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Biomedical subjects

V Lester

Publications and source records attributed to V Lester.

6 recordsLinked to original sources
PubMed1998

Reported dental attendance and perceived barriers to care in frail and functionally dependent older adults.

OBJECTIVES: This study was designed to investigate the reported dental attendance and the perceived barriers to dental care for frail and functionally dependent older adults. DESIGN: A single centre study of a housebound group of more than 60 years of age and their personal carers. SETTING: The study was carried out from a general dental practice in Ware, Hertfordshire, a market town 20 miles north of London. SUBJECTS AND METHODS: A group of 263 housebound adults more than 60 years old were identified. The subjects were living in 5 residential homes, 3 sheltered housing complexes and in private accommodation. The subjects and 115 of their personal carers were interviewed. RESULTS: 93% only attended a dentist when they had problems. The presence of natural teeth, residential status and age were all statistically significant independent explanatory variables for the time since the previous reported dental visit. Lack of perceived need was found to be a barrier to care for 86% of subjects. Cost and lack of suitable transport were also commonly identified. However, the true cost implication to a patient was poorly appreciated especially by those 34% of subjects who cited cost as a barrier. 52% of the whole group, rising with age to 75% of those more than 90 years old, expressed a preference for treatment to be carried out in their own homes. 93% of carers had found difficulty in arranging dental care for their clients but the difficulties were not always the same as the subjects' perceived barriers. Among the carers, younger, regular dental attendees who were paid to care were more likely to see benefit in obtaining dental care for their clients. CONCLUSION: The mechanisms by which these barriers to care may be lowered should be investigated in order to meet the unmet need identified by this study.

Adult↗
PubMed1998

The relationship between socio-dental indices of handicap, felt need for dental treatment and dental state in a group of frail and functionally dependent older adults.

The present study was designed to investigate the relationship between self-reported oral handicap as measured by socio-dental indicators and both dental state and felt need for dental treatment in a group of frail and functionally dependent older adults. A total of 263 housebound adults over the age of 60 years were investigated with regard to their self-reported dental handicap using the socio-dental indices derived by Locker (Community Dent Health 1992;9:109-24). Of these, 117 were in long-stay residential facilities, 67 in sheltered housing and 79 in private housing. The majority were female (76%) and the largest age group comprised 81-90-year-olds (44%), while only 8% were in the youngest group of 60-70-year-olds. A high level of handicap was recorded. In the previous 4 weeks, 74% of the group experienced difficulty in chewing, 54% some other functional handicap, 22% oral pain, 72% some incident of discomfort and 30% some social problem related to their oral condition. The socio-dental indices related more to the number of teeth than to age or gender. Ability to chew five index foods was related directly to the number of teeth present (P<0.001) but unless there were more than 20 teeth present, subjects with natural teeth were more dissatisfied with their appearance than those with complete dentures (P=0.002). The 57 subjects (29%) who expressed a desire for treatment had significantly higher handicap scores (P<0.001). Thus the results indicate that there are high levels of oral handicap in frail and functionally dependent older adults that are related to both the number of natural teeth retained and desire for treatment.

Age Factors↗
PubMed1995

Single-blind studies of the effects of improved periodontal health on metabolic control in type 1 diabetes mellitus.

Uncontrolled studies have suggested a beneficial effect of periodontal treatment on metabolic control of insulin-dependent diabetes mellitus (IDDM). We therefore conducted controlled single-blind studies, using current metabolic status indicators in IDDM subjects free of significant complications other than periodontal diseases. In the 1st study, 41 IDDM subjects with gingivitis and early periodontitis were randomly assigned to treatment (oral hygiene and scaling) or control groups. The study was completed by 16 experimental and 15 control subjects. Reassessment after 2 months showed a Hawthorne effect in the control group, and no difference between groups. However, further analysis showed a relationship between individual metabolic control variation and gingival inflammation. A 2nd study enrolled 23 IDDM subjects with advanced periodontitis, who were randomised to treatment (full initial therapy including root planning) or control groups. Only 1 subject failed to complete the study, owing to illness. In this study, a significant response to periodontal treatment was not accompanied by any improvement in metabolic control. These results support the concept that the effect of metabolic control may be predominant in the relationship between IDDM and periodontal health.

Adolescent↗
PubMed1993

Putting the pilot scheme into practice.

If we accept that in the future audit is going to be a fact of life and the probability is that optional schemes will, in time, be replaced by compulsory participation, then input by general practitioners at this pilot stage should be a good investment for the future.

Aged↗