[Development and validation of the Mini Dental Assessment : A procedure for improved estimation of need for dental treatment in geriatrics]. / Entwicklung und Validierung des "Mini Dental Assessment" : Ein Verfahren zur besseren Einschätzung des zahnärztlichen Behandlungsbedarfes in der Geriatrie.

BACKGROUND: In the future there will be an increasing demand for professional care with simultaneous retention of the dentition in older people. Due to inadequate dental knowledge, it is often not possible for caregivers to adequately assess dental deficits. OBJECTIVE: The aim of the study was to develop and validate a simple tool (Mini Dental Assessment, MDA) to assess possible dental treatment needs (DTN) of residential geriatric facilities by nursing personnel. MATERIAL AND METHODS: In the study 169 patients (51 from the University Hospital Giessen, 118 from the Bonifatius Hospital Lingen) underwent a dental examination. The dental status was evaluated based on the California Dental Association (CDA) criteria and the DTN determined. In addition, the time since the patients last visit to a dentist (TLVD) and denture age (DA) were documented and a chewing function test (carrot eating test, CET) was carried out. In a second study 155 patients were examined (115 from the University Hospital Giessen, 40 from the Bonifatius Hospital Lingen) corresponding to the reference sample and including a further chewing function test (after Schimmel und Slavicek) and questionnaires on quality of life (Oral Health Impact Profile (OHIP), Denatl Impact on Daily Living (DiDDL)). RESULTS: A total of 108 patients required dental treatment. The mean value (±SD) for the TLVD was 2.5 ± 3.8 years and 10.8 ± 8.9 years for the DA. There was a positive correlation (Spearman, P < 0.005) between the DTN and degree of comminution in the CET (3.4 ± 1.8 grade). Based on the results an assessment tool was developed using the variables CET, TLVD and DA weighted by the respective regression coefficients (10:3:1). The resulting mean total MDA score was 51.32 ± 28.14. A sensitivity/specificity analysis was conducted and a receiver operating characteristic (ROC) curve calculated (area under curve, AUC: 0.805; 95% CI: 0.738-0.873). The ROC curve from the follow-up study showed a good agreement with the ROC curve from the reference study (AUC 0.829, 95% CI: 0.751-0.907). CONCLUSION: Based on the results of the study it could be shown that the MDA is a suitable instrument for making a valid statement on the assessment of DTN of patients in long-term care facilities. The validation study revealed the validity of the MDA in its originally developed form and the addition of two further chewing function tests did not significantly improve the validity of the MDA. Overall, the MDA appears to be an appropriate tool to help nursing home personnel to assess the necessity for nursing home residents to visit a dentist.

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force.

Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulated via discussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.

Developing effective animal-assisted intervention programs involving visiting dogs for institutionalized geriatric patients: a pilot study.

AIM: An ever increasing interest in the therapeutic aspects of the human-animal bond has led to a proliferation of animal-assisted interventions (AAI) involving dogs. However, most of these programs lack a solid methodological structure, and basic evaluative research is needed. The purpose of this study was to test the value of dog-assisted interventions as an innovative tool to increase quality of life in the geriatric population. METHODS: Nineteen patients (men and women) with a mean age of 85 years participated in the study. Interactions between patients and visiting dogs occurred either in a social situation (socialization sessions) or in a therapeutic context (physical therapy sessions). We derived and characterized a specific ethogram of elderly-dog interactions aimed at evaluating the effectiveness of visiting dogs in improving mood, catalyzing social interactions and reducing their everyday apathetic state. Cortisol levels were also measured in the saliva, and depressive state was evaluated. RESULTS: Overall, results show a time-dependent increase in social behaviour and spontaneous interactions with the dogs. Dog-mediated interactions affected the daily increase in cortisol levels, thus having an 'activational effect', in contrast to the apathetic state of institutionalized elderly. CONCLUSIONS: Dog-mediated intervention programs appear to be promising tools to improve the social skills and enrich the daily activities of the institutionalized elderly.

Focus on the Different Projects of Telemedicine Centered on the Elderly In France.

Telemedicine is now in vogue, allowing computer and communication tools to be deployed in different fields of health, such as Cardiology, Dermatology, areas in which it has received interest, and in international studies. As the population ages, older people are increasingly concerned about this innovative practice. This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of geriatric subjects in France. Since the beginning of the 2000's, several telemedicine projects and trials focused on chronic heart failure have been developed in the elderly, and also in the field of dermatology. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and the number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects. We take a look at telemedicine projects in France concerning the elderly.

Oral health in geroscience: animal models and the aging oral cavity.

Age is the single greatest risk factor for many diseases, including oral diseases. Despite this, a majority of preclinical oral health research has not adequately considered the importance of aging in research aimed at the mechanistic understanding of oral disease. Here, we have attempted to provide insights from animal studies in the geroscience field and apply them in the context of oral health research. In particular, we discuss the relationship between the biology of aging and mechanisms of oral disease. We also present a framework for defining and utilizing age-appropriate rodents and present experimental design considerations, such as the number of age-points used and the importance of genetic background. While focused primarily on rodent models, alternative animal models that may be particularly useful for studies of oral health during aging, such as companion dogs and marmoset monkeys, are also discussed. We hope that such information will aid in the design of future preclinical studies of geriatric dental health, thus allowing more reliability for translation of such studies to age-associated oral disease in people.

Dental status, visits, and functional ability and dietary intake of elderly in Israel.

BACKGROUND: Epidemiological studies have shown deterioration in dental health accompanying the ageing process. Tooth loss increases with age. Chewing ability is closely correlated with number of natural teeth present: there is a threshold of 20-21 teeth, below which chewing ability declines. The government of Israel is currently considering adding dental treatment for elderly to the basket of services of the National Health Insurance Law. Information on the influence of elderly's dental health on nutrition and general health status can contribute to the decision making process. METHODS: Secondary analysis of data collected on a subsample (N = 1776) of the cross-sectional Mabat Zahav - National Health and Nutrition Survey of the Elderly was done. Intakes of energy, fiber, protein, fruits and vegetables, associations with dental visits, dentures presence and functional ability were analyzed. Linear regression adjusted for confounders was performed. RESULTS: Statistically significant differences in dietary intake of energy, fiber, protein and vegetables were found between elderly who visited a dentist in the last year and those who did not. Elderly who possessed dentures had lower dietary intakes than their dentate counterparts. Elderly with functional problems such as impaired chewing had worse dietary intakes than the others. This was so after controlling for education, degree of interest in the relationship between nutrition and health and reading the nutrition label. CONCLUSIONS: The findings in our study suggest that those who visited a dentist in the last year, had natural teeth and no denture/s and reported no chewing problems had better dietary intake. The results emphasize the importance of maintaining adequate dental health, preserving natural teeth and regular dental visits in the elderly to assure adequate nutrient status in this age group.

Unintentional Weight Loss in Older Adults: A Geriatric Interprofessional Simulation Case Series for Health Care Providers.

Introduction: Interprofessional teams can provide better care and management of complex geriatric patients. Unintentional weight loss in older patients can lead to significant morbidity and mortality and functional decline. This simulation curriculum focuses on teaching learners from all health care professions how to use the Carolina Geriatrics Workforce Enhancement Program unintentional weight loss tool and flowchart (T&F) to identify, diagnose, and create a plan of care for weight loss in geriatric patients. Methods: A presentation on use of the T&F and two standardized patient cases utilizing the T&F in an interprofessional team are included. Case 1 presents a 71-year-old male with dementia who has lost 20 pounds, with weight loss secondary to cognitive impairment, denture problems, oral candidiasis, and polypharmacy. Case 2 presents a 67-year-old female with a history of depression and breast cancer who has lost 15 pounds, likely related to alcohol dependence, social isolation, oral cancer, and food insecurity. Pre- and posttests measure knowledge gained through the course. Results: Overall knowledge of unintentional weight loss improved in the 14 learners who participated in two pilot sessions. Test scores improved an average of 1.2 points from pre- to posttest. Participants felt that interprofessional teams increased the quality of care provided to patients and job satisfaction. Discussion: This tool can be utilized by practitioners from multiple disciplines. By completing the curriculum, learners gain knowledge of how to identify geriatric patients with significant weight loss, determine next steps in diagnosis and workup, and work in an interprofessional group.

Assessment of masticatory performance by means of a color-changeable chewing gum.

PURPOSE: Previous research determined the relevance of masticatory performance with regard to nutritional status, cognitive functions, or stress management. In addition, the measurement of masticatory efficiency contributes to the evaluation of therapeutic successes within the stomatognathic system. However, the question remains unanswered as to what extent modern techniques are able to reproduce the subtle differences in masticatory efficiency within various patient groups. The purpose of this review is to provide an extensive summary of the evaluation of masticatory performance by means of a color-changeable chewing gum with regard to its clinical relevance and applicability. STUDY SELECTION: A general overview describing the various methods available for this task has already been published. This review focuses in depth on the research findings available on the technique of measuring masticatory performance by means of color-changeable chewing gum. Described are the mechanism and the differentiability of the color change and methods to evaluate the color changes. Subsequently, research on masticatory performance is conducted with regard to patient age groups, the impact of general diseases and the effect of prosthetic and surgical treatment. RESULTS: The studies indicate that color-changeable chewing gum is a valid and reliable method for the evaluation of masticatory function. CONCLUSION: Apart from other methods, in clinical practice this technique can enhance dental diagnostics as well as the assessment of therapy outcomes.

Undergraduate Students' Knowledge on Temporomandibular Disorders in Croatia.

The aim of this study was to evaluate Croatian undergraduate students' knowledge based on what they learned in the recent course, as well as the students' own judgment and opinions about geriatric dentistry education concerning temporomandibular disorders (TMDs) of the elderly. The study was carried out by means of a questionnaire administered in the last study year to students of the School of Dental Medicine, University of Zagreb and students of the Department of Dental Medicine at the School of Medicine, University of Rijeka. Th e questionnaire included questions about relevant specific knowledge on TMD, and statements related to their own opinion about geriatric dentistry education received during the study. Regarding students' knowledge related to TMDs, students from Rijeka gave more positive answers (p=0.012). Students from Rijeka gave more positive answers regarding physical therapy for treatment of TMD (p=0.004) and disc displacement and osteoarthritis as the most common disorders of the temporomandibular joint (p=0.031). Students from Zagreb were more unsatisfi ed with the skills in the field of geriatric dentistry (disagreed 57.45%) than students from Rijeka (45.83% had neutral standpoint and 37.50% agreed) (p=0.005). The level of the participants' knowledge pointed to the need of improving undergraduate dental teaching about the specific geriatric education, including knowledge about TMD.

Tego: a new concept of teledentistry for the elderly through a web platform and mobile app in the context of the covid-19 pandemic / Tego: un nuevo concepto de teleodontología para adultos mayores a través de una plataforma web y aplicación móvil en el contexto de la pandemia del covid-19

Objective: To develop a new concept of teledentistry for the elderly through a web platform and associated mobile application in the context of the COVID-19 pandemic. Material and Methods: A new concept for attention via teledentistry of the elderly supported by the web platform/app TEGO (Acronym for Tele-platform of Geriatric and Dental Specialties in Spanish) was developed. Priority and urgent dental care for elderly patients in the context of the COVID-19 pandemic was provided onboard a mobile dental clinic equipped with all the necessary conventional dental care facilities as well as state-of-the-art digital technology. Dental care was carried out in five cities of Chile. For the study, 135 elderly patients were treated. The tele-dental care model includes visit-appointment and remote interconsultation with a staff of specialists. To evaluate patient satisfaction aspects, regarding the service / care provided, a user satisfaction survey was applied. Results: A total of 68 questionnaires were completed by patients. The results showed high levels of patients' satisfaction after the priority or urgent dental care, which reached above 75% in all dimensions of the questionnaire (Access to dental care, user treatment, platform, recommendation). Conclusion: The generation of a technological ecosystem for teledentistry can provide a series of important advantages in the attention of elderly patients, by optimizing the dental care coverage by different specialists who can provide attention to a population that has limited or no access to them.

Objetivo: Desarrollar un nuevo concepto de teleodon-tología para adultos mayores a través de una plataforma web y aplicación móvil asociada en el contexto de la pandemia de COVID-19. Material y Métodos: Se desarrolló un nuevo concepto de atención vía teleodontología del adulto mayor apoyado en la plataforma/app web TEGO (Teleplataforma de Especialidades Geriatricas y Odontológicas). La atención dental prioritaria y urgente para pacientes de edad avanzada en el contexto de la pandemia de COVID-19 se brindó a bordo de una clínica dental móvil equipada con todas las instalaciones de atención dental convencional necesarias, así como con tecnología digital de última generación. La atención odontológica se realizó en cinco ciudades de Chile. Para el estudio, 135 pacientes de edad avanzada fueron atendidos. El modelo de atención teledental incluye visita-cita e inter-consulta remota con un staff de especialistas. Para evaluar los aspectos de satisfacción del paciente, respecto al servicio/atención brindada, se aplicó una encuesta de satisfacción del usuario. Resultados: Los pacientes completaron un total de 68 cuestionarios. Los resultados mostraron altos niveles de satisfacción de los pacientes tras la atención odontológica prioritaria o urgente, que superó el 75% en todas las dimensiones del cuestionario (Acceso a la atención odontológica, trato al usuario, plataforma, recomendación). Conclusión: La generación de un ecosistema tecnológico para la teleodontología puede brindar una serie de ventajas importantes en la atención de pacientes adultos mayores, al optimizar la cobertura de atención odontológica por parte de diferentes especialistas que pueden brindar atención a una población que tiene acceso limitado o nulo.

Relationship Between Mitochondrial DNA Mutations and Aging. Estimation of Age-at-death.

Some studies have pointed to the relationship between mitochondrial DNA (mtDNA) mutations and age in different tissues, which are potentially interesting in aging research and in forensic identification because they could help to improve the estimation of age-at-death. The present study aims to evaluate the mutations in mtDNA from dentin and pulp and their relation with age. Healthy erupted third molars were extracted from individuals from two Spanish populations, aged 20-70. When analyzing the amplification of hypervariable region 2 of the mtDNA by real-time polymerase chain reaction, a negative strong linear correlation was found between the mtDNA amplification and age in dentin from both populations. In contrast, a significant correlation between mtDNA amplification and age in pulp was not discovered, probably due to the majority of the mitochondria are placed in dentin. A difference in mtDNA damage between these two populations was also detected, indicating the role of ancestry as a component. The findings from this research enrich the current studies related to aging and mitochondrial damage and provide a new quantitative tool for estimating the age-at-death that, in combination with traditional age markers, could improve identification accuracy in forensic cases.

The effect of chlorhexidine in reducing oral colonisation in geriatric patients: a randomised controlled trial.

INTRODUCTION: Inadequate oral care has been implicated in the development of aspiration pneumonia in frail geriatric patients and is a major cause of mortality, due to the colonisation of microbes in vulnerable patients. This type of pneumonia has been associated with an increase in respiratory pathogens in the oral cavity. The aim of this study was to evaluate the effects of chlorhexidine compared to routine oral care in edentulous geriatric inpatients. METHODS: A double-blind, parallel-group randomised controlled trial was carried out. The intervention group received oral care with chlorhexidine 0.2%, while the control group received routine oral care with thymol. Nurses provided oral care with assigned solutions of 20 mL once daily over seven days. Oral cavity assessment using the Brief Oral Health Status Examination form was performed before each oral care procedure. Data on medication received and the subsequent development of aspiration pneumonia was recorded. An oral swab was performed on Day 7 to obtain specimens to test for colonisation. RESULTS: The final sample consisted of 35 (control) and 43 (intervention) patients. Chlorhexidine was effective in reducing oral colonisation compared to routine oral care with thymol (p < 0.001). The risk of oral bacterial colonisation was nearly three times higher in the thymol group compared to the chlorhexidine group. CONCLUSION: The use of chlorhexidine 0.2% significantly reduced oral colonisation and is recommended as an easier and more cost-effective alternative for oral hygiene.

How physicians approach advance care planning in patients with mild to moderate Alzheimer's disease.

Decision-making ability regarding end-of-life issues is often compromised by dementia in patients with Alzheimer's disease. This study assessed physicians' discussions of advance care planning with patients with mild to moderate Alzheimer's disease. Data were collected by a survey of full-time faculty in the departments of Medicine and Family Medicine and the Center for Aging at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, as well as physicians in private practice affiliated with the Kennedy Health System. Data consisted of questions that assessed whether advance care planning was provided, what specific topics were discussed, and what actions were taken if advance care planning was not offered. Of the 271 physicians to whom the survey was sent, 63 responded, for a return rate of 23%. Of those responding, 81% indicated that they counseled their patients regarding advance care planning issues, while 19% did not. Of those who provided advance care planning for their patients (N = 51), 88% discussed living wills; 53%, the durable power of attorney for healthcare; 47%, end-of-life care; and 35%, financial planning issues. Thirty-seven percent recommended an elder law attorney, and 31% made a referral to the Alzheimer's Association. Of those who provided advance care planning for their patients' caregivers (N = 51), 86% discussed living wills; 78%, nursing home care; 69%, driving issues; and 47%, end-of-life care. Twenty-five percent referred their patients to an elder law attorney. Results indicate that physicians need to be more knowledgeable and proactive in their approaches to advance care planning for patients with mild to moderate Alzheimer's disease.

Paying attention to pharmacokinetic and pharmacodynamic mechanisms to progress in the area of anticholinergic use in geriatric patients.

Many naturalistic studies agree that adverse drug reactions (ADRs), particularly cognitive deficits, frequently occur when medications with anticholinergic activity are used in geriatric patients. However, the studies disagree on which anticholinergic drugs may have clinical relevance. The three most important methods to establish clinically relevant anticholinergic activity are: 1) the drug's affinity for muscarinic receptors, demonstrated by in vitro studies and a profile compatible with antagonist properties; 2) serum anticholinergic activity measured by radioreceptor assay; and 3) the presence of typical antimuscarinic ADRs, such as dry mouth and constipation, in patient studies or clinical trials. More recently, brain imaging of muscarinic receptors and scales for quantifying antimuscarinic activity were developed. A comprehensive approach can be crafted only by paying attention to the pharmacodynamic and pharmacokinetic mechanisms of these drugs. ADR studies on drugs with anticholinergic activity should not only consider central muscarinic receptor blockade, but also peripheral receptor blockade. The ability to cross the blood-brain barrier is important in the drug's ADR profile. Patient personal characteristics, drug-drug interactions (DDIs) and probably genetic variations may contribute to increased ADR risk through pharmacokinetic and/or pharmacodynamic mechanisms. Sophisticated clinical designs and the evidence-based medicine approach cannot succeed unless the list of drugs of anticholinergic activity is agreed upon, and the studies include a sophisticated pharmacological approach guided by our current understanding of their pharmacodynamic and pharmacokinetic mechanisms. If one agrees that antimuscarinic ADRs are probably dose-related, future studies must consider all drugs, administration routes, doses, muscarinic receptor affinity, DDIs, and brain access.

Measuring human functional age: a review of empirical findings.

A review of empirical functional age studies published in English was conducted. Types of biomarkers used in functional age studies included sensorimotor, cognitive, psychosocial, behavioral, anthropometric, biomedical, physiological, and dental variables. Previous criticisms of the validity and utility of functional age research were evaluated with reference to empirical studies. While some of these criticisms remain valid, areas of research currently using established biomarkers to predict functional outcomes were identified, including driving, falls, and cognitive functioning. It was concluded that the success of functional age research is dependent on the relevance of biomarkers to specific functional outcomes.