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Lindqvist, S., Olai, L. & Hägglund, P. (2024). Factors associated with malnutrition among older people in Swedish short-term care: Poor oral health, dysphagia and mortality. International Journal of Dental Hygiene
Open this publication in new window or tab >>Factors associated with malnutrition among older people in Swedish short-term care: Poor oral health, dysphagia and mortality
2024 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: To investigate the relationship between malnutrition and potential contributing factors such as poor oral health, dysphagia and mortality among older people in short-term care.

METHODS: This cross-sectional study is a part of the multidisciplinary multicentre project SOFIA (Swallowing function, Oral health and Food Intake in old Age), which includes older people (≥65 years) in 36 short-term care units in five regions of Sweden. Nutritional status was measured with version II of the Minimal Eating Observation and Nutrition Form (MEONF-II), oral health with the Revised Oral Assessment Guide (ROAG), dysphagia with a water swallow test, and the mortality rate was followed for 1 year. Data were analysed using descriptive analysis and logistic regression models to calculate odds ratios for the association between malnutrition and these factors.

RESULTS: Among the 391 participants, the median age was 84 years and 53.3% were women. Mortality rate was 25.1% within 1 year in the total group, and was higher among malnourished participants than among their well-nourished counterparts. Severe dysphagia (OR: 6.51, 95% CI: 2.40-17.68), poor oral health (OR: 5.73, 95% CI: 2.33-14.09) and female gender (OR: 2.2, 95% CI: 1.24-3.93) were independently associated with malnutrition.

CONCLUSION: Mortality rate was higher among malnourished people than those who were well nourished. Severe dysphagia, poor oral health and female gender was predictors of malnutrition among older people in short-term care. These health risks should be given more attention in short-term care with early identification.

Keywords
intermediate care, mortality, oral health, risk factors, swallowing disorders, undernutrition
National Category
Geriatrics
Identifiers
urn:nbn:se:du-48649 (URN)10.1111/idh.12832 (DOI)001237389900001 ()38825769 (PubMedID)2-s2.0-85195209100 (Scopus ID)
Available from: 2024-06-04 Created: 2024-06-04 Last updated: 2024-08-28Bibliographically approved
Koistinen, S., Ståhlnacke, K., Olai, L., Ehrenberg, A. & Carlsson, E. (2021). Older people's experiences of oral health and assisted daily oral care in short-term facilities.. BMC Geriatrics, 21(1), Article ID 388.
Open this publication in new window or tab >>Older people's experiences of oral health and assisted daily oral care in short-term facilities.
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2021 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 21, no 1, article id 388Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Older people's oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

METHOD: A descriptive, qualitative study was performed through interviews with 14 older people (74-95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

RESULTS: The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff's knowledge.

CONCLUSIONS: The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff's attention towards older peoples' oral health.

Keywords
Daily oral care, Inductive content analysis, Older people, Oral health, Qualitative interviews, Short-term care
National Category
Dentistry Nursing
Identifiers
urn:nbn:se:du-37825 (URN)10.1186/s12877-021-02281-z (DOI)000669914000001 ()34176481 (PubMedID)2-s2.0-85108957660 (Scopus ID)
Available from: 2021-08-04 Created: 2021-08-04 Last updated: 2024-07-04Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A. & Ehrenberg, A. (2020). Oral health-related quality of life and associated factors among older people in short-term care.. International Journal of Dental Hygiene, 18, 163-172
Open this publication in new window or tab >>Oral health-related quality of life and associated factors among older people in short-term care.
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2020 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 18, p. 163-172Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: It is well known that oral health status is associated with oral health-related quality of life (OHRQoL) in the general population. The aim of this study was to describe and analyze OHRQoL among older people in short-term care and its associated factors.

MATERIALS AND METHODS: This cross-sectional study included 391 older people in 36 short-term care units. Data were collected via clinical oral assessments, questions about self-perceived oral and general health, Katz Index of Activities of Daily Living (Katz-ADL) and the Revised Oral Assessment Guide (ROAG). OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Multivariate logistic regression models were applied in the analysis.

RESULTS: Poor OHRQoL was reported by 34% of the older people. Associated factors were swallowing problems according to ROAG; quite poor/poor self-perceived physical, psychological, and oral health; and being a woman.

CONCLUSIONS: There is an association between OHRQoL and older people's self-perceived health according to the OHIP-14. This indicates the importance of early detection of oral health problems in frail older people and to assess both oral health and swallowing problems among older people in short-term care.

Keywords
Oral health-related quality of life, older people, oral health, self-perceived, short-term care
National Category
Clinical Medicine Health Sciences
Research subject
Research Profiles 2009-2020, Health and Welfare
Identifiers
urn:nbn:se:du-31197 (URN)10.1111/idh.12424 (DOI)000503028700001 ()31782889 (PubMedID)2-s2.0-85076879831 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2024-04-16Bibliographically approved
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, 47(6), 494-501
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 1600-0528, Vol. 47, no 6, p. 494-501Article in journal (Refereed) Published
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
Research Profiles 2009-2020, Health and Welfare
Identifiers
urn:nbn:se:du-30615 (URN)10.1111/cdoe.12491 (DOI)000482105300001 ()31407829 (PubMedID)2-s2.0-85071247073 (Scopus ID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2024-04-16Bibliographically 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
Research Profiles 2009-2020, 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: 2024-04-16Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A. & Ehrenberg, A. (2019). Oral health and related quality of life among older people in short-term care. In: : . Paper presented at International Association of Gerontology and Geriatrics - European Region, 23rd – 25th May 2019 in Gothenburg, Sweden.
Open this publication in new window or tab >>Oral health and related quality of life among older people in short-term care
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Research Profiles 2009-2020, Health and Welfare
Identifiers
urn:nbn:se:du-31437 (URN)
Conference
International Association of Gerontology and Geriatrics - European Region, 23rd – 25th May 2019 in Gothenburg, Sweden
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2024-04-16Bibliographically 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
Research Profiles 2009-2020, 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: 2021-11-12Bibliographically 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
Research Profiles 2009-2020, 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: 2024-04-16Bibliographically 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
Research Profiles 2009-2020, 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: 2024-04-16Bibliographically 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
Research Profiles 2009-2020, 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: 2024-04-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5499-2055

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