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PubMed2006

Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70.

OBJECTIVES: To measure relative fitness and frailty in older people without specific frailty instruments and to relate that measurement to long-term health outcomes. DESIGN: Retrospective cohort studies. SETTING: Two population-based studies of people aged approximately 70 at baseline and followed up to 10 years (in the Canadian Study of Health and Aging (CSHA)) or 26 years in the Gothenburg H-70 cohort study. PARTICIPANTS: Nine hundred sixty-two men and 1,178 women. MEASUREMENTS: Deficit accumulation (the exposure) was counted using self-reported (CSHA) or clinically designated (H-70) symptoms, signs, diseases, and disabilities. Relative fitness and frailty were measured in relation to the degree of deficit accumulation evaluated in four quartiles, representing those most fit to those most frail. The items that made up the frailty index were selected randomly without replacement in 1,000 iterations. The outcomes were risks of death or residential long-term care. RESULTS: Worse frailty, however measured, was associated with worse survival; the Kaplan-Meier curves of random iterations of the frailty definition showed virtually no interquartile overlap for mortality. For any given level of frailty, men died younger than women. Worse frailty was also associated with a higher risk of institutionalization. CONCLUSION: Frailty appears to be a robust concept that is readily operationalized, with the risk of adverse outcomes being largely established by age 70.

Activities of Daily Living↗
PubMed1999

Depressive symptoms among spousal caregivers of institutionalized mates with Alzheimer's: boundary ambiguity and mastery as predictors.

The goal of this study was to identify factors that predict whether or not community-dwelling spouses experience depressive symptoms upon institutionalization of a mate with Alzheimer's disease. Eighty-four community-dwelling spouses (50 wives/34 husbands) completed questionnaires. Boundary ambiguity alone accounted for 51% of the variability in the depressive symptoms score, while mastery alone was found to account for 32%. The total explained variance, when controlling for demographic variables, was 68%. In the stepwise regression analysis, it was observed that mastery did not add significantly to the explanation of the depressive symptom score over and above boundary ambiguity. However, boundary ambiguity and mastery were somehow linked together and were powerful in explaining caregiver symptoms of depression. If a goal is to keep caregivers healthy, then interventions and education about how to live with ambiguity and how to be masterful in spite of the ambiguous status of one's mate seem necessary. Clinical implications are discussed. Future research might build upon this study's limitations for an even better understanding of factors that relate to caregiver depressive symptoms.

Adaptation, Psychological↗
PubMed1999

The prevalence of gastroesophageal reflux disease in institutionalized intellectually disabled individuals.

OBJECTIVE: The prevalence of gastroesophageal reflux disease (GERD) was randomly investigated among Dutch and Belgian intellectually disabled individuals. METHODS: In six institutes including 1607 residents, 435 persons with IQ <50 underwent 24-h esophageal pH-metry and were scored for possible predisposing factors and characteristic reflux symptoms. In 49 (11.2%) cases the test failed because of technical reasons. A pathological pH test was defined as a pH <4 for >4.5% of the measured time. Subjects with a pathological pH test (patients) were compared with those with a normal pH test (controls). RESULTS: Of the remaining individuals, 51.8% (200/386) showed a normal pH test, whereas 186 showed a pathological pH test (median duration pH <4: 14.2%, range: 4.5-78.4%). As possible predisposing factors scoliosis, cerebral palsy, use of anticonvulsant drugs or other benzodiazepines, and IQ <35 were found, whereas symptoms such as vomiting, hematemesis, rumination, and depressive symptoms were indicative for reflux. At endoscopy reflux esophagitis was diagnosed in 129 of the 186 patients (69.4%). In 61 (47.3%) of 129 patients, grade I, 43 (33.3%) grade II, 25 (19.4%) grade III/IV (Savary-Miller) were found. Barrett's esophagus was found in 18 (14.0%) and peptic strictures in five (3.9%) cases. CONCLUSIONS: An abnormal 24-h pH-metry and symptoms suggestive for GERD were documented frequently in a large cohort of institutionalized intellectually disabled individuals. Further endoscopical evaluation confirmed the diagnosis of reflux esophagitis in the majority of these individuals.

Adolescent↗
PubMed1984

Phenytoin induced gingival overgrowth in institutionalized epileptics.

In a cross-sectional, epidemiological study of phenytoin induced gingival overgrowth in 77 institutionalized persons with epilepsy, the severity of the gum lesions was quantified by means of a precise new technique. Lesion severity was then compared statistically to other clinical and laboratory parameters. Positive correlations were detected between overgrowth severity and gingival inflammation, probing depths, calculus accumulation, plaque score and the measurement gingival margin to mucogingival junction (GM-MGJ). No correlation was observed between lesion severity and patients age, daily drug dosage, plasma or saliva phenytoin level, or salivary concentration of the major phenytoin metabolite.

Adolescent↗
PubMed1980

Age, degree of mental retardation, institutionalization, and socioeconomic status as determinants in the oral hygiene status of mentally retarded individuals.

Oral hygiene has been implicated as a casual factor in the development of dental caries and periodontal disease in mentally retarded individuals. Little attention, however, has been given to the determinants of oral hygiene status. The present paper assesses the oral hygiene status of institutionalized (I) and noninstitutionalized (NI) mentally retarded (MR) individuals aged 4 through 25, in relation to age, degree of mental retardation, and socioeconomic status. Institutional status was found to be a major determinant in oral hygiene conditions of the study group, as IMR individuals had significantly higher OHI scores than NIMR individuals. Associations of age and OHI were significant only for NIMR. Although differences between I and NI groups, with respect to degree of mental retardation, were seen for mildly, moderately, and severely retarded, no significant difference in OHI scores between I and NI profoundly retarded was seen. Socioeconomic status was not found to be a significant factor in the oral hygiene status of MR individuals. This study emphasizes the need to assess age, degree of mental retardation, and institutional status when implicating oral hygiene in caries and periodontal disease prevalence in MR individuals.

Adolescent↗
PubMed1987

Oral mucosal lesions among institutionalized elderly in Denmark.

The purpose of the study was to determine the prevalence of oral mucosal lesions among institutionalized elderly. The study population comprised 486 elderly from eight nursing homes, and 199 elderly from five hospital long-term care facilities in the eastern part of Denmark. Approximately half of the subjects exhibited one or more pathologic conditions of the oral mucosa. Denture related traumatic ulcerations were found in 3.9% of the nursing home residents, compared to 8.3% among the elderly in hospital long-term care. The most prevalent finding was denture stomatitis, which was manifest in about one third of the elderly. The prevalence was strongly influenced by the denture hygiene; 54% of the elderly with poor denture hygiene suffered from denture stomatitis, as compared to only 7% of those with clean dentures. The prevalence of denture stomatitis was also related to the usage of dentures at night and to the age of the dentures. The prevalence decreased significantly with increasing age, although the oldest age group did not have better denture hygiene, or more favorable wearing habits. It did not appear that sex, type of residency, degree of urbanization, denture conditions, or the use of anticholinergic drugs influenced the prevalence of denture stomatitis. The prevalence and severity of the disease can probably be reduced if the denture hygiene is improved and if the elderly only use their dentures during the daytime.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Dental caries and the need for treatment among institutionalized elderly.

The main purpose for the study was to determine the occurrence of untreated dental decay, and to assess the expressed demand for operative caries therapy among dentate institutionalized elderly in Denmark. The study population comprised all dentate elderly in eight nursing homes (n = 126) and in five hospital long-term care facilities (n = 75). In both groups of elderly 70% had untreated decay. The mean number of surfaces with untreated decay among the elderly in nursing homes (NH) and in hospital long-term care facilities (LTC) was respectively 9.7 and 7.5. The predominant factors influencing the occurrence of untreated decay were the use of dental services and the degree of helplessness. Regular use of dental services reduced the amount of untreated decay among the NH elderly, and the totally helpless LTC elderly had more decay than those able to manage alone. Half of the NH residents who had decay did not want treatment or were not able to express their demand for treatment due to poor mental or physical health. The realistic need for traditional operative filling therapy is discussed and it is concluded that the goal of an oral health care program for NH elderly should be to meet not only the demand for such treatment but also the need for emergency treatment and non-operative caries treatment.

Aged↗
PubMed1990

Tooth loss and dental caries in institutionalized elderly in Italy.

An epidemiological survey of dental health status and needs was conducted in a group of 234 randomly selected institutionalized elderly people in Naples, Italy. The mean age of the patients was 81.4 yr, 71.4% were women and 28.6% men. A total of 140 (59.8%) people were totally edentulous; an additional 13.7% were edentulous in one jaw. A significant increase in prevalence of edentulousness with increasing age was recorded. 44.3% of the edentulous in both jaws wore complete dentures. The mean number of remaining sound teeth, decayed teeth and root remnants in the elderly with maxillary and mandibular natural teeth decreased with increasing age. Of the 94 dentate elderly, 29.8% had no need of dental treatment. Of all dentate patients 68.1% needed one or more dental extractions with a mean need of 3.9 per patient; 37.2% needed restorative treatment for one or more teeth with a mean need per patient of 2.9. Analysis of the results showed poor dental health in this target group and the necessity of improving the dental health services programs for the elderly living in institutions.

Aged↗
PubMed1990

Comparison of oral and general health development among institutionalized elderly people.

This investigation comprises a longitudinal (2 yr) study of development in oral and general health among 100 institutionalized elderly people in Gothenburg. The aim of the study was to photographically document variations in oral health in relation to variation in the general health of these individuals during the period of the project. Changes noted from one examination to the next were limited to a judgment of an "unchanged", "deteriorated", or "improved" status. Medical analyses were based upon information collected from medical charts and the subjective impressions of the care staff, and odontological analyses were based upon photographic screening according to a set of given criteria. Results demonstrated a relation between developments in oral and general health among older people. The strongest relationships were registered between changes on the tongue and general health. The project has shown that a standardized photographic follow-up of health developments in oral tissues can be a valuable aid in cooperative efforts between medical physicians and dentists regarding health supervision of the elderly.

Aged↗
PubMed1997

Micronutrient supplementation and infection in institutionalized elders.

A randomized, double-blind, placebo-controlled clinical trial was conducted to determine the effects of a low-dose (< 2 times the Recommended Dietary Allowance) micronutrient supplement containing trace minerals (zinc and selenium) and/or vitamins/provitamins (vitamin C, alpha-tocopherol, and beta-carotene) on the incidence of respiratory and urogenital infections in institutionalized elderly. After 2 years, there was a significant decrease in the mean number of infections in elders given trace elements (p < 0.01) but not vitamins.

Aged↗
PubMedDate not supplied

Dental needs related to primary cause for institutionalization.

One hundred and forty-seven dentate residents of a long-term care facility were examined to determine oral status and need for treatment. The assessment included dental caries (NIDR criteria), oral hygiene index-simplified, and missing teeth. Caries was further divided into "restorable" and "nonrestorable." Also, the primary cause for institutionalization was determined.

Adult↗
PubMedDate not supplied

Research review of oral health status and service use among institutionalized older adults in the United States and Canada.

United States and Canadian studies have reported that a relatively large proportion of the institutionalized, older adult population is afflicted with a host of dental diseases and rarely seeks dental services. Analysis of existing published information indicates areas of concern including the need for incidence data, consensus on appropriate measures, and samples that will provide representative and comprehensive information about compromised older adults, irrespective of institutional or homebound status. Special emphasis should be placed on determining risk factors for dental disease, through longitudinal study of older adults.

Aged↗
PubMedDate not supplied

The dental status of dentate institutionalized older adults: consideration of retained roots.

Many studies have described the general dental findings in institutionalized older patients, but few studies have used standard dental indices to describe the dental status of these populations. Eighty-five dentate nursing home residents were examined by a single dentist. Dental findings were reported by means of the DMFS, DMFT, and RCI indices along with the D/DFS ratio for coronal and root caries. The mean DMFS, DMFT, and RCI were 97.0, 22.9, and 28.7%, respectively. The percentages of untreated coronal and root caries lesions, as measured by the D/DFS ratios were 65.4% and 85.4%, respectively. Forty-eight percent of the subjects had at least one retained root, with a mean of 1.0 for all 85 subjects. None of the dental findings was statistically significant in association with age, gender, or length of stay in the institution. In the population examined, no statistical or clinical differences in relation to age, gender, or length of stay in the institution were found. The dental status of a dentate older adult population can be accurately described by means of the standardized indices of DMFS, DMFT, and RCI along with the D/DFS ratios, with the caveat that these indices must be interpreted differently than when used with pediatric populations. Retained roots present a fifth surface at risk for root caries, the occlusal surface. The role of the occlusal root surface in the dental status of a population needs to be reported and analyzed.

Age Factors↗
PubMedDate not supplied

Medical conditions associated with missing teeth and edentulism in the institutionalized elderly.

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well-described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentulism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low' as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth-by-tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.

Aged↗
PubMedDate not supplied

Considerations for the use of oral sedation in the institutionalized geriatric patient during dental interventions: a review of the literature.

Some institutionalized elderly persons need a sedative prior to a dental examination or treatment because they have a disturbance due to physical illnesses, degenerative changes in the brain, and/or psychiatric disorders, associated with advanced aging. Oral administration is one of the safest methods of delivery of a sedative drug. It is almost universally acceptable, easy to administer, costs little, has a low incidence and severity of adverse reactions, and requires no additional formal specialized training for the dentist. However, theoretical and practical knowledge of sedation is essential. This paper reviews the literature on oral sedation for the geriatric patient. Benzodiazepines are most often used for oral sedation of geriatric patients. The properties of these drugs were reviewed, and recommendations were made with respect to the drugs of choice and their dosage. Generally, fast-acting benzodiazepines of short duration, with rapid rate of elimination and no active metabolites, are recommended. The drug of choice, and the dosage, may vary according to the medical history and physical condition of the patient.

Administration, Oral↗
PubMedDate not supplied

Oral health profile in an institutionalized population of Italian adults with mental retardation.

The oral health of 219 residents with mental retardation living in a long-term-care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty-five subjects had calculus and/or shallow pockets (4-5 mm); 61 had deep pockets (> or = 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.

Adult↗
PubMedDate not supplied

The influence of dental insurance on institutionalized older adults in ranking their oral health status.

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.

Activities of Daily Living↗