全身の健康状態の悪化が介護施設入所者の口腔健康に及ぼす短期的効果

Short-Term Effects of a Deterioration of General Health on the Oral Health of Nursing-Home Residents.

• Anna-Luisa Klotz
• Melania Zajac
• Judith Ehret
• Samuel Kilian
• Peter Rammelsberg
• Andreas Zenthöfer

抄録

目的:

本研究の目的は、一般的な健康状態の変化が、半年間にわたって介護施設入居者の口腔の健康にどのような影響を与えるかを明らかにすることであった。

Purpose: The purpose of this study was to identify how changes to general health might affect the oral health of nursing-home residents over a six-month period.

材料と方法:

本研究は、ドイツの9つの介護施設で実施された。ベースライン時と6ヵ月後に社会人口統計学的および一般的なデータが収集された。ベースラインと追跡調査の完全データは114人の参加者が利用可能であった。参加者の認知症の有無と、該当する場合は認知症の重症度を特定するために、Clinical Dementia Rating (CDR)とGlobal Deterioration Scale (GDS)を用いた。運動障害の識別には、TULIAのApraxia Screen（AST）を使用した。各参加者の包括的な歯科検診も実施された。検査には、歯科および義歯の状態、虫歯、欠損、充填歯の数（DMF-T）の記録が含まれていた。さらに，歯と義歯の衛生状態は，それぞれ Plaque Index (PI) と Denture Hygiene Index (DHI) を用いて定量的に評価した．口腔保健評価ツール（OHAT）を用いて，グローバルな歯科治療ニーズを評価した．従属変数に影響を与える可能性のある要因を分析するために、一変量および多変量の線形回帰モデルを作成した。

Materials and Methods: The study was conducted in nine nursing homes in Germany. Sociodemographic and general data were collected at baseline and after six months. Complete baseline and follow-up data were available for 114 participants. The Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS) were used to identify the presence and, if applicable, severity of dementia among participants. The Apraxia Screen of TULIA (AST) was used to identify motor impairment. A comprehensive dental examination of each participant was also performed. The examination included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMF-T). In addition, dental and denture hygiene were quantitatively assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI), respectively. Global dental treatment needs were evaluated by use of the Oral Health Assessment Tool (OHAT). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting the dependent target variables.

結果:

調査期間中，調査対象者の義歯衛生状態は平均15％悪化した．回帰モデルでは，年齢が高くなるほど義歯衛生状態の悪化は顕著ではなく，DHIの使用によって測定された（年齢が上がるごとに-0.806，=0.030）．さらに，必要介護度の増加（係数(C)-1.948；＝0.002）と，ベースライン時と比較して一般的な健康状態の評価が低い（C：1.054；＝0.026）ことがOHATによる口腔内の健康状態の悪化と関連していた．これらの結果に加えて，要介護度の増加もDMF-Tで評価した歯の健康状態の悪化と関連していた（C：0.966；＝0.013）．

Results: During the study period, denture hygiene among the study population worsened by an average of 15%. The regression models detected that a more advanced age (in years) was associated with a less pronounced deterioration of denture hygiene as measured by use of the DHI (-0.806 per additional year of age; = 0.030). Furthermore, an increase in the level of care needed (coefficient (C): -1.948; = 0.002) and a more poorly graded assessment of general health compared with the value at baseline (C: 1.054; = 0.026) were both associated with a deterioration of oral health as evaluated by use of the OHAT. In addition to these results, an increase in care needs was also associated with a deterioration of dental health as evaluated by use of the DMF-T (C: 0.966; = 0.013).

結論:

短期的には、要介護度の上昇を含めた全身状態の悪化が、介護施設入所者の口腔内の健康状態の悪化をより顕著に示す要因となっているようです。

Conclusion: In the short term, a deterioration of general health, including an increase in care needs, seems to be the predominant factor associated with a more pronounced deterioration of oral health among nursing-home residents.

© 2020 Klotz et al.