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.     

The effect of oral health on quality of life in an underprivileged homebound and non-homebound elderly population in Jerusalem

OBJECTIVES: To measure the effect of oral health on quality of life in elderly people in Jerusalem and to compare homebound and nonhomebound people.
DESIGN: A cross-sectional, purposive cluster sample.
SETTING: Community-based, one dental clinic, three geriatric day centers, and home visits.
PARTICIPANTS: Three hundred forty-four underprivileged people aged 60 and older, 64 of whom were homebound.
MEASUREMENTS: Score on the shortened version of the Oral Health Impact Profile (OHIP-14) (validated for Hebrew) was the dependent variable. One dental assistant conducted a structured interview, including universal variables, and one dentist examined dental status.
RESULTS: Average OHIP-14 level was 10.43. For total OHIP-14, the odds ratio comparing the homebound with the nonhomebound population was 2.06 ( P =.03). After multiple logistic regression, functional ability and education level reached independent significance for OHIP-14 level were.
CONCLUSION: Homebound elderly people reported greater difficulties than nonhomebound people in communication, eating, relaxation, and life satisfaction as related to oral health.     

Oral and general health-related quality of life among young patients with haemophilia

Summary.  The clinical diagnosis of dental diseases may indicate their cause and prognosis, however it gives little information about resulting levels of impairment from the patients' perspective. In this study, we aimed to investigate oral and general health-related quality of life (OHRQoL-HRQoL) in patients with haemophilia; and to test whether haemophiliacs would have worse or better OHRQoL compared with the general population. Data were collected from haemophiliacs (age range 14–35; mean 23 ± 6.58, n  = 71) and age/sex-matched controls (age range 14–35; mean 21.00 ± 6.45, n  = 60) through face-to-face interviews including nine questions and using oral health impact profile (OHIP)-14, oral health-related quality of life-UK (OHQoL-UK), short-form general measure of health (SF)-36 to measure self-rating oral health status, perceived dental treatment needs, tooth brushing frequencies, OHRQoL-HRQoL. In the field of self-rating oral health status, perceived dental treatment needs, tooth brushing frequencies and OHIP, OHQoL-UK, SF-36 scores – except the subscales including vitality, role emotional and mental health – the control group is in better conditions compared with the haemophilia group. At the same time, both the two groups are in good conditions in dental attendance, vitality, role emotional and mental health. Life quality is related with the perceived discrepancy between the reality of what a person has and the concept of what that person wants, needs or expects. In order to eliminate the dilemma in the field of health, we should facilitate the haemophiliacs' lives by serving the health care in a multidisciplinary view.     

General and oral health‐related quality of life among caregivers of Parkinson's disease patients

Aim: The aim of the present study was to evaluate the general and oral health‐related quality of life among caregivers of patients with Parkinson's disease. Methods: A representative sample (n = 80, 19 men and 61 women) of caregivers from São José dos Campos, Brazil, answered Oral Health Impact Profile (OHIP‐14) and Medical Outcomes Study 36‐Item Short Form (SF‐36) questionnaires, as well as another questionnaire regarding caregivers' characteristics and caring activities. Results: The OHIP‐14 average score was 2.56. The SF‐36 average score for the domain of physical function was 87.4; for role‐physical function, 85.0; for bodily pain, 62.9; for general health, 76.6; for vitality, 80.0; for social function, 88.4; for role‐emotional function, 83.8; and for mental health, 85.3. All domains of the SF‐36 also showed negative correlations with OHIP‐14 in the entire sample, but this correlation could not be observed among lower educated caregivers. There were significant differences between formal and informal caregivers for OHIP‐14 and for the majority of SF‐36 domains. Conclusions: Most caregivers were female, the mean scores for SF‐36 and OHIP‐14 were adequate, and formal caregivers had better results for the SF‐36 and OHIP‐14 when compared with informal caregivers. Geriatr Gerontol Int 2013; 13: 429–436 .     

Mundgesundheitsbezogene Lebensqualität älterer Menschen

PURPOSE: The aim of this study was to describe the oral health related quality of life (OHRQoL) of institutionalized elderly. MATERIAL: 159 elderly were randomly selected for this, study ranging in age from 61 to 98 (mean age 82.8; 19.1% male, 80.9% female). For measuring the OHRQoL the Oral Health Impact Profile (OHIP) was used. Additionally, a dental status was evaluated. RESULTS: 15% of the subjects had only natural teeth or fixed dentures, 80% removable dentures and 15% no dentures at all. OHIP-mean reached 33+/-25 points, between 0 and 112. The subcategory "functional limitation" showed the highest impairment (6.3%). The items with the highest impairment on OHRQoL in the different subcategories were: dentures not fitting properly, uncomfortable dentures, self-conscious due to teeth, avoid eating some foods, felt depressed, avoid going out and general health worsened. CONCLUSIONS: The OHIP summary score represents an overview of OHRQoL and answers detailed questions with the help of the single items. In institutionalized elderly many items showed impairment, especially in items concerning the prosthetic restorations. This demonstrates the need for dental aftercare and not only dental interventions for acute pain. Establishing aftercare and prophylaxis could increase the OHRQoL and subsequently the overall well-being.     

Oral health status and self-reported functional dependence in community-dwelling older adults

OBJECTIVES: To assess the strength of association between graded groups of oral health status and self‐reported functional dependence in community‐dwelling older adults. DESIGN: Population‐based cross‐sectional study. SETTING: National Health and Nutritional Examination Survey (NHANES) 1999 to 2004. PARTICIPANTS: Three thousand eight hundred fifty‐six participants aged 60 and older (mean age 71.2) without missing values in the examined correlates. MEASUREMENTS: Oral health status was evaluated according to edentulism, severity of periodontal disease, and recommendation of periodontal care and compared with that of healthy controls. Self‐reported functional dependence was assessed according to 19 questions in five domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM), and general physical activities (GPAs). RESULTS: After controlling for demographic and dental variables, health‐related behaviors, C‐reactive protein, and comorbidities, edentulism was significantly associated with disability in IADLs (odds ratio (OR)=1.58), LSAs (OR=1.63), LEM (OR=1.31), and GPAs (OR=1.45) compared with healthy controls. Likewise, severe periodontitis was associated with disability in IADLs (OR=1.58), LSAs (OR=1.70), and LEM (OR=1.63). The trends toward disability in IADLs, LSAs, LEM, and GPAs were statistically significant across increasing severity of oral health problems. CONCLUSION: Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late‐life disability, but a causal relationship cannot be established based on current study design.     

Association of the oral health impact profile with malnutrition risk in Spanish elders

The objective of this study was to determine any relationship between oral health-related quality of life (OHR-QoL) and malnutrition risk in the elderly using the oral health impact profile (OHIP). We studied 250 institutionalized elderly people, 162 females and 88 males, with and without teeth. Data were gathered on: general health; oral health; malnutrition risk, measured with the Mini Nutritional Assessment (MNA); and OHR-QoL, evaluated with the OHIP. A multivariate binary logistic regression model was constructed with malnutrition presence/risk as dependent variable. Mean age was 82.7 ± 8.2 years. Malnutrition or malnutrition risk was shown by 36.8% of the sample. OHIP was associated with malnutrition/risk after adjustment for age, sex, functional status, and mild dementia diagnosis. Malnutrition/risk was 3.43-fold more likely in participants with OHIP-reported “problems” than in those with none. The conclusion of the study was that OHIP-measured OHR-QoL is associated with malnutrition risk.     

Association of the oral health impact profile with malnutrition risk in Spanish elders

The objective of this study was to determine any relationship between oral health-related quality of life (OHR-QoL) and malnutrition risk in the elderly using the oral health impact profile (OHIP). We studied 250 institutionalized elderly people, 162 females and 88 males, with and without teeth. Data were gathered on: general health; oral health; malnutrition risk, measured with the Mini Nutritional Assessment (MNA); and OHR-QoL, evaluated with the OHIP. A multivariate binary logistic regression model was constructed with malnutrition presence/risk as dependent variable. Mean age was 82.7 ± 8.2 years. Malnutrition or malnutrition risk was shown by 36.8% of the sample. OHIP was associated with malnutrition/risk after adjustment for age, sex, functional status, and mild dementia diagnosis. Malnutrition/risk was 3.43-fold more likely in participants with OHIP-reported “problems” than in those with none. The conclusion of the study was that OHIP-measured OHR-QoL is associated with malnutrition risk.     

Knowledge and interest in ageing: a study of final‐year social work students

Objective: To evaluate social work students’ knowledge of older people's issues and their interest in working with older people in the future. Method: Fifty‐five final‐year students completed a questionnaire, including a knowledge/myths instrument and an interest scale. Independent variables included students’ prior contact with older people and exposure to a course on ageing. Results: Students achieved an average 70.4% success rate on the knowledge/myths instrument; no student got all answers correct. Interest levels were moderate with an average score of 5.13 on a 10‐point scale. Prior participation in ageing courses was positively correlated with knowledge of older people's issues and interest in working with older people. Conclusions: Correlations between course attendance and students’ knowledge and interest are in line with international findings. Such courses should challenge common myths associated with ageing and should promote social work with older people as skilled practice within complex health, welfare and family systems.     

An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care‐dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture‐related conditions, hyposalivation, and oral pre‐ and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person‐related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non‐dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.     

Resilience and self-perceived oral health: a hierarchical approach

OBJECTIVES: To determine whether positive self‐perceived oral health is associated with sociodemographic health variables, with an emphasis on resilience, in community‐dwelling older adults in southern Brazil. DESIGN: Cross‐sectional study nested within a cohort study. SETTING: Carlos Barbosa in southern Brazil. PARTICIPANTS: Four hundred ninety‐six community‐dwelling adults aged 64 and older. MEASUREMENTS: Sociodemographic information, a health history, and health perceptions were assessed using a structured questionnaire. Resilience was assessed using a resilience scale. For each participant, a brief oral examination was performed to assess number of teeth. Positive self‐perceived oral health was the outcome of interest. RESULTS: A final, fully adjusted Poisson regression model showed that high resilience potential (prevalence ratio (PR)=1.18, 95% confidence interval (CI)=1.06–1.32), income (PR=1.18, 95% CI=1.07–1.30), and no reported change in diet because of dental problems (PR=1.34, 95% CI=1.13–1.60) were associated with positive self‐perceived oral health. Participants living in rural areas were less likely to report positive self‐perceived oral health (PR=0.83, 95% CI=0.75–0.93). CONCLUSION: Using a hierarchical approach, positive self‐perceived oral health was found to be associated with several variables included in the conceptual framework of oral health outcomes, such as resilience. Resilience may act as a potentiating agent in the positive adaptation to tooth loss.     

Caring too much? Lack of public services to older people reduces attendance at work among their children

The need to provide care for older people can put a strain on their adult children, potentially interfering with their work attendance. We tested the hypothesis that public care for older people (nursing homes or home care services) would moderate the association between having an older parent in need of care and reduced work attendance among the adult children. The analysis used data from a survey of Norwegian employees aged 45–65 (N = 529). Institutional care for older people in need of care (i.e. nursing homes) was associated with improved work attendance among their children—their daughters in particular. Data also indicated a moderating effect: the link between the parents’ reduced health and reduced work attendance among the children was weaker if the parent lived in a nursing home. However, the results were very different for home-based care: data indicated no positive effects on adult children’s work attendance when parents received non-institutionalised care of this kind. Overall, the results suggest that extending public care service to older people can improve their children’s ability to combine work with care for parents. However, this effect seems to require the high level of care commonly provided by nursing homes. Thus, the current trend towards de-institutionalising care in Europe (and Norway in particular) might hamper work attendance among care-giving adult children, women in particular. Home care services to older people probably need to be extended if they are intended as a real alternative to institutional care.     

Oral health-related quality of life and life-space mobility in community-dwelling older adults

OBJECTIVES: To quantify the associations between measures of oral health–related quality of life (OHRQoL) and life‐space mobility (LSM) in community‐dwelling older adults. DESIGN: Cross‐sectional study using a 54‐item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). PARTICIPANTS: The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community‐dwelling adults aged 65 and older. MEASUREMENTS: Participants completed an in‐home interview about their OHRQoL and LSM. Life‐space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. RESULTS: Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self‐rated oral health. CONCLUSION: OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well‐being have a significant effect on mobility and the social participation of older adults.     

Opiniones: End‐of‐Life Care Preferences and Planning of Older Latinos

OBJECTIVES: To measure end‐of‐life (EOL) care preferences and advance care planning (ACP) in older Latinos and to examine the relationship between culture‐based attitudes and extent of ACP. DESIGN: Cross‐sectional interview. SETTING: Twenty‐two senior centers in greater Los Angeles. PARTICIPANTS: One hundred forty‐seven Latinos aged 60 and older. MEASUREMENTS: EOL care preferences, extent of ACP, attitudes regarding patient autonomy, family‐centered decision‐making, trust in healthcare providers, and health and sociodemographic characteristics. RESULTS: If seriously ill, 84% of participants would prefer medical care focused on comfort rather than care focused on extending life, yet 47% had never discussed such preferences with their family or doctor, and 77% had no advance directive. Most participants favored family‐centered decision making (64%) and limited patient autonomy (63%). Greater acculturation, education, and desire for autonomy were associated with having an advance directive (P‐values <.03). Controlling for sociodemographic characteristics, greater acculturation (adjusted odds ratio (AOR)=1.6, 95% confidence interval (CI)=1.1–2.4) and preferring greater autonomy (AOR=1.6, 95% CI=1.1–2.3) were independently associated with having an advance directive. CONCLUSIONS: The majority of older Latinos studied preferred less‐aggressive, comfort‐focused EOL care, yet few had documented or communicated this preference. This discrepancy places older Latinos at risk of receiving high‐intensity care inconsistent with their preferences.     

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.     

Predictors of overall quality of care provided to vulnerable older people

OBJECTIVES: Prior research shows that the quality of care provided to vulnerable older persons is suboptimal, but little is known about the factors associated with care quality for this group. In this study, the influences of clinical conditions, types of care processes, and sociodemographic characteristics on the quality of care received by vulnerable older people were evaluated. DESIGN: Observational cohort study. SETTING: Two senior managed care plans. PARTICIPANTS: Three hundred sixty-two community-dwelling patients aged 65 and older identified as vulnerable by the Vulnerable Elder Survey (VES-13). MEASUREMENTS: Outcome variable: patients' observed-minus-expected overall quality score. Predictor variables: types of care processes, types and number of clinical conditions, sex, age, VES-13 score (composite score of function and self-rated health), income, education, mental health status, and number of quality indicators triggered. RESULTS: Patients whose conditions required more history-taking, counseling, and medication-prescribing care processes and patients with diabetes mellitus received lower-than-expected quality of care. A greater number of comorbid conditions was associated with higher-than-expected quality of care. Age, sex, VES-13 score, and other sociodemographic variables were not associated with quality of care. CONCLUSION: Complexity, vulnerability, and age do not predispose older persons to receive poorer-quality care. In contrast, older patients whose care requires time-consuming processes such as history taking and counseling are at risk for worse quality of care and should be a target for intervention to improve care.     

African American church participation and health care practices

BACKGROUND: While religious involvement is associated with improvements in health, little is known about the relationship between church participation and health care practices. OBJECTIVES: To determine 1) the prevalence of church participation; 2) whether church participation influences positive health care practices; and 3) whether gender, age, insurance status, and levels of comorbidity modified these relationships. DESIGN: A cross-sectional analysis using survey data from 2196 residents of a low-income, African-American neighborhood. MEASUREMENTS: Our independent variable measured the frequency of church attendance. Dependent variables were: 1) Pap smear; 2) mammogram; and 3) dental visit-all taking place within 2 years; 4) blood pressure measurement within 1 year, 5) having a regular source of care, and 6) no perceived delays in care in the previous year. We controlled for socioeconomic factors and the number of comorbid conditions and also tested for interactions. RESULTS: Thirty-seven percent of community members went to church at least monthly. Church attendance was associated with increased likelihood of positive health care practices by 20% to 80%. In multivariate analyses, church attendance was related to dental visits (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3 to 1.9) and blood pressure measurements (OR, 1.6; 95% CI, 1.2 to 2.1). Insurance status and number of comorbid conditions modified the relationship between church attendance and Pap smear, with increased practices noted for the uninsured (OR, 2.3; 95% CI, 1.2 to 4.1) and for women with 2 or more comorbid conditions (OR, 1.9; 95% CI, 1.1 to 3.5). CONCLUSION: Church attendance is an important correlate of positive health care practices, especially for the most vulnerable subgroups, the uninsured and chronically ill. Community- and faith-based organizations present additional opportunities to improve the health of low-income and minority populations.     

Quality of life for older people in residential care is related to connectedness,willingness to enter care,and co‐residents

Aim: To establish associations with quality of life (QOL) of older people in long‐term residential care facilities in two New Zealand cities. Methods: The outcome measure of QOL was the Life Satisfaction Index. We used multiple linear regression to explore how broad categories of factors might contribute to QOL. Results: A total of 599 people (median age of 85 years; 74% women) participated. Response rates were 85% for facilities and 83% for residents. A resident's QOL was significantly related to the QOL of co‐residents. QOL was higher for people who were more positive about entry to residential care, more physically able, and not depressed, and for those with more family and emotional support. Conclusion: Attending to the circumstances around entry to residential care may enhance QOL, as may promoting physical activity, treating depression and ensuring older people remain emotionally connected to their families. In choosing a facility, noting the QOL of co‐residents is important.     

Social support and loneliness among frail older adults attending daycare centers: A multicultural study in Israel

AimsTo examine the link between intensity of use of formal support and loneliness among older adults, controlling for family support and covariates; and examine the moderating effect of contact frequency with family on this relationship.MethodsCross-sectional data were collected from September 2016 - April 2017 through structured interviews with 360 older adults attending adult day care centers (ADCCs) and representing three different ethnic groups in Israel. Loneliness was assessed by the UCLA Loneliness Scale. Hierarchical regression was applied to the study variables with loneliness scores as dependent variable, and bootstrapping with resampling strategies tested a moderating effect.ResultsLoneliness was linked negatively with contact frequency with the family network, frequency of ADCC attendance, and greater involvement in social activities at the ADCC. Significant negative correlation between ADCC attendance frequency and loneliness occurred only when family contact was at low-to-average frequency, but not in cases of high-contact frequency.ConclusionsFrequent use of ADCCs emerged as a significant contributor beyond the contribution of family support for reducing loneliness in older age, particularly for those with insufficient family contact. Service providers should improve the accessibility and availability of formal community services for the older population.     

Identifying older people at risk of abuse during routine screening practices

OBJECTIVES: To examine the association between various characteristics of community-based older people and a constructed measure of potential elder abuse. DESIGN: Cross-sectional design. SETTING: Public community-based long-term care programs in Michigan. PARTICIPANTS: Individuals aged 60 and older seeking home and community-based services in Michigan between November 1996 and October 1997 (N = 701). MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care (MDS-HC) assessment. The dependent variable is a constructed measure of potential elder abuse reflecting physical and emotional abuse and neglect. Independent variables include demographic characteristics; diagnoses; behavioral measures; and cognitive, physical, and social functioning. RESULTS: Several measures of social support and social function were strongly associated with the signs of a potentially abusive environment: brittle support (odds ratio (OR) = 3.5, 90% confidence interval (CI) = 1.5-8.1), older person feels lonely (OR = 2.4, 90% CI = 1.3-4.5), and older person expresses conflict with family/friends (OR = 2.3, 90% CI = 1.2-4.3). Home care participants' alcohol abuse, psychiatric illness, lack of ease interacting with others, and short-term memory problems were also significantly associated with the signs of potential elder abuse. CONCLUSIONS: The results of this study suggest that the signs of potential elder abuse are associated with a diminishing social network and poor social functioning, although some characteristics of the older person's health are contributing factors. Improved understanding of the link between those characteristics and potential abuse will help healthcare providers, case managers, and others identify older people at high risk of abuse.