Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting.
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If brief and easy to use self report screening tools are available to identify frail elderly, this may avoid costs and unnecessary assessment of healthy people. This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly.
Background: In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty. Objective: This study explored associations between oral health and two frailty measures in community-dwelling older people. Design: A cross-sectional study. Setting: The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands. Participants: Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study. Measurements: Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using ‘The Groningen Frailty Indicator’ (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions. Results: In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and surveybased frailty respectively. Conclusions: A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.
In het PRIMa mond CARE project wordt onderzocht in hoeverre de mondgezondheid bijdraagt aan de voorspelling van kwetsbaarheid bij thuiswondende ouderen.Doel Het doel van het PRIMa mond CARE project is te onderzoeken in hoeverre mondgezondheid bijdraagt aan de voorspelling van kwetsbaarheid bij thuiswonende ouderen. Resultaten Voor het onderzoek zijn 1202 ouderen geïncludeerd, waarvan 45% mannen. De gemiddelde leeftijd van de participanten was 73 jaar. De eerste resultaten laten verbanden zien tussen kwetsbaarheid en onderstaande gezondheidsfactoren: • het bezoeken van de tandarts voor een spoedconsult; • het ervaren van ongemakken in de mond; • het aanpassen van de voeding als gevolg van ongemakken in de mond en • het dragen van een gebitsprothese. De volgende artikelen over dit onderzoek zijn inmiddels gepubliceerd: 'Probing problems and priorities in oral health among community dwelling elderly in the Netherlands' in het International Journal of Health Sciences and Research. In het International Journal of Health Services is het artikel 'Needs in Sevice Provision for Older People: An comparison Between Greater Manchester (United Kingdom) and Utrecht (the Netherlands)' gepubliceerd. Recentelijk verscheen ‘’Measurement properties of oral health assessments for non-dental professionals in older people: a systematic review’’ in het BMC Geriatrics. Looptijd 01 november 2016 - 01 juli 2020 Aanpak De huisarts brengt met een softwareprogramma genaamd ‘’U-PRIM’’ de groep potentieel kwetsbare ouderen in kaart. De mensen uit deze screening komen in fase twee: U-CARE. Zij ontvangen een vragenlijst: de Groningen Frailty Indicator. Met de uitkomsten van de vragenlijsten worden de domeinen van kwetsbaarheid gedefinieerd. Deze mensen krijgen huisbezoek van een praktijkverpleegkundige die een zorgplan op maat maakt. De verpleegkundige screent tijdens dit bezoek de oudere ook op mondgezondheidsproblemen, naast de algemene gezondheidscontrole. Daarnaast zijn de gegevens uit het tandartsenbestand gekoppeld aan de gegevens van de huisarts. Ook zijn twee vragen over mondgezondheid toegevoegd aan de Groningen Frailty Indicator. Aan de deelnemers van het onderzoek is toestemming gevraagd om de tandartsgegevens op te vragen bij de tandarts en deze te koppelen aan de huisartsgegevens. Daarnaast zijn alle gegevens anoniem verwerkt.
