Flemish Netherlands Geriatric Oral Research Group

Gent, Belgium

Flemish Netherlands Geriatric Oral Research Group

Gent, Belgium
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Bots-Vantspijker P.C.,Flemish Netherlands Geriatric Oral Research Group | Bots-Vantspijker P.C.,Radboud University Nijmegen | Vanobbergen J.N.O.,Flemish Netherlands Geriatric Oral Research Group | Vanobbergen J.N.O.,Ghent University | And 7 more authors.
Community Dentistry and Oral Epidemiology | Year: 2014

Objective To identify barriers of delivering oral health care to older people experienced by dentists. Methods A comprehensive literature search was carried out for studies published in the period January 1990-December 2011, using free text and MESH term search strategies for PubMed (Medline), EMBASE and CINAHL. Results The initial search identified 236 potentially relevant publications: PubMed (Medline; n = 127), EMBASE (n = 108) and CINAHL (n = 1). After screening of titles and abstracts, 14 publications were revealed as relevant for further review. Seven articles, focusing on dentists delivering oral health care to older people in care homes, were suitable for this review, and seven articles did not meet the previously determined quality criteria. One of these articles also focused on barriers experienced by dentists working in their own practice and delivering oral health care to community-dwelling older people. Conclusions The most common barriers of delivering oral health care to older people were identified respectively as: the lack of adequate equipment in a care home and no area for treatment available (n = 4) and the lack of adequate reimbursement for working in a care home (n = 5). In addition, the inadequate training and experience in delivering oral health care to older care home residents (n = 2) were mentioned. Four publications indicated the loss of time from private practice as a barrier to deliver oral health care in a care home. We suggest that additional research should be initiated to investigate more in detail the barriers dentists experience in delivering oral health care to older people in their own dental practices. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


PubMed | HAN University of Applied Sciences, Flemish Netherlands Geriatric Oral Research Group and Radboud University Nijmegen
Type: | Journal: BMC geriatrics | Year: 2016

In nursing home residents, it is not possible to distinguish pneumonia and aspiration pneumonia clinically. International literature reveals no consensus on which and how many characteristics and risk indicators must be present to diagnose (nursing home-acquired) pneumonia and aspiration pneumonia. The aim of this survey was to reach consensus among a panel of clinical medical experts in geriatrics and pulmonology about the characteristics required for diagnosing pneumonia, and about the risk indicators needed to consider the diagnosis aspiration pneumonia in nursing home residents with pneumonia.Literature review and three expert-rating iterations using the electronically-modified Delphi Method were carried out. After each expert rating iteration, data analysis was performed. Qualitative responses and additional (nursing home-acquired) pneumonia characteristics which were mentioned in reply to structured open-ended questions were summarised, whilst similar responses were combined and these combinations were ordered by frequency in order to use them in the next iteration. Characteristics which failed to reach consensus were considered as inconclusive and eliminated. Consensus was reached when at least 70 % of the participants agreed.Literature review revealed 16 currently used common characteristics for diagnosing (nursing home-acquired) pneumonia. No consensus was reached about characteristics and the number of characteristics required for diagnosing (nursing home-acquired) pneumonia. However, 57 % agreed that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are the most important characteristics and the responses by the participants suggested that two or three characteristics should be present. Subsequently, 80 % of the participants agreed on the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment for considering the diagnosis aspiration pneumonia in nursing home residents with pneumonia.No final consensus could be reached about which and how many characteristics are required for diagnosing pneumonia in nursing home residents. However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. With regard to considering aspiration pneumonia in nursing home residents with pneumonia, final consensus was reached about the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment.


PubMed | HAN University of Applied Sciences, Flemish Netherlands Geriatric Oral Research Group and Radboud University Nijmegen
Type: Journal Article | Journal: BMJ open | Year: 2015

Pneumonia is an important cause of death in care home residents. Dysphagia and poor oral health are significant risk factors for developing aspiration pneumonia. Oral hygiene care reduces the number of oral bacteria and the risk of aspiration pneumonia. However, it is not clear yet which oral hygiene care intervention is most efficacious in reducing the risk of aspiration pneumonia. The aim of the study is to assess whether the application of a 0.05% chlorhexidine-containing solution in addition to the usual daily oral hygiene care reduces the incidence of pneumonia in physically disabled care home residents with dysphagia.The study was designed as a multicentre cluster randomised controlled clinical trial, with care homes as units of randomisation. During 1 year, 500 physically disabled care home residents with dysphagia will be followed. The intervention consists of applying a 0.05% chlorhexidine-containing solution twice daily, immediately after the usual oral hygiene care, whereas the control group receives no application after the usual oral hygiene care. The primary outcome is the incidence of pneumonia diagnosed by a physician, using a set of strictly described criteria. The effect of the intervention on the incidence of pneumonia will be determined using a Cox regression analysis. The secondary outcomes are correlations between incidence of pneumonia, age, gender, diagnosed diseases, dysphagia severity, care dependency, actually used medication, number of teeth and implants present and the presence of removable dentures.Ethical approval was obtained from the Medical Ethical Committee of Radboud university medical centre: NL.nr: 41990.091.12. Written and informed consent will be obtained from all participating care homes and residents. The studys findings will be published in peer-reviewed journals.The trial has been registered in the Netherlands in the National Trial Register: TC=3515.


De Visschere L.,Ghent University | De Visschere L.,Flemish Netherlands Geriatric Oral Research Group | De Baat C.,Radboud University Nijmegen | De Baat C.,Flemish Netherlands Geriatric Oral Research Group | And 8 more authors.
Gerodontology | Year: 2015

Objective This qualitative study explored barriers and enabling factors to the implementation of an oral hygiene protocol in nursing homes. Background Oral health care in nursing homes in Flanders (Belgium) is inadequate. Materials and methods Qualitative data were obtained from nurses employed in 13 nursing homes involved in two randomised controlled trials in Flanders-Belgium. Data were collected by focus group and face-to-face interviews during April 2005 and December 2009. All transcripts were analysed with support of NVivo 8 (Version 2008). Transcripts were intuitively analysed in a two-step method. Results Most revealed barriers were consistent with previous findings in the literature. Newly reported barriers were respect for residents' self-determination, experience based oral health care by nurses, residents' oral health status and nurses' inability to notice residents' oral health status. Demand-driven oral health care was found to be a strong enabling factor. Conclusion The integration of oral health care into day-to-day care seems to be a major problem due to a multitude of barriers. In future implementation innovations in oral health care an a priori assessment of influencing factors is recommended. © 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.


Van Der Maarel-Wierink C.D.,Flemish Netherlands Geriatric Oral Research Group | Van Der Maarel-Wierink C.D.,Radboud University Nijmegen | Vanobbergen J.N.O.,Flemish Netherlands Geriatric Oral Research Group | Vanobbergen J.N.O.,Ghent University | And 5 more authors.
Gerodontology | Year: 2013

Objective: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. Background: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. Methods: Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality. Results: Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity. Conclusions: According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia. © 2012 The Gerodontology Society and John Wiley & Sons A/S.


Van der Maarel-Wierink C.D.,Flemish Netherlands Geriatric Oral Research Group | Van der Maarel-Wierink C.D.,Radboud University Nijmegen | Meijers J.M.M.,Maastricht University | De Visschere L.M.J.,Flemish Netherlands Geriatric Oral Research Group | And 6 more authors.
International Journal of Nursing Studies | Year: 2014

Background: Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its early recognition and treatment. Objective: First, to assess the prevalence of subjective dysphagia in care home residents in the Netherlands. Second, to assess the associations of subjective dysphagia with potential risk factors of dysphagia. Design: Retrospective data-analysis of a cross-sectional, multi-centre point prevalence measurement. Setting: 119 care homes in the Netherlands. Participants: Data of 8119 care home residents aged 65 years or older were included and analyzed. Methods: Subjective dysphagia was assessed by a resident's response to a dichotomous question with regard to experiencing swallowing problems. If a resident was not able to respond (e.g. residents with dementia or aphasia), the question was answered by the ward care provider, or the resident's file was consulted for registered swallowing complaints and/or dysphagia. Several residents' data were collected: gender, age, (number of) diseases, the presence of malnutrition, the Care Dependency Scale score, and the body mass index. Results: Subjective dysphagia was found in 751 (9%) residents. A final model for subjective dysphagia after multivariate backward stepwise regression analysis revealed eight significant variables: age ( B -0.022), Care Dependency Scale score ( B -0.985), 'malnutrition' (OR 1.58; 95% CI 1.31-1.90), 'comorbidity' (OR 1.07; 95% CI 1.01-1.14), and the disease clusters 'dementia' (OR 0.55; 95% CI 0.45-0.66), 'nervous system disorder' (OR 1.55; 95% CI 1.20-1.99), 'cardiovascular disease' (OR 0.81; 95% CI 0.67-0.99) and 'cerebrovascular disease/hemiparesis' (OR 1.74; 95% CI 1.45-2.10). Conclusion: It seems justified to conclude that subjective dysphagia is a relevant care problem in older care home residents in the Netherlands. Care Dependency Scale score, 'malnutrition', and the disease clusters 'dementia', 'nervous system disorder', and 'cerebrovascular disease/hemiparesis' were associated with the presence of subjective dysphagia in this study. Age, 'comorbidity' and 'cardiovascular disease' showed very small influence. © 2013 Elsevier Ltd.


van der Maarel-Wierink C.D.,Flemish Netherlands Geriatric Oral Research Group | van der Maarel-Wierink C.D.,Radboud University Nijmegen | Vanobbergen J.N.O.,Flemish Netherlands Geriatric Oral Research Group | Vanobbergen J.N.O.,Ghent University | And 5 more authors.
Journal of the American Medical Directors Association | Year: 2011

Objective: To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. Design: Systematic literature review. Setting: PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009. Participants: Frail older people. Measurements: Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine. Results: A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited. Conclusion: Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited. © 2011 American Medical Directors Association.


PubMed | Academic Center for Dentistry Amsterdam, VU University Amsterdam and Flemish Netherlands Geriatric Oral Research Group
Type: Journal Article | Journal: Gerodontology | Year: 2016

The aim of this study was to investigate to what extent dentists in the Netherlands experience barriers in providing oral health care to community-dwelling older people.As most publications on the barriers in providing oral health care to older people consist of surveys on oral health care in care homes, it was decided to investigate the barriers dentists experience in their own dental practices while providing oral health care to community-dwelling frail older people.A representative sample of 1592 of the approximately 8000 dentists in the Netherlands aged 64 or younger were invited to respond to a questionnaire online. The dentists were asked to respond to 15 opinions concerning oral healthcare provision to community-dwelling frail older people aged 75 years or more who experience problems in physical, psychological and social areas, as well as possible financial problems.The total response rate was 37% (n = 595; male=76%; average age 49). The majority of those who responded agreed that the reimbursement of oral health care to older people is poor. Two thirds of those who responded (66%) agreed that there are limited opportunities to refer the frail and elderly with complex oral healthcare problems to a colleague with specific knowledge and skills.Dentists experienced barriers in two domains; a lack of knowledge and practical circumstances. It was concluded that the dentists gender, age, year of graduation and the number of patients aged 75 years or more treated weekly were in some respect, related to the barriers encountered.


van der Putten G.-J.,Flemish Netherlands Geriatric Oral Research Group | de Baat C.,Flemish Netherlands Geriatric Oral Research Group | De Visschere L.,Flemish Netherlands Geriatric Oral Research Group | Schols J.,Flemish Netherlands Geriatric Oral Research Group
Gerodontology | Year: 2014

This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.


PubMed | Flemish Netherlands Geriatric Oral Research Group
Type: Journal Article | Journal: Gerodontology | Year: 2013

To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia.Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people.Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality.Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity.According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.

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