Evaluation of the Oral Hygiene Ability Instrument (OHAI): Test of reliability.

OBJECTIVES: To evaluate the reliability of the new Oral Hygiene Ability Instrument (OHAI) developed to assess the cause of any inability for older adults to manage oral hygiene self-care. Oral hygiene is an important part of oral health. The inability to manage oral hygiene, combined with other risk factors, often results in poor oral health and impaired quality of life. A reliable OHAI could benefit preventive oral health care. METHODS: The preliminary OHAI uses 33 items in three parts: (I) interview, (II) clinical examination and (III) observation of oral hygiene activities. A total of 37 older adults participated in a test-retest study of Part I. Inclusion criteria were age ≥ 65 years, have at least one tooth and be able to oral hygiene self-care. The intra- and inter-rater reliability of parts II and III used films and photographs of OHAI assessments of 15 different individuals. These films/photographs were assessed twice by four dental professionals who had participated in the OHAI data collection. For statistical analyses of the reliability, per cent agreement, Krippendorff's alpha and E. Svensson's method were used. RESULTS: The test-retest for Part I items showed acceptable-to-good agreement and no systematic disagreement. In Part II, two items showed somewhat limited reliability. Part III showed good intra- and inter-rater reliability. CONCLUSION: The OHAI items seem stable and reliable for the intended sample, and the instrument may be a valuable tool to identify older adults at risk of impaired oral health. However, two items may need to be reformulated.

Development of an instrument to assess oral hygiene ability in older adults: The oral hygiene ability instrument.

OBJECTIVES: To describe the development process of an instrument to assess the ability to manage daily oral hygiene and the cause of impaired oral hygiene. The instrument is initially aimed for use by the dental team in the ageing population. BACKGROUND: Oral hygiene is an important component of oral health. Inability to manage oral hygiene combined with other risk factors often results in poor oral health and impaired quality of life. METHODS: A guideline for instrument development was used during the construction of the instrument. The method included three phases: I. planning: the purpose and target group of the instrument were determined, and a literature review and qualitative focus-group study were conducted; II. construction: objectives were formulated, and a pool of items was built; and III. evaluation and validation, which included two pilot studies, interviews, item analyses and revision of the instrument. RESULTS: The planning and construction phases resulted in an instrument with 47 items comprising three parts: (a) interview, (b) clinical examination and (c) observation of activities of daily living (oral hygiene). After two pilot studies, the instrument was found to have good content validity. Analyses of qualitative and quantitative data resulted in a reduction in the number of items to 33. CONCLUSION: OHAI can be a valuable tool as a preventive method to identify older adults at risk of impaired oral health. However, the instrument needs further evaluation before wider use.

Discontinued dental attendance among elderly people in Sweden.

AIM: Our objective was to study the loss of dental attendance and a possible age trend among patients aged ≥65 years in Sweden. Regular dental check-ups are considered to be an important factor in maintaining oral health. Approximately 80% of the adult population in Sweden are enrolled in a regular check-up system; however, dental practitioners often find that older patients attend fewer check-ups. Old people may naturally lose contact with dental services as they move to special housing or die. In this systematic study, these factors were investigated and used as exclusion criteria. MATERIALS AND METHODS: Data were collected for all patients (n = 4759) aged 65 or older from the electronic journal system in 3 large public dental clinics in 3 communities. Their dental records for the years 2004-2009 were studied longitudinally by 1 person at each clinic; 1111 patients were excluded (patients died during study period, wanted emergency care only, obtained special dental care allowance, moved from the community or moved to special housing, or left the clinic for another caregiver). The statistical analyses were performed using the Statistical Package for the Social Sciences version 21 (IBM). RESULTS: Of the 3648 patients (1690 men and 1958 women) included in the study, 13% lost contact with their dental service over the course of the study (10% of those were aged 65-79 and 21% ≥80). The decrease in regular dental contact had a statistically significant association with increasing age (P < 0.001). CONCLUSION: A considerable number of older people living independently or with moderate supportive care in their own homes lost contact with dental service despite enrolment in a recall system.