Optimising oral health in frail older people

Abstract Aging in place is an important goal for both older adults as well as many health policies worldwide, as it is in the Netherlands. Within an aging society, the number of frail older people with complex care needs living at home is increasing. Despite the various definitions of frailty, it is important to early identify who is at risk in clinical practice in order to prevent functional decline, enhance quality of life, and reduce health care costs. Furthermore, an important requirement is effective collaboration between primary care professionals. Various factors are associated with frailty. However, early detection of frailty and its risk factors such as oral health, nutrition and medication related problems is not part of routine care of professionals. To recognize frailty and its risk factors we started a large proactive integrated primary care program that successfully identified frail older people living at home based on routine care data in the Netherlands. After two-year follow-up, a reduction in acute visits at the emergency department was observed. Next, we performed additional studies focusing on early detection and prevention of risk factors of frailty such as oral health, nutrition, and medication related problems among older people living at home. During this symposium we will present the results of the program, followed by our studies that investigated frailty or frailty related risk factors. Additionally, we will show how we enhanced and evaluated the knowledge and skills of professionals working with frail older people in primary care.

Download Full-text

The Effect of Medicated Chewing Gums on Oral Health in Frail Older People: A 1-Year Clinical Trial

Journal of the American Geriatrics Society ◽

10.1046/j.1532-5415.2002.50355.x ◽

2002 ◽

Vol 50 (8) ◽

pp. 1348-1353 ◽

Cited By ~ 42

Author(s):

Debra Simons ◽

Susan R. Brailsford ◽

Edwina A. M. Kidd ◽

David Beighton

Keyword(s):

Clinical Trial ◽

Oral Health ◽

Older People ◽

Frail Older People ◽

Chewing Gums

Download Full-text

Oral health care and aspiration pneumonia in frail older people: a systematic literature review

Gerodontology ◽

10.1111/j.1741-2358.2012.00637.x ◽

2012 ◽

Vol 30 (1) ◽

pp. 3-9 ◽

Cited By ~ 127

Author(s):

Claar D. van der Maarel-Wierink ◽

Jackie N.O. Vanobbergen ◽

Ewald M. Bronkhorst ◽

Jos M. G. A. Schols ◽

Cees de Baat

Keyword(s):

Health Care ◽

Oral Health ◽

Literature Review ◽

Older People ◽

Aspiration Pneumonia ◽

Systematic Literature Review ◽

Oral Health Care ◽

Frail Older People

Download Full-text

‘Don’t forget the mouth!’: a process evaluation of a public oral health project in community-dwelling frail older people

BMC Oral Health ◽

10.1186/s12903-021-01884-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bach Van Ho ◽

Claar Debora van der Maarel-Wierink ◽

Annemiek Rollman ◽

Roxane Anthea Francesca Weijenberg ◽

Frank Lobbezoo

Keyword(s):

Health Care ◽

Oral Health ◽

Older People ◽

Process Evaluation ◽

Health Care Professionals ◽

Community Dwelling ◽

Dental Practice ◽

Frail Older People ◽

Structured Interviews ◽

Health Project

Abstract Background Older people are encouraged to remain community dwelling, even when they become care-dependent. Not every dental practice is prepared or able to provide care to community-dwelling frail older people, while their ability to maintain oral health and to visit a dentist is decreasing, amongst others due to multiple chronic diseases and/or mobility problems. The public oral health project ‘Don’t forget the mouth! (DFTM!) aimed to improve the oral health of this population, by means of early recognition of decreased oral health as well as by establishing interprofessional care. A process evaluation was designed to scientifically evaluate the implementation of this project. Methods The project was implemented in 14 towns in The Netherlands. In each town, health care professionals from a general practice, a dental practice, and a homecare organization participated. The process evaluation framework focused on fidelity, dose, adaptation, and reach. Each of the items were examined on levels of implementation: macro-level, meso-level, and micro-level. Mixed methods (i.e., quantitative and qualitative methods) were used for data collection. Results The experiences of 50 health care professionals were evaluated with questionnaires, 22 semi-structured interviews were conducted, and the oral health of 407 community-dwelling frail older people was assessed. On each level of implementation, oral health care was integrated in the daily routine. On macro-level, education was planned (dose, adaption), and dental practices organized home visits (adaption). On meso-level, health care professionals attended meetings of the project (fidelity), worked interprofessionally, and used a screening-referral tool of the project DFTM! in daily practice (dose, adaption, reach). On micro-level, the frail older people participated in the screening of oral health (fidelity, dose), had their daily oral hygiene care observed (adaption) and supported if necessary, and some had themselves referred to a dental practice (reach). The semi-structured interviews also showed that the project increased the oral health awareness amongst health care professionals. Conclusions The project DFTM! was, in general, implemented and delivered as planned. Factors that contributed positively to the implementation were identified. With large-scale implementation, attention is needed regarding the poor accessibility of the oral health care professional, financial issues, and increased work pressure. Trial registration The Netherlands Trial Register NTR6159, registration done on December 13th 2016. URL: https://www.trialregister.nl/trial/6028

Download Full-text

Oral health diseases among the older people: a general health perspective

10.31083/jomh.v17i1.316 ◽

2020 ◽

Keyword(s):

Public Health ◽

Health Care ◽

Oral Health ◽

Older People ◽

Health Professionals ◽

General Health ◽

Oral Health Care ◽

Oral Diseases ◽

Public Health Professionals ◽

The Relationship

Background: The relationship between oral health and general health is gaining interest in geriatric research; however, a lack of studies dealing with this issue from a general perspective makes it somewhat inaccessible to non-clinical public health professionals. Purpose: The purpose of this review is to describe the relationship between oral health and general health of the elderly on the basis of literature review, and to give non-clinical medical professionals and public health professionals an overview of this discipline. Methods: This study was based on an in-depth review of the literature pertaining to the relationship between oral health and general health among the older people. The tools commonly used to evaluate dental health and the academic researches of male elderly people were also reviewed. And future research directions were summarized. Results: Dental caries, periodontal disease, edentulism, and xerostomia are common oral diseases among the older people. Dental caries and periodontal diseases are the leading causes of missing teeth and edentulism. Xerostomia, similar to dry mouth, is another common oral health disease in the older people. No clear correlation exists between the subjective feeling of dryness and an objective decrease of saliva. Rather, both conditions can be explained by changes in saliva. The General Oral Health Assessment Index (GOHAI) and the Oral Health Impact Proﬁle (OHIP) are the main assessment tools used to examine oral health and quality of life in the older people. The GOHAI tends to be more sensitive to objective values pertaining to oral function. In addition, oral health studies in male elderly people are population-based cohort or cross-sectional studies, involving masticatory function, oral prevention, frailty problems, cardiovascular disease risk, and cognitive status. Conclusion: It is possible to reduce the incidence of certain oral diseases, even among individuals who take oral health care seriously. Oral health care should be based on the viewpoint of comprehensive treatment, including adequate nutrition, good life and psychology, and correct oral health care methods. In the future, researchers could combine the results of meta-analysis with the clinical experience of doctors to provide a more in-depth and broader discussion on oral health research topics concerning the older people.

Download Full-text

Dysphagia and Oral Health in Older People

10.21926/obm.geriatr.2001109 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Sima Farpour ◽

◽

David Smithard ◽

Hamid Reza Farpour ◽

◽

...

Keyword(s):

Oral Health ◽

Older People

Download Full-text

Fall Prevention in Dutch Physician Practices: A Descriptive Study

Innovation in Aging ◽

10.1093/geroni/igaa057.758 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 235-235

Author(s):

Wytske Meekes ◽

C J Leemrijse ◽

J C Korevaar ◽

L A M van de Goor

Keyword(s):

The Netherlands ◽

Older People ◽

Fall Prevention ◽

Fear Of Falling ◽

Daily Practice ◽

Health Issues ◽

Frail Older People ◽

Physician Practices ◽

Important Health ◽

Underlying Causes

Abstract Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians completed 1396 questionnaires. More than half (n=726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.

Download Full-text