Dental Status in the Elderly: A Review of the Swedish Literature1

1. Elderly persons living in their own homes have over the past 20 years tended to retain an increased number of natural teeth. This tendency is confirmed especially in the ongoing studies by Tor Österberg, nr 12 and 13. These studies indicate a decreasing edentulous part of the 70-year old cohorts from 1971, 1976 and 1981. 2. Elderly persons dependent on institutional care are edentulous in as high degree today as 20 years ago. According to this criterion, therefore, their dental health has not improved. 3. Dentures worn by elderly persons frequently are defective in fit and function. For the general wellbeing and health in later life, mastication of a well-balanced diet and lack of discomfort from denture-bearing mucosal surfaces are important. Information in this respect and measures to improve masticating function are greatly needed among persons in the higher age groups, whether living at home or in institutional care. 4. Caries activity is increasing among elderly persons. 5. Periodontitis (loosening of the teeth) is very frequently found in elderly persons. 6. Oral hygiene requires improvement. 7. Among the elderly, living in their own homes or in institutions, the need for odontologic care is objectively great, but the demands currently made are remarkably low. 8. Of the aged in institutional care, about 75 per cent are suitable for measures of oral care. A change in dental health seems to be slowly taking place among the elderly, in that increasing numbers keep more of their own teeth longer in life. The demands made by the high age groups on the odontologic services, though increasing, are still very low relative to the objective and consequently great accumulated needs. This contrast is especially pronounced among geriatric patients in institutions. An aggressive, searching approach to both restorative and preventive oral care in the higher age groups is of pressing importance if optimum conditions for eating and chewing late in life are to be achieved. For timely counteraction of the tendency to a more passive attitude t o dental care that commonly accompanies rising age, information on these matters should be energetically disseminated among persons due for retirement or new-l y retired.     

Aging, disability, and frailty: implications for universal design

Throughout the world all populations are seeing burgeoning numbers of "elders", defined as persons aged 65 year and older. In many countries, including Japan, the United States, Norway, Sweden and the United Kingdom, those aged over 65 are at or approaching 15% of the population. As their numbers have increased, so have their health care expenses, leading to extensive research on the health, well being, and life expectancy of these increasingly older elders. Today this group is further sub-divided: the young-old ages 65-74, the old-old ages 75-84, and the oldest-old ages 85+, for both health care and research purposes. However broad variation still characterizes even these groupings. Rates of frailty and disability increase with increasing age among these elders. For example, inabilities to complete at least one activity of daily living increased from about 5-7% at ages 65-69 years to about 28-36% at ages 85+ in 1987. Death rates continue to decline at all ages past 50 years and rates of disability seem to be doing the same. For the foreseeable future, we may expect increasing numbers of older, frail elders than in previous decades. Thus, people are not only living longer, they generally are healthier at advanced ages than were previous cohorts, thus "old age" disabilities of the 20th century will be put off to even older ages during the 21st century. As yet there is no clear way to assess senescent changes in humans, although activities of daily living, allostatic load, and frailty indices have all been suggested. One future need is greater development and use of universal and accessible design in all aspects of the built environment.     

Associations between self-assessed masticatory ability and some general health factors in a Swedish population

Objectives : The aims of this study were 1) to describe changes in self-assessed masticatory ability over a 14 year period (1975–89); and 2) to describe associations between self-assessed masticatory ability and age, dental state and some other background factors in a sample of the Swedish population in 1988/89. Design: The Swedish National Central Bureau of Statistics investigates annually the living conditions of the Swedish population by means of interviews by trained persons. The data were analysed by means of stepwise logistic regression and calculation of adjusted relative risks. Subjects: In the investigation in 1988/89, 12901 people above 16 years of age participated and the response rate was 80%. Results: In comparison between the investigations, the prevalence of reported impairment was lower in 1988/89 than in 1975 and 1980/81. Prevalence of reported impairment of chewing ability increased with ageing from 2% in young adults (16–34 years old) to 44% in older elderly (>85 years old). In most age groups, edentulous people reported the highest prevalence, and dentate people the lowest. Relative risks for impaired masticatory ability, independent of age, gender and dental state, were higher for people in rural areas, with low income and living single, as well as for those with skeletal, gastrointestinal, psychiatric and tumour diseases. In the elderly, results from the logistic regression showed that some disability and psychosocial factors were also associated with masticatory ability. Conclusions : The results indicated that there was a group of elderly people who reported several functional and health problems including impaired masticatory ability.     

Endocrine Treatment of Transsexual Persons: Extensive Personal Experience

ObjectiveThe Endocrine Society’s recently published clinical practice guidelines for the treatment of transsexual persons acknowledged the need for further information on transsexual health. We report here the experience of one provider with the endocrine treatment of transsexual persons over the past 2 decades.MethodsData on demographics, clinical response to treatment, and psychosocial status were collected on all transsexual persons receiving cross-sex hormone therapy since 1991 at the endocrinology clinic at Albany Medical Center, a tertiary care referral center serving upstate New York.ResultsThrough 2009, a total 192 male-to-female (MTF) and 50 female-to-male (FTM) transsexual persons were seen. These patients had a high prevalence of mental health and psychiatric problems (over 50%), with low rates of employment and high levels of disability. Mental health and psychiatric problems were inversely correlated with age at presentation. The prevalence of sex reassignment surgery was low (31% for MTF). The number of persons seeking treatment has increased substantially in recent years. Cross-sex hormone therapy achieves very good results in FTM persons and is most successful in MTF persons when initiated at younger ages.ConclusionTranssexual persons seeking hormonal therapy are being seen with increasing frequency. The dysphoria present in many transsexual persons is associated with significant mood disorders that interfere with successful careers. Starting therapy at an earlier age may lessen the negative impact on mental health and lead to improved social outcomes. However, significant barriers exist, such as insufficient insurance coverage, which limit comprehensive care. (Endocr Pract. 2013;19:644-650)     

The health status and health care use of elderly living in sheltered residences. A comparison with independently living elderly

A sheltered residence for older persons is a living arrangement in between independent living and a residential institution. There is little knowledge about the health of elderly living in these residences. We studied the physical, functional and psychosocial health of 401 persons living in a sheltered residence for elderly in Zwolle through a standardised interview. We compared the health of these elderly to the health of independently living elderly in the same region studied in the Longitudinal Aging Study Amsterdam and adjusted for sex, age and married state. We found an impaired functional health and more chronic illnesses among elderly living in a sheltered residence. In addition, more medication was used (OR = 2.4). The studied elderly felt more often depressed (OR = 1.9) or lonely (OR = 1.7). Their mental state was more frequently impaired (OR = 1.7), they visited health professionals more often and received more help for personal care (OR = 2.0) and housekeeping (OR = 1.6). We conclude that people living in sheltered residences form a distinct group of elderly, characterised by impaired physical, functional and psychosocial health. Planners of future care must be aware of this vulnerable group.     

Selenium status and its correlates in a British national diet and nutrition survey: people aged 65 years and over.

Plasma selenium (Se) concentrations were measured in 1134 British people aged 65 years and over, living in mainland Britain during 1994-1995. Eight hundred and eighty-three lived in the community ("free-living"), while the remainder lived in institutions (residential and nursing homes). The overall mean plasma Se concentrations was 0.90 micromol/l (inner 95% range 0.50-1.36 micromol/l). Free-living people had significantly higher values than counterparts living in institutions, and there was an overall inverse correlation with age. Plasma Se varied with season (lower from October to December than at other times of the year), while values were higher in southern Britain than in the North. Socio-economic associations also existed (lower plasma Se in people receiving state benefits or with poorer educational attainment), while smokers had lower values than non-smokers. Several indices of poor health status or of medicine use were correlated with lower plasma Se, which was also predicted by several biochemical or haematological indices of infection or inflammation. Plasma Se was strongly and directly correlated with plasma albumin, zinc, cholesterol, vitamin C, several carotenoids, alpha-tocopherol, pyridoxal phosphate, and with blood haemoglobin and several anthropometric indices. All relationships were independent of age and gender, and are consistent with the view that plasma Se levels are higher in fit and well-nourished elderly people and lower in those who are frail, poorly-nourished and unwell. Whole-blood glutathione peroxidase generally did not share these relationships, was only very weakly correlated with plasma Se, and appeared to be less useful as a status indicator in this population group.     

Artificial environments and an aging population: designing for age-related functional losses

Over the past century there has been a large and continuing increase in the frequency of persons aged over 65 years; particularly those aged over 100 years. During the 21st century the number of persons over 100 years will continue to increase. This will occur at such a rapid rate that the 21st century may one day be called the century of centenarians. Frailty and disability secondary to senescence, disease, and trauma have accompanied old age (often defined as age 65 and over) as far back as recorded history. However, during the 20th century, age, frailty, disability, and chronic degenerative diseases have been decoupled to some extant in the most long-lived human populations. Until recently, there was little need to design artificial environments for the unique needs of the elderly due to their low representation in most national populations. Today that need is increasing in concert with the number of persons aged 65 and older.The purpose of this review is to suggest areas wherein physiological anthropologists may have an opportunity to contribute to design trends for this rapidly increasing aging population. Major considerations for design of environments for the elderly are based upon altering the environment to accommodate their declining visual, auditory, and kinesthetic senses, thereby enhancing their declining faculties and improving their autonomy, independence, and self perceptions of well-being. To date most design considerations have been directed toward improving environments for those suffering from Alzheimer's disease or residing within assisted living facilities. Many such design improvements also may be effective in improving life satisfaction and functional abilities of the non-institutionalized elderly.     

Utilization of dental health services by community-dwelling older adults in Japan who attended a weekly educational programme

Objectives: The purpose of this study was to describe dental health services utilization and identify factors which influenced a group of independently living elderly persons in an urban area of Japan. Subjects: The study sample consisted of 2,990 participants, 83% of the total sample of the Senior Citizen's College, who were 60 years and over. Measurements: Their dental utilization and satisfaction with dental treatment were measured by a questionnaire from 1993 to 1998 Results: The mean age of the subjects was 66.5 years and 52% were male. Sixty percent of the subjects had visited a dentist within the previous year, and 33% of them had received a regular oral health check‐up. The majority of the subjects (63%) were satisfied with their dental treatment. A multiple stepwise logistic regression analysis showed that dental services utilization had a significant positive association with presence of teeth (p<0.001), being male (p<0.01) and satisfaction with financial status (p<0.05). A regular oral health check‐ups had a significant association with presence of teeth (p<0.001), satisfaction with financial status (p<0.05) and aging (p=0.001). Conclusions: Dental health services utilization was related to the presence of teeth and financial status, rather than age or medical conditions, among independently living elderly persons in an urban area of Japan.     

Social Support,Socio-Economic Status,Health and Abuse among Older People in Seven European Countries

Background

Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment.

Methods

The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden).

Results

Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse.

Conclusions

High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.     

An epidemiologic and immunologic study of measles under conditions of massive immunization against that infection]

Massive measles immunization in Riga led to a marked reduction of measles incidence and to a change of the principal regularities of the epidemic process in this infection. Among those who contracted the disease there was an increase in the percentage of schoolchildren; affection with measles of children attending creches and kindergartens and the intensity of the spread of the infection in them diminished. Selective examination of the immunological efficacy of the living measles vaccine prepared of the (see article) and applied in 1967--1972 demonstrated the presence of specific stimulation of the antibody formation in about 90% of the persons vaccinated. The intensity of humoral immunity in the persons vaccinated did not diminish with the advance of time after the vaccination, and 6--7 years after the vaccination over 90% of the vaccinated individuals were reliably protected from measles. The presence of numerous negative results in carrying out the vaccinations in individual institutions is apparently attributed chiefly to disturbances of the storage regimen of transportation and of the use of the vaccine.     

Diarrheal Illness and Healthcare Seeking Behavior among a Population at High Risk for Diarrhea in Dhaka,Bangladesh

Diarrhea remains one of the major causes of death in Bangladesh. We studied diarrheal disease risk and healthcare seeking behavior among populations at high risk for diarrhea in Dhaka, Bangladesh. Data were obtained from a cross-sectional survey conducted during April and September 2010. The prevalence of diarrhea was calculated by age-group and sex. A generalized estimating equation with logit link function was used to predict diarrheal disease risk and seeking care from a professional healthcare provider. Of 316,766 individuals, 10% were young children (<5 years). The prevalence of diarrhea was 16 per 1000 persons among all ages; young children accounted for 44 per 1000 persons. Prevalence of diarrhea was significantly higher (p=.003) among younger males (<15 years) compared to that among younger females. In contrast, prevalence of diarrhea was significantly higher (p<.0001) among older females (≥15 years) compared to that among older males. An increased risk for diarrhea was observed in young children, males, and those staying in rented houses, lower family members in the house, using non-sanitary toilets, living in the area for short times, living in a community with less educated persons, living in a community with less use of safe water source for drinking, or living close to the hospital. About 80% of those with diarrhea sought care initially from a non-professional healthcare provider. Choice of the professional healthcare provider was driven by age of the patient, educational status of the household head, and hygienic practices by the household. The study reaffirms that young children are at greater risk for diarrhea. Like other developing countries most people in this impoverished setting of Dhaka are less likely to seek care from a professional healthcare provider than from a non-professional healthcare provider, which could be attributed to a higher number of diarrheal deaths among young children in Bangladesh. Dissemination of information on health education, increasing the supply of skilled healthcare providers, and low-cost and quality healthcare services may encourage more people to seek care from professional healthcare providers, thus may help reduce child mortality in the country. Further studies are warranted to validate the results.     

Effects of depression on physical health and mortality in the elderly. Longitudinal results of the LASA research

This longitudinal study examines the physical health consequences of depression among 3107 older persons (55-85 years). Major depression was defined according to DSM-III criteria in a psychiatric interview. Minor depression was defined by a Center for Epidemiologic Studies Depression score > or = 16. Health consequences were assessed by 3-year change in self-reported functional status, 3-year change in performance on objective tests, and risk of death over 4.5 years. At baseline, 12.8% of the older persons had minor depression and 2.0% major depression. Minor depression was associated with a significantly greater decline in functional status and performance and, only in men but not in women, with an increased risk of death. Major depression also increases decline in functional status and the risk of death (irrespective of sex), but was not associated with decline in physical performance. These results show that late-life depression has strong unfavorable physical health consequences. The consequences of minor depression are comparable with those of major depression.     

Variations de l'incidence des fractures de l'extrémité supérieure du fémur chez les personnes agées de la région de Québec.

To estimate the incidence of fracture of the proximal end of the femur in people aged 50 years or older living in the Quebec area in 1971, 1976 and 1981 we determined the number of admissions for such fractures to the 15 acute care hospitals in the region. From 1971 to 1981 the number of fractures increased by 71%; the increases for those aged 75 to 84 years and 85 years or over were 98% and 118% respectively. The variation is only partly explained by changes in sex and age distribution of the population; the incidence rates also increased. Among men aged 75 to 84 years the incidence rate per 1000 person-years rose from 2.63 in 1971 to 5.22 in 1981, an increase of 98%; the corresponding figures for men aged 85 years or more were 9.76 and 16.91, an increase of 73%. Among women aged 75 to 84 years the rate rose from 7.28 to 8.81, an increase of 21%; the corresponding figures for women aged 85 years or more were 20.40 and 24.27, an increase of 21% and 19% respectively.     

A Review of Regional Studies on the Dental Health of Older Canadians1

The last national survey of dental health in Canada was conducted in 1970–72 as part of the Nutrition Canada study. In that survey, 52% of Canadians over 60 were found to be edentulous. In 1980, epidemiologists in Quebec conducted the only provincewide, population-based survey of seniors and found 72% were edentulous. In Ontario, published local or regional surveys and province-wide interview data, obtained over the past 20 years, show that between 81% and 51% of those over 65 years of age were edentulous with the lower rates found in the more independently living, younger elderly, and in the more recent studies. Further, between 18% and 42.5% of those over 65 had visited a dentist in the previous year with higher rates among dentate and independently living elderly. Dental treatment needs were higher among the dentale and the institutionalized. These data are contrasted with recent findings from a population-based study in East York, Ontario, and local data from British Columbia, Manitoba, and Prince Edward Island. The regional differences in health and the trends to increased life span, less edentulism and increased rates of visiting present challenges to Canadian policy makers and dental practitioners.     

Demographic and social characteristics of adults with cystic fibrosis in the United Kingdom.

OBJECTIVE--To obtain information about social and demographic characteristics and lifestyle of adult patients with cystic fibrosis, including those who do not attend major specialist clinics. DESIGN--Confidential self completion postal questionnaire to adult patients with cystic fibrosis, asking about social and demographic characteristics, social class and occupation, employment, education, insurance and social security benefits, symptom severity, and medical care. SETTING--National association for adults with cystic fibrosis. SUBJECTS--1052 adult members of the Association of Cystic Fibrosis Adults UK, accounting for 68% of those with cystic fibrosis in the United Kingdom population over 16 years of age and over 80% of those over 25 in June 1990. RESULTS--The response rate was 82% (397 women, 423 men). Most adults with cystic fibrosis were found to be living fulfilling lives into adulthood. Significantly fewer men were married or cohabiting than women (110 (26%) men, 175 (44%) women). 420 (55%) responders were working, and of these 235 (56%) had less than two weeks'' sick leave a year. Half of those not employed gave ill health as the reason. Revealing that they had cystic fibrosis at job interviews reduced likelihood of being employed for those with mild to moderate disease. People with cystic fibrosis had been less successful than the general population in achieving O level or equivalent qualifications, but more successful in achieving A level or higher qualifications. Achievement of any qualifications enhanced employment prospects irrespective of disease severity. CONCLUSION--Contrary to an image of chronic ill health and disability, a high proportion of adults with cystic fibrosis are living full and productive lives.     

Decreasing Hepatitis C Virus Infection in Thailand in the Past Decade: Evidence from the 2014 National Survey

Hepatitis C virus (HCV) infection affects ≥ 180 million individuals worldwide especially those living in developing countries. Recent advances in direct-acting therapeutics promise effective treatments for chronic HCV carriers, but only if the affected individuals are identified. Good treatment coverage therefore requires accurate epidemiological data on HCV infection. In 2014, we determined the current prevalence of HCV in Thailand to assess whether over the past decade the significant number of chronic carriers had changed. In total, 5964 serum samples from Thai residents between 6 months and 71 years of age were obtained from 7 provinces representing all 4 geographical regions of Thailand and screened for the anti-HCV antibody. Positive samples were further analyzed using RT-PCR, sequencing, and phylogenetic analysis to identify the prevailing HCV genotypes. We found that 56 (0.94%) samples tested positive for anti-HCV antibody (mean age = 36.6±17.6 years), while HCV RNA of the core and NS5B subgenomic regions was detected in 23 (41%) and 19 (34%) of the samples, respectively. The seropositive rates appeared to increase with age and peaked in individuals 41–50 years old. These results suggested that approximately 759,000 individuals are currently anti-HCV-positive and that 357,000 individuals have viremic HCV infection. These numbers represent a significant decline in the prevalence of HCV infection. Interestingly, the frequency of genotype 6 variants increased from 8.9% to 34.8%, while the prevalence of genotype 1b declined from 27% to 13%. These most recent comprehensive estimates of HCV burden in Thailand are valuable towards evidence-based treatment coverage for specific population groups, appropriate allocation of resources, and improvement in the national public health policy.     

The effect of marriage on utilization of colorectal endoscopy exam in the United States

Purpose: This study examines the association between marriage and colorectal endoscopy exam, and whether this association varies by gender and financial benefits of marriage including improved access to health insurance and pooled family income. Methods: Representative survey data of the non-institutionalized United States population were used from the 2000, 2005, and 2008 National Health Interview Survey. Analyses targeted persons 50-85 years of age without a personal history of cancer and with complete information on all study variables (n=21,760). Multivariate logistic regression was used to model marital status differences in the probability of undergoing a colorectal endoscopy exam with interaction effects used to model variation over time by gender, health insurance, and poverty level. Results: Married persons were more likely than unmarried persons to report ever having undergone a colorectal endoscopy exam (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12-1.29), and the difference between married and unmarried persons in the probability of undergoing a colorectal endoscopy exam remained stable over time. Married persons were more likely than unmarried persons to report having undergone a colorectal endoscopy exam within the past 10 years (OR, 1.49; 95% CI, 1.15-1.95). For each survey year, married men were significantly more likely than women and unmarried men to report having undergone a colorectal endoscopy exam. For example, in 2008, 56% of married men reported having undergone a colorectal endoscopy exam, compared to 49% of unmarried men, 52% of married women, and 50% of unmarried women. Among persons with health insurance, married persons were significantly more likely than unmarried persons to have undergone a colorectal endoscopy exam. Among persons who were poor, there was no difference by marital status in the likelihood of having undergone a colorectal endoscopy exam. However, among persons who were not poor, married persons were more likely than unmarried persons to have undergone a colorectal endoscopy exam. Conclusion: Given that colorectal endoscopy exams are a potentially life-saving procedure, persistently higher uptake of colorectal endoscopy for married persons over time may be an important health promoting benefit of marriage. Therefore, clinicians and policy makers should focus on improving the use of cancer prevention services among unmarried persons.     

Exploring the quality of life after denture-wearing within elders in Kaohsiung

doi: 10.1111/j.1741‐2358.2012.00614.x
Exploring the quality of life after denture‐wearing within elders in Kaohsiung Objective: The objective of the research is to investigate whether the elderly people’s quality of life get improved after denture wearing. Material and methods: About 1600 elderly persons, over 65 years old, were sampled as the research target. The overall response rate was 71.62%. The tool of research is a structural questionnaire Oral Health Impact Profile (OHIP) that was used to measure the oral health–related quality of life. Individual’s satisfaction of denture wearing divides into three groups: edentulous individuals who are satisfied with denture wearing, edentulous individuals who are not satisfied with denture wearing and dentulous individuals. Results: The result shows the eight variables, which are oral health condition, frequency of snacks‐eating, age, frequency in participation in social activities, instrumental activities of daily living (IADL), vision, satisfaction with life and physical functions, have significant influence on total OHIP score. Conclusions: Although being edentulous, if the elderly are satisfied with their denture, the quality of life can be maintained and not affected by oral health problems. It is suggested that the further researches can include more relevant factors when in a discussion on the oral health–related quality of life, especially, the subjective perception of individual’s feeling.