Abstract
BackgroundOral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. However, psychometric properties of RAI-MDS 2.0 oral/dental items have been challenged and criterion validity of these items has never been assessed.MethodsWe used 73,829 RAI-MDS 2.0 records (13,118 residents), collected in a stratified random sample of 30 urban nursing homes in Western Canada (2007–2012). We derived a subsample of all residents (n = 2,711) with an admission and two or more subsequent annual assessments. Using Generalized Estimating Equations, adjusted for known covariates of nursing home residents’ oral health, we assessed the association of oral/dental problems with time, dentate status, dementia, debris, and daily cleaning.ResultsPrevalence of oral/dental problems fluctuated (4.8 %–5.6 %) with no significant differences across time. This range of prevalence is substantially smaller than the ones reported by studies using clinical assessments by dental professionals. Denture wearers were less likely than dentate residents to have oral/dental problems (adjusted odds ratio [OR] = 0.458, 95 % confidence interval [CI]: 0.308, 0.680). Residents lacking teeth and not wearing dentures had higher odds than dentate residents of oral/dental problems (adjusted OR = 2.718, 95 % CI: 1.845, 4.003). Oral/dental problems were more prevalent in persons with debris (OR = 2.187, 95 % CI: 1.565, 3.057). Of the other variables assessed, only age at assessment was significantly associated with oral/dental problems.ConclusionsRobust, reliable RAI-MDS 2.0 oral health indicators are vital to monitoring and improving oral health related quality and safety in nursing homes. However, severe underdetection of oral/dental problems and lack of association of well-known oral health predictors with oral/dental problems suggest validity problems. Lacking teeth and not wearing dentures should be considered an indicator for urgent oral/dental treatment needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0108-y) contains supplementary material, which is available to authorized users.
Highlights
Oral health in nursing home residents is poor
Oral/dental problems Tooth problems, periodontal problems, and mouth pain fluctuated across assessments (Table 1)
The final adjusted model, including all covariates, indicated that the odds to have oral/dental problems were less than half as high for denture wearers than for dentate residents
Summary
Oral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. Older people are at particular risk for poor oral health As people age, their oral health deteriorates, partly through physical changes but primarily through reduced/ limited access to dental services [5] and through chronic diseases that increase frailty and limit ability for self-care [6]. Their oral health deteriorates, partly through physical changes but primarily through reduced/ limited access to dental services [5] and through chronic diseases that increase frailty and limit ability for self-care [6] International organizations, such as the World Health Organization [7], the FDI World Dental Federation [8, 9], the English National Health System [10], the US Institutes of Medicine [11, 12], and the Canadian Academy of Health Sciences [5], have made strong policy statements calling for action to improve oral health care for frail older adults by applying an “oral-health-in-all-policies approach” [7], and proclaiming life-long oral health as a “fundamental human right” [7]
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