Gert-Jan van der Putten

The Seattle Care Pathway for securing oral health in older patients

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.

Association of some specific nutrient deficiencies with periodontal disease in elderly people: A systematic literature review.

OBJECTIVE Deficiency of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium has been associated with periodontal disease. This article systematically reviews the currently available literature on the feasible association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in elderly people. METHODS We performed a systematic review of relevant English- and Dutch-language medical literature published from January 1990 to May 2007, with critical appraisal of those studies evaluating the association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in elderly people. RESULTS None of the studies meeting the selection criteria included institutionalized elderly people. In the studies on non-institutionalized elderly people, no significant or consistent association was found between vitamin B complex, vitamin C, vitamin D, calcium, and magnesium dietary intakes and serum levels and periodontal disease. Although in those studies decreased dietary vitamin C intake was found to be associated with increased risk of periodontal disease, no conclusive evidence could be demonstrated. CONCLUSION There is no evidence of an association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in non-institutionalized elderly people. To produce conclusive evidence on the subject of this systematic literature review, longitudinal cohort studies and follow-up randomized controlled trials are needed.

Poor oral health, a potential new geriatric syndrome.

This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome.

An oral health care guideline for institutionalised older people.

Institutionalized older people are prone to oral health problems and their negative impact due to frailty, disabilities, multi-morbidity, and multiple medication use. Until recently, no evidence-based oral health care guideline for institutionalized older people has been available. For that reason, the Dutch Association of Nursing Home Physicians developed the Oral health care Guideline for Older people in Long-term care Institutions (OGOLI), meeting the requirements of the AGREE instrument for assessing a guidelines quality. This short report presents the keynotes and the content of the Oral health care Guideline. Most recommendations are based on expert opinions. Only 4 recommendations (education, pneumonia, use of an electric toothbrush, and fluoride rinsing in case of a sudden increase of oral plaque amount) are based on evidence level A2 conclusions. This emphasizes the need for further research on oral health of institutionalized older people.

Nursing Staffs Knowledge about and Skills in Providing Oral HygieneCare for Patients with Neurological Disorders

Objectives: To determine nursing staff’s current knowledge on providing oral hygiene care to patients with neurological disorders, to develop a structured basic oral examination guideline and flowchart, to educate and train the nursing staff practically concerning performing a structured basic oral examination, and to compare their perceptions on their knowledge and skills before and after education and practical training. Methods: The study was performed at a hospital’s department for patients with neurological disorders in the Netherlands. The study was conducted in two Projects: (1) using a questionnaire, several aspects of providing oral hygiene care by the nursing staff were examined; (2) a guideline for a structured basic oral examination was developed, the nursing staff received training to use the guideline, the potential increase of the nursing staff’s knowledge and skills was evaluated using a scoring form before and after the education and practical training and their perception on performing this examination was assessed using 11 questions. Results: (1) The nursing staff experienced some problems during providing oral hygiene care and demonstrated a lack of knowledge on cleansing and handling removable dentures, whereas they considered themselves adequately skilled. (2) Education and practical training did not improve their knowledge and skills, but enhanced their perception of competence significantly. Conclusions: The nursing staff demonstrated a lack of knowledge. Education and practical training enhanced their perception of their knowledge and skills concerning performing a structured basic oral examination.

Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study

Background: Nursing home‐acquired pneumonia (NHAP) is a common infection among nursing home residents. There is also a high prevalence of dysphagia in nursing home residents and they suffer more often from comorbidity and multimorbidity. This puts nursing home residents at higher risk of (mortality from) NHAP. Therefore it is important to gain more insight into the incidence of NHAP and the associated medical conditions in nursing home residents with dysphagia. Objective: To investigate possible associations between NHAP and dysphagia in nursing home residents and to search for a medical risk profile for NHAP. Design: A retrospective cross‐sectional study. Setting: Three nursing homes in The Netherlands. Participants: 416 electronic medical files of nursing home residents aged 65 or older living in 3 nursing homes. Methods: Data about age, gender, diagnosis of dysphagia and/or pneumonia, medical diagnosis and possible cause of death of the nursing home residents were extracted from electronic medical files. Results: The data of 373 electronic medical files were analyzed. A significant difference in the prevalence of dysphagia was found between the nursing homes (p < 0.001). The incidence of NHAP was 5–12% in the participating nursing homes. Statistically significant higher incidence of NHAP was found in residents with dysphagia (p = 0.046). Residents with dysphagia had statistically significantly more diseases compared to residents without dysphagia (p = 0.001). Logistic regression analyses revealed no statistically significant associations between NHAP and the number of diseases and the ICD‐10 diseases. Conclusions: Dysphagia was found to be a risk factor for NHAP. Awareness of the signs of dysphagia by nurses and other care providers is important for early recognition and management of dysphagia and prevention of NHAP. What is already known about the topic?:Nursing home‐acquired pneumonia is the second‐most common infection in nursing homes and is associated with high mortality, health complications and multimorbidity.Nursing home‐acquired pneumonia is associated with dysphagia.Nursing home residents do recognize their swallowing problems (subjective dysphagia), but consider their swallowing problems a natural symptom of aging or of their diseases.

Kwetsbare ouderen (2)

SamenvattingHet aantal ouderen met natuurlijke dentitie, soms in combinatie met orale implantaten en/of geavanceerde prothetische constructies, neemt gestaag toe. De politiek is erop gericht ouderen, ook wanneer zij zorgafhankelijk worden, zo lang mogelijk thuis te laten wonen. Dat betekent dat u als tandarts-algemeen practicus steeds vaker geconfronteerd zal worden met kwetsbare ouderen met een complexe medische anamnese die implicaties kan hebben voor de mondgezondheid en de mondzorg. Voor het uitvoeren van adequate mondzorg is het noodzakelijk voor iedere kwetsbare oudere een individueel mondzorgplan op te stellen.