Biomarkers of ageing in New Zealand VLBW young adults and controls.

BACKGROUND: There is individual variation in physiological ageing. Former very low birthweight (VLBW; birthweight < 1500 g) young adults may have less satisfactory measurements on some physiological parameters than term controls. We hypothesized that a summation score of physiological biomarkers that change with age would show VLBW adults to have a more advanced physiologic age than controls. METHODS: VLBW adults (229; 71% survivors of a national VLBW cohort) and term-born controls (100) were clinically assessed at 26-30 years. Ten measured physiological biomarkers were selected and measurements converted to z-scores using normative reference data. Between-group comparisons were tested for statistical significance for individual biomarker z-scores and a summation score. RESULTS: Nine of 10 biomarkers showed a mean z-score suggestive of older physiological age in the VLBW group versus controls. The observed mean difference in the summation score was highly significant (p < 0.001), representing a mean shift of 0.47 SD in the distribution of test scores for VLBW relative to controls. CONCLUSIONS: Utilizing a 10-biomarker score, VLBW young adults have a score indicative of poorer physiological functioning than term-born controls. Repeating these measures after an interval could provide insights into the comparative pace of ageing between VLBW and term-born adults. IMPACT: A summation score of 10 physiological biomarkers that are known to change with age shows that former very low birthweight adults have significantly poorer physiological functioning by the end of their third decade than term-born controls. This result adds to existing literature showing very preterm and very low birthweight young adults often have physiological and metabolic test results that are less satisfactory than those from term controls, despite mostly being in the normal range for age; for instance, higher systolic blood pressure. Although the pace of ageing in later years is yet to be established, the implications of this study are that preventative measures and lifestyle choices that impact on physiological ageing might have even greater importance for very preterm and very low birthweight graduates.

Dental status of young adults born with very low birthweight: A national cohort study.

OBJECTIVES: Little is known about the oral health of very low birthweight (<1500 g: VLBW) young adults. This study compared the oral health and self-reported oral health in a 1986 birth cohort of VLBW young adults with that of term-born controls. METHODS: Oral health interviews and dental examinations were conducted. The dental examinations were carried out in a dental clinic using the standardized examination protocols from the 2009 New Zealand Oral Health Survey. Participants were interviewed to obtain data on self-reported oral health, oral hygiene practices, use of dental health services and oral health-related quality of life using the OHIP-14 measure. RESULTS: Interviews were completed by 250 VLBW participants and 226 (90.4%) of those underwent the dental examination. All 100 controls completed both the interview and dental examination. While there were few overall differences in clinical or self-reported oral health between the VLBW or control groups, proportionally fewer VLBW participants attended the dentist for regular check-ups or cleaned between their teeth than controls. The VLBW and controls did not differ in the prevalence of untreated dental caries or in the number of carious tooth surfaces after adjusting for confounders. However, participants in the control group had more teeth that had been restored due to caries (4.4 teeth) than did the VLBW group (3.4 teeth, P = .045), after adjusting for confounding. CONCLUSIONS: Very low birthweight young adults showed poorer self-care than the control group when it came to oral health; they were less likely to regularly attend dental visits, had poorer oral hygiene and were less likely to have had their dental disease treated. VLBW young adults should be encouraged to attend regular dental check-up appointments and to carry out effective home oral hygiene care.

Oral Health Among Older Adults With Complex Needs Living in the Community and in Aged Residential Care Facilities within New Zealand.

OBJECTIVES: To describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables. DESIGN: Secondary analysis of 2 continuously recruited national cohorts. SETTING AND PARTICIPANTS: Adults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent. METHODS: All community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models. RESULTS: Overall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Maori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts. CONCLUSIONS AND IMPLICATIONS: Heavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.

The New Zealand 1986 very low birth weight cohort as young adults: mapping the road ahead.

BACKGROUND: Very low birth weight (less than 1500 g) is associated with increased morbidity and costs of health care in childhood. Emerging evidence suggests these infants face a range of health and social problems as young adults. We studied all New Zealand very low birth weight infants born in 1986 (when 58% were exposed to antenatal corticosteroids) in infancy, with later follow-up at 7 to 8 years and 23 to 24 years. We now aim to assess the cohort at 26-28 years compared with controls. METHODS/DESIGN: The case sample will comprise a minimum of 250 members of the 1986 New Zealand national very low birth weight cohort (77% of survivors). Outcomes will be compared with a control group of 100 young adults born at term in 1986. Following written informed consent, participants will travel to Christchurch for 2 days of assessments undertaken by experienced staff. Medical assessments include growth measures, vision, respiratory function, blood pressure and echocardiogram, renal function, dental examination and blood tests. Cognitive and neuropsychological functioning will be assessed with standard tests, and mental health and social functioning by participant interview. A telephone interview will be conducted with a parent or significant other person nominated by the respondent to gain a further perspective on the young person's health and functioning. All those born at less than 28 weeks' gestation, plus a random subset of the cohort to a total of 150 cases and 50 controls, will be offered cranial magnetic-resonance imaging. Statistical analysis will examine comparison with controls and long-term trajectories for the very low birth weight cohort. DISCUSSION: The research will provide crucial New Zealand data on the young adult outcomes for very low birth weight infants and address gaps in the international literature, particularly regarding cardiovascular, respiratory, visual and neurocognitive outcomes. These data will inform future neonatal care, provide evidence-based guidelines for care of preterm graduates transitioning to adult care, and help shape health education and social policies for this high risk group. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000995875 . Registered 1 October 2012.

Adults with intellectual disability: a mixed-methods investigation of their experiences of dental treatment under general anaesthetic.

OBJECTIVES: This study aimed to explore the experiences of dental care under general anaesthesia in adults with an intellectual disability. METHODS: The study used an explanatory mixed-methods design. In the initial quantitative phase of the study, a clinical audit of oral health services provided for adults with intellectual disabilities was carried out for individuals who underwent a general anaesthetic (GA) for dental treatment at Christchurch Hospital during a 5-year period. In a qualitative second phase, fifteen semi-structured interviews were carried out for 13 individuals with an intellectual disability to investigate the experience and perceptions of individuals with an intellectual disability (and caregivers and guardians) relating to their oral health care. RESULTS: The majority of the treated patients lived in care, and many had severe medical problems. Most had both restorative treatment and tooth extractions carried out under GA. Their major concern was anxiety associated with the dental visits. Support people/ guardians shared this concern, and played a vital role in helping to manage this anxiety. Many of the latter had difficulty identifying dental problems in their charges, and they often relied on detection of changes in the individual's behaviour or demeanour. The time spent waiting in waiting rooms for treatment was a frequently reported cause of stress. CONCLUSIONS: As a group, these individuals present challenges for the provision of oral health care, given their severe disability and medical conditions, and many require a high level of support for daily activities. When dental treatment is required, a GA is often necessary in order to carry it out. The management of anxiety was a key issue for the patient group and support people play a vital role in helping to manage this anxiety, and achieve a successful visit. There is potential to improve the service with a multidisciplinary approach to coordinate other health services during treatment episodes, reduced time spent in waiting rooms, and improved waiting room layout.

Oral health status and oral treatment needs of dependent elderly people in Christchurch.

AIM: To describe the general health, oral health status, and treatment needs of dependent older people living in Christchurch rest homes. METHODS: 210 Grade 3 residents from seven randomly selected care facilities were examined for: dental/denture status, caries, periodontal disease, and oral cleanliness. RESULTS: Age ranged from 65 to 103 with an average age of 84.6 years. The female-to-male ratio was 3:1. Thirty-two percent of residents were dentate (average 14 teeth). This figure was up from 16-19% one decade ago (p<0.01; chi-squared test). Sixty-five percent of dentate residents had caries. Each dentate person had an average of 2.38 teeth with carious lesions in the root or crown. 51.5% of residents required restorative treatment and 38.2% required an extraction. Twenty residents had at least one 'carious stump'. Eighty-two percent of residents required scaling of the teeth. Two thirds had no natural teeth, and one third of those with dentures required treatment. Eighty-nine residents (42%) were unable to communicate about past dental behaviours. CONCLUSIONS: These data indicate that (compared to one decade ago) more dependent elderly people are retaining their natural teeth--but they are keeping no more teeth, and the health of the teeth has not improved. Most elderly people do not regularly receive dental assessments or care.

A qualitative study of oral health knowledge and attitudes among staff caring for older people in Dunedin long-term care facilities.

Over the next few decades, the number and proportion of older New Zealanders will increase, and many will retain their natural teeth. Many older people in care will be dependent on caregivers for their oral health care. The purpose of this qualitative study was to investigate the dental knowledge and attitudes of staff caring for older people in Dunedin long-term care facilities. In-depth, semi-structured interviews with 20 participants from three facilities were recorded on audiotape and subsequently transcribed. The transcripts were analysed to identify themes expressed by the participants. Some of the staff reported poor oral health, and many were irregular dental attenders. Interviewees had a reasonable basic knowledge of dental caries, but were uninformed on many other dental issues, such as the benefits of fluoride and the effects of medication on oral health. All understood that oral health could influence general health. The staff had received very little education about oral health and related issues in their training. There is a need to improve the oral health care knowledge of long-term care facility staff. Incorporation of oral health care into in-service and formal training programmes would be valuable.