Well-being Of Elderly Patients Research Articles

Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial

Study objectivesThis study aimed to assess the effect of perioperative rehabilitation exercise, initiated shortly after hospital admission, on postoperative outcomes in elderly patients. DesignA prospective, multicenter, randomized, controlled, open-label, and assessor-blinded clinical trial. SettingHospital wards. PatientsElderly patients (≥65 years, n = 160) scheduled for gastrointestinal surgery between June 2021 and November 2022 were enrolled and randomly assigned to the intervention or control group. InterventionsPatients were divided into two groups base on whether they had received a specific type of exercise program initiated after hospital admission and continued until 30 days after surgery. MeasurementsThe primary outcome was the Comprehensive Complications Index (CCI) measured at 30 days after surgery. Secondary outcomes were the rate of complications, number of complications, patient satisfaction, hospital readmission, postoperative length of stay, gastrointestinal function recovery, postoperative quality of life and psychological status. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted. Main resultsITT analysis showed a significantly lower 30-day CCI in the intervention group (β: -6.31; 95 % Confidence Interval [CI], −11.26 to −1.37, P = 0.013). Compared to controls, the intervention group had a decreased rate of hospital readmission (Odds Ratio: 0.00; 95 % CI, 0.00 to 0.32, P = 0.022), less number of complications (β: -0.57; 95 % CI, −1.03 to −0.11, P = 0.016), as well as lower rate of postoperative anxiety (β: -0.74; 95 % CI, −1.42 to −0.06, P = 0.033) and depression scores (β: -1.13; 95 % CI, −0.97 to −1.30, P = 0.008). Additionally, the intervention group reported higher satisfaction (β: 0.98; 95 % CI, 0.33 to 1.64, P = 0.004) and Euro quality of life-Visual Analogue Scale scores (β: 8.88; 95 % CI, 2.48 to 15.28, P = 0.007). Similar results were found in the PP analysis. ConclusionPerioperative rehabilitation exercise has a positive impact on postoperative complications, quality of life and psychological well-being in elderly patients undergoing gastrointestinal surgery, even when implemented after hospital admission.

Global variations in elderly cancer mortality pattern in 2020 & prediction to 2040: A population-based study.

Background & objectives Cancer contributes to decreasing life expectancy, especially in low- and middle- income countries (LMIC) and countries in transition where resources for diagnosis and care are limited. As the world population is ageing, and by 2050, two-thirds of the population in LMIC will be elderly, the greater impact of cancer on the expectation of life in years at a given age of an adult will be seen in these countries. Methods Estimated cancer mortality for older adults (60 yr or above) was estimated using statistics available on Globocan 2020 platform (gco.iarc.fr). This platform provided the number of deaths and age-standardized truncated mortality rates (per 100,000) by sex and continent. We calculated the projected cancer deaths in 2040 by applying the projection model, considering a stable rate. Results Globally, with an estimated 7.5 million deaths, cancer deaths in older population represented a total of 71.2 per cent of all cancer-related deaths. The truncated age-adjusted mortality rate among the older population (both sexes) was estimated as 615.1 deaths per 100,000 and the mortality rate was 62.6 per cent higher in elderly (60 yr or above) males as compared to elderly females. The overall future cancer death among the elderly was estimated to increase from 7.05 to 12.7 million deaths, representing a total 80.2 per cent increase in deaths by 2040. Interpretation & conclusions The projected mortality increase will challenge existing healthcare systems, especially in lower or lower medium-income countries where resources are limited. Elderly patients are at an elevated risk of adverse outcomes due to the high prevalence of co-morbid conditions. Geriatric oncology will play an important role in the coming years to ensure the overall health and well-being of elderly patients, which needs to be supported by good stratified data on elderly cancer.

Artificial Intelligence in Geriatric Rehabilitation

The use of artificial intelligence (AI) in geriatric rehabilitation offers a novel approach to elderly care. This article explores how AI can alleviate pain and enhance the quality of care for aging populations. Machine learning algorithms aid in customizing rehabilitation programs, monitoring progress, and predicting individual patient needs. Furthermore, AI facilitates clinical data management, streamlining health care processes and ultimately improving the overall well-being of elderly patients.

Effect Of Nursing Intervention Based on Behavioral Shaping Therapy on Blood Glucose Index, Self-Efficacy and Subjective Well-Being in Elderly Patients with T2DM

Objective: To investigate the effect of nursing intervention based on behavioral shaping therapy on blood glucose index, self-efficacy and subjective well-being in elderly patients with type 2 diabetes mellitus (T2DM). Methods: 100 elderly patients with T2DM admitted to our hospital from February 2019 to January 2020 were selected and divided into control group and observation group according to the random number table method, 50 cases in each group. The control group adopted the nursing method of routine education combined with motivation interview, and the observation group adopted the nursing method of behavior shaping on the basis of the control group. The fasting plasma glucose (FPG), 2h postprandial plasma glucose (2h PG), glycosylated hemoglobin (HbAlc) level, self-management ability score, diabetes management self-efficacy scale (DMSES) score and subjective well-being score were compared between the two groups before and after intervention. Results: The levels of FPG, 2h PG and HbAlc in the two groups were significantly decreased, and those of the observation group were significantly lower than those in the control group (P<0.05). After intervention, the total scores of self-management ability, DMSES and subjective well-being of the two groups were significantly increased, and the observation group was significantly higher than the control group (P<0.05). Conclusion: Behavioral shaping therapy combined with routine education and motivation interview can significantly improve the self-management ability, self-efficacy, blood glucose index and subjective well-being of elderly patients.

Distancing Measures in COVID-19 Pandemic: Loneliness, More than Physical Isolation, Affects Health Status and Psycho-Cognitive Wellbeing in Elderly Patients with Chronic Obstructive Pulmonary Disease

Since the outbreak of the SARS-CoV-2 pandemic in 2020, many governments have been imposing confinement and physical distancing measures. No data exist on the effects of lockdowns on the health status of patients affected by chronic pathologies, specifically those with Chronic Obstructive Pulmonary Disease (COPD). Our study aims to establish variations across the psychological and cognitive profile of patients during the isolation period in Italy, in a cohort of patients affected by COPD, between February and May 2020. Forty patients with established COPD were comprehensively evaluated by geriatric multidimensional assessment before the spread of the epidemic in Italy, and submitted to a second evaluation during the subsequent lockdown. We assessed functional ability, basic and instrumental Activities of Daily Living (ADL and IADL), cognition and mood status. We compared the scores obtained at baseline against those obtained during the pandemic, and used mean differences for correlation with major clinical and functional indexes. The score differences from MMSE, ADL and IADL were statistically significant. Such differences were correlated to the presence of a caregiver and to the total number of family members living together. Remarkably, the loneliness dimension, more than the restrictions themselves, seemed to represent the major determinant of altered health status and depressed psycho-cognitive profile in our population. Also remarkably, we detected no correlation between the score variation and the respiratory function indexes of disease severity. The isolation measures adopted during the SARS-CoV-2 pandemic have triggered the classic clinical string associated to geriatric isolation, which leads to a deterioration of cognitive functions, independence and frailty levels in a population affected by a chronic degenerative disease, such as COPD. If considered from a multidimensional geriatric point of view, the individual benefit of isolation measures could be small or non-existent.

Communicating with Companions. The Impact of Companion Empowerment and Companion Literacy on the Well-being of Elderly Patients

ABSTRACT The complexity of the current healthcare ecosystem justifies the convenience of targeting patients’ companions in health communication strategies. Designing successful interventions requires taking into account which keys should be pressed in companions in order to generate positive outcomes in the accompanied patients. In particular, this paper explores how companion health empowerment and companion health literacy affect the well-being of chronically-ill elderly patients. Data for this research come from a cross-sectional quantitative study including 1,814 individuals (907 chronically-ill elderly patients and their 907 companions). Data were collected through two online questionnaires, one for patients and one for companions. The findings suggest that companion health empowerment is defined by the dimensions information search empowerment and knowledge development and decision participation empowerment. Furthermore, the distinction between functional, interactive and critical health literacy has revealed to be useful for comprehending companion health literacy. A structural equation model shows that critical health literacy sets the threshold above which companion health literacy improves accompanied patient well-being, even more so when it is backed up by companion information search empowerment and by companion knowledge development and decision participation empowerment.

Avaliação da satisfação do resultado de enfermagem Bem-estar Pessoal em idosos com doenças crônicas

Estudos que trazem a avaliação do grau de satisfação do resultado de enfermagem Bem-estar Pessoal em idosos com doenças crônicas ainda são incipientes. O objetivo desse estudo foi avaliar o resultado de enfermagem Bem-estar Pessoal de idosos com hipertensão arterial e diabetes mellitus. Pesquisa transversal, realizada com 103 idosos acompanhados em uma Unidade de Atenção Primária à Saúde de um município do estado do Ceará, Brasil. Analisou-se a magnitude de resposta dos indicadores do resultado de enfermagem Bem-estar Pessoal da Classificação de Resultados de Enfermagem, segundo o grau de satisfação dos pacientes. Os indicadores que apresentaram maiores índices de satisfação foram: Vida espiritual (92,2%) e Relações sociais (91,2%). As únicas variáveis com associação estatisticamente significativa com o resultado de enfermagem foram etilismo (p=0,011) e atividade cultural (p=0,012). Os resultados sugerem que idosos com hipertensão arterial e diabetes mellitus possuem Bem-estar Pessoal considerado satisfatório, com média de satisfação de 4,06 (±0,76).

Effects of strengthening out-of-hospital health beliefs on perceived well-being and behavioral change in elderly patients with colon cancer

Objective To explore the effects of strengthening out-of-hospital health beliefs on perceived well-being and behavioral change in elderly patients with colon cancer. Methods Totally 112 elderly patients with colon cancer admitted in Nanyang City Center Hospital from August 2015 to August 2017 were selected by convenient sampling and divided into two groups (n=56) based on the time of admission. Patients in the control group received conventional nursing care, while patients in the observation group received out-of-hospital health beliefs. Both interventions lasted for 6 months. The knowledge needs scale for cancer patients and the Health Promoting Lifestyle Profile-Ⅱ (HPLPⅡ) were used to evaluate the perceived well-being and healthy behaviors in the two groups before and after intervention. Results The scores of psychological needs, technical needs, medication needs and rehabilitation needs and the total score of the knowledge needs scale for cancer patients in the observation group were higher than those before intervention and those of the control group after intervention. The scores of self-fulfillments, exercise, health responsibility, nutrition, pressure handling and interpersonal support and the total score of HPLP Ⅱ of the observation group were higher than those before intervention and those of the control group after intervention (P<0.05) . Conclusions Strengthening out-of-hospital health beliefs can effectively improve the perceived well-being of elderly patients with colon cancer and enable them to develop healthy behaviors. Key words: Colon neoplasms; Aged; Health beliefs; Perceived well-being; Healthy behavior

Identification of prognostic factors for activities of daily living in elderly patients after hospitalization for acute infectious disease in Japan: A 6-month follow-up study.

We investigated factors that predict the prognosis of activities of daily living (ADL) in elderly patients who had undergone rehabilitation during hospitalization for acute infectious disease. The present prospective cohort study included 131 patients who were hospitalized due to acute infectious disease and who had undergone rehabilitation during hospitalization. Patient characteristics collected from medical records included age, sex and comorbidity score. The level of ADL 2 weeks before admission was assessed by interview at the start of rehabilitation. Grip strength testing, Short Physical Performance Battery as an assessment of lower limb function and the Mini-Mental State Examination as an assessment of cognitive status were carried out at the time of hospital discharge. The level of ADL at 6 months after discharge was assessed by telephone interview. Multivariate logistic regression analysis was used to identify factors that independently predict ADL dependence (defined as being dependent in one or more ADL items at 6 months after discharge). The average age of participants was 81.5 years, and 52.7% were women. A total of 22.1% of patients showed dependence in an ADL at 6-month follow-up. Factors that predicted an ADL dependence were comorbidity score (OR 4.19, 95% CI 1.19-14.69) and lower limb function (OR 0.51, 95% CI 0.36-0.72) at discharge. The present findings have implications for the healthcare planning and well-being of elderly patients during hospitalization and after discharge. Geriatr Gerontol Int 2018; 18: 615-622.

Application of Nutritional Risk Score-2002 Questionnaire and Other Nutritional Status Parameters Among Hospitalized Elderly

Summary Background Proper nutritional status is an important factor of successful aging and wellbeing of elderly patients. Screening and then treatment of malnutrition should be one of the main focuses of public health. The main aim of this study is to evaluate the usefulness of Nutritional Risk Score-2002 (NRS-2002), and the anthropometric and biochemical parameters in the context of nutritional status. Methods Total of 1100 patient records from September 2012 to December 2014 were analyzed in terms of nutritional status assessment. The following were included for the analysis: NRS questionnaire, Body Mass Index (BMI), arm (AC) and calf circumference (CC), and concentration of albumin. Results Mean age was 80.5 ± 7.3 years. The most frequent NRS-2002 score was indicating “risk of malnutrition” and its value increased with age. Mean albumin concentration was 3.49 ± 0.53 g/dl. Significant correlations between albumin concentration and arm and calf circumferences were found (p Conclusions Percentage of patients at nutritional risk determined with NRS was 18.8%. This result was significantly lower than in other studies. With accordance to results of other researchers, values of the NRS increased with age. Results regarding the relationship between the NRS values and albumin concentration, AC and CC (negative correlations) and albumin concentration with CC and AC (positive correlations) were consistent with the results of other researchers. In the assessment of the nutritional status of hospitalized elderly, the NRS-2002 should be combined with basic anthropometric measurements.

Multimorbidity in Urology

As people age, they increasingly experience multimorbidity, especially regarding urological conditions. Multimorbidity in elderly patients frequently includes urinary incontinence and subvesical obstruction. While urinary incontinence is often directly associated with other existing diseases or polymedication, subvesical obstruction may be unrelated to other morbidities. Subvesical obstruction often requires polymedication and is therefore a noteworthy condition in urological diagnostics and treatment. First and foremost, a focused diagnostic investigation must be performed, which then enables a systematic therapeutic approach. Urological problems must be treated in due consideration of other possible diseases, and priority should be given to the general well-being of elderly patients. An interdisciplinary collaboration between primary care physicians, geriatricians and urologists seems to be advisable.

Effect of Islam-based religious program on spiritual wellbeing in elderly with hypertension.

Background:Lack of spiritual health in patients with hypertension leads to many mental, social, and physical effects, On the other hand, considering the prevalence of hypertension among the elderly, interventions to enhance their spiritual wellbeing is essential. Therefore, the aim of this study was to examine the effect of religious programs based on Islam on spiritual wellbeing in elderly patients with hypertension who referred to the health centers of Isfahan in 2014.Materials and Methods:This study was a randomized clinical trial. The participants (52 elderly patients with hypertension) were randomly divided in to experimental and control groups. Religious program was implemented for the experimental group in eight sessions in two Isfahan health centers. Spirituality wellbeing survey (SWB) questionnaire was completed in three steps, namely, pretest, posttest and follow-up (1 month) in two groups. In the study, Chi-square test, independent t-test, and repeated-measures analysis of variance were performed for analyzing the data.Results:Before the intervention, there was no significant difference between the mean scores of spiritual wellbeing, the religious dimension, and the existential aspect of spiritual wellbeing of the two groups. However in the posttest step and follow-up stage, the mean scores of spiritual wellbeing, the religious dimension, and the existential aspect of spiritual wellbeing in the experimental group was significantly higher than in the control group (P < 0.001).Conclusions:The religious program based on Islam promoted the SWB of elderly patients with hypertension; further, nurses can use these programs to promote the SWB of elderly patients with hypertension.

Subjective well-being of elderly patients with chronic obstructive pulmonary disease and its predictors analysis

Objective To analyze the status and the influencing factors of subjective well-being of elderly patients with chronic obstructive pulmonary disease(COPD). Methods Totals of 156 elderly patients with COPD were selected by convenience sampling. The general information questionnaire, the Subjective Well-being Scale, the Self-Rating Anxiety Scale and the Self-Rating Depression Scale were used to get patients′ general information and the status of subjective well-being, anxiety and depression were measured. Results The score of subjective well-being of elderly patients with COPD was 1 to 6, and the average score was (3.53±1.332). The standard score of anxiety was 40 to 72, and the average score was (50.86±7.23). 67 patients had anxiety, with an incidence of 43.0%, within which 48 patients (30.8%) had mild anxiety, 14 patients (9.0%) had moderate anxiety, and 5 patients (3.2%) had severe anxiety. The standard score of depression was 38 to 74, and the average score was (50.64±8.29). 66 patients had depression, with an incidence of 42.3%, within which 38 patients (24.4%) had mild depression, 22 patients (14.1%) had moderate depression, and 6 patients (3.8%) had severe depression. It showed that economic conditions, educational level, religion, relationship with children, anxiety and depression were the influencing factors of subjective well-being for elderly patients with COPD (t=18.553, 15.690, 3.711, 13.111, 4.335, 9.783, 8.440, respectively; P<0.05). Conclusions The elderly patient with COPD have a low level of subjective well-being and high incidence rate of anxiety and depression, which may seriously affect their physical and psychological health. As a result, medical and health service institutions should take effective measures to improve the health status and subjective well-being to increase their life qualities. Key words: Pulmonary disease, chronic obstructive; Anxiety; Depression; Subjective well-being

Validity of the FACIT-Sp to Assess Spiritual Well-Being in Elderly Patients

Among instruments measuring spiritual well-being, the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp-12) is the most widely used instrument in research. It has been validated in patients suffering from cancer or HIV/AIDS, but has rarely been used in elderly patients. The objectives of this study were to determine the psychometric properties and suitability of the FACIT-Spto assess spiritual well-being in hospitalized elderly patients. This cross-sectional study uses a mixed method approach. Subjects were patients (N = 208), aged 65 years and older, consecutively admitted in post-acute rehabilitation. Psychometric properties of the FACIT-Sp were investigated. The internal structure of the FACIT-Sp (factor structure and internal consistency) was assessed. Convergent validity of the FACIT-Sp was assessed using the Spiritual Distress Assessment Tool (SDAT), the question “Are you at peace?” and the Geriatric Depression Scale (GDS). Predictive validity was assessed using length of stay (LOS) and discharge destination. Understanding and interpretation of FACIT-Sp items were consecutively assessed in a sub-sample of 135 patients. Results show that FACIT-Sp scores ranged from 7 to 46 (mean 29.6 ± 7.8); 23.1% of the patients had high spiritual well-being. Cronbach’s α was good (0.85). Item-to-total correlations were all significant (0.34 to 0.73). Principal component analyses performed with 2 or 3 factors were only moderately consistent with previous work. FACIT-Sp correlated with SDAT, “Are you at peace?” and GDS (Rho = -0.45, P < 0.001; 0.51, P < 0.001 and -0.38, P < 0.001). No association was found with LOS or discharge destination. Spontaneous comments about one or more FACIT-Sp items were made by 97/135 (71.9%). Specifically, items that address purpose and meaning in life were frequently found difficult to answer. Analyses suggest that the FACIT-Sp may underestimate spiritual well-being in older patients. In conclusion, despite having acceptable psychometric properties, the FACIT-Sp presents limitations for measurement of spiritual well-being in hospitalized elderly patients.

Efficacy of Horticultural Activity in Elderly People with Dementia: A Pilot Study on the Influence on Vitality and Cognitive Function

Objective: The purpose of this pilot study was to examine the effects of an intervention of the horticultural activities program in elderly people with mild to moderate dementia. Methods: The study design was a before–after study. The subjects were 11 elderly people with dementia. The horticultural activities program was developed to support mental, behavioral, social, and cognitive aspects of well-being in elderly patients. The program was conducted once a week for a total of six weeks. Vitality Index (VI) and Mini-Mental State Examination (MMSE) were used to determine the effects of the horticultural activities program. Results: The results showed that VI and MMSE scores significantly improved immediately after intervention compared with those at baseline. In addition, the scores significantly decreased after 1 month of intervention compared with those immediately after the intervention. Conclusions: In this study, VI and MMSE scores of elderly people with mild to moderate dementia improved after participation in the horticultural activities program. However, as the number of subjects was small in the present study, further studies are required to fully elucidate the effects of a horticultural activities program.

Well-being and physical activity in the frail elderly

Physical inactivity damage the elderly patients. The Authors stressed the concept about the very important role of daily, moderate, physical activity on self-sufficiency and mental health and the importance of the house-care for the efficiency and well-being of elderly patients.

The Effects of Music as Therapy on the Overall Well-Being of Elderly Patients on Maintenance Hemodialysis

In this study, the authors explored the use of music during hemodialysis (HD) as a complementary therapy to improve overall well-being in elderly patients. The authors recruited a convenience sample of 88 patients on maintenance HD from a teaching hospital in northern Taiwan and randomly assigned them to either an experimental group (n = 44) or a control group (n = 44). In the first week, participants in the experimental group created their own music playlists. During the second week, these participants listened to music from their own playlists during each HD session (three times/week). The authors evaluated the effects of music as therapy by assessing its impact on perceived stressors and adverse reactions during HD (HD Adverse Reactions Self-Assessment Scale and HD Stressor Scale [HSS]) and measuring changes in physiological indices during the course of the music listening. After 1 week of the use of music as therapy during HD, the authors noted significant reductions in the frequency and severity of adverse reactions during dialysis and in scores on the HSS, p < .001. The authors also observed significantly decreased respiratory rate and significantly increased finger temperature and oxygen saturation, p < .001, during the same period. In conclusion, listening to music during HD may promote overall patient well-being. It may thus serve as a complementary form of therapy that facilitates care and delivery of adequate dialysis and thus improves overall patient well-being in the long run.

Orthodontic treatment in elderly patients

Objective In recent years there has been a significant increase in the number of elderly patients requesting orthodontist consultations. Masticatory performance is an important factor influencing the quality of life in independent healthy elderly subjects and only the restoration of skeletal and dental relationships in the three planes of space can assure oral health and functions with the consequential nutritional balance of the whole organism. The rehabilitation treatment in elderly subjects must comprehend orthodontic and prosthetic needs. This kind of treatment has two main goals: firstly, the restoration of oral function and secondly the restoration of facial morphology. Materials and methods In this article three clinical cases treated with multidisciplinary approach are described showing an efficient procedure to a successful management of the elderly patients. Results The results obtained underlined an oral cavity in good condition which facilitates adequate nutritional intake, an essential factor in the health and well-being of elderly patients and it is important for preserving physical and mental health. Conclusions With appropriate treatment planning and selection of the patients, the orthodontic therapy can be accomplished successfully elderly patients.

The COGNITION Study Rationale and Design: Influence of Closed Loop Stimulation on Cognitive Performance in Pacemaker Patients

Several studies showed the beneficial effect of pacemaker implantation on cognitive performance in patients with bradycardia. But it has never been investigated if patients with chronotropic incompetence may improve their cognitive performance if treated by a rate-adaptive system reacting to mental stress in comparison to the most frequently used accelerometer-driven pacing. The randomized, single-blind, multicenter COGNITION study evaluates if closed loop stimulation (CLS) offers incremental benefit in the speed of cognitive performance and the overall well-being of elderly patients with bradycardia compared with accelerometer-based pacing. Four hundred chronotropically incompetent patients older than 55 years will be randomized 3-6 weeks after implantation to CLS or accelerometer sensor. Follow-up visits are performed after 12 and 24 months. The speed of cognitive performance, which is the underlying function influencing all other aspects of cognitive performance, will be assessed by the number connection test, a standardized psychometric test for the elderly. Secondary endpoints include patient self-assessment of different aspects of health (by visual analogue scales), quality of life (by SF-8 health survey), the incidence of atrial fibrillation (episodes lasting for longer than 24 hours), and the frequency of serious adverse events. In the ongoing COGNITION study, we aim at long-term comparison of two rate-adaptive systems, focusing on the cognitive performance of the patients, which was neglected in the past evaluation of pacemaker sensors.

‘Oral health is not my department’ Perceptions of elderly patients’ oral health by general medical practitioners in primary health care centres: a qualitative interview study

The purpose of this study was to explore general medical practitioners' (GPs) perceptions of the oral health of their elderly patients. The design was a qualitative study based on individual in-depth interviews with GPs. The criterion for inclusion in the study was that the GP was a specialist in family medicine working in a primary health care centre (PHCC:s) in the county of Stockholm. The participants took part in the study after informed consent. Eleven GPs were interviewed. The interview started with semi-structured questions about the respondents' clinical presentation of their elderly patients', e.g. medication, medical treatment and socioeconomic status. The interview concluded with questions about the respondents' experiences of and perceptions of the oral health of their patients. This process started with the first interview and proceeded with successive interviews until no new relevant information was forthcoming. The initial semi-structured part of the interview guide was analysed for content with special reference to descriptive answers. The final open questions were analysed by a method inspired by grounded theory (GT) and comprised three stages: open coding, axial coding and selective coding. In the GT influenced analysis process, three categories, health perspective, working conditions and cultural differences, each in turn containing subcategories, were identified and labelled. The most significant category, cultural differences, was identified as the core category, explaining the central meaning of the respondents' perceptions of the oral health of their elderly patients. The GPs in this study showed little or no awareness of the oral health of their elderly patients. The interviews disclosed several contributing factors. Barriers to closer integration of oral and general health in the elderly were identified. There existed a cultural gap between the disciplines of dentistry and medicine, which does not enhance and may be detrimental to the overall well-being of elderly patients.