Use of oral health care services among older home care clients in the context of an intervention study.

BACKGROUND: An increasing number of care-dependent older people living at home need external support to receive regular dental care. OBJECTIVES: To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition. MATERIALS AND METHODS: This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up. RESULTS: At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use. CONCLUSIONS: In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

High anticholinergic burden and hyposalivation and xerostomia in the elderly.

OBJECTIVE: The aim was to study the association between high anticholinergic burden and hyposalivation and xerostomia among older people. BACKGROUND: Anticholinergic drugs have been shown to cause xerostomia and hyposalivation. Yet there are few studies on the association between anticholinergic burden and hyposalivation and xerostomia in the elderly. MATERIAL AND METHODS: The study population consisted of community-dwelling older people (n = 321, mean age 81.6 years) from the Oral health GeMS study. Participants provided salivary samples and xerostomia was determined with a questionnaire. The baseline data were collected by interviews, oral clinical examinations and from patient records. Each participant's anticholinergic burden was determined by eight anticholinergic scales. Poisson regression models with robust error variance were used to estimate relative risks (RR) with a 95% confidence interval (CI). RESULTS: RRs of high anticholinergic burden in anticholinergic scales for xerostomia (multiple symptoms) ranged from 1.02 to 1.68; for low unstimulated salivary flow (≤0.1 mL/min) from 1.47 to 1.67; and for low stimulated salivary flow (≤0.7 mL/min) from 0.99 to 2.07. A high anticholinergic burden according to seven out of eight scales was associated (p < .05) with hyposalivation or xerostomia. CONCLUSIONS: A high anticholinergic burden was associated more strongly with hyposalivation (both unstimulated and stimulated) than with xerostomia.

Eating problems among old home care clients.

AIMS: The purpose was to examine the prevalence and determinants of self-reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist. METHODS AND RESULTS: The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75-year-old home care clients living in Finland. The structured interviews were conducted at the participants' (n = 250) homes. Of the participants, 29% reported poor appetite, 20% had problems with chewing, and 14% had problems with swallowing when asked by a clinical nutritionist. Additionally, 18% reported oral health-related eating problems when asked by a dental hygienist. Participants with continuous xerostomia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0-9.0) or poor self-reported oral health (OR: 4.3, 95% CI: 1.4-13.0) had a higher risk for problems with chewing when asked by a clinical nutritionist. Edentulous participants (OR: 3.5, 95% CI: 1.2-10.9) and participants with toothache or problems with dentures (OR: 10.3, 95% CI: 4.0-26.0) had a higher risk for oral health-related eating problems when asked by a dental hygienist. CONCLUSION: Eating problems are common in older adults, and interprofessional collaboration is required for their identification and alleviation.

Physical ability and comorbidity and oral health among home-dwelling older people in the Finnish population.

AIM: To examine how physical ability and comorbidity associate with oral health. METHODS AND RESULTS: The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self-perceived oral health (pain/discomfort in mouth). Physical ability was determined by measuring limitations in daily activities (activities of daily living [ADL] and instrumental activities of daily life [IADL]) and the number of comorbidities with Functional Comorbidity Index (FCI). Poisson's multivariate regression model was used to estimate prevalence rate ratio (PRR) and their 95% confidence intervals (CI). The physical ability or number of comorbidities did not associate consistently with oral diseases, but ADL, IADL and FCI associated all with self-perceived oral discomfort (PRR: 1.74, CI: 1.01-3.03; PRR: 1.20, CI: 1.06-1.35; PRR: 1.20, CI: 1.05-1.36, respectively). Furthermore, IADL associated also with poor self-perceived oral health (PRR: 1.27, CI: 1.03-1.57). CONCLUSION: Older people with impaired physical ability and comorbidities are more likely to have oral discomfort and have poorer self-perceived oral health.

Oral Health and Hygiene and Association of Functional Ability: A Cross-Sectional Study Among Old Home Care Clients.

PURPOSE: To describe oral health and hygiene in old home care clients and investigate how functional ability was associated with them. MATERIALS AND METHODS: This study employed part of the baseline data of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. Structured interviews were used to measure ability to function in activities of daily living (ADL), instrumental activities of daily living (IADL), comorbidity (functional comorbidity index, FCI), depression (geriatric depression scale, GDS-15), cognitive function (mini-mental state examination, MMSE), nutritional status (mini nutritional assessment, MNA) and numbers of prescription drugs used. Clinical oral examination was included. RESULTS: The majority of participants were at least moderately dependent on support for ADL. Of the examined, 46% were edentulous and average number of teeth was 8.4. Dental plaque in ≥ 20% of teeth present was detected in 74%, bleeding on probing in ≥ 25% of teeth examined in 75%, and caries in 30% of the dentate participants. In multivariate analyses, better functional ability (ADL) was statistically significantly associated with lower occurrence of dental plaque in ≥ 20% of teeth present. Better functional ability (ADL) and higher number of teeth were associated with lower occurrence of bleeding on probing in ≥ 25% of teeth examined and higher number of teeth with plaque with higher occurrence of bleeding on probing. CONCLUSION: Impaired functional ability is an important determinant of poor oral health and hygiene among old home care clients.

The association of frailty with oral cleaning habits and oral hygiene among elderly home care clients.

BACKGROUND: Increasing numbers of frail elderly people living at home but dependent on supportive care will face complex oral health challenges. OBJECTIVES: To investigate the associations of frailty status with oral cleaning habits and oral hygiene taking into account the effects of preventive oral health intervention among home care clients aged 75 or over. METHODS: Data were gathered by interviews and clinical oral examinations at baseline and after a 6-month follow-up. Frailty status was evaluated at baseline using the abbreviated comprehensive geriatric assessment (aCGA) scale, which consists of 15 questions from three different domains: cognitive status, functional status and depression. A total of 231 home care clients completed the aCGA at baseline and the interview and clinical oral examination both at baseline and after the follow-up. RESULTS: Using the aCGA classification with at least one score in the ≥2 domain, 62% of clients were classified as frail at baseline. They had poorer oral cleaning habits and hygiene, and they had lost more teeth than nonfrail participants. Multivariate analysis showed that being frail at baseline was statistically significantly associated with a lower frequency of toothbrushing and denture cleaning (OR = 0.4, 95% CI = 0.1-0.9 and OR = 0.3, 95% CI = 0.1-0.8) at baseline, but not after the follow-up. Membership in the intervention group was associated with better oral cleaning at the follow-up. However, among the frail participants, toothbrushing frequency was still significantly lower and oral hygiene poorer than among the nonfrail group. CONCLUSIONS: Oral cleaning habits of frail elderly people were slightly improved as a result of external support, which had a positive effect on oral hygiene. Individual preventive actions in the context of oral health and hygiene should be integrated into the daily care plan of home care clients with the first signs of frailty.

The combined effect of individually tailored xerostomia and nutritional interventions on dry mouth among nutritionally compromised old home care clients.

OBJECTIVE: To examine the effectiveness of tailored xerostomia and nutritional 6-month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition. BACKGROUND: A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy, dehydration and malnutrition are often underlying causes of xerostomia. MATERIALS AND METHODS: The data are based on the NutOrMed study with a dietary intervention group of 119 patients and control group of 97 patients. In-home interviews were carried out by home care nurses, nutritionists, dental hygienists and pharmacists and tailored interventions by nutritionist and dental hygienists. Xerostomia intervention included individual counselling on dry mouth care and was applied to all those suffering occasionally or continuously from xerostomia (57%, n = 66) in the intervention group. Nutritional intervention was applied to all participants in the intervention group, and it included instructions on increasing the number of meals, energy, protein intake and liquid intake. RESULTS: Among participants who received both interventions, xerostomia decreased by 30% and malnutrition or risk of malnutrition decreased by 61%. The interventions were highly significant (OR 0.1, 95% CI: 0.06; 0.2) in reducing xerostomia. CONCLUSIONS: Home care clients suffering from xerostomia profited significantly from tailored xerostomia and dietary interventions. Evaluation and treatment of xerostomia are important among older persons who are malnourished or at risk of malnutrition as a part of a comprehensive health intervention to improve their nutrition and oral health.

Oral diseases and inflammatory burden and Alzheimer's disease among subjects aged 75 years or older.

AIM: To study whether dental caries, periodontal disease, and stomatitis, and the related inflammatory burden associate with diagnosed Alzheimer's disease (AD) and dementia among older people. METHODS: The study population included 170 individuals aged ≥75 years. The primary outcome was diagnosed AD and the secondary outcome was any types of diagnosed dementia. Information about participants' oral diseases and the related inflammatory burden was based on the clinical oral examination. Relative risks (RRs) and confidence intervals (CIs) were estimated using regression models. RESULTS: Dental caries, the presence of ≥3 carious teeth (RR: 3.47, 95% CI: 1.09-11.1) and the number of carious teeth (RR: 1.24, CI: 1.11-1.39), and inflammatory burden (RR: 1.44, CI: 1.04-2.01) were associated with a higher likelihood of having AD. Also, periodontal disease and stomatitis were associated, although nonstatistically, with AD and dementia. The risk estimates for any type of dementia were in most cases lower than for AD. CONCLUSION: Oral diseases and the related inflammatory burden were in most cases associated more strongly with diagnosed AD than dementia in general. Of the oral diseases studied, the strongest association was between dental caries and AD.

Anticholinergic burden and dry mouth among Finnish, community-dwelling older adults.

OBJECTIVE: The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people. BACKGROUND: Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia. METHODS: The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). A Poisson regression model with robust error variance was used to estimate relative risks (RR) with 95% confidence intervals (CI 95%). RESULTS: Participants with a high-anticholinergic burden (ADS ≥ 3) were more likely to have xerostomia (RR: 3.17; CI: 1.44-6.96), low-unstimulated salivary flow (<0.1 mL/min; RR: 2.31, CI: 1.22-4.43) and low-stimulated salivary flow (<1.0 mL/min; RR: 1.50, CI: 0.80-2.81) compared to reference group (ADS 0). In participants with a moderate anticholinergic burden (ADS 1-2), all the risk estimates for xerostomia, unstimulated and stimulated salivary secretion varied between 0.55 and 3.13. Additional adjustment for the total number of drugs, antihypertensives and sedative load caused only slight attenuation of the risk estimates. CONCLUSION: A high-anticholinergic burden was associated with low-unstimulated salivary secretion and xerostomia.

Preventive oral health intervention among old home care clients.

Background: poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene. Aim: to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over. Patients and methods: the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months. Results: the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene. Conclusions: the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.

Sedative load, carious teeth and infection in the periodontium among community-dwelling older people.

OBJECTIVE: To study the relation of sedative load to carious teeth and periodontal pocketing - indication of infectious periodontal disease - among older people. MATERIALS AND METHODS: This cross-sectional study was based on a subpopulation of 158 community-dwelling, dentate, non-smoking, 75-year-old or older people from the Oral Health Geriatric Multidisciplinary Strategy study. The data were collected by interviews and clinical oral examinations during 2004-2005. Sedative load was measured by means of the sedative load model, and Poisson multivariate regression models were used to estimate relative risk (RR) with 95% confidence intervals (CI). RESULTS: Participants with a sedative load of either 1-2 (n = 31) or ≥3 (n = 12) had an increased likelihood of having carious teeth (RR: 1.8, CI: 1.2-2.6 and RR: 2.4, CI: 1.4-4.1, respectively) compared to participants without a sedative load. There was an inverse association between sedative load and the number of teeth with periodontal pockets. CONCLUSIONS: Presence of dental caries was associated with the use of drugs with sedative properties. The use of drugs with sedative properties was not associated with the presence of periodontal pockets.

Xerostomia among older home care clients.

OBJECTIVES: The purpose of this study was to examine drug use and other factors associated with xerostomia in home care clients aged 75 years or older. METHODS: The study sample included 270 home care clients aged ≥75 years living in Eastern and Central Finland. The home care clients underwent in-home interviews carried out by trained home care nurses, nutritionists, dental hygienists and pharmacists. The collected data contained information on sociodemographic factors, health and oral health status, drug use, depressive symptoms (GDS-15), cognitive functioning (MMSE), functional ability (Barthel Index, IADL) and nutrition (MNA). The primary outcome was xerostomia status (never, occasionally or continuously). RESULTS: Among the home care clients, 56% (n = 150) suffered from xerostomia. Persons with continuous xerostomia used more drugs and had more depressive symptoms and a higher number of comorbidities than other home care clients. In multivariate analyses, excessive polypharmacy (OR = 1.83, 95% Cl 1.08-3.10) and depressive symptoms (OR = 1.12, 95% Cl 1.03-1.22) were associated with xerostomia. CONCLUSIONS: Xerostomia is a common problem among old home care clients. Excessive polypharmacy, use of particular drug groups and depressive symptoms were associated with xerostomia. The findings support the importance of a multidisciplinary approach in the care of older home care clients.

Sedative load and salivary secretion and xerostomia in community-dwelling older people.

OBJECTIVE: The aim was to investigate how sedative load and the total number of drugs used are related to hyposalivation and xerostomia among 75-year-old or older dentate, non-smoking, community-dwelling people. MATERIALS AND METHODS: The study population consisted of 152 older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations during 2004-2005. Sedative load, which measures the cumulative effect of taking multiple drugs with sedative properties, was calculated using the Sedative Load Model. RESULTS: The results showed that participants with a sedative load of either 1-2 or ≥3 had an increased likelihood of having low stimulated salivary flow (<0.7 ml/min; OR: 2.4; CI: 0.6-8.6 and OR: 11; CI: 2.2-59; respectively) and low unstimulated salivary flow (<0.1 ml/min; OR: 2.7, CI: 1.0-7.4 and OR: 4.5, CI: 1.0-20, respectively) compared with participants without a sedative load. Participants with a sedative load ≥3 had an increased likelihood of having xerostomia (OR: 2.5, CI: 0.5-12) compared with participants without a sedative load. The results showed that the association between the total number of drugs and hyposalivation was weaker than the association between sedative load and hyposalivation. CONCLUSION: Sedative load is strongly related to hyposalivation and to a lesser extent with xerostomia. The adverse effects of drugs on saliva secretion are specifically related to drugs with sedative properties.

Oral health intervention among community-dwelling older people: a randomised 2-year intervention study.

OBJECTIVE: The aim of this study was to investigate the effects of a 2-year oral-health-promoting intervention on oral health behaviour and oral health among people aged 75 years or older. MATERIALS AND METHODS: In a 2-year randomised intervention study, 279 community-dwelling older people completed the study: 145 persons in an intervention group and 134 in a control group. Interviews and clinical oral examinations were performed at the beginning of the study and at a 2-year follow-up. Changes in oral health behaviour and oral health were used as outcomes. INTERVENTION: Oral health intervention included individually tailored instructions for oral and/or denture hygiene, relief of dry mouth symptoms, decrease of sugar-use frequency, use of fluoride, xylitol or antimicrobial products, and professional tooth cleaning. RESULTS: More participants in both the intervention and control groups had better dental and denture hygiene and were free of oral diseases or symptoms at the 2-year follow-up than at the baseline. The differences in changes in outcomes between the intervention and control groups were not statistically significant. CONCLUSION: The results of this study showed that oral health of community-dwelling older people could be improved. Oral health improved in both groups, more among the participants in the intervention group compared with control group, but the effect attributed to oral-health-promoting intervention remained small.

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.

Salivary flow rate and risk of malnutrition - a study among dentate, community-dwelling older people.

OBJECTIVE: To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home-dwelling elderly people. BACKGROUND: Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. MATERIALS AND METHODS: The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short-Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). RESULTS: Subjects with a low unstimulated salivary flow rate (<0.1 ml/min) or stimulated salivary flow rate (<1.0 ml/min) had no statistically significant increase in risk of malnutrition, OR: 1.3, CI: 0.5-3.9, OR: 1.5, CI: 0.5-4.2, respectively, when compared with those with a normal unstimulated and stimulated salivary flow rate. CONCLUSION: Our results do not support the concept that low salivary secretion is an important risk factor for malnutrition among community-dwelling elders.

Associations of instrumental activities of daily living and handgrip strength with oral self-care among home-dwelling elderly 75+.

OBJECTIVE: To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland. MATERIALS AND METHODS: The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. RESULTS: Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. CONCLUSION: The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly.

Dementia and oral health among subjects aged 75 years or older.

OBJECTIVE: To study the association between diagnosed dementia and oral health, focusing on the type of dementia, among an elderly population aged 75 years or older. BACKGROUND: Elderly people with dementia are at risk from oral diseases, but to date, only a few studies have analysed the association between type of dementia and oral health, and their results are inconclusive. MATERIALS AND METHODS: This cross-sectional study is based on the Geriatric multi-disciplinary strategy (Gems) study that included 76 demented and 278 non-demented subjects. The data were collected by means of an interview and an oral clinical examination. The type of dementia was diagnosed according to DSM-IV criteria. Poisson's and logistic regression models were used to determine relative risks (RR), odds ratios (OR) and 95% confidence limits (CI). RESULTS: Our results showed that patients with Alzheimer's disease and those with other types of dementia had an increased likelihood of having carious teeth, teeth with deep periodontal pockets, and poor oral and denture hygiene, compared with non-demented persons. The results showed that the type of dementia does not seem to be an essential determinant of oral health. CONCLUSIONS: Among the elderly aged 75 years or older, patients with Alzheimer's disease or other types of dementia are at increased risk of poor oral health and poor oral hygiene.

Preference for dentist's home visits among older people.

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.