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Hägglund, P., Koistinen, S., Olai, L., Ståhlnacke, K., Wester, P. & Levring Jäghagen, E. (2019). Older people with swallowing dysfunction and poor oral health are at greater risk of early death. Community Dentistry and Oral Epidemiology
Open this publication in new window or tab >>Older people with swallowing dysfunction and poor oral health are at greater risk of early death
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2019 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.

METHODS: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI).

RESULTS: The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02-2.75; P = .041 and aHR: 1.98, 95% CI 1.07-3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15-5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%).

CONCLUSIONS: Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.

Keywords
mortality, nursing homes, oral care, oral hygiene, swallowing disorders
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30615 (URN)10.1111/cdoe.12491 (DOI)000482105300001 ()31407829 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-09-17Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Anna, F. & Ehrenberg, A. (2019). Oral health and oral care in short-term care: prevalence, related factors, and coherence between older peoples and professionals assessments. Scandinavian Journal of Caring Sciences, 33(3), 712-722
Open this publication in new window or tab >>Oral health and oral care in short-term care: prevalence, related factors, and coherence between older peoples and professionals assessments
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2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 3, p. 712-722Article in journal (Refereed) Published
Abstract [en]

Background: Oral health is important for well-being and overall health. Older peoples oral health is well described in the residential care context, but remains understudied in short-term care.

Objective: The aim of this study was to describe oral health, daily oral care and related factors among older people in short-term care and to compare self-perceived oral health with professional assessment.

Materials and methods: This cross-sectional study included 391 older people in 36 short-term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self-perceived oral health. Self-care ability was assessed with Katz Index of Activities of Daily Living (Katz-ADL).

Results: Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self-care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self-perceived oral health.

Conclusion: Professionals’ assessments of oral health differed considerably from the older peoples own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self-care (ADL). This study indicates that in order to improve older peoples oral health and oral care we need to provide person-centred oral care and to develop a close collaboration between nursing and dental staff.

Keywords
oral health, oral care, older people, short-term care, self-perceived, functional ability
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29647 (URN)10.1111/scs.12667 (DOI)000486090000021 ()30859599 (PubMedID)2-s2.0-85062833660 (Scopus ID)
Note

Open Access beslut 5/2019

Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-10-07Bibliographically approved
Bergman Bruhn, Å. & Olai, L. (2019). Utvärdering av Hemsjukvården i Dalarna 2014: Slutrapport. Falun: Högskolan Dalarna
Open this publication in new window or tab >>Utvärdering av Hemsjukvården i Dalarna 2014: Slutrapport
2019 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Falun: Högskolan Dalarna, 2019. p. 30
Series
Arbetsrapport / Högskolan Dalarna, ISSN 1653-9362 ; 2019:01
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30797 (URN)978-91-85941-68-1 (ISBN)
Note

Åsa Bergman Bruhn och Lena Olai, mars 2015. Reviderad maj 2015.

Available from: 2019-09-27 Created: 2019-09-27 Last updated: 2019-09-27Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A. & Ehrenberg, A. (2018). Munhälsa hos äldre personer inom korttidsvård bedömd ur två perspektiv, självupplevd och professionell. In: : . Paper presented at Tandhygienistdagarna, 22-24 April 2018, Visby.
Open this publication in new window or tab >>Munhälsa hos äldre personer inom korttidsvård bedömd ur två perspektiv, självupplevd och professionell
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2018 (Swedish)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29211 (URN)
Conference
Tandhygienistdagarna, 22-24 April 2018, Visby
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A. & Ehrenberg, A. (2018). Munhälsa hos äldre personer inom korttidsvård, bedömd ur två perspektiv, självupplevd och professionell. In: : . Paper presented at Forskningens och utvecklingens dag, Örebro universitet.
Open this publication in new window or tab >>Munhälsa hos äldre personer inom korttidsvård, bedömd ur två perspektiv, självupplevd och professionell
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29209 (URN)
Conference
Forskningens och utvecklingens dag, Örebro universitet
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A. & Ehrenberg, A. (2018). Munhälsorelaterad livskvalitet hos äldre personer inom korttidsvård. In: : . Paper presented at Svensk samhällsodontologisk förening.
Open this publication in new window or tab >>Munhälsorelaterad livskvalitet hos äldre personer inom korttidsvård
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2018 (Swedish)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29204 (URN)
Conference
Svensk samhällsodontologisk förening
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A. & Ehrenberg, A. (2018). Oral health among elderly people assessed from two perspectives: self-perceived and professional. In: : . Paper presented at 24th Nordic Congress of Gerontology, Oslo, 2-4 May 2018.
Open this publication in new window or tab >>Oral health among elderly people assessed from two perspectives: self-perceived and professional
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29210 (URN)
Conference
24th Nordic Congress of Gerontology, Oslo, 2-4 May 2018
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Eldh, A. C., Olai, L., Jönsson, B., Wallin, L., Denti, L. & Elf, M. (2018). Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study. Nordic journal of nursing research (2), 87-95
Open this publication in new window or tab >>Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study
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2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, no 2, p. 87-95Article in journal (Refereed) Published
Abstract [en]

This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.

Keywords
context, frail older people, knowledge implementation, leadership, nursing home, oral care
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26788 (URN)10.1177/2057158517713379 (DOI)
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-06-08Bibliographically approved
Hägglund, D. & Olai, L. (2017). Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home. Nordic journal of nursing research, 37(2), 109-116
Open this publication in new window or tab >>Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home
2017 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 2, p. 109-116Article in journal (Refereed) Published
Abstract [en]

The aim of the present follow-up study was to describe staff perceptions of enabling and inhibitory factors that influenced implementation of evidence-based practice (EBP) for urinary incontinence in a nursing home. Focus group interviews were carried out and the text was deductively analyzed using the PARIHS framework and qualitative content analysis.  Factors believed to be most enabling for implementation were the EBP being considered as relevant and as a social process and visiting the lavatory being considered as a right for all. One determinant of successful implementation was having clear and involved leaders who had a continuous positive attitude toward the EBP and demanded results. Staffs who were given the role of continence agents were important facilitators. The factor believed to inhibit implementation most was staff having to carry out pad-weight tests before prescribing individual incontinence aids. The EBP offers a successful concept for caring for older persons with urinary incontinence in nursing homes. The EBP should be spread, both local and more widely.

Keywords
Implementation, nursing home, staff, urinary incontinence
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23358 (URN)10.1177/2057158516667644 (DOI)
Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2017-06-05Bibliographically approved
Hägglund, P., Olai, L., Ståhlnacke, K., Persenius, M., Hägg, M., Andersson, M., . . . Carlsson, E. (2017). Study protocol for the SOFIA project: Swallowing function, oral health, and food intake in old age. BMC Geriatrics, 17(1), Article ID 78.
Open this publication in new window or tab >>Study protocol for the SOFIA project: Swallowing function, oral health, and food intake in old age
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2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, no 1, article id 78Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia).

METHODS/DESIGN: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT <10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups.

DISCUSSION: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

TRIAL REGISTRATION: This trial was retrospectively registered at ClinicalTrials.gov, on July 4, 2016, identifier: NCT02825927 .

Keywords
Aged, Deglutition, Eating, Oral health, Oral screen, Quality of health care, Quality of life, Short-term care, Swallowing disorders
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24672 (URN)10.1186/s12877-017-0466-8 (DOI)28335729 (PubMedID)
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2017-11-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5499-2055

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