Oral health care of older people in domiciliary care – perspectives of the domiciliary care clients and personnel

The aim was to study the perceived oral health, oral health-related quality of life (OHRQoL) and oral health behaviours of older people with or without domiciliary care in Finland. Another aim was to examine domiciliary care planning and implementation of oral health aspects from domiciliary care personnel. Data concerning perceived oral health and OHRQoL of older domiciliary care clients was based on secondary analyses of interview data of the nationally representative Health 2000 and 2011 surveys. Home-dwelling at least 70-year older people with or without domiciliary care were enrolled in the study. Differences in perceived oral health, OHRQoL and oral health behaviours were analyzed in terms of the use of domiciliary care. Respectively, oral health care aspects of domiciliary care personnel were analyzed from two different datasets collected through questionnaires for case managers, CMs (care planning) and nursing personnel (care implementation) in one of the largest cities in Finland. Poor perceived oral health, edentulousness, chewing difficulties and dry mouth problems were more typical among domiciliary care clients than non-clients. Clients had also tendency for poorer OHRQoL. In particular, the psychological discomfort was emphasized from the dimensions of OHRQoL. In addition, the use of removable dental prostheses (RDP) predicted poorer OHRQoL among the participants. Clients had poorer oral health behaviours indicated as poorer utilization of dental care services and impaired ability to maintain oral hygiene. Oral health-related issues (OHRIs) were considered as important in the care planning but were not routinely included in the assessment of domiciliary care by the CMs. Knowledge about oral health was generally high, yet shortcomings with the received oral health education and difficulties to use the given education in practical work were reported by nursing personnel. Oral care support was to some extent active but not as a part of daily routine. Oral health care needs and regular use of dental care services ought to be emphasized in domiciliary care since care-dependency among clients extends also to oral health due to frailty, functional and cognitive limitations of the clients. Domiciliary care personnel require practical oral health education and guidelines. Iäkkäiden suun terveydenhuolto kotihoidossa – Kotihoidon asiakkaiden ja henkilökunnan näkökulmasta Tavoitteena oli tutkia kotona asuvien iäkkäiden henkilöiden koettua suun terveyttä, suun terveyteen liittyvää elämänlaatua ja suun terveystottumuksia kotihoidossa ja sen ulkopuolella olevilla henkilöillä. Toisena tavoitteena oli tarkastella kotihoidon henkilökunnan suun terveydenhuollon suunnittelua ja toteutusta. Iäkkäiden henkilöiden koettua suun terveyttä ja suun terveyteen liittyvään elämänlaatua käsittävää tietoa saatiin sekundaarianalyyseistä, jotka tehtiin Terveys 2000 ja 2011 tutkimuksien haastatteluaineistoista. Tutkimukseen valittiin vähintään 70- vuotiaita kotona asuvia, kotihoidossa ja sen ulkopuolella olevia iäkkäitä henkilöitä. Eroja koetussa suun terveydessä, suun terveyteen liittyvässä elämänlaadussa ja suun terveyskäyttäytymisessä analysoitiin kotihoidon palveluiden käytöllä. Vastaavasti kotihoidon henkilöstön suun terveydenhuollon näkökohtia analysointiin kahdesta eri aineistosta, jotka kerättiin asiakasohjaajien (hoidon suunnittelu) ja hoitohenkilökunnan (hoidon toteutus) kyselylomakkeiden avulla yhdessä Suomen suurimmista kaupungista. Huono koettu suun terveys, hampaattomuus, pureskeluvaikeudet ja kuivan suun ongelmat olivat tyypillisempiä kotihoidon asiakkailla kuin heillä, jotka eivät saaneet kotihoitoa. Asiakkailla oli myös taipumus huonompaan suun terveyteen liittyvään elämänlaatuun. Elämänlaadun osa-alueista korostui erityisesti psyykkiseen epämukavuus. Lisäksi irrotettavien hammasproteesien käyttö ennusti osallistujilla heikompaa suun terveyteen liittyvää elämänlaatua. Asiakkaiden heikommat suun terveystavat näkyivät heikompana hammashoitopalveluiden käyttönä ja kykynä ylläpitää suuhygieniaa. Kotihoidon suunnittelussa tärkeäksi koettuja suun terveysasioita ei otettu säännöllisesti huomioon asiakasohjauksessa. Hoitohenkilöstön tietotaso suun terveydestä oli yleisesti korkealla, mutta puutteet koulutuksessa hankaloittivat työn suorittamista. Suun terveyttä tuettiin jokseenkin aktiivisesti, mutta ei osana hoitorutiinia. Suun terveydenhuollon tarpeellisuutta ja hammashoitopalveluiden säännöllistä käyttöä on korostettava kotihoidossa, sillä asiakkaiden hoitoriippuvuus ulottuu myös suun terveyteen asiakkaiden haurauden, toiminnallisten ja kognitiivisten rajoitusten vuoksi. Kotihoidon henkilöstö tarvitsee ikääntyneen suun hoitoon liittyvää käytännön koulutusta ja ohjeita

Iäkkäiden suun terveys ja kotihoito. Kohteena Tampereen kaupungin kotihoito

Suun terveyden merkitys on suuri iäkkään henkilön yleisterveyden kannalta. Iän myötä suussa tapahtuu muutoksia, mutta myös yleisterveys ja toimintakyky ovat yhteydessä suun terveyteen. Tutkimuksia kotona asuvien iäkkäiden suun terveydestä on tehty verrattain vähän ja tutkimukset ovatkin keskittyneet laitoshoidossa oleviin. Tämän kyselytutkimuksen tarkoituksena oli selvittää iäkkäiden suun terveyden huomioiminen kotihoidontoimesta. Tutkimuskohteena oli Tampereen kaupungin kotihoito. Kaksiosaisen kyselytutkimuksen kohderyhmänä olivat asiakasohjaajat (n=25) ja kotihoidon työntekijät (n=465). Vastanneita asiakasohjaajia oli 22 ja kotihoidon työntekijöitä 115. Kyselyt toteutettiin pääosin monivalintakysymyksinä. Tutkimuksen tulokset käsiteltiin prosenttiosuuksina. Iäkkäiden, asiakkaiden suun terveys koettiin kotihoidon puolesta aiheena, johon panostaminen on tärkeää. Tutkimusten tulosten perusteella ilmeni tarvetta lisäkoulutukselle molempien kohderyhmien osalta. Kotihoidon vastanneista työntekijöistä yli puolella oli tarvetta lisäkoulutukselle. Lisäksi todettiin tarvetta kotihoidon asiakkaiden suun terveyden huomioimisen lisäämiseksi ja säännöllistämiseksi. Vastanneista asiakasohjaajista kaikki kannattivat rutiinia suun terveyden huomioimista kotihoidon puolesta.Siirretty Doriast

Approaching Localized Politics of European Memories

Peer reviewe

Diseases with oral manifestations among adult asthmatics in Finland : a population-based matched cohort study

Objectives Many comorbidities are associated with adult asthma and may exacerbate the asthma burden of disease. This study aims to investigate the risk for major oral diseases or oral-manifesting diseases in asthmatic compared with non-asthmatic adults. Design We conducted a population-based matched cohort study with a 13.8-year follow-up. Setting A baseline questionnaire was completed by participants in 1997 and follow-up data were extracted from the national hospital discharge registry of the National Institute for Health and Welfare in Finland from 1997 to 2014. Participants A total of 1394 adults with asthma were matched with 2398 adults without asthma based on sex, age and area of residence. Asthmatic adults were identified from the Drug Reimbursement Register of the Finnish Social Insurance Institution based on a special drug reimbursement right resulting from asthma. Participants without asthma were identified from the Population Register. Main outcomes and measures Oral health-related primary diagnoses were retrieved using codes from the International Classification of Diseases, 10th edition and divided into groups of diseases. Cox's proportional hazards models stratified by matching unit and models matched and adjusted for pack-years, education level and body mass index (when possible) were used to evaluate the matched and further adjusted HRs for diseases comparing asthmatic and non-asthmatic cohorts. Results Adult asthma was associated with a higher risk for any oral-manifesting disease (adjusted HR 1.41, 95% CI 1.11 to 1.80), herpes zoster (adjusted HR 6.18, 95% CI 1.21 to 31.6), benign tumours of the oral cavity and pharynx (matched HR 1.94, 95% CI 1.05 to 3.56) and dermatological diseases (pemphigus, pemphigoid, dermatitis herpetiformis, psoriasis and lichen planus, HR 1.67, 95% CI 1.01 to 2.78). Conclusions In this study, adult asthmatics experienced a higher risk for a major oral disease or oral-manifesting disease.Peer reviewe

Risk factors for severe adult-onset asthma : a multi-factor approach

Background The aim was to identify risk factors for severe adult-onset asthma. Methods We used data from a population-based sample (Adult Asthma in Finland) of 1350 patients with adult-onset asthma (age range 31-93 years) from Finnish national registers. Severe asthma was defined as self-reported severe asthma and asthma symptoms causing much harm and regular impairment and >= 1 oral corticosteroid course/year or regular oral corticosteroids or waking up in the night due to asthma symptoms/wheezing >= a few times/month. Sixteen covariates covering several domains (personal characteristics, education, lifestyle, early-life factors, asthma characteristics and multiple morbidities) were selected based on the literature and were studied in association with severe asthma using logistic regressions. Results The study population included 100 (7.4%) individuals with severe asthma. In a univariate analysis, severe asthma was associated with male sex, age, a low education level, no professional training, ever smoking, >= 2 siblings, >= 1 chronic comorbidity and non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) (p = 2 siblings (2.51 [1.17-5.41]). There was a dose-response effect of the total sum of these five factors on severe asthma (OR [95% CI] = 2.30 [1.81-2.93] for each one-unit increase in the score). Conclusions Male sex, smoking, NERD, comorbidities, and >= 2 siblings were independent risk factors for self-reported severe asthma. The effects of these factors seem to be cumulative; each additional risk factor gradually increases the risk of severe asthma.Peer reviewe

Neonatal Intestinal Failure Is Independently Associated With Impaired Cognitive Development Later in Childhood

Objective: The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. Methods: We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. Patients with IF with >60 days of parental nutrition (PN) dependency aged between 3 and 16 years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wechsler Intelligence Scale for Children, 4th edition, and Movement Assessment Battery for Children, 2nd edition. Results: All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age, and birth weight was 7.5 (range 3-16) years, 35 (interquartile range [IQR] 28-38) weeks and 2238 (IQR 1040-3288) grams, respectively. Median duration of PN was 13 (IQR 5-37) months and 9 patients were currently on PN. Median intelligence quotient was 78 (IQR 65-91) and 10 (35%) patients had an intelligence quotient under 70 (-2 standard deviation). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, whereas adverse motor outcome was associated with prematurity. Conclusion: Clinically significant cognitive and motor impairments are alarmingly common among neonatal patients with IF. We recommend early neurodevelopmental follow-up for all children with IF.Peer reviewe

Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018 : A national registry study

Background In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period ((sic) 2 800 to (sic)1 200). Interpretation The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Peer reviewe

Perceived oral health and oral health behaviours among home-dwelling older people with and without domiciliary care

Objectives The aim was to compare the perceived oral health and oral health behaviours of home-dwelling older people with and without domiciliary care.Background Oral health is poor in long-term care, but less is known about perceived oral health of home-dwelling older people receiving domiciliary care.Materials and methods Data from the Health 2000 and Health 2011 surveys (BRIF8901) were used. Interview participants were at least 70 years old and living at home with or without domiciliary care (n = 1298 in 2000 and n = 1027 in 2011). Differences in perceived oral health (subjective oral health, pain, eating difficulties) and oral health behaviours (hygiene, use of services) were compared based on the use of domiciliary care and stratified by gender. Differences between groups were compared with the chi-square test.Results In 2011, compared to non-clients, domiciliary care clients more often had poor subjective oral health (40.3% vs. 28.9%, P = .045). In both surveys, they also used oral health services less recently (2000, 76.4% vs. 60.9%; and 2011, 61.1% vs. 46.6%) and more often had difficulties chewing hard food (2000, 50.6% vs. 34%, P Conclusion Domiciliary care clients have poorer perceived oral health, and greater difficulties with eating and oral hygiene maintenance than non-clients.</div

Oral health-related quality of life among home-dwelling older people with and without domiciliary care

Objectives The aim was to compare oral health-related quality of life (OHRQoL) between home-dwelling older people with and without domiciliary care when adjusted for gender, education, use of dental services and removable dental prostheses. Background OHRQoL of home-dwelling older people with and without domiciliary care is a neglected area of research, with few studies having been conducted. Materials and Methods A secondary analysis was conducted on the Finnish Health 2011 interview data. Home-dwelling participants (age >= 70) with or without domiciliary care were included (n = 758). OHRQoL was measured with the Oral Health Impact Profile questionnaire (OHIP-14) calculating three outcomes: prevalence of at least one impact reported: "occasionally," "fairly often" or "very often" (OFoVo), severity as mean sum score and mean of the seven OHIP-14 dimensions. These were evaluated by use of domiciliary care using logistic and negative binomial regression analyses. Results Domiciliary care clients tended to have poorer OHRQoL than non-clients (severity mean 4.33 vs 4.11, P = .057), especially men (6.71 vs 4.15, P = .027), and reported more psychological discomfort than non-clients (mean 1.10 vs 0.82, P = .039). The use of removable dental prostheses was the strongest predictor (OR 2.84, P < .001) of poor OHRQoL. Conclusion Domiciliary care clients tended to report poorer OHRQoL, especially with regard to psychological discomfort dimension than non-clients. Thus, support of oral hygiene and regular utilisation of oral health services should be part of domiciliary care among older people to enhance OHRQoL