Oral health, experiences of oral care, associated factors, and mortality among older people in short-term care

Sammanfattning: Objective: The overall aim of this thesis was to describe oral health and oral health-related quality of life (OHRQoL), to compare self-perceived oral health with professional assessment, and to examine associated factors of importance for oral health, experiences, and mortality among older people in short-term care. Paper I describes oral health, daily oral care, and related factors among older people in short-term care and compares the older people’s self-perceived oral health with professional assessment of oral health. Paper II describes OHRQoL among older people in short- term care, and identifies associated factors. Paper III investigates the association between poor oral health, swallowing dysfunction, and mortality in older people. Paper IV describes how older people in short-term care experience their oral health and daily oral care.Methods: The thesis is part of a Swedish research study: Swallowing Function, Oral Health, and Food Intake in Old Age (SOFIA). In total, 391 older people from 36 short-term care units from 19 Swedish municipalities in 5 regions were included. Papers I–II are based on descriptive cross-sectional studies, Paper III is a prospective cohort study, and Paper IV is a descriptive qualitative study. Oral health was assessed professionally by clinical oral assessment (Papers I– II) and the Revised Oral Assessment Guide (ROAG) (Papers I–III). The older people’s perceived oral and general health was measured via self-reported questions (Papers I–II). Self- care ability was assessed with the Katz Index of Activities of Daily Living (Katz-ADL) (Papers I–III), OHRQoL was measured using the Oral Health Impact Profile (OHIP-14) (Paper II), and swallowing function was assessed with the Timed Water Swallow Test (TWST) (Paper III). Qualitative data were collected through fourteen individual interviews using a semi-structured interview guide (Paper IV). Data were analysed with descriptive statistics, Cohen-s kappa coefficient, logistic regression models, survival analysis, and inductive content analysis.Results: Papers I–III: The median age of the 391 participants was 84 years, and 209 (53%) were women; 167 (43%) had at least 20 remaining teeth and 74 (19%) were completely edentulous. A need for dental treatment was identified among 148 (41%) of the older people. A total of 74 (19%) participants received some or entire help with oral self-care, and 190 (54%) had less good to poor oral hygiene (Papers I–II). Oral problems according to ROAG were identified in 297 (77%) participants, with the most frequent problems being related to teeth and dentures (Papers I–III). There was a low level of agreement between the clinical assessment based on ROAG and the older people’s self-perceived oral health (Paper I). Poor OHRQoL was reported by 125 (34%) and associated factors were swallowing problems according to ROAG; quite poor/ poor self-perceived physical, psychological, and oral health; and being a woman (Paper II). Poor oral health and swallowing dysfunction were both independently associated with 1-year mortality, and in combination they predicted the highest mortality rate (Paper III). The older people’s experiences of oral health and daily oral care could be expressed as one main category: Adapting to a changed oral condition while striving to retain independence (Paper IV).Conclusion: Oral problems were identified among most older people in short-term care, although the participants claimed that they were satisfied with their oral health. There was an association between OHRQoL and self-perceived health and oral problems. Poor oral health and swallowing dysfunction were risk factors for 1-year mortality. These results show the importance of both asking older persons about how they perceive their oral health and making systematic assessment of oral health status and swallowing function. The ability to perform daily oral care and need for assistance with oral care should be included in the individual care planning. A close collaboration among different health professionals is important to support older people’s oral health and quality of life.