of depression among HIV positive outpatients in Vietnam: Findings from a three-month follow up study

ABSTRACT

This study investigated whether screening for symptoms of mental disorders and referral to mental health services was associated with decreased depression symptoms among people living with HIV/AIDS (PLHIV) in Vietnam. Four hundred PLHIV (63.5% male, mean age 34.8 (SD?=?6.8) years) at two outpatient clinics in Ho Chi Minh City were interviewed by psychiatrists and also completed the Center for Epidemiologic Studies–Depression scale (CES-D). One hundred and seventy-four (43.5%) were identified with symptoms of a range of mental illnesses, including depression, anxiety, alcohol use disorder, substance use disorder and HIV associated dementia and were referred to mental health services. Of the 174 PLHIV referred, 162 (93%) returned and completed the CES-D three months later and 125 of these 162 (77%) had attended a mental health service and undertaken treatment. A significant improvement was found in the mean CES-D scores of the 125 attenders from baseline (M?=?19.0, SD?=?7.5) to month three (M?=?11.7, SD?=?7.9, p?<?0.001). PLHIV who had attended a mental health service and undertaken treatment demonstrated a greater reduction of mean scores on the CES-D compared to PLHIV who had either received a referral but not attended a mental health service to undertake treatment, or not been referred initially.     

Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis

Aim: To assess the frequency of, and factors associated with, depression and anxiety in Singaporean patients with rheumatoid arthritis (RA). Method: One hundred RA patients were recruited in a cross‐sectional study. Socio‐demographics, severity of anxiety and depression, disease activity, levels of serological markers and health‐related quality of life were analyzed. Results: Twenty‐six percent presented with anxiety, 15% with depression and 11% with both. Univariate regression showed that age (P = 0.039), Disease Activity Scale (DAS‐28) (P < 0.001), number of medications (P < 0.001) and rheumatoid factor (RF) (P < 0.001) were positively associated with severity of depression, while income (P = 0.001), education (P = 0.029), self‐perceived social support (P = 0.007), Short form 12 (SF‐12) physical health (P < 0.001) and SF‐12 mental health (P < 0.001) were negatively associated with severity of depression. After adjustment for confounding factors in multivariate regression, income (β = ?0.347, P = 0.018), RF (β = 0.304, P = 0.043) and SF‐12 mental health (β = ?0.501 P = 0.001) remained significantly associated with depression. Univariate regression showed that DAS‐28 (P = 0.009), number of medications (P = 0.004) and RF (P = 0.043) were positively associated with anxiety, while income (P = 0.022), self‐perceived social support (P = 0.04), SF‐12 physical health (P < 0.001) and SF‐12 mental health (P < 0.001) were negatively associated with anxiety. After adjustment for confounding factors, no factors remained significantly associated with anxiety. Conclusion: Low income, high levels of RF and poor mental health were associated with depression in RA. Our findings may help to formulate depression screening strategies. Further research is required to identify the role of RF in depression.     

Oral health of Alzheimer's patients in São José dos Campos,Brazil

Aim: Neglecting oral health can negatively affect the quality of life of Alzheimer's patients. This work evaluates the oral health of Alzheimer's patients in São José dos Campos, Brazil. Methods: Brazilian versions of the Oral Health Risk Assessment and Index to dental management of patients with Alzheimer's disease questionnaires were given to 50 patients (14 men, 36 women) diagnosed with Alzheimer's disease, with an average age of 79.7 years (SD = 9.2 years). Alternatively, the questionnaire was given to patients' caregivers. Cronbach's alpha test was applied to validate the Brazilian versions of these tests. Non‐parametric tests were applied to test for possible associations. Results: Cronbach's alpha was 0.677. Nearly half of the patients (42%) presented with mild Alzheimer's disease, 38% moderate, and 20% severe. Most of the patients did not have their natural teeth (74%), had no oral health problems (64%), were on medication (92%), had not visited the dentist in the last year (70%), and had no need for urgent dental treatment (92%). Of the 42% of patients who used dentures, 76.2% had been wearing the same dentures for over 5 years. There was no association between severity of disease and the presence of natural teeth (P = 0.346), use of removable dentures (P = 0.233), and the presence of oral health problems (P = 0.066). Conclusions: Patients with Alzheimer's disease have unmet oral health needs, but there was no association between severity of their disease and the presence of oral health problems. Geriatr Gerontol Int 2012; 12: 265–270.