Implementation of oral health care and normal diet on the psychogeriatric ward; the relationship with quality of life

Oral health is commonly compromised in elderly persons, especially in those
receiving institutionalized care. Elderly persons with a mental disability, for
example dementia, have an increase chance of having oral health problems. A
MMSE score of 24-26 (mild cognitive impairment) combined with functional
disability is associated with a higher chance of root caries. Edentulism is
also commonly observed and can cause a diminished nutrient intake. This is
associated with several ailments such as Parkinson*s disease (shortage of
vitamin E), cardiovascular disease (shortage of vitamin C) and ailments of the
central nervous system (shortage of vitamin B).

Quality of life (QoL) of an elderly person with dementia is influenced by the
disease itself, but also by several other factors. Loss of teeth is a risk
factor for developing Alzheimer*s disease, but the number of remaining teeth in
elderly persons also predicts possible disability and mortality. A study showed
a positive relationship between chewing ability, and memory and executive
function in healthy independently living elderly persons. Chewing ability is
also directly related to QoL in this population. Oral health care can improve
chewing ability and thus improve QoL.

Interventions aimed at increasing physical activity can improve QoL for elderly
persons suffering from dementia. Animal experiments show that offering a soft
diet and/or removal of teeth can diminish cognitive performance in mice. By
offering a normal consistency diet instead of mashed foods, masticatory
activity will increase. This could also positively influence QoL.

In the current study, the effect of oral health care and normal diet on quality
of life of elderly persons suffering from dementia.

The results from the baseline assessment will be used as cross-sectional data
to establish correlations between the several variables.

This is a multicentre randomised study; participants will be included in the
study for six months, and will be assessed four times: during a baseline
assesment, six weeks later, 12 weeks after baseline and 24 weeks after
baseline. Assessments include neuropsychological testing and assessment of
several physical parameters (e.g. blood pressure and masticatory function).

Participants will be included in either an intervention of control group. The
control group will receive care as usual; the intervention group will receive
improved oral health care and an improved diet (i.e. a diet of normal
consistency). The intervention is always executed in concurrence with the local
medical and care staff.

The risk of participation is minimal; the intervention is in fact an
improvement of daily care, in accordance to national guidelines and therefore
no risk is expected. The duration of the (neuropsychological) assessments could
be burdensome, since they can be tiring. However, the assessments can be broken
up into smaller part, thus minimizing the burden.

The assessment of the masticatory function only includes voluntary actions
(e.g. bite down as hard as you can; open your mouth as far as you can); the
risks of these assessments are judged by a dentist and medical technician and
are deemed to be of minimal risk.