Factors associated with dental anxiety among older people in Britain

Objective: This paper reports on a study of denial anxiety among adults aged 60 years living independently in Britain. Design: A national cross‐sectional study carried out with the assistance of the Office for National Statistics' Omnibus Surveys in 1999. Setting: Data was collected by face to face interviews with older people in their homes Measurements : Data on dental anxiety were collected from 973 subjects by means of face to face interviews and was measured by the Dental Anxiety Scale (DAS) (Corah, 1969). In addition, data on dental service use and oral health status (self‐reported) was collected. Results: The mean DAS score was 8.4 (sd 3.5), and 13% (129) of subjects were classified as dentally anxious (DAS ≥ 13). DAS scores were associated with numerous socio‐demographic factors (P<0.01), self‐reported oral health status (P<0.01) and dental service (P<0.01) factors. A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioural and oral health outcomes. Conclusion: One in eight older people in Britain are dentally anxious and this is associated with their use of services and oral health status (self‐reported).     

Detecting psychogeriatric problems in primary care: factors related to psychiatric symptoms in older community patients

Objective The aim was to determine the relationship and influence of different variables on the psychiatric symptomatology of older people who reside in the community, as detected by family practitioners.Design A cross-sectional and multi-centre study.Setting Twenty-eight general practices and two psychiatric practices in Huesca, Spain, from 19 primary care health centres.Subjects A sample of 324 patients aged over 65 years, representative of the older people who reside in the community in the province of Huesca.Main outcome measures Symptoms of depression (Yesavage GDS), cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured by family practitioner and were detected following specific questions from the Geriatric Mental State (GMS-B) examination, following DSM-IV criteria, being defined as 'concern and fear of suffering, or the idea of having a serious disease based on the interpretation of somatic symptoms'. Sociodemographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in three phases: univariate, bivariate and multivariate with logistic regression.Results At the time of the study, 46.1% of the older people studied suffered from some psychiatric symptom; 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (prevalence ration (PR) 3.3) and anxiety (PR 3.9). Age was a factor associated with cognitive impairment (PR 4.4). Depression was significantly related to severity of the physical illness (PR 61.7 in extremely severe impairment). Isolation (PR 16.3) and being single (PR 13.4) were factors which were strongly associated with anxiety; living in a nursing home was associated with psychotic symptoms (PR 7.6).Conclusions Severity of physical illness, isolation, living in a nursing home and female gender, among others, are related to psychiatric symptoms in community-residing older people identified in primary healthcare centres.     

Oral health care and aspiration pneumonia in frail older people: a systematic literature review

Objective: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. Background: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. Methods: Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality. Results: Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity. Conclusions: According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.     

Assessing the difference between sociodental and normative approaches to assessing prosthetic dental treatment needs in dentate older people

Objective: To illustrate differences in assessed need using normative and sociodental approaches to assess prosthetic treatment needs of dentate older people. Design: A cross‐sectional study using non‐random sample. Setting: Metropolitan area of Chiang Mai, Thailand. Subjects: 707 older individuals, 549 of the total sample were dentate, living independently, aged 60 to 74 years. Results: The dentate population examined consisted of 289 classified as ‘normal health’ and 44 with a nutritional problem. Of the total population, 60% (333) had a normative need for partial dentures. Excluding the 44 with a nutritional problem, 50% (146) of the NTM group had ‘impact‐related treatment need’ and of the latter 146, 69% (102) had a high propensity for health behaviour. 41% of the 102 who had ‘impact‐related’ and ‘propensity related treatment need’ had ‘accessible treatment need’. That is 14.5 per 100 of those with normative need. The gap between normative and ‘accessible need’ was greater among those with ‘general health related treatment need’ due to underweight. Of the 44 with a NTM and had a health problem, 45% (20) had a “propensity related treatment need”. 40% of the group with a ‘propensity related treatment need’ had ‘accessible treatment need’. Overall of the 44 older people with a normative need for a prosthesis and who had a health problem, only 2.4% had ‘accessible treatment need’ mainly due to lack of finance. If the treatment were subsidised then 45% of those with ‘propensity related treatment need’ would be eligible for treatment. Conclusion: Large differences of estimated treatment need were found between a socio‐dental and a normative approach to assess prosthetic dental treatment needs of older Thai people.     

The prevalence of dental impacts on daily performances in older people in Northern Thailand

Objective: To assess the prevalence of oral related impacts on the quality of daily life in older Thais. Desing: A cross‐sectional study on a non‐random sample. Setting: Metropolitan area of Chiang Mai, Thailand Subjects: 707 older individuals living independently, aged 60 to 74 years, 549 were dentate, 158 were edentate. Methods: Clinical examination and questionnaire for the Oral Impacts on Daily Performances (OIDP) index and on dental behaviours. Results: About one half of the older people interviewed (52.8%) had at least one OIDP oral impact. The most common performance affected was eating (47.2%). The two main symptoms that caused oral impacts in the total sample were functional limitation and pain. The majority of older people had low OIDP scores below 8.0 (76.4%). Almost one in 10 had OIDP scores above 16.0. Individuals with a high income were more likely to have lower OIDP score (p<0.001). Subjects who had attended a dentist were more likely to have no oral impacts (p=0.02). There was a significant difference between OIDP scores related to some clinical variables; dental status (p=0.002), having mobile teeth (p=0.005), periodontal attachment loss (p<0.001), missing anterior and posterior teeth (p<0.001). Conclusions: Oral impacts that affected quality of life of older people were relatively common but not severe. The impacts were related to some social and clinical variables.     

A study of the impact of oral health on the quality of life of older people in the UK- findings from a National Survey.

Objectives The aim of this study was to was to determine whether older adults perceive oral health as affecting their life quality and to identify variations in impacts in relation to socio-demographic factors, dental service utilisation and method of payment. Design This study formed part of the Office for National Statistics Omnibus Survey, which utilised a random probability sample of addresses from the British Postcode Address File (PAF). Setting 3,000 homes were selected from one hundred post sectors across Britain. Respondents were interviewed in their homes about how oral health affects their quality of life. Subjects 454 older people (aged 65 and over) took part in the survey. Main outcome measures The study group perceived oral health as impacting on their quality of life in general (negative and/or positive impact) (70%, 318), enhancing (53%, 241) and detracting (44%, 199) from their life quality. The most frequently perceived way in which oral health affects life quality was its effect on eating and comfort. Older people from higher socio-economic groups reported that oral health had a greater impact on their quality of life in general (positive and/or negative impacts), (OR=1.77,95% CI= 1.22,2.78) and specifically, enhancing their quality of life (OR=1.52, 95% CI=1.01,2.30). Those who reported attending the dentist within the last year perceived that their oral health enhanced their life quality (OR=1.55, 95% CI=1.01,2.38). Conclusions Socio-economic background and dental attendance pattern are associated with how older people perceived oral health as affecting quality of life. These findings may have implications for promoting regular dental attendance and auditing dental services for older people.     

Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care

doi: 10.1111/j.1741‐2358.2009.00274.x
Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care Background: Older people represent a growing and diverse section of the population. As age increases, people are more likely to experience health and mobility problems and be at higher risk of developing oral disease. Nevertheless, few older people utilise primary oral healthcare services. It is therefore important to understand the value older people place on oral health and dental services to inform providers and planners of oral health care. This research was conducted as part of a study to identify potential ways of minimising barriers to oral health care in older people. Objectives: To explore perceptions of oral health and oral healthcare services amongst older people living in a socially deprived inner city area and how these are related to service utilisation. Methods: A qualitative approach was utilised to explore the range of issues related to older people’s perceptions of oral health and their views on health care. This involved a combination of focus groups and semi‐structured individual interviews with older people and their carers. Data analysis was conducted using the Framework approach. Results:

• ? Response: Thirty‐nine older people and/or their carers participated in focus groups.
• ? Oral health perception: Oral health was associated with the presence of natural teeth, the absence of pain, practical/social functioning, preferably supported by positive assessment by a dentist.
• ? Oral health life‐course: Older people have a long and complex dental history. Past negative experiences with oral health care, especially in childhood, strongly influenced present attitudes towards dentistry and dental personnel.
• ? Citizenship and right to health care: There was a strong perception that, as ‘British citizens’, older people should have a right to free health care and that the National Health Service (NHS) should support them in this phase of their life.

Conclusions: The oral health life‐course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of importance and place great emphasis on their citizenship and rights of access to state funded oral health care. This raises important issues for the funding and delivery of NHS oral health care for older people.     

The importance of oral health to older people's quality of life

Objectives This study was designed to determine whether older people perceive oral health as being important to Quality of Life (QoL) and if so, to identify the most important ways in which their lives are affected. In addition, to identify if subgroups of older people perceive its importance differently. Design: Nationwide qualitative face to face interviews with older people were carried out utilising the Office for National Statistics Omnibus survey in Great Britain. Subjects and methods 454 adults aged 65 or older took part in this study, part of a random probability sample of adults in the UK. Setting Respondents were interviewed in their homes. Results 72% (313) perceived their oral health status as important to their QoL through a variety of physical, social and psychological ways. Most frequently its impact on function: eating (29%, 126) and symptoms: comfort (14%, 59) were considered most important. Gender and social class variations were apparent (P<0.05). Conclusion Older people perceive oral health as being important to life quality in a variety of different ways. There are significant social class and gender variations which must be taken into consideration when assessing oral health needs of older people.     

Factors associated with oral health perception in older Brazilians

Objectives: To investigate the self‐perception of oral health in older people, aged 65–74, from the central region of southern Brazil. Methods: Cross‐sectional population‐based study using data from the Oral Health Conditions Survey of Southern Brazil, developed between the years 2002 and 2003, by the State Health Secretary (SHS) of Rio Grande do Sul (RS), Brazil. Socioeconomic and demographic variables, self‐perception of oral health and clinical data, as well as dental pain were evaluated in 618 elderly people. Multinomial logistic regression was used to evaluate the effect of explanatory variables on the self‐perception of oral health. Results: Almost half of the elderly were edentate and rated their oral health as good or very good. With regard to dental pain, 28.8% of the people declared that they had experienced dental pain in the 6 months before the interview. There was a significant relationship between dental pain and classification of oral health, and chewing ability. Following adjustment, the need for dental prostheses remained associated with the influence of oral health on establishing relationships. Similarly, personal income remained associated with the elderly's perception of their ability to talk. Finally, the level of education remained related to the influence of oral health status in people's relationships. Conclusion: Dental pain and the need for dental prostheses were the main factors that affected the self‐perception of oral health of elderly people from southern Brazil.     

Functional tooth units and nutritional status of older people in care homes in Indonesia

Gerodontology 2012; doi: 10.1111/j.1741‐2358.2012.00673.x Functional tooth units and nutritional status of older people in care homes in Indonesia Objectives: To investigate the relationship between functional tooth units (FTUs) and nutritional status. Methods: One hundred females (mean age: 72.4 ± 8.2 years) at four private care homes in Jakarta, Indonesia were interviewed and clinically examined. The oral examination included the assessment of teeth, prosthetic status, and number of FTUs. The total number of FTUs was further divided by tooth composition: natural tooth against natural tooth (NN‐FTUs), natural tooth against denture (ND‐FTUs), and denture against denture (DD‐FTUs). Nutritional status was evaluated using the body mass index (BMI) and the Mini Nutritional Assessment (MNA). Results: The mean numbers of teeth present, NN‐FTUs, ND‐FTUs, DD‐FTUs, and total FTUs were 13.1 ± 10.4, 1.7 ± 3.0, 1.2 ± 3.3, 0.4 ± 1.2 and 3.3 ± 4.4, respectively. The mean BMI and MNA scores were 24.8 ± 5.0 and 22.6 ± 2.8, respectively. Subjects with a normal BMI had a significantly higher total number of FTUs (3.6 ± 4.6) compared with underweight subjects (0.1 ± 0.3). Subjects with a normal MNA had a significantly higher number of NN‐FTU (2.6 ± 3.7) compared to those who were at risk or in a state of under‐nutrition (1.2 ± 2.4). Conclusion: This study revealed significant relationships between the number of FTUs and nutritional status. Keeping the posterior occlusion should be emphasized in order to maintain good nutritional status in older subjects.     

Impact of dry mouth conditions on oral health-related quality of life in older people

Objective: The aim of the present study was to evaluate the impact of dry mouth conditions on oral health‐related quality of life in frail old people, residents at community care centers. Further, reliability and validity of a visual analogue scale (VAS) for dry mouth symptoms were determined within the study cohort. Background: In old people functional, social and psychological impacts of oral conditions are associated with an overall sense of well being and general health. Subjective dry mouth and reduced saliva flow are common disorders in old people caused by disease and medication. Thus, dry mouth conditions may be determinants for compromised oral health‐related quality of life in old people. Method: In total, 50 old people living at service homes for the old people were asked to answer questionnaires on subjective dry mouth (VAS) and Oral Health Impact Profile (OHIP14) for oral health‐related quality of life. Saliva flow was estimated by absorbing saliva into a pre‐weighed cotton roll. Results: The final study cohort comprised 41 old people (aged 83–91 years). Significant associations were identified between both objective and subjective dry mouth and overall or specific aspects of oral health‐related quality of life. Conclusion: Dry mouth (objective and subjective) is significantly associated with oral health‐related quality of life strengthening the value of monitoring dry mouth conditions in the care of frail old people.     

Recognition and behaviour of caregiver managers related to oral care in the community

Objectives: The purposes of this study were to investigate the knowledge, practice and educational background of caregiver managers regarding oral health, how they cope with visiting activities, and to explore related factors to develop an appropriate working strategy for them in the community. Methods: The subjects were 102 caregiver managers, who voluntarily participated in a seminar organised by the M city government. The collected data were analysed to assess the relationship between the related factors of oral health, career and age, and the correlation amongst items of action process concerning oral health using Spearman’s correlation coefficient and Fisher’ s exact test with spss 14.0 for Windows. Results: The results were as follows; (i) the mean length of careers of home‐care staff and caregiver managers was 3.6 ± 3.2 and 1.6 ± 1.6 years respectively, (ii) 90.2% recognised the importance of oral care and 92.2% were interested in oral care, although 32.4% hesitated to provide oral care, (iii) the career of caregiver managers was not significantly related to recognition of concrete objectives of oral care, soft debris and symptoms of periodontal disease, but they recognised the effectiveness of oral care in prevention of aspiration pneumonia, (iv) there was a total of 11 significantly correlated items of knowledge, recognition and practice of oral care and (v) there was a total of 10 significantly correlated items amongst factors of action process. Conclusion: Results suggested that knowledge of oral care was related not only to the career but also to age and revealed a basic gap in the range of abilities between the respondent caregiver managers. Some did perform appropriate oral care and carried out the necessary processes.