A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults.

OBJECTIVES: The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. METHODS: This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. RESULTS: The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. CONCLUSIONS: Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.

Moving toward a competency-based curriculum: Analyzing patients' information and students' evaluation in geriatric dentistry.

OBJECTIVE: There is no core competency for geriatric dentistry and special patient care (GSP) in Thailand. Therefore, GSP program was developed as a knowledge-based curriculum. This study aimed to describe the development and architecture of the GSP curriculum by analyzing patients' information and students' evaluation to move toward a competency-based curriculum. Comparisons with the original GSP curriculum and future direction are discussed. METHODS: Development and architecture of the GSP curriculum were described. Information of 130 patients attending the GSP clinic, and those who participated in a maintenance recall was analyzed. Students' evaluation was performed using a 21-item questionnaire within seven domains based on the ASEAN University Network-Quality Assurance (AUN-QA) checklist. The responses were made using a five-point ordinal scale ranging from totally agree to totally disagree. RESULTS: Only 50% of the patients attended a maintenance recall. Among the recalled patients, 74.2% reported emerging problems. The AUN-QA questionnaire responses indicated that students mostly agreed with the program specification, teaching and learning approach, students' assessment methods, student quality, and support domains. The modified curriculum was developed based on the patients' information and students' evaluation. The original and modified GSP curricula were compared. CONCLUSIONS: Information analysis of the patients and students' evaluation are essential to move a knowledge-based curriculum for geriatric and special patient care dentistry toward a competency-based curriculum that is appropriate for patients' condition and serves students' requirements. Oral health care in elderly and special care patients requires a multidisciplinary approach, and should encompass oral disease problems, behavior, and social context.