Do subjectively and objectively impaired oral health parameters influence geriatric assessment results in hospitalized geriatric patients?

BACKGROUND: Impaired oral health affects oral health-related quality of life (OHrQoL) in orthogeriatric hospitalized patients, and both might be associated with potential risk factors for functional impairment, based on the comprehensive geriatric assessment (CGA) and related blood laboratory values. As data on this field are scarce, we investigated possible associations between oral health, items of the geriatric oral health assessment instrument (GOHAI), CGA assessment tools, and relevant laboratory values. METHODS: Explorative cross-sectional pilot study investigating oral and general health, OHrQoL, and functionality based on objective oral health, GOHAI, CGA, and routinely assessed laboratory parameters of orthogeriatric patients. Correlations (Spearman's rho and Pearson's) and regression analysis were performed for the dependent variables functionality, cognition, Mini-Nutritional Assessment, Falls Efficacy Scale (FES), and the 15-item geriatric depression scale (GDS). RESULTS: Among all participants (N = 40), several GOHAI single items (GOHAI 1,4,5,7,10,11) correlated with certain CGA assessment results (fear of falling, Barthel index, handgrip power). Reduced subjective oral health (GOHAI, xerostomia) and objective oral health (oral hygiene index, root caries index, unstimulated salivation rate) correlated with reduced general health and CGA results (polypharmacy, handgrip power, FES, GDS). Anemia was seen in all participants, but no associations between reduced oral health and laboratory blood values were detected. CONCLUSION: Our results demonstrate the association between impaired subjective and objective oral health, OHrQoL, and physical functional impairment among orthogeriatric patients. Impaired GOHAI item results at the dentist, and the association between GOHAI values and CGA results that implies an association between physical and oral health, should encourage a geriatric check based on CGA, and vice versa. Results encourage interdisciplinary cooperation between geriatricians and dentists, but also indicate the need for further research in this field. TRIAL REGISTRATION: DRKS00013230.

Xerostomia and hyposalivation in orthogeriatric patients with fall history and impact on oral health-related quality of life.

PURPOSE: Falls are a common cause of morbidity and mortality in older people, and identification of risk indicators and risk factors to prevent falling is essential. Dry mouth (xerostomia and hyposalivation) can exacerbate conditions known to be fall risk indicators, such as nutritional status and sarcopenia. But there is little evidence regarding whether it is an independent risk factor for falling. We explored xerostomia prevalence and intensity and objective salivation rates in hospitalized geriatric patients to determine whether they were associated with an increased risk of falling. PATIENTS AND METHODS: Hospitalized geriatric patients with and without a fall history were compared. We investigated several oral health issues including xerostomia, stimulated and unstimulated salivation rates, total number of teeth and prosthetics, periodontal status, and oral health-related quality of life. RESULTS: Forty patients were included, 28 in the fall history group and 12 in the control group. All patients had oral health issues that impacted on their oral health-related quality of life. However, there were no significant differences between the groups, including xerostomia and hyposalivation, apart from increased dysphagia and less flavor in food in patients with a fall history. CONCLUSION: Dry mouth does not appear to be an independent risk factor for falling in this population, but oral health was impaired. Thus, it is important that dentists and geriatricians are aware of and investigate these conditions in their patients and that appropriate action is taken to reduce the consequences of impaired oral health, including a potential reduction in falls.

Blood loss and operative duration using monopolar electrosurgery versus ultrasound scissors for surgical preparation during thoracoscopic ventral spondylodesis: results of a randomized, blinded, controlled trial.

PURPOSE: Monopolar electrosurgery is the gold standard for surgical preparation in thoracoscopic spine procedures. However, use of ultrasound scissors could decrease blood loss, accelerate the preparation time and improve patient safety, while minimizing operative costs. This trial compares both preparation techniques for ventral thoracoscopic spondylodesis. METHODS: The study design is an open, prospective, randomized, and double-blinded two-armed clinical trial performed in two centres. Forty-one patients with vertebral body fractures from T10 to L2 were included. Primary endpoint: preparation time. Secondary endpoints: blood loss, organ injuries, duration of hospitalization. RESULTS: Primary and secondary endpoints did not differ significantly between groups (p level 0.05). Increased blood loss (150 ml or more) was eliminated with ultrasound scissors (p = 0.0014). CONCLUSIONS: Primary and secondary endpoints did not differ significantly between the two preparation techniques. The use of either ultrasound scissors or electric scalpel offers safe and effective preparation for thoracoscopic spine surgery.