Oral care training in the basic education of care professionals

doi:10.1111/j.1741‐2358.2009.00304.x
Oral care training in the basic education of care professionals Objective: To investigate the quantity and quality of oral care training in the basic education of future long‐term care (LTC) professionals in Norway. Background: The level of oral hygiene has often proved inadequate in LTC facilities. It has been maintained that this could be due to insufficient knowledge of oral care among care professionals. Materials and methods: A self‐administered questionnaire was sent to all 270 schools in Norway which offered basic education of LTC personnel in 2004/05. Information on theoretical and practical oral care training, scope of oral care in teaching material and curriculum, educational background of the teaching staff and schools opinion regarding adequacy of their training programme was collected. Results: Of the 203 respondents (75% response rate), 188 (participants) included oral care in their educational programme. Approximately two‐thirds of the participating schools provided 3 h or more of oral care training and many of the important themes were presented in the textbooks that were recommended. Moreover, the practical exercises performed in practice placement supplemented the knowledge. Conclusion: The results could not confirm that LTC professional’s basic education concerning oral care was inadequate. There may therefore be other explanations for the poor oral hygiene in many LTC facilities.     

Improving quality of care: focus on liaison old age psychiatry

Introduction Elderly patients occupy up to 65% of acute hospital beds and a significant proportion of them present with a comorbid psychiatric condition such as depression, delirium or dementia. Liaison old age psychiatry (LOAP) services have been developed to provide psychiatric consultation in medical and surgical settings, improving at the same time the knowledge and expertise of general ward staff.Objective The aim of this study is to evaluate clinical characteristics across different psychiatric disorders among elderly patients in medical wards.Method A prospective observational study was developed between October 2011 and January 2013, which involved 107 subjects aged 65 years or older that were hospitalised in the Department of Internal Medicine and referred to the LOAP service. Psychiatric diagnostic was assessed using the Confusion Assessment Method, the Geriatric Depression Scale, the Mini-Mental State Examination and the Clinical Global Impression Scale.Results Delirium (40.6%), depression (22.4%) and dementia (20.4%) were the most common psychiatric diagnoses. Patients with delirium were significantly older, had more severe psychiatric symptomatology (mean CGI = 5.35) and presented infectious processes as acute medical conditions more frequently than the other patients.Conclusion Psychiatric disturbances occurring in elderly inpatients in medical wards are highly prevalent and complex. A LOAP service may play an important role in effectively reducing the overutilisation and consumption of health resources through early recognition of these conditions, effective management and prevention of adverse outcomes, and effective communication with out-patient clinics, community mental health teams and day-care centres.     

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

doi: 10.1111/j.1741‐2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people’s oral health has been quantitative. A need for more in‐depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically‐mixed sample of older New Zealanders. Methods: In‐depth interviews were conducted with 24 older people in two communities in New Zealand’s South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people’s ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.     

Need for gerodontology education in India

Objectives: To evaluate the status and need for education in Geriatric Dentistry in India. Materials and methods: The status of dental education in India was studied. India has 185 dental schools producing 12 000 dental graduates every year. At postgraduate level, there are nine recognised specialities in Dentistry, and approximately 58 institutions offer 1160 places for postgraduate degree courses. Dental education is shaped and administered by the Dental Council of India. Results: So far, Geriatric dentistry has not developed as a separate, independent speciality at postgraduate level. The undergraduate curriculum does not have any significant component of geriatric dentistry. The lack of training results in poor understanding of special needs of older adults in young graduates. Without adequate training and personal experience of growing old, young graduates may not be able to understand the physical, socio‐economic and psychological problems of the elderly and the complexities involved in treatment planning for patients with multiple chronic diseases and medication. Conclusions: It is emphasized that geriatric dentistry should be included in each of the pre‐clinical, para‐clinical and clinical subjects at the undergraduate level. Graduate students should be encouraged to treat elderly patients in clinics under supervision using a multi‐disciplinary approach. Also, postgraduate diploma and degree courses in geriatric dentistry should be developed to address the needs of the vast elderly population in India.     

Understanding the psychology of geriatric edentulous patients

doi: 10.1111/j.1741‐2358.2011.00496.x Understanding the psychology of geriatric edentulous patients Objective: This article focuses on understanding our older patients who require complete prosthodontic care. By breaking down the patient psychology to its component parts, it is easier to obtain a clear picture of this special cohort of patients. Considering the increase in number of geriatric edentulous patients, this knowledge will help the dentist serve the geriatric population better. Background: The role of psychology and personality in complete denture treatment is well documented. The geriatric patient who needs complete dentures has a psychological aspect that needs consideration. Although significant, these aspects may sometimes be ignored or considered irrelevant. Materials and methods: A review of relevant literature was carried out to obtain data on the psychology and personality of geriatric, complete denture patients and their behavioural changes. The obtained data was filtered and condensed to provide a short but comprehensive look at the geriatric edentulous patient’s psychology. Conclusion: When handling geriatric edentulous patients, the dentist must be confident of addressing and managing the psychology of these patients. A thorough understanding of the geriatric mental state thus becomes important and significant for the clinician.     

Effect evaluation of a supervised versus non‐supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial

doi: 10.1111/j.1741‐2358.2010.00418.x
Effect evaluation of a supervised versus non‐supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial Objective: To compare a supervised versus a non‐supervised implementation of an oral health care guideline in Flanders (Belgium). Background: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline ‘Oral health care in care homes for elderly people’ was developed to improve oral health of institutionalised elderly. Materials and Methods: A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6‐month study period. The intervention included a supervised implementation of the guideline. Results: At the 6‐month follow‐up, only a small but statistically significant (p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level. Conclusion: Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result.     

Evaluation of compressive strength in the first premolars between young and elderly people: ex vivo study

doi: 10.1111/j.1741‐2358.2011.00583.x Evaluation of compressive strength in the first premolars between young and elderly people: ex vivo study Objective: This study evaluated the compressive strength of first maxillary premolars from young and elderly people. Background: Findings have revealed that changes happening on dental structure lead to a higher susceptibility of tooth fracture. Materials and methods: Thirty teeth were divided into four groups as follows: G I (n = 7) premolars of elderly patients with fused roots, G II (n = 8) premolars of elderly with separate roots, G III (n = 7) pre‐molars of young people with fused roots and G IV (n = 8) premolars of young people with roots separated. The roots were placed in polyvinyl chloride (PVC) cylinder and embedded in acrylic resin. Afterward, the samples were subjected to fracture by compressive strength in a universal testing machine. Loads were applied in continuous and progressive speed of 0.5 mm/min until the moment of fracture. The values found underwent statistical analysis (anova α = 0.05). Results: With regard to age, there was a statistical difference, the teeth of the elderly being more susceptible to fracture (p < 0.05). With regard to root morphology, no significant differences between both groups were observed (p > 0.05). Conclusion: It was concluded that with the methodology employed, the age factor was important with regard to fracture resistance to compression.     

Sexual and Hormonal Cycles in Geriatric Gorilla gorilla gorilla

As our closest living relatives, great apes likely experience behavioral and physiological patterns associated with reproductive aging and menopause that are similar to human patterns. We present results from a nationwide zoo-based study on behavioral and hormonal changes in female western gorillas. We evaluated progestogen concentrations via daily fecal sampling in 30 gorillas, 22 of which were geriatric (≥30). We collected concurrent behavioral data 1–3 times weekly on 16 of the females. While control females cycled regularly, ca. 23% of geriatric females are acyclic (menopausal), and another 32% show variable hormonal patterns suggesting perimenopause. Patterns included increased variability in cycle length and peak progestogen values, and frequent insufficient increases in progestogen levels during the luteal phase. Acyclic females have significantly lower overall progestogen concentrations than the self cycling females, though differences are not significant when cycle phase is incorporated. We detected behavioral estrus in 9 of 10 cycling females for which data were available. In all but 1 case, proceptive behavior occurred during the follicular phase, preceding ovulation on average by 6.6 d. Females spent more time in proximity to the silverback male while in behavioral estrus than during other periods. To date, maximum longevity in captive female gorillas is 52 yr, with poor reproductive prognosis beginning from the age of 37. We demonstrate that both perimenopause and menopause characterize aged female gorillas, which may experience a postreproductive lifespan of >25% of their lives. Continued study of aging apes is warranted, and apes may serve as models for age-related reproductive changes in humans.     

Tooth loss and associated factors in long-term institutionalised elderly patients

Objective: To compare partial and total tooth loss in dependent institutionalised elderly patients and identify any associated factors. Background: A poor oral health status, together with a reduction of autonomy can seriously affect the general health and increase the risk of death in elderly people. Those with total tooth loss and in need of assistance are the most at risk. Materials and methods: In 2004, a cross‐sectional study of 321 elderly patients was conducted in long‐term hospital services provided in Montpellier, France. Socio‐demographic, behavioural, medical and oral health information was recorded for each patient. Multivariate logistic regression models were performed to test the relationship between those covariates and partial or total tooth loss. Pearson chi‐squared tests were used for bivariate analyses. Results: The proportion of edentulousness was 26.9%; among these12.6% had no dentures. The factors significantly associated with edentulism were: an age ‘older than 87 years’ [odds ratio (OR) = 9.4], the presence of a nephropathy (OR = 6.8), and inadequate oral hygiene (OR = 0.1). The factors most significantly associated with partial tooth loss (at least 21 missing teeth) were ‘cancerous disease’ (OR = 9.9), the presence of a nephropathy (OR = 5.6) and the presence of a neurological disease (OR = 4.1). The factors significantly related to dentate status (20 or more natural teeth retained) were ‘hypertension treatment’ (OR = 2.4), and ‘cortisone treatment’ (OR = 0.2). Conclusion: General health problems as well as a poor oral condition were significant risk indicators for tooth loss among the long‐term institutionalised elderly. This suggests that the number of remaining teeth has a strong effect on oral health‐related quality of life.     

Undergraduate teaching in gerodontology in Austria, Switzerland and Germany

Objective: To survey the present state of undergraduate teaching in the domain of gerodontology in Germany, Switzerland and Austria. Study participants: All universities of Austria (A), Germany (D) and Switzerland (CH). Protocol: A questionnaire on undergraduate teaching in gerodontology was mailed to all Deans (A: n = 3; CH: n = 4; D: n = 31) and all independent departments except paediatric dentistry and orthodontics (A: n = 11; CH: n = 15; D: n = 111). Results: The questionnaires were completed and returned by 29 Deans (A: n = 2; CH: n = 4; D: n = 23) and 102 departments (A: n = 7; CH: n = 8; D: n = 87). In Austria, gerodontology is a very small component of the dental curriculum and the Deans did not want this to be increased. Most German universities claimed to teach some aspects of gerodontology to undergraduate students and 87.4% of the Deans voted for separate lectures in gerodontology. In Switzerland, gerodontology seems well established. The results of questionnaires from the independent departments revealed that in all three countries lectures were more prevalent (A: n = 0; CH: n = 4; D: n = 6) than practical training in nursing homes (A: n = 0; CH: n = 3; D: n = 6). Conclusion: Considering the demographical shift which is leading to an increasing proportion of elderly in the population, the weighting of gerodontology in the undergraduate dental curriculum should be considered for revision in Austria and Germany.