School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand; School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia; Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Inala, Queensland, Australia.
J Am Med Dir Assoc. 2021 Jun;22(6):1177-1183.e1. doi: 10.1016/j.jamda.2020.06.041. Epub 2020 Jul 28.
To describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables.
Secondary analysis of 2 continuously recruited national cohorts.
Adults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent.
All community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models.
Overall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Māori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts.
Heavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.
描述社区和老年住宅护理（ARC）设施中患有复杂需求的老年人的口腔健康状况和牙科服务利用情况，并确定牙科服务利用与社会人口学变量之间的关联。
对 2 个连续招募的全国队列进行二次分析。
2012 年 7 月 1 日至 2018 年 5 月 31 日期间在新西兰接受标准化评估且同意参与的年龄≥65 岁的成年人。
所有有复杂需求的社区居住老年人都接受标准化评估，使用国际家庭护理住宅评估工具（interRAI-HC），而所有 ARC 设施居民都接受长期护理设施评估（interRAI-LTCF）。从同意的参与者中提取匿名数据。采用逻辑回归模型对口腔健康状况和牙科服务使用变量进行横断面分析，采用二项广义估计方程模型对影响牙科服务利用的因素进行纵向分析。
共有 97229 名参与者的 144380 次 interRAI-HC 评估和 62798 名参与者的 195549 次 interRAI-LTCF 评估符合条件。第一次评估时，他们的平均年龄分别为 81.9 岁（范围：65-109 岁）和 84.4 岁（范围：65-110 岁）。大约 65%的参与者佩戴义齿；9%的人有破损、碎裂、松动或其他不完整的天然牙齿；10%的人报告有咀嚼困难。总体而言，只有 25.3%的社区居住老年人和 17.5%的 ARC 居民在过去一年接受过牙科检查。观察到明显的不平等现象，例如，毛利参与者在社区和 ARC 设施环境中接受牙科检查的调整后比值分别为 3.14（95%置信区间：2.88，3.42）和 2.08（95%置信区间：1.81，2.39），与新西兰欧洲人相比，没有接受牙科检查。
患有复杂需求的老年人的口腔健康负担沉重且不平等，同时牙科服务利用率较低。新西兰需要制定一项针对老年人的口腔健康政策。
