The Effect of Food Odor Exposure on Appetite and Nutritional Intake of Older Adults with Dementia.

OBJECTIVES: Dementia can lead to decreased appetite and nutritional intake. Food odor exposure has been shown to increase appetite and nutritional intake in young healthy adults. This study investigates the effect of food odor exposure on appetite, nutritional intake and body weight of Dutch nursing home residents with dementia. DESIGN: This was a one-armed, non-randomized, non-blinded intervention study consisting of a four-week control period followed by a twelve-week intervention period. SETTING: Four nursing homes in the Netherlands. PARTICIPANTS: Forty-five nursing home residents with dementia. INTERVENTION: During the intervention period, odors were dispersed prior to the main meals. MEASUREMENTS: General and specific appetite for sweet and savory foods was measured weekly. Nutritional intake was measured once during the control period and three times during the intervention period through a 3-day food record. Body weight was assessed at the start and end of the control period and at the start, end and halfway the intervention period. Data were analyzed with linear mixed models. RESULTS: Small changes in general and specific appetite were observed after odor exposure. Overall energy intake did not change during the first four intervention weeks, but increased during the second and third (+118kcal/d, p=0.003 and +122kcal/d, p=0.004). Protein intake and body weight did not significantly change during the study. CONCLUSION: In this study, no clinically relevant changes in appetite, nutritional intake and body weight were observed after food odor exposure. Future studies should assess the effect of natural food odors and/or meal-tailored odors on nutritional intake of older adults with dementia.

[Research agenda oral care for older people in the Netherlands and Flanders (Belgium)]. / Wetenschapsagenda 'Mondzorg voor ouderen' in Nederland en Vlaanderen.

Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.

[The relationship between oral health and general health in the elderly]. / De relatie mondgezondheid en algemene gezondheid bij ouderen.

Scientific literature demonstrates relationships to exist between oral health and general health in a number of areas. A healthy oral cavity contributes to general wellbeing, but poor oral health can increase the risk of physical disorders, such as aspiration pneumonia, cardiovascular disorders, diabetes mellitus, and other disorders. Given the risks of these systemic diseases for frail older people, adequate and high-quality oral care is of great importance for this patient group.

[Active oxygen in the treatment of (root) caries and its suitability for frail older people]. / Actieve zuurstof bij de behandeling van (wortel)cariës en de toepasbaarheid ervan bij kwetsbare ouderen.

In 2000 it was suggested that there was a new, fast and simple way to treat dental caries based on the outcomes of an in vitro study of the antimicrobial effect of ozone, a form of active oxygen, on caries lesions in dental roots. The aim of the review of literature described in this article was to determine the effectiveness of active oxygen in the treatment of dental (root) caries as demonstrated by in vivo research of frail older people'. From the results it became clear that the quality of the various trials is not very high and that there is, at least at the present time, an insufficient solid scientific evidence base that the use of ozone is an effective treatment for dental (root) caries. It is, however, still too early to conclude that active oxygen, in whatever form, cannot contribute positively to the fight against caries.

[Priorities and recommendations in oral health care for older people]. / Prioritering en aanbevelingen in de mondzorg voor ouderen.

The oral health of older people in the Netherlands, especially those who are vulnerable and dependent on care, is insufficient. Older people and other stakeholders participated in a so-called Priority Setting Partnership study to identify hindrances that have been experienced in oral health care and to distil from their experience items for the agenda for further research. For this reason, discussions were held in 5 focus groups with respectively 1 group of older people, caregivers, external parties and health care professionals. In a fifth focus group, a so-called 'consensus group', the definitive list of prioritised items on the agenda was formulated. The most important priorities concern policy and organisation of oral health care, awareness, cooperation among various health care professionals, the financing and organisation of oral health care for older people living at home and education concerning oral health care for all health care professionals. Awareness about the importance of good oral health for older people among health care professionals is the first step towards better oral health care for older people in the Netherlands.

[Medicaments and oral healthcare 4. Pharmacotherapy in (frail and care dependent) older people]. / Medicamenten en mondzorg 4. Medicatie bij (kwetsbare en zorgafhankelijke) ouderen.

Polypharmacy is the consequence of multimorbidity. Both phenomena may cause functional limitations and/or frailty and/or care dependency in older people. In the human body, a medicament undergoes at least 3 important actions: absorption, distribution and elimination. These actions may proceed aberrantly in older people. Following interaction with receptors, a medicament triggers a chain reaction in the human body. The receptors and each link of the chain reaction may be subject to changes due to diseases as well as ageing. This, particularly, is the case with regard to medications directed towards the central nervous system and the cardiovascular system. Furthermore, interactions may occur between various medications mutually and between medications on the one hand and on the other hand food and water intake, self-medication with herbs, and diseases. Moreover, older people usually experience more adverse effects of medications when compared to younger people. This is due to altered body actions and reactions, polypharmacy and the many possible interactions. In older people, utilisation and intake of medications often give rise to problems that can be divided into medicament-related, patient-related, care- and care provider-related and other problems.

[Dissertations 25 year after date 41. Older people's adaptability]. / Proefschriften 25 jaar na dato 41. Aanpassingsvermogen van ouderen.

In 1990, the thesis 'Removable complete dentures in older people, an issue dealing with adaptability?' was published. Among other things, this thesis aimed at finding a method of measuring older people's adaptability to removable complete dentures. Its conclusion was that a subscale of the "Beoordelingsschaal voor Oudere Patiënten" (Rating scale for older patients) had predictive value. Subsequently, only a few research projects on this topic have been carried out. They dealt with demonstrated adaptation achieved after treatment, the realised adaptation. The results were disappointing. Ever since the availability of endosseous oral implants, research into adaptability to conventional removable complete dentures seems less relevant. During the last decades, inquiries into a method of measuring treatment effectiveness has focused on older people's quality of life and general health condition. However, to assess with respect to oral health care an older person's general health condition and load-taking capacity adequately, some experience is indispensable.

The impact of undergraduate geriatric dental education on the attitudes of recently graduated dentists towards institutionalised elderly people.

OBJECTIVE: The aim of the study was to assess the impact of undergraduate geriatric dentistry education on knowledge of ageing and on attitudes towards institutionalised elderly people, as perceived by recently graduated dentists. METHODS: A validated questionnaire was sent by mail to all dentists of the study group (n = 357). The questionnaire collected socio-demographic data, motives for pursuing a dental career, knowledge of ageing, attitude towards institutionalised elderly people using the Aging Semantic Differential (ASD), and aspects of geriatric dentistry education. RESULTS: Great variability between the six dental schools involved was observed in respect of the undergraduate education received in geriatric dentistry. Dentists' knowledge of ageing was also low. The mean value of ASD-total indicated that in this study there was a negative attitude towards the institutionalised elderly. The covariate 'financial motive for pursuing a dental career' was the only item that seemed to have any significant influence on the ASD. Age was the only significant variable for knowledge. All other covariates were found not to have any influence. CONCLUSIONS: From this study it would appear that the attitude of recently graduated dentists in Belgium towards the institutionalised elderly is rather negative and their knowledge of ageing is poor. The actual level of geriatric dentistry education in the undergraduate curriculum did not appear to influence this attitude, but Belgian dental schools are challenged to reorientate their provision of geriatric dentistry education to include activities that help to develop positive perceptions towards the elderly, with an empathic positive and caring attitude.

Evaluation of decompression tables by Doppler technique in caisson work in The Netherlands.

INTRODUCTION: Hyperbaric work was conducted for constructing an underground tramway in the Netherlands. A total of 11,647 exposures were conducted in 41,957 hours. For these working conditions specifically developed oxygen decompression tables were used. METHODS: Fifteen workers were submitted to Doppler monitoring after caisson work at a depth at 12 msw. Measurements were done according to the Canadian DCIEM protocol. For bubble grading the Kisman-Masurel 12-points ordinal scale (0-IV) was used. RESULTS: Bubbles were detected in 17 of the 38 examinations. The highest grade (III-) was found in four measurements. At rest the grading was never higher than I+. Two hours after decompression the grading was remarkably higher than after one hour. CONCLUSIONS: Bubble scores were relatively low, although the maximum grading probably is not reached within two hours after decompression. It may be concluded that the oxygen decompression tables used, were reliable under these heavy working conditions. At group level, decompression stress can be evaluated by Doppler monitoring. In order to reduce health hazard of employees, use of oxygen during decompression in caisson work should be embodied in the occupational standard.

[Oral health care guidelines for elderly people in long-term care facilities. Effectiveness and implementation in The Netherlands and Flanders]. / De richtlijn mondzorg voor ouderen in zorginstellingen. Effectiviteit en implementatie in Nederland en Vlaanderen.

Oral health care includes self-care, volunteer care, and professional care for maintaining or advancing appropriate oral health. It has been demonstrated that the oral health care in long-term care facilities for elderly people in The Netherlands and Flanders (Belgium) is not adequate. Daily oral hygiene care, carers' knowledge and skills providing adequate oral health care, (co)morbidity, and drug usage are points of special interest in realizing an improvement of oral health care and oral health. The Dutch Association of Nursing Home Physicians has formulated oral health care guidelines for elderly people in long-term care facilities. A research project on the effectiveness and implementation will be carried out, determining the guidelines'quality. The aim of the project is improving the quality of oral health care for and the quality of oral health and life of elderly people in long-term care facilities in The Netherlands and Flanders.

[The guideline Oral Health Care for dependent residents in long term care facilities, 2007: dire necessity!]. / De Richtlijn Mondzorg voor zorgafhankelijke cliënten in verpleeghuizen, 2007: bittere noodzaak!

The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of) their natural teeth, the need for good oral health care is increasing even more. Therefore a specific guideline was developed. The ultimate aim of the guideline "Oral health care for dependent residents in long term care facilities" is to improve the oral health of nursing home residents. Oral health care needs to be incorporated in daily nursing home care routine and in the integral care plan of every resident. Attention is given to the importance of an adequate implementation of this guideline as well as to the necessity of research evaluating the effects of it's implementation.

[Prevalence of xerostomia and hyposalivation in the nursing home and the relation with number of prescribed medication]. / Prevalentie van xerostomie en hyposalivatie in een verpleeghuis en de relatie met voorgeschreven medicatie.

In nursing homes, the number of patients with their own dentition increases. Many of them, however, are unable to perform oral hygiene procedures. Medication is considered to be an important cause of hyposalivation, which may lead to oral alterations and loss of teeth. The aim of the present study was to investigate the prevalence of xerostomia and hyposalivation in a Dutch nursing home and to examine the possible relation with medication usage. Between January and March 2001, the salivary flow rates were measured in 50 patients residing in a nursing home in Amsterdam. Unstimulated saliva, parafilm-stimulated saliva and citric acid stimulated saliva were determined. Xerostomia was determined by the question "My mouth feels dry" and the medication used was examined. The data were analysed with (M)ANOVA. The average age of the patients was 78.1 +/- 9.7 years. Forty-eight % of the patients had an unstimulated flow rate of less then 0.20 ml/min and 24% had a flow rate even lower than 0.10 ml/min (reference values: 0.25-0.50 ml/min). The flow rate of women was significantly lower than that of men (p < 0.01), even after correction for age, smoking and the number of prescribed medications. Salivary flow rates decreased significantly with age (p < 0.05). The number of prescribed medication was significantly higher in patients over the age of 70 (p < 0.01, n = 42) and also in women (p < 0.01). The prevalence of xerostomia was 52% with no difference between men and women. In nursing homes, the prevalence of hyposalivation and xerostomia is high. The number of xerogenic medications used seems to be an important factor. Women and patients aged over the age of 70 years need special attention with respect to oral health.