Inger Wårdh

Chewing Ability and Tooth Loss: Association with Cognitive Impairment in an Elderly Population Study

To determine whether there is an association between tooth loss, chewing ability, and cognitive function in a general elderly population.

Attitudes to and knowledge about oral health care among nursing home personnel – an area in need of improvement

BACKGROUND In 1999, a dental reform became law in Sweden that regulated both dental care to dependent individuals and training in oral health care for nursing home personnel. Substantial resources have been channelled into these efforts, but the outcome of these efforts has not been evaluated. The aim of this study was to explore attitudes to and knowledge about oral health care among nursing home personnel more than 5 years after the law was adopted, that being 2005. METHODS A total of 454 individuals employed at nursing homes answered a questionnaire of 16 multiple-choice items concerning attitudes to and knowledge about oral health care. RESULTS Eighty-nine per cent considered oral health care to be an important part of good nursing. The answers indicated problems, however, when it came to its implementation and knowledge, and 35% stated that they had had no formal education in oral health care. CONCLUSIONS Despite generally positive oral health care attitudes, it is important that oral health care education is available to and made of interest for all nursing home personnel, especially in light of the increase in number of natural teeth and frequency of crowns and bridges among dependent elderly.

Assessments of oral health care in dependent older persons in nursing facilities

The number of dependent elderly with natural teeth is increasing dramatically. If these elderly persons do not receive proper oral health care, severe oral problems are likely to result. In conjunction with an oral health care education program for the staff of nursing facilities, oral health status was assessed and semi-structured interviews performed with residents and their relatives about oral health care. The assessments were made at baseline and at an 18-month follow-up. The project was conducted as a longitudinal, controlled study with an intervention and a control group. The aim of the study was to evaluate differences between the intervention and control group after oral health care intervention. At follow-up, it was shown that the intervention group had established more dental contacts. However, the results also indicated that the residents were not concerned about their oral health. Nursing staff therefore have to be responsible for oral health care if improved care for residents is to be realized.

Oral status, oral hygiene habits and caries risk factors in home-dwelling elderly dependent on moderate or substantial supportive care for daily living.

OBJECTIVES Elderly people with disabilities have an increased risk of developing oral diseases as compared with the healthy elderly. The aim of this study was to investigate oral hygiene habits, clinical variables related to oral self-care and caries risk in elderly individuals living at home with moderate and substantial needs of home care. METHODS A random sample of 151 elderly people with moderate needs and 151 with substantial needs of home care were examined. Data concerning general health, social conditions and oral hygiene habits were collected using a questionnaire. Data showing the prevalence of caries, plaque scores and gingival bleeding were obtained through clinical examinations. RESULTS Elderly subjects with substantial needs of home nursing had more active caries (P < 0.01) and more often gingival bleeding (P < 0.05), as compared with elderly people with moderate needs. Forty-nine per cent of the elderly with moderate needs performed acceptable self-care, as compared with 25% of the individuals with substantial needs. Good self-care was associated with women, low plaque scores, less bleeding and less caries. Factors increasing the risk of having caries were low saliva secretion, high plaque scores and a large number of fillings, while having a dentist and good oral hygiene habits increased the chance of not developing caries. CONCLUSIONS Good oral hygiene habits were associated with less prevalence of plaque and oral disease in the elderly irrespective of extent of needs of home nursing. However, the elderly with moderate needs more often performed good self-care, indicating that the possibilities of strengthening self-care and learning new routines are better when functions are less affected.

Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease

OBJECTIVES The aim of this study was to compare the prevalence of edentulous subjects, caries and periodontal disease among the home-dwelling elderly with moderate and substantial needs of support for daily living. MATERIALS AND METHOD A sample of 302 randomly selected elderly with moderate or substantial needs of supportive care were examined in Sweden. Several oral clinical variables were registered: number of teeth, dentures, caries, probing pocket depth, gingival bleeding and Eichners index. RESULTS Both in general and in oral health, the differences were small when comparing elderly with moderate and substantial care needs for daily living. Those with substantial needs had more caries lesions (p < 0.01) and more gingival bleeding (p < 0.05), while the number of teeth and prevalence of edentulous subjects did not differ in relation to the need of daily support. The elderly had, on average, 9.8-11.7 teeth, one-third of whom had no natural teeth. According to Eichners index, half of the elderly in both groups had no opposing tooth contacts. Fifty-five per cent used dentures. CONCLUSIONS Elderly people with needs of supportive care have lost many teeth before they become dependent. Health promotion should be a priority in early ageing populations to prevent oral diseases and tooth loss.

Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments

Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group.

The district nurse's perceptions of elderly patients' oral health: a qualitative interview study.

Objective. The aim of this qualitative study based on interviews was to explore the perceptions that district nurses have of the oral health of elderly patients. Material and methods. The criterion for inclusion was being a district nurse working in a primary health-care centre in the County of Stockholm. The respondents were asked open-ended questions about their perceptions of oral health and about the impact of oral problems on the general health and well-being of elderly patients. The analyses started at the first interview and proceeded in parallel until no further relevant information could be obtained. Analysis of the open-ended questions was inspired by grounded theory methodology and comprised four stages: native reading, open coding, axial coding, and selective coding. Results. The one core category identified, namely indistinct professional duties of the district nurse, formed the central meaning of the district nurses perceptions of oral health in elderly patients. This related to two other categories labelled ‘insights into the district nurses professional role’ and ‘obstacles for the district nurse’, with sub-categories. Conclusion. Although the district nurses in this study were aware of the impact of oral health in old age, their attitude was that this was a matter for dentistry.

Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta‐Analysis

The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare‐associated pneumonia (HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials (RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta‐analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio (RR) = 0.43, 95% confidence interval (CI) = 0.25–0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP (RR = 1.20, 95% CI = 0.97–1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes.

Using medical knowledge sources on handheld computers – A qualitative study among junior doctors

Background: The emergence of mobile computing could have an impact on how junior doctors learn. To exploit this opportunity it is essential to understand their information seeking process. Aim: To explore junior doctors’ experiences of using medical knowledge sources on handheld computers. Method: Interviews with five Swedish junior doctors. A qualitative manifest content analysis of a focus group interview followed by a qualitative latent content analysis of two individual interviews. Results: A focus group interview showed that users were satisfied with access to handheld medical knowledge sources, but there was concern about contents, reliability and device dependency. Four categories emerged from individual interviews: (1) A feeling of uncertainty about using handheld technology in medical care; (2) A sense of security that handhelds can provide; (3) A need for contents to be personalized; (4) A degree of adaptability to make the handheld a versatile information tool. A theme was established to link the four categories together, as expressed in the Conclusion section. Conclusion: Junior doctors’ experiences of using medical knowledge sources on handheld computers shed light on the need to decrease uncertainty about clinical decisions during medical internship, and to find ways to influence the level of self-confidence in the junior doctors process of decision-making.

A prospective study on oral microbial flora and related variables in dentate dependent elderly residents.

OBJECTIVE Oral microorganisms and related variables were followed over a 1-year period in dentate dependent elderly. BACKGROUND For nursing personnel, oral hygiene for the dependent elderly is demanding. It requires good knowledge of how to carry out preventive oral health measures and to judge when help is needed. Previous studies indicate low levels of knowledge, which might be reflected in the oral health of dentate residents. MATERIAL AND METHODS Twenty-one subjects participated at baseline and 14 one year later. Microbial samples were analysed using cultivation technique. The labial minor gland secretion rate was measured using the Periotron(®) method, and oral clinical data were registered. RESULTS Low labial mucosal flow rates were seen for 95% of the participants. At baseline, visibly thick plaque was seen in 48% and 1 year later in 57%. Both frequency and number of bacteria associated with caries and frequency of microorganisms associated with oral soft tissue infections were high. One year later, a decrease in bacteria associated with good oral health and a tendency to an increase in aciduric microorganisms were seen. CONCLUSION Poor oral health, tending to further deteriorate over time, advocates regular professional supplementary support when elderly dentate dependent residents need assistance with their oral care.