Oral health-related quality of life among home-dwelling older people with and without domiciliary care.

OBJECTIVES: The aim was to compare oral health-related quality of life (OHRQoL) between home-dwelling older people with and without domiciliary care when adjusted for gender, education, use of dental services and removable dental prostheses. BACKGROUND: OHRQoL of home-dwelling older people with and without domiciliary care is a neglected area of research, with few studies having been conducted. MATERIALS AND METHODS: A secondary analysis was conducted on the Finnish Health 2011 interview data. Home-dwelling participants (age ≥ 70) with or without domiciliary care were included (n = 758). OHRQoL was measured with the Oral Health Impact Profile questionnaire (OHIP-14) calculating three outcomes: prevalence of at least one impact reported: "occasionally," "fairly often" or "very often" (OFoVo), severity as mean sum score and mean of the seven OHIP-14 dimensions. These were evaluated by use of domiciliary care using logistic and negative binomial regression analyses. RESULTS: Domiciliary care clients tended to have poorer OHRQoL than non-clients (severity mean 4.33 vs 4.11, P = .057), especially men (6.71 vs 4.15, P = .027), and reported more psychological discomfort than non-clients (mean 1.10 vs 0.82, P = .039). The use of removable dental prostheses was the strongest predictor (OR 2.84, P < .001) of poor OHRQoL. CONCLUSION: Domiciliary care clients tended to report poorer OHRQoL, especially with regard to psychological discomfort dimension than non-clients. Thus, support of oral hygiene and regular utilisation of oral health services should be part of domiciliary care among older people to enhance OHRQoL.

Perceived oral health and oral health behaviours among home-dwelling older people with and without domiciliary care.

OBJECTIVES: The aim was to compare the perceived oral health and oral health behaviours of home-dwelling older people with and without domiciliary care. BACKGROUND: Oral health is poor in long-term care, but less is known about perceived oral health of home-dwelling older people receiving domiciliary care. MATERIALS AND METHODS: Data from the Health 2000 and Health 2011 surveys (BRIF8901) were used. Interview participants were at least 70 years old and living at home with or without domiciliary care (n = 1298 in 2000 and n = 1027 in 2011). Differences in perceived oral health (subjective oral health, pain, eating difficulties) and oral health behaviours (hygiene, use of services) were compared based on the use of domiciliary care and stratified by gender. Differences between groups were compared with the chi-square test. RESULTS: In 2011, compared to non-clients, domiciliary care clients more often had poor subjective oral health (40.3% vs. 28.9%, P = .045). In both surveys, they also used oral health services less recently (2000, 76.4% vs. 60.9%; and 2011, 61.1% vs. 46.6%) and more often had difficulties chewing hard food (2000, 50.6% vs. 34%, P < .001; and 2011, 38.4% vs. 20.7%, P < .001) than non-clients. In 2000, clients had more difficulty eating dry food without drinking (39.5% vs. 21.6%, P < .001) and cleaning their teeth and mouth (14.3% vs. 1.1%, P < .001) than non-clients. Women clients in 2011 brushed their teeth less often than non-clients (43.5% vs. 23.7%, respectively, P = .001). CONCLUSION: Domiciliary care clients have poorer perceived oral health, and greater difficulties with eating and oral hygiene maintenance than non-clients.

Oral health assessment in domiciliary care service planning of older people.

OBJECTIVES: The aim was to examine importance and consideration of oral health-related issues (OHRIs) during service planning by the case managers (CMs). METHODS AND RESULTS: The study was conducted in a major Finnish city. All 25 CMs, supervising over 450 domiciliary care employees who are caring for 4600 domiciliary care clients, received a multiple-choice questionnaire with additional open-ended questions. CMs were dichotomized by age and educational background. Differences were compared with the chi-square test and Fisher´s exact test. Response rate was 88%. All CMs considered OHRIs important. However, OHRIs were not routinely considered during service planning, especially by the CMs with a social service than health background (0% vs 30%, P < 0, 0.056). OHRIs were considered never or seldom by 73% of the CMs. OHRIs were mostly considered after evaluating the overall need for domiciliary care. A lack of guidelines was reported by 45% of the CMs. Of the CMs, 41% could use their knowledge for paying attention to OHRIs. All CMs wished for better routines for paying attention to OHRIs. CONCLUSION: OHRIs are not routinely considered in service planning. This study indicated a need for structured guidelines and further education for assess the need for oral home care assistance.

Knowledge, perceived skills and activities of nursing staff to support oral home care among older domiciliary care clients.

BACKGROUND: Increasing number of older adults lives in their own homes, but needs help in many daily routines. Domiciliary care nursing staff (DCNS) is often needed to support oral home care. However, information of nursing staff's knowledge, skills and activity in this task is sparse. OBJECTIVES: The study aimed to assess DCNS knowledge, perceived skills and activities to support oral home care of older domiciliary care clients. MATERIAL AND METHODS: The study was conducted among DCNS in one of the largest cities in Finland. All DCNS members (n = 465) received a questionnaire with 14 multiple choice and open questions regarding the perceived skills, knowledge and activities of oral health guidance of older domiciliary care clients. In total, 115 (25%) DCNS members returned the questionnaires. Frequencies, percentages, means and standard deviations were used to describe the samples and study variables. DCNS was categorised according to age and working years for group comparisons, which were assessed with chi-squared test. RESULTS: Knowledge concerning oral health was mostly on a high level. Around 50% of DCNS considered their knowledge regarding dental prosthesis hygiene as sufficient. Of the DCNS, 67% informed that they had received education on oral health care. However, over 50% of the DCNS had a need for further education in issues related to oral home care. DCNS were active in supporting most oral and prosthesis hygiene means, yet less in guidance concerning toothbrushing. Activity to support cleaning the interdental spaces was the weakest, in which only 12% of the respondents considered having average or excellent skills. Younger DCNS had better knowledge on oral home care due to recent education, but older staff members were more skilful in performing oral hygiene measures. CONCLUSIONS: There is a need for structured instructions and training on oral home care for DCNS. Oral home care should be taken into account more often and regularly.