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Assessments of oral health status in frail patients in hospital
Kristianstad University, Department of Health Sciences.ORCID iD: 0000-0003-0269-730X
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aims of this thesis were to evaluate the usefulness of an oral assess¬ment guide and to determine the oral health status among frail patients in hospital settings. A further aim was to analyze possible factors that may be associated with oral health status, with special focus on the relationship between oral health and nutritional status among elderly rehabilitation patients. The Oral Assessment Guide (OAG) was used in patients with haematological malignancies undergoing chemotherapy. In further studies a Revised Oral Assessment Guide (ROAG) was used among geriatric rehabilitation patients. The inter-rater reliability of the OAG between registered nurses at the ward and a dental hygienist (DH) was good, as well as between a registered nurse and a DH using ROAG. Problems in the oral cavity were detected in all patients with haematological malignancies undergoing chemotherapy. Problems related to mucous membranes, teeth and/or dentures were most frequent. Oral health problems were also a frequent finding among the geriatric rehabilitation patients. The frequency of oral health problems was significantly lower at discharge compared to admission. Oral health problems were more often found among patients that stayed for longer periods at the hospital, were more dependent on help with daily activities and suffered for dysphagia, than among the healthier patients. Oral health problems were more common among the patients being at risk of undernourishment, suspected to be or severely undernourished (UN), than among the well-nourished patients. Problems in oral health status were significantly associated with the occurrence of respiratory diseases, living in special accommodation, being UN and being a woman. The highest Odds Ratio (OR) was found in problems with gums in relation to the occurrence of respiratory diseases (OR 8.9; 95 % CI 2.8-27.8). OAG as well as ROAG were found to be useful for assessing oral health status in frail patients at hospital. Oral health problems were a frequent finding among the patients. The use of an oral assessment tool on a routine basis may facilitate the detection of problems which otherwise can be hidden, and can serve as a guide for initiating individualised oral health procedures.

Place, publisher, year, edition, pages
Malmö: Malmö högskola , 2004. , 68 p.
National Category
Dentistry
Identifiers
URN: urn:nbn:se:hkr:diva-5307ISBN: 91-628-6019-4 (print)OAI: oai:DiVA.org:hkr-5307DiVA: diva2:277001
Public defence
(English)
Available from: 2009-12-10 Created: 2009-11-13 Last updated: 2014-06-17Bibliographically approved
List of papers
1. Testing an oral assessment guide during chemotherapy treatmen in a Swedish care setting: a pilot study
Open this publication in new window or tab >>Testing an oral assessment guide during chemotherapy treatmen in a Swedish care setting: a pilot study
1999 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 8, no 2, 150-158 p.Article in journal (Refereed) Published
Abstract [en]

Oral complications are common in patients with haematological malignancies who undergo chemotherapy treatment. A pilot study including 16 haematological patients was carried out to evaluate the oral status using an Oral Assessment Guide (OAG) and to test the reliability of the OAG. The oral assessments were made daily by registered nurses at a Department of Internal Medicine in Sweden. Once a week a dental hygienist made the oral assessments independent of the registered nurses in order to provide data for calculations of inter-rater reliability. All patients had varying degrees of alterations in the oral cavity, especially in the mucous membranes, teeth/dentures and gums. The inter-rater agreement between the nurses and the dental hygienist was good for saliva and swallow, and moderate for voice and gums. Assessments to detect alterations in the oral cavity afford the opportunity for early and individualized interventions and may decrease the risk of oral infections. It is necessary to train the nurses to ensure high levels of reliability in the oral assessments. The OAG seems to be a reliable and clinical useful tool for assessing the oral cavity status and determining changes.

Keyword
acute leukaemia, chemotherapy, Hodgkin's disease, myeloma, non-Hodgkin's lymphoma, nursing care, oral assessment guide, oral health
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-5237 (URN)10.1046/j.1365-2702.1999.00237.x (DOI)000082095800005 ()10401348 (PubMedID)
Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2014-06-17Bibliographically approved
2. Inter-rater reliability of an oral assessment guide för elderly patients residing in a rehabilitation ward
Open this publication in new window or tab >>Inter-rater reliability of an oral assessment guide för elderly patients residing in a rehabilitation ward
2002 (English)In: Special Care in Dentistry, ISSN 0275-1879, Vol. 22, no 5, 181-186 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.

Keyword
lnter-rater reliability, elderly, oral health, oral assessment guide, nursing care
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-5239 (URN)10.1111/j.1754-4505.2002.tb00268.x (DOI)12580356 (PubMedID)
Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2014-06-17Bibliographically approved
3. Oral health and nutritional status in a group of geriatric rehabilitation patients
Open this publication in new window or tab >>Oral health and nutritional status in a group of geriatric rehabilitation patients
Show others...
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 3, 311-318 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to evaluate the oral health status and nutritional status in a group of geriatric rehabilitation patients, and to analyse the relationship between these two parameters. Nurses at the ward performed structured assessments of oral and nutritional status using the Revised Oral Assessment Guide and the Subjective Global Assessment form in 223 newly admitted patients. Most oral health problems were found among patients who stayed longer at the hospital and were more dependent on help as compared with the healthier patients. Thirty-four per cent of the patients were either severely undernourished, at risk or suspected to be undernourished (UN). Oral health problems were more common among UN patients (p < 0.0005) compared with well-nourished patients. The most frequent oral health problem was found on teeth or dentures (48%). Problems related to the tongue and lips were also common among UN patients (56 and 44%, respectively). Oral health status was correlated (r = 0.32) to nutritional status. Problems with swallowing had the strongest association to the nutritional status (OR 6.05; 95% CI 2.41-15.18). This study demonstrated that poor oral health status was related to undernourishment.

Keyword
geriatric rehabilitation patients, nutritional status, oral assessment guide, oral health status, undernourishment
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-5238 (URN)10.1046/j.1471-6712.2002.00086.x (DOI)000177832200015 ()12191044 (PubMedID)
Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2014-06-17Bibliographically approved
4. Comparison of oral health status on admission and discharge in a group of geriatric rehabilitation patients
Open this publication in new window or tab >>Comparison of oral health status on admission and discharge in a group of geriatric rehabilitation patients
2003 (English)In: Oral Health and Preventive Dentistry, Vol. 1, no 3, 221-228 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare oral health status on a geriatric rehabilitation ward among patients who were assessed using the Revised Oral Assessment Guide (ROAG) on admission and at discharge; and to investigate in what respect the oral health procedures (OHP) suggested in ROAG were applied when oral health problems were detected. MATERIALS AND METHODS: Registered nurses on the ward performed oral health assessments using ROAG with 107 patients on admission and at discharge. When oral health problems were detected measures to be taken were suggested using ROAG. RESULTS: Oral health problems were common among the patients on admission (86%), as well as at discharge (51%). The frequency of the problems was significantly lower at discharge compared to admission. The OHP that were recommended in ROAG were completely followed when saliva flow-related problems were detected. Regarding other oral health problems, measures other than the recommended ones were often performed. CONCLUSION: This study demonstrated that the oral health was better at the end of the hospital stay compared to admission.

National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-5240 (URN)15641500 (PubMedID)
Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2014-06-17Bibliographically approved
5. Oral health problems in elderly rehabilitation patients
Open this publication in new window or tab >>Oral health problems in elderly rehabilitation patients
Show others...
2004 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 2, no 2, 70-77 p.Article in journal (Refereed) Published
Abstract [en]

A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8–27.8; P < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.

Keyword
elderly rehabilitation patients, gender, nursing care, oral health problems, respiratory diseases. revised Oral Assessment Guide, special accommodation, undernourishment
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-5241 (URN)10.1111/j.1601-5029.2004.00073.x (DOI)16451465 (PubMedID)
Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2014-06-17Bibliographically approved

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