Poor Oral Health in Hospitalized Patients Associated With Dementia and Kidney Disease

MedicalResearch.com Interview with:

Danielle Mairead Maire Ni Chroinin, MB BCh BAO BMedSc MD MRCPI FRACP Staff Specialist in Geriatric Medicine Liverpool Hospital and Senior Conjoint Lecturer UNSW

Dr. Danielle Ni-Chroinin

Danielle Mairead Maire Ni Chroinin,

Staff Specialist in Geriatric Medicine
Liverpool Hospital and Senior Conjoint Lecturer UNSW

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Oral disease may have a large impact on older persons’ health and wellbeing, causing pain, impairing speech, adversely affecting nutrition, contributing to systemic infection and harming self-esteem. However, this important issue may be neglected in the acute hospital setting. Our aim was to investigate oral health status and abnormalities in older patients admitted acutely to hospital, exploring the association with medical co-morbidities. We included all individuals aged 70 and older admitted to a geriatric service over 3 months (N=202), and evaluated oral health using a simple bedside tool the Oral Health Assessment Tool (OHAT).

Overall, we found that poor oral health was not uncommon, and was associated with dementia and renal impairment. This association persisted even after adjustment for anticholinergic medication and oral pH, highlighting that patients with these conditions may be particularly vulnerable.

MedicalResearch.com: What should readers take away from your report?

Response: The top three take-home messages from this study are that oral disease is not uncommon in older persons, that hospitalisation may allow for opportunistic assessment and management, and that certain subgroups- namely those with renal impairment or dementia- may be at particular risk. Nonetheless it must be stressed that this was a single-centre study,with small numbers of patients with advanced renal disease, and as such, our findings should be considered hypothesis-generating.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further research might investigate not only the effect of routinely using tools such as the OHAT during acute hospital episodes, but also the effect of targeted interventions for particularly high-risk groups (such as those which were associated with poorer oral health status in our study), and the potential benefits and costs of any practice guidelines. In the interim, we hope that studies such as this will raise awareness of oral assessment as part of comprehensive patient care.

MedicalResearch.com: Is there anything else you would like to add?

Response: Studies such as this only highlight the tip of the iceberg when it comes to oral health and disease in older populations. The Australian New South Wales Oral Health and Ageing draft Strategy document states that the availability of “accurate evidence-based information on needs and demands” is a key element in establishing effective public health policy. In our comprehensive cross-sectional study, we found that poor oral health status is common in acutely-admitted geriatric patients. However, performing comprehensive oral assessments in the acute hospital setting may be difficult, in the context of an acute illness where the patient may be very unwell and/or the focus is on other pressing health issues, and with the pressures on acute hospital beds, which continuously urge shorter lengths-of-stay. Assessment in the acute hospital should thus be seen to compliment community-based assessment and management strategies, including those targeting persons with dementia and individuals in residential aged care.

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Oral Health Status Is Associated with Common Medical Comorbidities in Older Hospital Inpatients Danielle N ı Chroin ın, MD,*† Adrian Montalto, BOH,‡ Shahrzad Jahromi, MBBS,* Nicholas Ingham, MBBS,* Alexander Beveridge, MBBS,* and Peter Foltyn, BDent
Journal compilation © 2016, The American Geriatrics Society

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Last Updated on August 6, 2016 by Marie Benz MD FAAD