Probing problems and priorities in oral health (care) among community dwelling elderly in the Netherlands: a mixed method study

Background: Complex dentitions and decline in adequate oral hygiene in elderly may lead to poor oral health. This may have impact on their general health, wellbeing and quality of life. With increased longevity, the problems and needs in oral health of community dwelling elderly lead to changes in oral health care needs. We identified and prioritized problems and needs in oral health of community dwelling elderly. Methods: The problems and needs in oral health of community dwelling elderly were elicited during focus groups and interviews. The list of problems and needs derived thereof was presented to 97 elderly who prioritized these. Results: Overall, older people appeared to be satisfied with their current oral health, and the maintenance and care for their oral health. Cost of care was identified as a major problem in general. There are differences in current perceived problems and needs and problems and needs anticipated for the future. Perceived current problems and needs concern dental care provision and knowledge on oral health of professionals and patients. For anticipated future problems and needs the importance of daily oral care by caregivers was prioritised, while emphasis was placed on fear of losing autonomy. Conclusion: It is important to take the perspectives and expectations of elderly into account in policy and planning of future oral health care practice, because these differ from the perspectives of dental professionals

Prioritering en aanbevelingen in de mondzorg voor ouderen

De mondgezondheid van ouderen, vooral kwetsbare zorgafhankelijke ouderen is suboptimaal. In een Priority Setting Partnershiponderzoek hebben ouderen en andere belanghebbenden geparticipeerd om ervaren belemmeringen in de mondzorg te inventariseren en hieruit agendapunten voor onderzoek te destilleren. Hiertoe zijn in 5 focusgroepen discussies gehouden met respectievelijk een groep ouderen, verzorgers, externe partijen en behandelaars. In een vijfde zogenoemde consensusgroep werd de definitieve lijst van prioriterende agendapunten geformuleerd. De belangrijkste prioriteiten betreffen beleid en organisatie, bewustwording, samenwerking tussen verschillende zorgverleners, financiering en organisatie van mondzorg voor thuiswonende ouderen, en onderwijs over mondzorg aan alle zorgverleners. Bewustwording over het belang van de mondgezondheid van ouderen bij zorgverleners is de eerste stap naar betere mondgezondheid van ouderen in Nederland

How do we incorporate patient views into the design of healthcare services for older people: A discussion paper

Background: Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people's quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people. Main text: People's emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional 'top-down' medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision. Discussion: The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co-produced process to the research and design of healthcare services of the future. These methods facilitate partnerships between researchers, healthcare professionals and patients to produce more responsive and appropriate public services for older people. © 2018 The Author(s)

The association between polypharmacy and malnutrition(risk) in older people: A systematic review.

BACKGROUND & AIM: Malnutrition adversely influences a broad range of physical and psychological symptoms. Although polypharmacy is often mentioned to be associated with malnutrition, especially in older people it is unclear to what extent. The aim of this systematic review was to investigate the extent of the association between polypharmacy and malnutrition in older people. METHODS: The methodology followed the guidelines of the Cochrane Collaboration. Literature search was performed in PubMed, CINAHL and Embase. The population of interest for this systematic review were people of 65 years and older with polypharmacy. Because there is ambiguity with regard to the actual definition of malnutrition and polypharmacy, in this systematic review all articles describing malnutrition prevalence rates were included, regardless of the criteria used. Both observational and intervention studies were screened for eligibility. Selection and quality assessment of the included full text studies was assessed by two reviewers independently. A level of evidence and methodological quality score was adjudged to each article based on this assessment. RESULTS: A total of 3126 studies were retrieved by the literature search, of which seven studies were included in this systematic review. There was considerable variation in the definition of polypharmacy between studies. Two studies defined polypharmacy as the use of five or more drugs, two studies as the use of six or more drugs, two studies provided a mean and standard deviation that corresponded to the minimum of five drugs, and one study distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs). However, all studies showed a statistically significant association between (the risk) of becoming malnourished and polypharmacy regardless the instrument or criterion used to define risk of malnutrition. Studies presented the associations respectively as OR ≥ 1.177, p-value ≤ 0.028, β ≥ -0.62 and r  ≥ -0.31. CONCLUSION: This review demonstrated a statistically significant association between polypharmacy and malnutrition. Further research is required to determine the magnitude of the effect by increased number of drugs in combination with the type of drugs, on the risk of malnutrition

The association between polypharmacy and malnutrition(risk) in older people : A systematic review

Background & aim: Malnutrition adversely influences a broad range of physical and psychological symptoms. Although polypharmacy is often mentioned to be associated with malnutrition, especially in older people it is unclear to what extent. The aim of this systematic review was to investigate the extent of the association between polypharmacy and malnutrition in older people. Methods: The methodology followed the guidelines of the Cochrane Collaboration. Literature search was performed in PubMed, CINAHL and Embase. The population of interest for this systematic review were people of 65 years and older with polypharmacy. Because there is ambiguity with regard to the actual definition of malnutrition and polypharmacy, in this systematic review all articles describing malnutrition prevalence rates were included, regardless of the criteria used. Both observational and intervention studies were screened for eligibility. Selection and quality assessment of the included full text studies was assessed by two reviewers independently. A level of evidence and methodological quality score was adjudged to each article based on this assessment. Results: A total of 3126 studies were retrieved by the literature search, of which seven studies were included in this systematic review. There was considerable variation in the definition of polypharmacy between studies. Two studies defined polypharmacy as the use of five or more drugs, two studies as the use of six or more drugs, two studies provided a mean and standard deviation that corresponded to the minimum of five drugs, and one study distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs). However, all studies showed a statistically significant association between (the risk) of becoming malnourished and polypharmacy regardless the instrument or criterion used to define risk of malnutrition. Studies presented the associations respectively as OR ≥ 1.177, p-value ≤ 0.028, β ≥ −0.62 and r ≥ −0.31. Conclusion: This review demonstrated a statistically significant association between polypharmacy and malnutrition. Further research is required to determine the magnitude of the effect by increased number of drugs in combination with the type of drugs, on the risk of malnutrition

Energie- und Oekobilanz des Sicherheits-Daemmstoffes FOAMGLAS

Fuer die oekologische Bewertung eines Baustoffes muss sowohl das Materialverhalten als auch die impliziten Auswirkungen auf Gesundheit und Umwelt beruecksichtigt werden. Im Rahmen der vorliegenden Firmenschrift wird die sog. Oeko-Bilanz des Baustoffes Foamglas T4 untersucht. Gemaess den in vielen Veroeffentlichungen verwendeten Oekoschluesseln wird Foamglas die Oeko-Klasse 3, d.h. empfehlenswert zugeordnet. Der Studie nachgestellt sind Gutachten und Pruefberichte zu Foamglas hinsichtlich Silikogenitaet, Zytotoxizitaet, oekotoxikologische Relevanz, Unbedenklichkeit gegenueber H_2S beim Einbau gegen Erdreich, Beurteilung des Zweikomponenten-Bitumenkaltklebers sowie der toxische und mutagene Wirkung von oxidiertem Bitumen. (BWI)For the ecological evaluation of a building material both material behaviour as well as implicit impacts on health and environment have to be taken into account. In this company paper the ecobalance of the material Foamglas T4 is gone into. According to eco-classifications used in many publications foamglas belongs in the eco-class 3, i.e. recommendable. After the study certification and test reports follow concerning silicogenity, cytotoxicity, ecotoxicologic relevance and safety in view of H_2S of foamglas when contact with the soil is possible and concerning the evaluation of two-component bituminous cold-bonding agent as well as the toxic and mutagene effect of oxidized bitumen. (BWI)Available from TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman