Gerodontology最新文献

Objective: This study aimed to clinically validate the Oral Frailty Five-item Checklist (OF-5) by clarifying the relationship between its score and the diagnosis of oral dysfunction, as well as its association with seven sub-items.

Background: Assessing oral frailty is important for preventing frailty in older adults. The recently developed OF-5 is anticipated as a convenient screening tool; however, its relationship with oral hypofunction, assessed through quantitative testing in dental clinics, has not been sufficiently verified.

Materials & methods: The study included 421 outpatients aged 65 years or older who underwent their first oral hypofunction test at a university dental hospital. Data on age, sex, OF-5 score, and oral hypofunction test values (oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function) were extracted from medical records and analyzed using multivariate analysis.

Results: The age of the participants was 80.9 ± 6.5 (mean ± standard deviation) years, and 254 (60.3%) were female. Logistic regression analysis showed that the OF-5 score was significantly associated with the diagnosis of oral hypofunction (odds ratio: 2.54), with a cutoff value of 2 points. Multiple regression analysis showed significant associations between the OF-5 and all test components except oral hygiene.

Conclusion: The OF-5 is a useful screening test for oral hypofunction, involving masticatory, swallowing, and tongue dysfunction and oral dryness. However, there is also a need for dental examination to identify poor oral hygiene, which cannot be detected using the OF-5 test.

Introduction: Oral health literacy (OHL) influences older adults' capacity to obtain, process and apply oral health information for self-care and decision-making. Evidence on OHL in community-dwelling older adults in Chile remains scarce. This study explored the factors shaping OHL among Chilean community-dwelling older adults.

Methods: A qualitative exploratory study was conducted using the Grounded Theory approach. Older adults (≥ 65 years) were purposively sampled from three municipalities in Santiago, Chile, representing different levels of social vulnerability. Thirteen in-depth, face-to-face, semi-structured interviews were conducted. The interviews were audio-recorded, transcribed verbatim and analysed iteratively using constant comparison and open, axial and selective coding, categorising the answers to identify emerging topics until reaching saturation. Data triangulation included interviews, field observations and document reviews.

Results: Findings emerged into two overarching dimensions shaping OHL across the life course: upstream and downstream factors. Upstream factors included contextual factors, provider-related factors and system-related factors. Downstream factors encompassed individual and behavioural aspects that influenced access to dental care and attention.

Conclusion: OHL in older adults is shaped by cumulative life-course experiences across structural, social and individual domains. Addressing OHL requires integrated public policies, professional training in patient-centred communication and community-based strategies targeting social determinants to promote equitable oral health in older age.

Aim: To investigate oral health status, number of teeth, and denture use in older care recipients and their caregivers' perceptions of burden.

Methods: This was a cross-sectional survey of home care patients aged ≥ 65 years and their families who use the home-visit dental care service provided by the Sendai Dental Association. The short Japanese version of the Zarit Burden Interview (J-ZBI_8) was used to assess caregiver burden, with a score of ≥ 13 indicating high caregiver burden. Data on the oral and general condition of patients were extracted from home-visit dental treatment records. Oral health status was assessed using the Oral Health Assessment Tool (OHAT) as a median dichotomised ordinal variable (OHAT scores ≥ 5 or < 5). Multiple logistic regression analysis included 'high caregiver burden' as the dependent variable and 'number of teeth present' and 'denture use' as explanatory variables, incorporating an interaction term between 'number of teeth present' and OHAT status (≥ 5) alongside other covariates.

Results: A total of 117 individuals were included. 'Number of teeth present' (OR: 1.20; 95% CI: 1.06-1.36) was associated with higher odds of 'high caregiver burden' only in those with 'OHAT score ≥ 5'. 'Denture use' (OR: 4.29; 95% CI: 1.22-15.10) was associated with higher odds of 'high caregiver burden' regardless of oral health status.

Conclusion: Older adults with poor oral health and a high number of teeth, or denture users, pose a greater caregiving burden. Dental professionals should recognise these stressors and support caregivers.

Introduction: The Dutch organisation for the development of clinical practice guidelines (CPGs) in oral care known as the Kennisinstituut Mondzorg (KIMO) developed three CPGs to support professionals in oral care for (frail) older patients: (1) treatment of root caries, (2) xerostomia and hyposalivation related to medication and polypharmacy, and (3) oral care for homebound frail older adults. However, actual CPG use in practice is not guaranteed. This study aims to assess adherence to these CPGs among Dutch dentists, identify opportunities and barriers for implementation, and formulate recommendations for an effective implementation strategy.

Methods: A modified two-round Delphi study investigated current practices and opinions of dentists; 260 dentists were invited to participate. For round one, an online survey was developed based on the KIMO CPG recommendations. Round two, informed by round one results, explored perceived facilitators, barriers, suggestions for adapting less-followed recommendations, and preferences regarding CPG information and accessibility.

Results: In round one 41 dentists responded and in round two 44 responded. While the value of CPGs was acknowledged, adherence to several recommendations was limited due to practical barriers, such as time, equipment, training, and reimbursement. Further, communication with other healthcare providers was infrequent. Dentists preferred e-mail notifications and on-demand webinars. Digital availability via a website or app was favoured, though half still appreciate paper versions.

Conclusion: Practical barriers hinder the use of CPG recommendations in oral care for (frail) older patients. Involving clinicians in guideline development is essential to improve feasibility and implementation.

Introduction: This paper describes the development and preliminary validation of the Partial Denture Experience Questionnaire (P-DEQ), a new, condition-specific instrument designed to measure the multifaceted impacts of living with removable dentures.

Methods: The P-DEQ was developed using a multi-phase, mixed-methods design. Item generation was informed by qualitative interviews (n = 20) with denture wearers in the UK and guided by the World Health Organisation's International Classification of Functioning, Disability and Health (ICF) framework. A 34-item scale, with five core sub-scales (Body Function, Emotional Function, Daily Abilities, Social Impacts and Participation Restrictions) and a separate 'My Denture' sub-scale, was tested in a cross-sectional study with online panels from the UK (n-224) and US (n-224). Reliability, item-total correlations, item impacts and sub-scale correlations were assessed.

Results: The P-DEQ sub-scales demonstrated good to excellent reliability (Cronbach's α = 0.71-0.88) across both samples. Sub-scale-to-total score correlations were high and significant, with the Emotional Function (r = 0.92) and Social Participation (r = 0.92) sub-scales showing particularly strong relationships in the UK sample. Most item-total correlations exceeded the 0.4 threshold, supporting the instrument's underlying coherence. Item impact scores varied widely; items concerning psychosocial worries (e.g., the denture breaking) and functional limitations (e.g., avoiding certain foods) registered the highest impact. In contrast, items reflecting potential benefits of the denture, such as improved appearance, had lower impact scores. Furthermore, the 'My Denture' sub-scale, measuring personal appraisal of the prosthesis, was significantly correlated with the total P-DEQ score (r = -0.50 UK; r = -0.55 US), indicating that a more favourable personal evaluation of a denture was associated with fewer negative impacts.

Conclusions: The P-DEQ demonstrates promising reliability and content validity for assessing the complex experience of living with a removable denture. The instrument is sensitive to the nuanced, often ambivalent, emotional states of wearers. Whilst this initial validation is based on cross-sectional data, longitudinal testing is required for item reduction and to fully establish the P-DEQ as a robust measure that can detect change over time.

Objective: This study evaluated muscle electrical activity, bite force, quality of life, and satisfaction in individuals with maxillectomy rehabilitated with complete obturator prostheses (COP).

Background: Most patients undergoing maxillectomy and rehabilitated with COP experience masticatory and functional limitations.

Materials and methods: This pre-post interventional study included 11 individuals (mean age: 64 years) who had undergone maxillectomy and were rehabilitated with COP designed to prosthetically restore the palate and improve oropharyngeal function. Electromyography, mouth opening angle, and bite force were assessed at 60, 120, and 180 days after COP installation. The University of Washington Quality of Life (UWQOL) questionnaire and the Obturator Functional Scale (OFS) were administered at baseline and at the same follow-up intervals. Electromyography of facial muscles was performed at rest and during mastication of hard and soft foods. Maximum bite force was recorded at the central incisors and first molars. Data were analysed descriptively and analytically.

Results: Bite force values increased significantly over the 180-day period, while muscle electrical activity remained stable throughout COP wear. The appearance, swallowing, speech, and chewing domains significantly influenced COP performance. The OFS indicated improvements in liquid swallowing, reduction of nasal speech, and greater voice clarity in public settings. Most significant changes were accompanied by moderate to large effect sizes, supporting their practical relevance.

Conclusion: COP effectively improved patients' quality of life and functional outcomes following maxillectomy.

Introduction: Oral frailty, a multidimensional decline in oral function involving chewing, swallowing, and oral behaviours, is a recognised precursor of dysphagia, malnutrition, and physical frailty. The Oral Frailty Index-8 (OFI-8) is a brief self-report screening tool for assessing oral frailty. This study's aim is to adapt the OFI-8 into Turkish (OFI-8-TR) and evaluate its psychometric properties among older adults.

Methods: A cross-sectional study was conducted in 341 adults aged ≥ 65 years attending a geriatrics outpatient clinic. Internal consistency (KR-20), test-retest reliability (ICC), and construct validity (convergent, known-groups, and confirmatory factor analyses) were evaluated. Comparator measures included the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) scale, Clinical Frailty Scale (CFS), Eating Assessment Tool-10 (EAT-10), Functional Oral Intake Scale (FOIS), and Mini Nutritional Assessment-Short Form (MNA-SF).

Results: The OFI-8-TR showed acceptable internal consistency (KR-20 = 0.62) and excellent test-retest reliability (ICC = 0.898). Confirmatory factor analysis supported a one-factor model (Comparative Fit Index (CFI) = 0.93, Goodness-of-Fit Index (GFI) = 0.95, adjusted Goodness-of-Fit Index (AGFI) = 0.91). Convergent validity was confirmed through strong correlations with the EAT-10 (r = 0.63) and FOIS (r = -0.62), and moderate correlations with FRAIL, CFS, and MNA-SF in the expected directions. Known-groups validity showed significantly higher scores among participants with malnutrition or risk of malnutrition.

Conclusions: The OFI-8-TR is a valid and reliable instrument for assessing oral frailty and identifying swallowing-related and nutritional vulnerability in older adults. Its brevity and multidimensional structure make it a practical screening tool for routine geriatric assessments to support early identification of swallowing- and nutrition-related vulnerability.

Objective: To present an overview of the development process of an evidence- and theory-based multi-level oral health promotion intervention targeting frail, home-dwelling older persons.

Background: Good oral health is vital for healthy ageing, but frail, home-dwelling older persons are disproportionately affected by poor oral health. Multi-level evidence- and theory-based approaches to target frail, home-dwelling older persons and increase access to dental care are recommended.

Materials and methods: This oral health promotion programme for frail, home-dwelling older persons was developed using the six-step, theory- and evidence-based Intervention Mapping protocol. It was guided by a literature review and exploratory research involving frail, home-dwelling older persons, informal caregivers, oral health professionals, general practitioners and pharmacists. The sixth step, the evaluation plan, was further informed by the Medical Research Council framework guidelines.

Results: Applying the six-step Intervention Mapping protocol resulted in a needs assessment to gain a general understanding of the problem (Step 1), setting programme goals (Steps 1 and 2) and creating matrices of change objectives (Step 2). Theoretical methods were chosen and turned into practical applications (Step 3), leading to programme components (Step 4) for frail, home-dwelling older persons, informal caregivers, general practitioners, pharmacists and oral health professionals. An implementation (Step 5) and evaluation plan (Step 6) were also developed.

Conclusion: After pilot testing, a feasibility study will refine the design before a larger effectiveness assessment. Future developers can use our detailed example to create a theory- and evidence-based intervention programme targeting oral health.