Dental treatment intensity in frail older adults in the last year of life
Identifieur interne : 000408 ( Pmc/Curation ); précédent : 000407; suivant : 000409Dental treatment intensity in frail older adults in the last year of life
Auteurs : Xi Chen ; Hong Chen ; Christian Douglas ; John S. Preisser ; Stephen K. ShumanSource :
- Journal of the American Dental Association (1939) [ 0002-8177 ] ; 2013.
Abstract
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.
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.
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).
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.
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PubMed: 24177401
PubMed Central: 4215005
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<author><name sortKey="Chen, Xi" sort="Chen, Xi" uniqKey="Chen X" first="Xi" last="Chen">Xi Chen</name>
</author>
<author><name sortKey="Chen, Hong" sort="Chen, Hong" uniqKey="Chen H" first="Hong" last="Chen">Hong Chen</name>
</author>
<author><name sortKey="Douglas, Christian" sort="Douglas, Christian" uniqKey="Douglas C" first="Christian" last="Douglas">Christian Douglas</name>
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<author><name sortKey="Preisser, John S" sort="Preisser, John S" uniqKey="Preisser J" first="John S." last="Preisser">John S. Preisser</name>
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<author><name sortKey="Shuman, Stephen K" sort="Shuman, Stephen K" uniqKey="Shuman S" first="Stephen K." last="Shuman">Stephen K. Shuman</name>
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<author><name sortKey="Chen, Xi" sort="Chen, Xi" uniqKey="Chen X" first="Xi" last="Chen">Xi Chen</name>
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<author><name sortKey="Chen, Hong" sort="Chen, Hong" uniqKey="Chen H" first="Hong" last="Chen">Hong Chen</name>
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<author><name sortKey="Douglas, Christian" sort="Douglas, Christian" uniqKey="Douglas C" first="Christian" last="Douglas">Christian Douglas</name>
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<author><name sortKey="Preisser, John S" sort="Preisser, John S" uniqKey="Preisser J" first="John S." last="Preisser">John S. Preisser</name>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">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.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">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.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">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).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">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.</p>
</sec>
</div>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7503060</journal-id>
<journal-id journal-id-type="pubmed-jr-id">4439</journal-id>
<journal-id journal-id-type="nlm-ta">J Am Dent Assoc</journal-id>
<journal-id journal-id-type="iso-abbrev">J Am Dent Assoc</journal-id>
<journal-title-group><journal-title>Journal of the American Dental Association (1939)</journal-title>
</journal-title-group>
<issn pub-type="ppub">0002-8177</issn>
<issn pub-type="epub">1943-4723</issn>
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<article-meta><article-id pub-id-type="pmid">24177401</article-id>
<article-id pub-id-type="pmc">4215005</article-id>
<article-id pub-id-type="manuscript">NIHMS636158</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Dental treatment intensity in frail older adults in the last year of life</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Chen</surname>
<given-names>Xi</given-names>
</name>
<degrees>DDS, PhD</degrees>
<aff id="A1">Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Chen</surname>
<given-names>Hong</given-names>
</name>
<degrees>DDS, MS</degrees>
<aff id="A2">Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Douglas</surname>
<given-names>Christian</given-names>
</name>
<degrees>BS, MS</degrees>
<aff id="A3">Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Preisser</surname>
<given-names>John S.</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A4">Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Shuman</surname>
<given-names>Stephen K.</given-names>
</name>
<degrees>DDS, MS</degrees>
<aff id="A5">Department of Primary Dental Care, School of Dentistry, University of Minnesota, Minneapolis</aff>
</contrib>
</contrib-group>
<author-notes><corresp id="FN1"><bold>Corresponding author:</bold>
Xi Chen, Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Campus Box 7450, Chapel Hill, N.C. 27599, <email>xxi_chen@hotmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>17</day>
<month>10</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><month>11</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>31</day>
<month>10</month>
<year>2014</year>
</pub-date>
<volume>144</volume>
<issue>11</issue>
<fpage>1234</fpage>
<lpage>1242</lpage>
<abstract><sec id="S1"><title>Background</title>
<p id="P1">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.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">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.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">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).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">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.</p>
</sec>
</abstract>
<kwd-group><kwd>Palliative dentistry</kwd>
<kwd>oral health</kwd>
<kwd>geriatrics</kwd>
<kwd>long-term care</kwd>
<kwd>terminal illness</kwd>
</kwd-group>
</article-meta>
</front>
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