Home or away? Differences between home‐ and clinic‐based dental examinations for older people

Objective: To determine whether home‐based and clinic‐based dental examinations of older people are comparable. Background: Despite a number of studies which have examined the concordance between different examiners or examination circumstances, none has directly compared an oral examination conducted at home with one conducted in an appropriate clinical setting. Materials and methods: Dentate participants (n = 61) aged between 65 and 74 years underwent two clinical examinations, one in a conventional dental clinic and the other in the person’s home. Kappa statistics, intra‐class correlation coefficients and ‘Difference against mean’ plots were used to determine the nature and extent of any bias. Results: The summary estimates for missing teeth and dental caries were close, although the home‐based examinations resulted in a lower estimate of the mean number of decayed teeth and of untreated coronal decay. The lowest reliability statistics were observed with respect to the prevalence of untreated coronal caries, filled root surfaces and root surface (Decayed or Filled Surfaces) DFS. The periodontitis prevalence estimates were closer, but the reliability statistics were relatively low. The extent of bleeding on probing was relatively under‐estimated in the home‐based examinations. ‘Difference against mean’ plots indicated that, overall, the clinic‐based examinations detected more disease (although this was not observed for all clinical parameters which were measured). Conclusion: While clinic‐based examinations will remain the preferred option, the potential loss of information associated with home‐based examinations is unlikely to be great enough to preclude using them where required, although surveys with larger samples (and therefore more accurate estimates) should restrict their proportion of home‐based examinations to no more than 10%. As they are less precise, surveys with samples of 300 or fewer can safely accommodate up to about one‐third of their examinations being conducted in participants’ homes.     

The effects of group and individual animal-assisted therapy on loneliness in residents of long-term care facilities

Abstract

Animal-assisted therapy (AAT) has been shown to reduce the loneliness of residents in long-term care facilities (LTCFs). In this study, we determined the relative contribution of socialization (human–human bonding) and human–animal bonding as mechanisms by which AAT reduces loneliness. Residents in LTCFs volunteering for AAT were randomized to receive AAT as individuals (Individual) or in groups of two to four (Group). Individual AAT was used as a measure of animal–human bonding, and Group AAT was used as a measure of the combination of animal–human bonding and socialization. Any greater effect of Group AAT in comparison to Individual AAT would be ascribed to socialization. Thirty-seven residents of LTCFs, who were cognitively intact, volunteered for AAT, and scored as significantly lonely on the UCLA Loneliness Scale (Version 3), were studied. Six weeks of AAT, one 30-minute session per week, in an individual or group setting was performed, with posttesting during week five. Two residents dropped out of each group, giving us group sizes of 17 (Individual) and 16 (Group). A two-way ANOVA showed a statistically significant effect of pretest vs. posttest scores (F_(1,31) = 25.3, p < 0.001), with no effect of Group vs. Individual or of interaction. Newman Keuls post-hoc tests showed that the pretest scores for Individual and Group participants did not differ. There was a significant difference between pretest and posttest scores for Individual participants (p < 0.05) but not for Group participants. There was no difference between the posttest values for Individual vs. Group. When the data from all 33 participants were combined, Delta scores (pretest minus posttest), correlated positively (p < 0.01) with pretest scores, showing that lonelier individuals benefited more from AAT. In conclusion, AAT was more effective in improving loneliness in residents of LTCFs when given individually than in a group situation. Therefore, the main effect of AAT was not mediated by socialization.     

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.     

Is Europe prepared to meet the oral health needs of older people?

OBJECTIVE: To discuss the preparedness of the social and health care systems and the health workforce in Europe to manage the increasing general and oral health care needs of older adults. BACKGROUND AND DISCUSSION: There are large inequalities across European countries and regions in the demographic, socioeconomic and health status of the elderly. The ageing of the population and the economic crisis put at risk the existing social and health care systems and are expected to further widen the existing inequalities. Despite the increase in funding for the general health care, public funding for dental care has reduced, limiting the access for the disadvantaged elderly. Dental care is isolated from health care policies and funding. At the same time there is a significant shortage of adequately trained personnel in the care of the elderly and a shortage of training opportunities particularly at a postgraduate and continuing education level. CONCLUSION: Immediate action is needed and appropriate strategies need to be implemented. Oral health prevention, delivery policies and funding should be integrated within the general health care system. Clinical protocols and guidelines need to be developed on the oral care of the elderly. Interdisciplinary training in the care of the elderly needs to be implemented for all health care workers (dentists, physicians, nurses, health care aids, social workers) at all education levels to enhance comprehensive care.     

Las ganas de vivir como expresión del bienestar de las personas mayores

IntroductionWill-to-live, a central concept in well-being theories, represents a positive attitudinal component towards one's own life. It has been identified as a mediator between the self-perception of aging and longevity and health. The objective of this study is to characterise elderly people with high levels of will-to-live in the main dimensions of positive psychology.MethodThe study included the voluntary participation of 165 adults, aged between 54-89 years, users of senior centres in the Community of Madrid. Will-to-live and other dimensions of well-being and health were evaluated. The correlations between the different evaluated dimensions were analysed, and comparisons made in terms of different levels of will-to-live, as well as an analysis of the dimensions that contribute most to the will-to-live.ResultsCorrelations among the majority of variables were statistically significant, with a decrease in the coefficients being observed when controlling the effect of the will-to-live. When groups with different levels of will-to-live are compared with well-being and health, there are statistically significant differences in practically all of the dimensions. Gratitude, positive affect, and depression are the dimensions that best predict will-to-live.ConclusionOlder adults that make up the group with high will-to-live are characterised by higher levels of optimism, gratitude, positive affect, sense of life, psychological prosperity, resilience, happiness, and satisfaction with life, as well as lower levels of depression and negative self-perception of aging. The implications of these results point towards the relevance of will-to-live in successful aging.     

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.