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Oral health, experiences of oral care, associated factors, and mortality among older people in short-term care
Dalarna University, School of Education, Health and Social Studies, Care Sciences. Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.ORCID iD: 0000-0003-0290-5586
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: The overall aim of this thesis was to describe oral health and oral health-related quality of life (OHRQoL), to compare self-perceived oral health with professional assessment, and to examine associated factors of importance for oral health, experiences, and mortality among older people in short-term care. Paper I describes oral health, daily oral care, and related factors among older people in short-term care and compares the older people’s self-perceived oral health with professional assessment of oral health. Paper II describes OHRQoL among older people in short- term care, and identifies associated factors. Paper III investigates the association between poor oral health, swallowing dysfunction, and mortality in older people. Paper IV describes how older people in short-term care experience their oral health and daily oral care.

Methods: The thesis is part of a Swedish research study: Swallowing Function, Oral Health, and Food Intake in Old Age (SOFIA). In total, 391 older people from 36 short-term care units from 19 Swedish municipalities in 5 regions were included. Papers I–II are based on descriptive cross-sectional studies, Paper III is a prospective cohort study, and Paper IV is a descriptive qualitative study. Oral health was assessed professionally by clinical oral assessment (Papers I– II) and the Revised Oral Assessment Guide (ROAG) (Papers I–III). The older people’s perceived oral and general health was measured via self-reported questions (Papers I–II). Self- care ability was assessed with the Katz Index of Activities of Daily Living (Katz-ADL) (Papers I–III), OHRQoL was measured using the Oral Health Impact Profile (OHIP-14) (Paper II), and swallowing function was assessed with the Timed Water Swallow Test (TWST) (Paper III). Qualitative data were collected through fourteen individual interviews using a semi-structured interview guide (Paper IV). Data were analysed with descriptive statistics, Cohen-s kappa coefficient, logistic regression models, survival analysis, and inductive content analysis.

Results: Papers I–III: The median age of the 391 participants was 84 years, and 209 (53%) were women; 167 (43%) had at least 20 remaining teeth and 74 (19%) were completely edentulous. A need for dental treatment was identified among 148 (41%) of the older people. A total of 74 (19%) participants received some or entire help with oral self-care, and 190 (54%) had less good to poor oral hygiene (Papers I–II). Oral problems according to ROAG were identified in 297 (77%) participants, with the most frequent problems being related to teeth and dentures (Papers I–III). There was a low level of agreement between the clinical assessment based on ROAG and the older people’s self-perceived oral health (Paper I). Poor OHRQoL was reported by 125 (34%) and associated factors were swallowing problems according to ROAG; quite poor/ poor self-perceived physical, psychological, and oral health; and being a woman (Paper II). Poor oral health and swallowing dysfunction were both independently associated with 1-year mortality, and in combination they predicted the highest mortality rate (Paper III). The older people’s experiences of oral health and daily oral care could be expressed as one main category: Adapting to a changed oral condition while striving to retain independence (Paper IV).

Conclusion: Oral problems were identified among most older people in short-term care, although the participants claimed that they were satisfied with their oral health. There was an association between OHRQoL and self-perceived health and oral problems. Poor oral health and swallowing dysfunction were risk factors for 1-year mortality. These results show the importance of both asking older persons about how they perceive their oral health and making systematic assessment of oral health status and swallowing function. The ability to perform daily oral care and need for assistance with oral care should be included in the individual care planning. A close collaboration among different health professionals is important to support older people’s oral health and quality of life.

Place, publisher, year, edition, pages
Falun: Dalarna University, 2020.
Series
Dalarna Doctoral Dissertations ; 13
Keywords [en]
older people, oral care, oral health, oral health-related quality of life, self-perceived, short-term care, swallowing dysfunction, mortality
National Category
Nursing
Research subject
Research Profiles 2009-2020, Health and Welfare
Identifiers
URN: urn:nbn:se:du-34337ISBN: 978-91-88679-05-5 (print)OAI: oai:DiVA.org:du-34337DiVA, id: diva2:1447104
Public defence
2020-09-25, Fö5, Falun, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-08-31 Created: 2020-06-25 Last updated: 2024-04-16Bibliographically approved
List of papers
1. Oral health and oral care in short-term care: prevalence, related factors, and coherence between older peoples and professionals assessments
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
2. Oral health-related quality of life and associated factors among older people in short-term care.
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
3. Older people with swallowing dysfunction and poor oral health are at greater risk of early death
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
4. Older people's experiences of oral health and assisted daily oral care in short-term facilities.
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, ISSN 1471-2318, 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: 2024-04-16Bibliographically approved

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