Evidence summary: the relationship between oral health and dementia.

This is the fourth and final paper of a series of reviews undertaken to explore the relationships between oral health and general medical conditions, in order to support teams within Public Health England, health practitioners and policy makers. This review aimed to explore the most contemporary evidence on whether poor oral health and dementia occurs in the same individuals or populations, to outline the nature of the relationship between these two health outcomes and to discuss the implication of any findings for health services and future research. The review was undertaken by a working group comprising consultant clinicians from medicine and dentistry, trainees, public health and academic staff. Whilst other rapid reviews in the current series limited their search to systematic reviews, this review focused on primary research involving cohort and case-control studies because of the lack of high level evidence in this new and important field. The results suggest that poor oral hygiene is associated with dementia, and more so amongst people in advanced stages of the disease. Suboptimal oral health (gingivitis, dental caries, tooth loss, edentulousness) appears to be associated with increased risk of developing cognitive impairment and dementia. The findings are discussed in relation to patient care and future research.

The Barthel index in clinical practice: use on a rehabilitation ward for elderly people.

Primary activities of daily living (ADL) were monitored weekly in 102 patients admitted to a rehabilitation ward for elderly people using the Barthel index. The three commonest diagnoses were 'stroke', 'fractured neck of femur' and 'dementia recovering from acute illness'. Multiple disabling diagnoses were common: 60% of patients had dementia and 23% had a live-in carer; mean (median) length of stay in the rehabilitation ward was 98 (62 days). Over 18 months, the weekly assessment of patients in the ward was omitted once. No extra resources were needed. There was a significant rise in Barthel scores between admission to the rehabilitation ward (median Barthel 6) and discharge (median 13) for the group as a whole (median change 6, 95% CI 5-7; p < 0.001) and for each of the three main diagnostic groups. Barthel scores on discharge were significantly lower than in patients discharged from an acute ward for elderly people. Barthel scores and mental test scores (MTS) at discharge were significantly related to destination on discharge, with a characteristic pattern for patients unable to return home and having to be placed in nursing homes (Barthel < 10, MTS < 7). Our experience confirms that routine clinical use of the Barthel in this setting is feasible and responds to clinically important change, at least in group evaluation. It suggests that the Barthel may be useful in outcome measurement, case-mix adjustment and audit of discharge practices.