Gerodontology最新文献

Purpose: To investigate the effects of tongue-strengthening exercise (TSE) based on exercise intensity on tongue strength and thickness in older adults with sarcopenic dysphagia.

Methods: Participants were randomly assigned to groups 1 and 2. Group 1 underwent TSE at an intensity of 80% 1-repetition maximum (1RM) for 90 times/day, 5 days/week, for 8 weeks. In contrast, group 2 performed TSE at an intensity of 50% 1RM for the same period and number of times as group 1. The outcome measures were tongue strength, thickness and dropout rate owing to exercise compliance.

Results: Tongue strength increased from 16.7 to 22.1 kPa in Group 1 (d = 2.97) and from 16.9 to 19.1 kPa in Group 2 (d = 1.18). Tongue thickness increased from 37.1 to 40.5 mm in Group 1 (d = 1.13) and from 37.9 to 38.8 mm in Group 2 (d = 0.31). Post-intervention, Group 1 achieved greater gains than Group 2 in both strength (+3.0 kPa, d = 1.46) and thickness (+1.7 mm, d = 0.56). Dropout rates were 26.7% in Group 1 and 6.7% in Group 2.

Conclusion: TSE with an intensity of 80% 1RM was more effective than 50% 1RM in increasing tongue strength and thickness in older adults with sarcopenic dysphagia, but showed a relatively high dropout rate. Thus, it is recommended to select and apply an appropriate exercise intensity.

Objectives: This study aimed to compare the effectiveness of virtual reality (VR) and augmented reality (AR) geriatric oral care modules with traditional teaching methods for training nurses, nursing assistants (NAs), and residents in a residential aged care facility (RACF).

Background: VR/AR geriatric oral care modules have been used to enhance the knowledge, attitudes, and self-efficacy of nursing students and NAs regarding geriatric oral health.

Materials and methods: This study employed a quasi-experimental design. The experimental group, consisting of nurses and NAs, received training through VR/AR geriatric oral care modules, whereas the control group attended a traditional 2-h lecture on oral care. The effectiveness of the training in terms of knowledge, attitudes, and self-efficacy related to geriatric oral care among nurses and NAs was analysed using generalised estimating equations.

Results: Three months after the training, the oral care attitude scores of the nurses and NAs in the experimental group (26.0 ± 1.3) were significantly higher than those in the control group (23.5 ± 2.4, β = -3.7). The two training methods showed similar effects on knowledge and self-efficacy immediately after the training and 3 months later. However, no improvement in oral function was observed in residents of either group at the three-month follow-up.

Conclusion: Training with VR/AR modules for geriatric oral care can significantly enhance the attitudes of nurses and NAs 3 months after training in an RACF. It is recommended that such training be conducted regularly for nurses and NAs to further evaluate its effectiveness.

Objective: While clinical training is considered a key strategy for fostering positive attitudes, the impact of exposure to older patients-particularly in home-visit dentistry-on dental residents' attitudes remains unclear. This study examines the effect of clinical training in home-visit dentistry on ageism in dental residents.

Methods: A longitudinal single-arm pre-post design was employed. The study was conducted at Kyushu Dental University from April 2024 to March 2025. A total of 63 dental residents participated at baseline. Of these, 36 (57.1%) completed all assessments and were included in the final analysis. Participants completed two validated Japanese instruments: the Fraboni Scale of Ageism (FSA) for general ageism and the Ageism Scale for Dental Students (ASDS) for profession-specific ageism. Assessments were conducted at baseline, 6 months, and 12 months. Participants were categorised by number of home-visit sessions: ≤ 3 or ≥ 4 visits at 6 months, and ≤ 6 or ≥ 7 at 12 months.

Results: ASDS scores remained largely stable over a 12-month period (mean difference from baseline to 12 months: +2.0; effect size [ES] = -0.29). In contrast, FSA scores at 6 months (37.0 [23-73], ES = -1.08), and at 12 months (49.0 [25-87], ES = -2.76) were higher than the baseline median of 33.5 [14-42], indicating a very large deterioration in general ageism. FSA scores were even higher among residents with greater exposure to home-visit dentistry.

Conclusion: General ageism increased during the clinical training period, particularly among residents with greater exposure to home-visit dentistry. In contrast, profession-specific ageism remained largely unchanged.

Background: Individuals with dementia frequently show care-resistant behaviour toward the provision of oral care. Providing oral care despite care-resistant behaviour is legally considered to be involuntary oral care. In the Netherlands, the provision of involuntary oral care to incapacitated individuals with dementia is regulated by the Care and Coercion Act (CCA) since 2020.

Objective: This study aimed to assess how care providers experienced the CCA in the context of involuntary oral care for individuals with dementia.

Methods: 32 one-on-one semi-structured interviews were conducted with different care providers involved in oral care for incapacitated individuals with dementia.

Results: Through the interviews, multiple experiences concerning the CCA were identified. These experiences were related to: (1) awareness of involuntary care, (2) implementation of the law, (3) definitions, (4) circumvention of the law and (5) responsibility for involuntary care.

Conclusion: The CCA creates awareness about involuntary oral care among care providers. However, many care providers view the legal definitions differently, causing variation in the interpretations and applications of the legislation. Also, several care providers feel that the law could result in quicker discontinuation of oral care provision. Care organisations and policymakers should provide clarity concerning the legal definitions and provide training on legislation and the provision of oral health care in cases of care-resistant behaviour.

Aims: To investigate and describe the concordance between salivary flow rates and xerostomia among older dependent adults, describe the association between medication use and dry mouth, and describe the impact of dry mouth on oral health-related quality of life (OHRQoL).

Methods: A clinical examination survey was conducted with 50 older adults residing in residential care facilities in Dunedin, New Zealand. Xerostomia was measured using the five-item Summated Xerostomia Inventory-Dutch Version (SXI-D), and the unstimulated salivary flow rate was also measured. The clinical manifestations of oral dryness were evaluated using the Clinical Oral Dryness Scoring (CODS) scale. Medications were recorded.

Results: Participants ranged in age from 65 to 99 years (mean 83.0, SD 9.1). The prevalence of xerostomia was 34.8%, while salivary gland hypofunction (SGH) was present in 26.1%. Only 13.0% of participants had both conditions, and 52.2% had neither. A weak negative correlation was observed between the SXI-D score and salivary flow rate (r = -0.20), while a moderate positive correlation was found between the SXI-D and the CODS scale (r = 0.55). Additionally, the CODS scale showed a moderate negative correlation with the salivary flow rate (r = -0.47).

Conclusion: Dry mouth is common among older adults in residential care, but the relationship between its signs and symptoms is complex. Salivary hypofunction data alone do not fully capture the experience of oral dryness, emphasising the need for a more comprehensive approach to diagnosis and treatment.

Background: The rapid evolution of mobile healthcare technology holds promise for enhancing efficiency and care outcomes in nursing homes. However, accepting and effectively using such technologies poses challenges for caregivers, exacerbated by limited resources and various barriers. SmartJournal represents an innovative mobile healthcare application (app) designed specifically for enhancing oral healthcare in nursing home settings.

Objective: To investigate factors associated with intentions to use SmartJournal, focusing on the contributions of variables within the Technology Acceptance Model (TAM) framework.

Materials and methods: A cross-sectional study was conducted among 85 nursing home caregivers in Norway utilising the SmartJournal app, followed by a survey assessing predictors of technology acceptance based on extended versions of the TAM framework. Factor analysis was utilised to identify and evaluate the underlying dimensions of the measured constructs and their relationships. Multiple linear regression analysis was used to examine the factors associated with intentions for future SmartJournal usage explained by the constructs in the chosen framework.

Results: The TAM variables perceived usefulness, perceived ease of use and image were revealed as predictors of intention for future SmartJournal usage in the present study sample. Together, these variables explained 41.8% of the variance, with perceived usefulness being the most influential factor, accounting for 19.6%.

Conclusion: This study identified perceived usefulness (PU) and perceived ease of use (PEOU) as key factors associated with nursing home caregivers' intention to use SmartJournal, providing insights for future implementation of the tool.

Objective: We aimed to examine the effects of oral care in patients with terminal cancer approaching death.

Background: Patients with terminal-stage cancer often experience symptoms like oral dryness and candidiasis. Previous studies showed that without professional dental care, oral hygiene significantly worsens within 3 weeks before death. Therefore, oral management is essential for patients with terminal cancer. However, the specific effects of oral hygiene in these patients remain unclear.

Material and methods: Twenty patients were admitted to two palliative care units at our institution between June 2022 and May 2023 and received oral care multiple times before death. Oral hygiene was assessed using the Oral Health Assessment Tool (OHAT), and oral dryness was evaluated with an oral moisture checker. The Face Rating Scale (FRS) was assessed before and after professional oral care.

Results: During the week of death, the number of people who were able to speak and follow instructions decreased, while the number who used sedatives and oxygen increased. There was no significant difference in the degree of oral dryness before oral care between the time of hospitalisation and the week of death. However, oral dryness improved significantly after oral care at admission (before: 21.0 ± 8.3, after: 26.7 ± 3.2) and the week of death (before: 16.8 ± 8.4, after: 25.8 ± 3.7). There was no difference in the time taken for oral care or FRS scores at admission and the week of death.

Conclusion: Continuous oral care in patients with terminal cancer can prevent worsening oral hygiene and maintain moisture.

Background: Dental caries remains highly prevalent in older adults and represents a growing public health concern due to increased tooth retention, polypharmacy, hyposalivation and functional limitations. Silver diamine fluoride (SDF) is widely used for caries arrest in this population but causes undesirable tooth staining. Nano Silver Fluoride (NSF) has emerged as a potential alternative, combining antimicrobial and remineralizing properties with improved aesthetics. However, its applicability in geriatric dentistry remains unclear.

Objective: This scoping review aimed to identify and map existing evidence on the use of Nano Silver Fluoride for the prevention or management of dental caries in older adults.

Methods: The review followed the PRISMA-ScR guidelines framework. A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and SciELO for articles published between January 2020 and December 2024. Studies were eligible if they involved human participants aged ≥ 60 years, evaluated NSF for caries prevention or treatment and were published in English, Spanish or Portuguese. In vitro studies, animal models, case reports, reviews, and studies on children or young adults only were excluded.

Results: A total of 157 records were identified; 14 full-text articles were assessed. None met the inclusion criteria, as all clinical studies involving NSF were conducted in paediatric or young adult populations, lacked older adult participants, or were laboratory-based. No clinical trials, observational studies, or reviews evaluating NSF in older adults were found.

Discussion: This scoping review reveals a complete absence of clinical evidence regarding the use of Nano Silver Fluoride in adults aged 60 years or older. Although NSF has shown promising results in younger populations and is chemically related to SDF, its effectiveness and safety in geriatric dentistry remain unknown. High-quality clinical studies in older adults are urgently needed.

Background: Patient groups and policymakers are calling for the implementation of relationship-centred, co-ordinated care for vulnerable older people. Relationship-centred care highlights the significance of strong, quality relationships among residents, their families and the broader healthcare team. The present work performed a qualitative evidence synthesis to explore issues relating to the provision of relationship-centred dental care for older people living in care homes, as perceived by care home staff, dental professionals, family and residents. This builds on the existing evidence base and outlines areas for improvement of dental care provision within residential care homes.

Methods: A 'best fit' framework synthesis of primary research was used to understand how and why current dental care might or might not be relationship-centred. A palliative healthcare-focused conceptual framework for relationship-centred care was used as the basis for the synthesis. The review focuses on qualitative primary research studies exploring dental care for care-home residents.

Results: Of 235 unique citations, fifteen qualitative primary research papers were included. The synthesis identified supporting evidence for all five of the broad a priori themes from the relationship-centred care coding framework: Relationship-centred care, Integration within the wider health and social care systems, Digital inclusion, Workforce support and Parity of esteem. Relationships between themes were articulated.

Conclusions: This 'best-fit' framework synthesis found that care home staff identified numerous barriers to providing relationship-centred dental care for older residents. Dentists, families and residents were underrepresented, highlighting the need for further research into their perspectives. By acknowledging the complexity of dental care and addressing issues such as integration, workforce support, digital services and parity of esteem, the synthesis suggests that applying organisational change research may help improve oral health outcomes in care homes.