Dental treatment intensity in frail older adults in the last year of life

Abstract

Background Palliative care focusing on pain and infection is recommended for patients who are terminally ill. It is difficult to implement this strategy in practice because of the lack of clear guidelines. The authors conducted a study to examine dental treatment provided to a group of long-term care (LTC) residents in the last year of life. Methods The authors retrospectively followed 197 LTC residents (60 years or older) in the last year of life to death. On the basis of the dental services patients received between the new patient examination and death, the authors categorized the patients into three groups: no care (NC), limited care (LC) and usual care (UC). The authors developed a multivariable continuation ratio logit model with shared regression coefficients across two logits to identify the factors associated with the end-of-life dental care pattern. Results The authors found that 50.8 percent of the patients received NC before death. Among those who received treatment, 62.9 percent received UC, and 60.7 percent of the patients in the UC group had completed their treatment in the last three months of life. A three-month increment in survival and having dental insurance resulted in 1.74 (95 percent confidence interval [CI], 1.32–2.30) and 2.59 (95 percent CI, 1.03–6.52) times greater odds, respectively, of receiving some dental treatment before death. Neither survival nor dental insurance, however, was associated with dental care intensity in the last year of life (that is, UC versus LC). Conclusions While most of the patients who were in the last year of life received insufficient dental care, comprehensive treatment was provided commonly to frail patients at the end of life, raising questions about quality of care.

Oral health trajectories in community‐dwelling older adults in the last 3 years of life

“…As a result of increased disease burden, physical and cognitive functional decline and psychological distress, the risk of dental caries and other oral disease can elevate in older adults at the end of life. These changes have been observed in NH residents who usually experience complex oral health decline as a result of progressive functional loss at the end of life 8–12 . However, how oral health changes over time in community-dwelling older adults at the end life is virtually unknown.…”

“…remain unstudied. The lack of information makes clinical treatment planning for end-of-life patients difficult and raises concerns for the quality of care for these vulnerable individuals 8 .…”

Strategies for Oral Health Management in Patients with Acute Confusional State

“…Previous study showed that dementia, congestive heart failure and cancers were the most common medical condition found in the hospitalized older adults. 4 The cognitive dysfunction affects the capacity of individuals to complete daily activities, but also basic activities. The global cognitive dysfunction and inattention were the main features of acute confusional state (ACS).…”

“…Previous study showed that 40% of remained teeth in patients with terminal illness were carious or retained roots. Almost 60% of patients who were hospitalized at the end of life did not receive any dental treatment before death 4 . It is sometimes difficult to perform the treatment, since there is a tendency of prolonged functional decline at this stage of life.…”

“…The evidence-based dentistry on the decision on the timing and the type of palliative care are still limited. 4,7 The management of oral health problems on those patients must be distinguished depends on the stage of illness with the intention of increasing comfort and pain reduction. 7 The patients sometimes do not receive an appropriate oral health treatment for some reasons.…”