Oral health of older people admitted to hospital for assessment

Abstract

Introduction and objectives: New Zealand’s population of older people is increasing, and a corresponding dental transition is occurring, whereby older people are retaining their natural teeth for longer than before. New Zealand epidemiological evidence indicates that there is continuing profound oral disease experience in the older population. There are currently no data describing the oral health of older people admitted to hospital in New Zealand and how their treatment needs are being met. When older people are admitted to hospital due to sudden or further worsening of their general health, they enter a major change in lifestyle, from independence to supported living. The importance of oral health is frequently forgotten in the midst of these major changes. Little is known about whether there is a change in the oral health of hospitalised older people as their life characteristics become greatly affected, and as they transition from independence (community-dwelling) to dependent living (institutionalised). The objectives of this study were to: (1) Describe the clinical oral health status and treatment needs of older people admitted to older persons’ wards for assessment at Dunedin Public Hospital due to sudden worsening of their general health; and (2) Describe the oral-health-related quality of life (OHRQoL) of those older people, together with its associations.

Materials and methods: An oral survey was performed of 200 patients (81 males, 119 females; mean age of 82.6 ± 6.6 years) admitted to older person’s wards at Dunedin Public Hospital. The study included one thorough bedside clinical oral examination, a face-to-face interview, and a panoramic radiographic examination (where appropriate). Participants’ medical notes were reviewed, and details of social-demographic data, existing medical conditions, including the reason for admission, and current medications were obtained.

In the study, the oral assessment comprised examination of the participants’ extra-oral structures, oral mucosal, periodontal status, dentition status and prosthetic status, along with their respective treatment needs. The interview elucidated information about the participants’ use of oral health services, and their perceptions on oral health. The Oral Health Impact Profile-20 (OHIP-20) was utilised to assess OHRQoL, and the Xerostomia Inventory (XI) was included to measure the symptoms of dry mouth.

Results: One in three (36.0%) participants were living independently at home prior to their hospital admission. However, due to worsening of their general health, the majority (85.9%) of the participants expected to be dependent on others for assistance when discharged from the hospital. The majority (55.0%) of the participants had been admitted for a medical reason which required assessment. The mean total number of pre-existing medical conditions for the participants was 7.5, and each participant was taking an average of 10.5 medications. One-third (33.4%) of all medications taken by the participants during their hospital admission were xerogenic, and the mean number of xerogenic medications taken was 3.5.

Half (50.0%) of the participants were dentate (with an average of 16.8 teeth). Dental caries was active in this sample of older people where each dentate participant had an average of 1.9 teeth with carious lesions in the crown and root. Restorative treatment and extraction needs for both coronal and root surface caries were high (70.7% of the dentate participants). Approximately 90% of the dentate participants required simple scaling of the teeth and prophylaxis (CPITN 2 or 3). Three of four (75.0%) participants with dentures required either a reline or new dentures made. Oral ulcerations and oral candidiasis were most frequently observed in the edentulous participants.

The majority of participants (64.9%) did not have a regular dentist. Only one in three (31.9%) participants claimed to have visited a dentist in the previous twelve months, with a significant difference by their dentate status. A high proportion of the participants (77.0%) reported the reason for their last dental visit was problem-oriented. Lack of perceived need and cost of treatment were reported barriers to seeking dental treatment.

One in six (16.8%) participants described their oral health in general as fair to poor, while one in three (30.3%) participants experienced xerostomia; the overall mean Xerostomia Inventory score was 22.6. Dentate participants, those without xerostomia, and those reporting better oral health had lower total OHIP-20 scores; in other words, they reported to have better OHRQoL (P<0.01). Just over two-fifth of the participants (43.7%) reported experiencing one or more impacts fairly often or very often. Functional limitation (37.1%) was the most commonly experienced of the OHIP-20 dimensions, followed by physical disability and physical pain (18.0% and 15.6% respectively).

Conclusion: The older people included in the study are best described as “elderly”, medically compromised, functionally dependent but cognitively competent. The study has demonstrated that oral health of these older people is poor, and there is a definite need for oral health care. Treatment needs were high but there was a general lack of perceived need. Fewer than half reported an oral health impact on their quality of life, and functional limitation was the predominant aspect. Moreover, the dentate older people in the study had heavily restored dentition indicating a considerable demand for continuing restorative maintenance. If the general health prognosis for an older person is poor and transfers to long-term care facilities is inevitable, early and proper preventive measures and appropriate dental contact should be advocated. These steps are necessary to ensure that good oral health is achieved for older people before they become frail. It should be stressed that such collaboration can reduce morbidity, and improve quality of life for older people.