Suu- ja ravitsemusongelmat palvelutalojen asukkailla

ABSTRACT This study formed part of a developmental project in the Helsinki Metropolitan Area of Finland during 2003 2011 that aimed to develop nutritional care in long-term care facilities. The aim of this study was to assess tooth brushing/denture cleaning habits, dentition, chewing problems, and swallowing difficulties and their associations with nutritional status and eating habits. Furthermore, the aim was to explore the prognostic value of dentition, chewing problems and swallowing difficulties in relation to mortality. In addition, the adequacy of the dietary intake of energy, protein, and other nutrients was examined. Of all the residents in assisted living facilities (N = 2188) in the cities of Helsinki and Espoo, 67% (1475) participated in this study in 2007. Trained registered nurses familiar with the residents assessed each participant and collected demographic data, the medical history, information on the functional and cognitive status, tooth brushing/dentition cleaning habits, dentition, oral symptoms, eating habits and diets. The nutritional status was assessed with the Mini Nutritional Assessment (MNA). In addition, 343 volunteer residents provided one-day food diaries. Their energy, protein, and nutrient intakes were calculated from these detailed food diaries and compared with the recommendations of the Finnish National Nutrition Council as a measure of dietary adequacy. Information on three-year mortality was retrieved from central registers on 6 July 2010. The mean age of the residents was 83 years and 79% of them were women. The educational level was low; 56% of the residents had a primary school level of education or less. In activities of daily living, most residents (84%) required at least prompting or assistance in dressing, hygiene and the keeping of personal effects, or required considerable help with personal care, often involving incontinence. Over half of the residents (55%) had cognitive impairment. Edentulousness was common; more than half of the residents (52%) had lost all their teeth, while 7% (n = 94) were totally edentulous without prosthesis. Of the residents, 17% did not clean or had not cleaned their teeth/dentures daily. According to the MNA, 13% were malnourished, 65% were at risk of malnutrition and 22% were well nourished. Edentulousness without prostheses and infrequent tooth brushing were associated with malnutrition, oral symptoms and infrequent use of oral health care services. Residents with chewing problems (n = 287) were older, had more comorbidities and were more likely to be malnourished according to the MNA, to be dependent in activities of daily living (ADL) and to have poorer subjective health than those without chewing problems. In logistic regression analysis including age, sex, MNA class and the Charlson´s Comorbidity Index as covariates, chewing problems still independently predicted mortality (OR = 1.46, 95% CI = 1.10 1.93). Of the residents, 12% (n = 173) had swallowing difficulties and they were more likely to be malnourished that those residents without swallowing difficulties. Swallowing difficulties also had an independent predictive value for mortality (OR = 1.49, 95% Cl = 1.04-2.12). Large proportions of volunteer participants in the subsample that provided one-day food diaries received less than the recommended amounts of energy, protein or micronutrients. The dietary intake of protein was significantly lower among edentulous subjects without dentures than those with natural teeth. In the adjusted (age, gender and Charlson s comorbidity index) logistic regression model, being in Group 1 (edentulous participants without dentures) and Group 2 (edentulous participants with some removable dentures in one or both jaws) predicted a poorer protein intake (less than 60 g/day; OR 2.4, 95% CI 1.0 5.7, p = 0.042 and OR 1.6, 95% CI 1.0 2.6, p = 0.045, respectively) compared with the reference Group 3 (dentulous participants all or some natural teeth and with or without removable dentures in one or both jaws; OR = 1). Oral problems were common among frail older residents in assisted living facilities and they were associated with nutritional problems. These findings suggest the need for co-operation between nursing staff and oral care personnel.Tehostetun palveluasumisen yksiköissä asuu ikääntyneitä, jotka tarvitsevat ympärivuorokautista hoivaa. Yhä useampi ikääntyy omat hampaat suussa, mutta ikääntymisen mukanaan tuoma toimintakyvyn heikentyminen, haurastuminen ja sairaudet voivat heikentää kykyä huolehtia omatoimisesti suun päivittäisestä hoidosta. Hoitohenkilökunnan tulisi tukea tai tarvittaessa huolehtia ikääntyneen suuhygienian toteuttamisesta osana hyvää ja laadukasta hoivaa. Suun terveys on merkittävä osa ikääntyneen hyvinvointia ja yleisterveyttä. Suun terveydellä on merkitystä ikääntyneen hyvälle ravitsemukselle ja toimintakyvyn säilymiselle. On tärkeä selvittää tehostetussa palveluasumisessa olevien ikääntyneiden suun terveyttä ja sen yhteyttä ravitsemukseen. Hampaattomuus oli edelleen yleistä iäkkäiden tehostetun palveluasumisen asukkaiden keskuudessa. Yli puolet asukkaista (52 %) oli menettänyt kaikki omat hampaansa. Asukkaista suurimmalla osalla oli kokoproteesit, mutta n. 7 % ei käyttänyt minkäänlaista proteesia. Ravitsemusongelmat olivat myös hyvin yleisiä. Asukkaista vain noin joka viidennellä oli hyvä ravitsemustila. Aliravitsemus todettiin 13 % asukkaista ja 65 % oli aliravitsemusriskissä. Aliravitsemus oli yleisintä niiden hampaattomien asukkaiden keskuudessa, jotka eivät käyttäneet proteesia. Suuri osa asukkaista sai myös liian vähän energiaa ja ravintoaineita ruuasta. Puolet asukkaista sai ruuasta liian vähän proteiinia ja hampaattomuus oli yhteydessä vähäiseen proteiinin saantiin. Monella asukkaalla (17 %) päivittäinen suun puhdistaminen ei toteutunut. Päivittäinen suun puhdistaminen toteutui kaikista huonoiten niillä asukkailla, joilla oli huono toimintakyky ja avuntarvetta päivittäisissä toiminnoissaan, muistiongelmia tai aliravitsemusta. Matalasti koulutetut, hampaattomat sekä ne asukkaat, joilla päivittäinen suun puhdistaminen ei toteutunut, käyttivät muita harvemmin suun terveydenhuollon palveluja. Joka neljännellä asukkaalla todettiin jokin suun ongelma. Noin joka viides asukas (21 %) kärsi puremisongelmista tai suun kuivuudesta, 12 % nielemisongelmista ja suun kivusta 7 %. Puremisongelmat ja nielemisongelmat olivat yhteydessä huonoon ravitsemustilaan ja ne myös ennustivat kuolleisuutta. Väitöstutkimuksessa selvitettiin tehostetun palveluasumisen yksiköissä asuvien ikääntyneiden hampaistoa, suun terveystottumuksia, suun ongelmien yleisyyttä sekä arvioitiin niiden yhteyttä ravitsemukseen ja kuolleisuuteen. Tutkimuksessa oli mukana 1475 asukasta Helsingissä ja Espoossa sijaitsevista yksiköistä. Osallistujien keski-ikä oli 83 vuotta. Sairaanhoitajat keräsivät tietoa asukkaista haastattelemalla, havainnoimalla ja arvioimalla asukkaita. Sairaustiedot saatiin potilasasiakirjoista. Ravitsemustilan arviointiin käytettiin MNA-testiä, joka on kehitetty ikääntyneiden henkilöiden ravitsemustilan arviointiin. Osa asukkaista (N=345) osallistui myös tutkimukseen, jossa ruokapäiväkirjan avulla arvioitiin energian ja ravintoaineiden saantia. Tehostetussa palveluasumisen yksiköissä tulisi asukkaiden ravitsemustilaa arvioida säännöllisesti. Myös säännölliset suun tutkimukset ja tarvittava hammaslääketieteellinen hoito sekä päivittäinen suuhygienia tulisi taata näille hauraille ikääntyneille osana hyvää ravitsemushoitoa ja toimintakyvyn säilyttämiseen tähtäävää hoivaa. Tämä edellyttää kiinteä yhteistyötä hoitohenkilökunnan, geriatrien, ravitsemusterapeuttien ja suun terveydenhuollon ammattilaisten kesken kokonaisvaltaisen hoitosuunnitelman laatimiseksi ja laadukkaan huolenpidon ja hoivan toteuttamiseksi asumispalveluyksiköissä vanhuspalvelulain mukaisesti

Oral hypofunction and association with need for daily assistance among older adults in long-term care

Background Oral hypofunction (OHF) is related to occlusal status and bite force. It has specific symptoms and varying degrees of severity. Objectives OHF was determined with five signs. The relationships between OHF and need for assistance in oral hygiene, moving, eating and occlusal status in older adults living in long-term care (LTC) were examined. Methods A comprehensive clinical oral examination was conducted on 393 residents who lived in LTC in Helsinki, Finland. The five signs to determine OHF were mouth dryness, visible food residue on oral or denture surfaces, ability to keep the mouth open during examination, clearness of speech, and diet of pureed or soft food. Score points of 0-2 were given for each sign, and the sum was categorised as mild, moderate or severe OHF. Participants were divided into three groups accordingly, and occlusal status was determined based on contact units. In addition, nurses collected background information on number of medications and level of cognition. Need for assistance was based on oral hygiene, moving and eating. Results Of participants (n = 319), 21% showed severe and 41% moderate OHF. Occlusal status differences between the OHF groups were significant. OHF severity associated linearly with increased severity of cognitive impairment and increased need for assistance in oral hygiene, eating and moving. Conclusions OHF score based on the five signs can be used to determine OHF severity. OHF was common and associated with occlusal status, cognitive impairment and need for assistance in oral hygiene, moving and eating in older adults living in LTC.Peer reviewe

Changes in Institutionalized Older People's Dentition Status in Helsinki, 2003-2017

Non peer reviewe

Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study

Background A growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents' poor oral health. Methods In this cross-sectional observational study dentists examined 209 residents' oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents' poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome. Results Participants were grouped according to their ADS scores: low (n = 39), moderate (n = 96) and high ODB (n = 74). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB. Conclusion Poor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents' oral health when considering a resident's need for consultation with an oral health professional.Peer reviewe

Relationship between Fried's frailty phenotype and oral frailty in long-term care residents

Background: oral frailty (OFr) may be called a syndrome lacking a consensus on its definition. Objective: the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care. Design: the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition. Setting: participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs). Subjects: the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland. Methods: frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination. Results: a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties. Conclusions: OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.Peer reviewe

Oral hygiene and health-related quality of life in institutionalized older people

Purpose We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. Methods This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants' background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. Results Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. Conclusions Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents' oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups. Key summary pointsAim We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities. Findings Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL. Message Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.Peer reviewe

Iäkkäiden asukkaiden ravitsemustila Helsingin pitkäaikaisen ympärivuorokautisen hoidon yksiköissä

Helsingissä vuosina 2003-2017 tehtyjen ravitsemustutkimusten tarkoituksena on ollut tutkia ympärivuorokautisessa hoidossa olevien vanhusten ravitsemustilaa. Tässä artikkelissa kuvataan ravitsemustilan ja -hoidon kehittymistä tehostetussa palveluasumisessa vuosina 2007, 2011 ja 2017 sekä laitoshoidossa (vanhainkodeissa) vuosina 2003, 2011 ja 2017 tehtyjen tutkimusten tulosten pohjalta. Helsingin ravitsemustutkimukset on toteutettu käyttäen samaa strukturoitua kyselylomaketta ja MNA-ravitsemusarviota (Mini Nutritional Assessment). Tässä artikkelissa esitetään tutkimuslomakkeiden muuttujia (ikä, sukupuoli, siviilisääty, koulutustaso, fyysinen ja kognitiivinen toimintakyky, sairaudet ja lääkitys) kuvaamaan asukasrakenteen eroja eri asumismuodoissa. Ravitsemukseen liittyvistä muuttujista esitetään välipalojen syömistä, täydennysravintovalmisteiden ja D-vitamiinivalmisteiden käyttöä sekä painon seurantaa ja painehaavoja. Tulosten mukaan asukkaiden toiminnanvajeet ja muistisairaiden osuus ovat merkittävästi lisääntyneet. Tästä huolimatta ravitsemustilan mukaan riski- tai virheravitsemustilassa olevien osuudessa ei ole tapahtunut lisäystä. Ravitsemushoitokäytännöt ovat parantuneet. Tässä artikkelissa raportoidaan keskeiset trenditiedot eri tutkimusvuosilta. Noin 15 vuotta kestänyt tutkimus- ja kehittämishanke on ollut hyödyllinen asukkaiden hyvinvoinnin kannalta. Hyvä ravitsemus on merkittävä tekijä ikääntyneiden hyvinvoinnissa.Peer reviewe

Dietary fat intake and quality in long-term care residents in two cohorts assessed 10 years apart

Purpose To describe and compare detailed dietary fat intake, fat quality and associative factors between two measuring points 10 years apart of residents living in long-term care facilities, and to reflect how fat composition and fat quality corresponds to current nutrition recommendations. Methods In 2007 long-term care residents (n = 374) of 25 assisted-living facilities and nursing homes and in 2017-18 long-term care residents (n = 486) of 17 respective facilities in Helsinki metropolitan area were recruited for this study. Information on the residents' heights, demographic information and use of calcium and vitamin D supplementation were retrieved from medical records. Residents' clinical assessment included Clinical Dementia Rating (CDR), the Mini Nutritional Assessment (MNA) and questionnaire related to nutrition care. Participants' energy and fat intake were determined from 1--2-day food diaries kept by the ward nurses, and fat quality indicators calculated. Results Age, gender distribution, MNA score or body mass index did not differ between the two cohorts. Residents' cognitive status, subjective health and mobility were poorer in 2017 compared to 2007. Total fat and saturated fatty acid (SFA) intakes were higher and fat quality indicators lower in the 2017 cohort residents than in the 2007 cohort residents. Sugar intake, male gender, eating independently, eating larger amounts and not having dry mouth predicted higher SFA intake in the 2017 cohort. Conclusions The fat quality in long-term care residents in our study worsened in spite of official recommendations between the two measurement points.Peer reviewe

Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral® group (p = 0.01). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy

Burden of Oral Symptoms and Its Associations With Nutrition, Well-Being, and Survival Among Nursing Home Residents.

Objectives: To explore how oral problems, chewing problems, dry mouth, and swallowing difficulties cluster and whether their burden is associated with nutritional status, eating habits, gastrointestinal symptoms, psychological well-being, and mortality among institutionalized residents. Design: Cross-sectional study with 1-year mortality. Setting and participants: 3123 residents living in assisted facilities and nursing homes in Helsinki, Finland. Measures: Trained nurses assessed residents in all nursing homes and assisted living facilities in Helsinki in 2011. A personal interview, the Mini Nutritional Assessment (MNA), oral symptoms, questions about eating habits, and psychological well-being were used to assess each resident. We divided the subjects first according to the number of oral symptoms into 4 groups: no oral symptoms (G0), 1 oral symptom (G1), 2 oral symptoms (G2), and all 3 symptoms (G3); and second according to the symptoms: dry mouth, chewing problems, and swallowing difficulties. The diagnoses and medications were retrieved from medical records, and mortality data were obtained from central registers. Results: In all, 26% of the subjects had 1 oral problem (G1), 11% had 2 oral problems (G2), and 4% had all 3 oral problems (G3), whereas 60% (n = 1870) had no oral symptoms. Thus, the oral symptoms moderately overlapped. The burden of oral symptoms was linearly associated with malnutrition, higher numbers of comorbidities, dependency in physical functioning, gastrointestinal symptoms, and eating less and more often alone. The higher the burden of oral symptoms, the lower the self-rated health and psychological well-being. Mortality increased along with the higher oral symptoms burden. Among residents having 1 or more symptoms, 26% had chewing problems, 18% swallowing difficulties, and 15% dry mouth. Conclusions/Implications: The burden of oral health problems was associated in a stepwise fashion with poor health and psychological well-being, malnutrition, and mortality. Clinicians should routinely assess older institutionalized residents' oral health status to improve residents' well-being. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe