Saudi Cultural Missions Theses & Dissertations
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Item Restricted The association between loneliness and Oral health among older adults In England. Secondary data analysis of the English Longitudinal Study of Ageing (2018-2019)(University Collage London, 2024-08) Bedaiwi, Alia; Venturelli, Renato; Heilmann, AnjaBackground: Population aging is a global phenomenon, accompanied by increasing rates of oral diseases and loneliness among older adults. These two issues have significant impacts on individuals' quality of life. While the relationship between loneliness and various health outcomes is well-established, the connection between loneliness and oral health has been less explored. Aim: The aim of this research was to investigate the association between loneliness and subjective measures of oral health, including OHRQoL and SROH, among older people living in England using cross-sectional data from ELSA. Methods: Secondary analysis was conducted using data from ELSA Wave 9. The study population consisted of adults aged 50 and above, with oral health outcomes measured through OIDP and SROH, and loneliness assessed using a three-item UCLA scale. After controlling for socioeconomic, behavioral, and health-related variables, the relationship between oral health outcomes and loneliness was examined using logistic regression models. Results: The study found a significant association between loneliness and poorer oral health outcomes. Those who reported feeling lonely were more likely to experience at least one impact on daily performance due to oral health problems and were more likely to rate their oral health as fair or poor. These associations remained significant after adjusting for factors such as gender, age, cohabitation ,status, wealth, and smoking. Conclusion: Loneliness is associated with poorer oral health among older adults. Addressing loneliness could improve oral health and overall well-being, suggesting a need for integrated public health interventions that target both social and health-related factors in aging populations.9 0Item Restricted Progress of multimorbidity among older adults and the role of Oral Health(King's College London, 2024-08-14) Mira, Rolla; Sabbah, WaelThe world's ageing population has rapidly increased because of the demographic shift that has occurred over the last several decades. Multimorbidity is one of the most significant effects of the ageing population on public health. When a person has more than two chronic conditions, this is known as multimorbidity. Furthermore, multimorbidity is common, increases with age, and is more prevalent in those from lower socioeconomic backgrounds, according to all current studies. Multimorbidity is linked to worse outcomes such as lower quality of life, increased mortality, polypharmacy, high treatment burden, higher rates of adverse drug events, and much higher use of health services, including emergency hospital admissions. The mechanism of multimorbidity development is a multifactorial dynamic process, oral health could be associated with multimorbidity through different pathways. One of the most plausible pathways is the impact of poor oral health on nutritional status. Aim: The thesis aimed to explore socioeconomic inequalities in the progress of multimorbidity, among older adults. The second aim is to assess whether tooth loss is associated with the progress of multimorbidity. The objectives of the thesis were to (1) examine socioeconomic inequalities in the progress of multimorbidity among older adults in the U.S.A. (2) Assess whether tooth loss is longitudinally associated with the progress of multimorbidity and (3) explore the nutritional pathway between tooth loss and the progress of multimorbidity. (4) Examine the relationship between allostatic load and the progress of multimorbidity and whether it mediates socioeconomic inequalities in multimorbidity. Methods: Seven waves were used (2006-2018) of the Health and Retirement Study, a longitudinal survey of older Americans. Multimorbidity was indicated by self-reported diagnosis of 5 conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Socioeconomic indicators were ethnicity, education, wealth, and income. Behavioural factors were smoking, excessive alcohol consumption, physical activity, and body mass index. Allostatic load was used as a biomarker of stress and was indicated by high-density lipoprotein, glycosylated haemoglobin, c-reactive protein, waist circumference, and high blood pressure. Nutritional intake was calculated in 2013 by summing 10 nutrients (Protein, Vitamins C, D, B12, E, Calcium, Zinc, Polyunsaturated fatty acids, Folate and ß- carotene). Finally, edentulism (total tooth loss) was assessed in three waves (2006, 2012, and 2018). Multilevel models for the analysis of longitudinal data were used to assess the association between socioeconomic factors and multimorbidity and whether behavioural factors mediate this association. Multilevel models were used to examine the relationship between oral health and multimorbidity and whether nutritional intake mediates this association. The association between allostatic load as a marker of chronic stresses with progress of multimorbidity was also assessed using multilevel models for longitudinal panel data. Results: Socioeconomic indicators showed different significant associations with the progress of multimorbidity demonstrating social gradients. However, after adjusting for behavioural factors these associations were attenuated. Incidence rate ratios (IRR) of multimorbidity was considerably higher in those who did not finish high school (IRR 1.21; 95% CI 1.18, 1.23) compared to those who attended college. After adjusting for behaviours, IRR decreased to 1.11 (95% CI 1.07, 1.14). Furthermore, IRR of multimorbidity was greater in the lowest quartiles of total wealth and income, with IRR 1.47 (95% CI 1.44, 1.51) and 1.25 (95% CI 1.22, 1.28), respectively. These IRRs decreased to 1.31 (95% CI 1.26, 1.36) and 1.22 (95% CI 1.18, 1.27), respectively, after accounting for behaviours. Moreover, longitudinal associations were found between edentulism in the years 2006 and 2012 and the progress of multimorbidity. After adjusting for behavioural factors, and total nutrients, the IRR for multimorbidity among edentate individuals was 1.12 (95%CI 1.06, 1.18) and 1.10 (95%CI 1.05, 1.16) in 2006 and 2012, respectively. Moreover, the analysis showed an association between edentulism (in 2006 and 2012) and total nutrition (2013) adjusting for age and gender. Total nutrients in 2013 were lower among those who were edentate in 2006 [IRR 0.97 (95%CI 0.95, 0.99)] and in 2012 [IRR 0.98 (95% CI 0.96, 0.99)]. A positive association was found between allostatic load and multimorbidity even after accounting for socioeconomic and behavioural factors. Conclusion: This thesis illustrated that socioeconomic factors were associated with the progress of multimorbidity, and behavioural factors appeared to mediate the association. It also demonstrated that the association between socioeconomic factors and multimorbidity was slightly attenuated after adjusting the allostatic load. Additionally, the allostatic load was significantly associated with multimorbidity even after accounting for socioeconomic and behavioural factors. Moreover, edentulism in 2006 and 2012 showed a statistically significant association with multimorbidity, although. The association between total nutrition and multimorbidity was significant only in the unadjusted models.16 0Item Restricted Association between Activities of Daily Living (ADLs) and oral health among older Saudi adults(King's College London, 2024-08-07) Almazam, Abdulmalik; Sabbah, Wael; Hakeem, FaisalAim: To investigate the association between Activities of Daily Living (ADLs) and oral health among older Saudi adults. Method: This cross-sectional investigation was carried out in Medina, Saudi Arabia, encompassing 362 individuals aged 60 years or older. The study's ethical conduct (HR-18/19-8791) was approved by the Research Ethics Committee of King's College London and both organisations granted authorization. Additionally, the Research Ethics Committee of Taibah University, College of Dentistry (TUCDREC/20190129/FHakeem) also offered approval. The participants were selected from outpatient clinics at Taibah University Dental College and social centres associated with the Ministry of Social Affairs. Participants were physically independent and provided informed consent. The data were obtained by conducting clinical oral examinations and administering structured questionnaires that encompassed sociodemographic characteristics, general health, oral health behaviours, and ADLs. The primary independent variable was the tooth count, determined by means of a clinical examination. Poisson regression models were utilised to conduct statistical analyses, aiming to investigate the associations between oral health and ADLs. Adjusting for sociodemographic and other covariates. Results: The study revealed significant associations between the number of teeth and the ability to perform ADLs. Older adults with a greater number of teeth demonstrated enhanced functional autonomy in ADLs. Both age and comorbidities were found to have a significant association with ADL performance. Specifically, older age and a higher number of comorbidities were associated with increased problems in performing ADLs. There is an association between socioeconomic characteristics, such as having a lower income and being divorced, and experiencing a higher level of impairment in ADLs. There was no association between gender, BMI, and ADLs after adjusting for other variables. Conclusion: The results emphasise the significance of maintaining proper oral hygiene in order to promote independence in ADLs in older individuals. Regular dental appointments and comprehensive healthcare that includes managing oral health are essential for improving the quality of life and performance of ADLs in this population. It is crucial for policymakers and healthcare professionals to provide a high priority to including oral health within the wider healthcare system for older individuals in order to support the process of ageing in a healthy manner and maintain their ability to function independently.37 0Item Restricted Effect of Prescribed Medications on Oral Health in Older Adults: A Review of Reviews(Saudi Digital Library, 2023-12-01) Alnashwan, Mohammed; Tsakos, GeorgeBackground The global demographic is experiencing an increasingly ageing population. Older adults are frequently prescribed medications to manage chronic diseases they accumulate over the years. Occasionally, these medications can have undesirable side effects on oral health, compromising oral health in the process. Implications of ageing, polypharmacy and systemic diseases can further complicate this issue in the context of older adults. Aim The aim of this is study to conduct a literature review on the existing reviews on the effect of prescribed medications on oral health in older adults. Methods A narrative literature review of reviews published between 2000 and 2023 on effect of prescribed medications on oral health in older adults was conducted. Literature search was conducted using online databases Ovid Medline and Embase, which retrieved 463 studies. Only 18 studies that matched the eligibility criteria were included for the review. Relevant findings were reported from each study and summarized in a narrative synthesis. Results Many side effects from certain medications have been reported in older adults, with one of most frequent being xerostomia, or dry mouth. Upwards of 400 medications including anticholinergics, anticonvulsants, antidepressants, antihypertensives, antipsychotics and bronchodilators have been identified as potential xerostomia inducers among many others. Cardiovascular medicines like beta-blockers and calcium channel blockers can cause symptoms ranging from taste disturbances to gingival enlargement in addition to dry mouth. Diabetes has bidirectional connections with oral health issues, where poorly managed diabetes can lead to infections and bone loss, and certain antidiabetic drugs cause taste disturbances and other complications. Mental health medications pose a significant risk to oral health as well, with antidepressants leading to dental caries due to xerostomia, and some types of antidepressants can induce teeth clenching and bruxism among other issues. Other medications such as anxiolytics and antipsychotics have been xerostomia. In addition, anticonvulsants has been reported to cause gingival enlargement and taste disturbance. Respiratory diseases medications are also associated with a number of oral health side effects. Some bronchodilators are associated with dry mouth, and certain respiratory inhalants can cause changes in taste perception. Systemic corticosteroid usage may cause impaired wound healing and taste disturbances, while chronic use of such medications might even induce osteoporosis in older adults. Conclusion Older adults are prone to side effects from medications, including xerostomia, which can further worsen existing oral health issues and induce new issues like speech difficulties and higher infection risk. This is often caused by medications for chronic illnesses, including those treating hypertension, diabetes, mental health conditions and respiratory diseases. Medications for such diseases can even lead to various oral problems such as gingival hyperplasia, lichenoid reactions and dysgeusia, ultimately leading to compromised oral health in older adults. Therefore, it is important to research medications with fewer negative impacts on oral health. The ultimate goal is to incorporate oral health for the comprehensive wellbeing of the elderly.16 0Item Restricted A Multimethod Approach To Identify Factors And Improve The Process Of Deprescribing Anticholinergics In Older Adults.(HammerRR, 2023-04-28) Alamer, Khalid Ahmed A; Campbell, NollPolypharmacy in older adults presents several challenges, such as suboptimal therapeutic outcomes and increased adverse effects. Deprescribing, a clinically supervised process of decreasing dosage or stopping the medication when risks outweigh benefits, has emerged as one possible solution to these problems. However, the literature describing deprescribing intervention frameworks is heterogenous regarding targeted medications to deprescribe, population characteristics, clinical settings, and measured outcomes. This dissertation utilizes Linsky et al.'s deprescribing conceptual model, which details factors influencing decisions regarding initiating deprescribing interventions and their direct impact on the process. This dissertation utilizes a multimethod approach to investigate factors that facilitate and improve the deprescribing of anticholinergic medications for older adults, addressing gaps in this population's anticholinergic medication use. The three studies included in this dissertation provide a comprehensive understanding of deprescribing anticholinergic medications for this population, each contributing unique insights and results. The first study explores the feasibility of in-person and remote Home Medication Inventory Method (HMIM) approaches to evaluate over-the-counter (OTC) and prescription medication possession and use, including anticholinergics. Results demonstrate that both methods can accurately assess anticholinergic medication usage patterns, providing healthcare providers with reproducible methods and detailed medication profiles to make informed deprescribing decisions based on complete medication lists. The second study examined the intertwined roles of social determinants of health and health beliefs in predicting older adults' self-reported deprescribing behaviors, proposing the Deprescribing Health Belief Model (DeRx-HBM) framework that can be utilized for these efforts. These results emphasize the importance of considering these elements when creating a patient-centric and culturally sensitive intervention since they significantly shape deprescribing behaviors. In the third study, we explored the use of a symptom-specific scale for measuring the symptom burden in older adults during the deprescribing of anticholinergic medications prescribed for urinary incontinence, depression, and pain management. This research introduces a validated scale for assessing anticholinergic symptom burden prior to, throughout, and following the deprescribing attempt. The implementation of this scale has the potential to enhance the reproducibility and standardization of deprescribing decisions. Furthermore, it can improve communication between healthcare professionals and patients, as well as monitor the effectiveness of interventions during and after the deprescribing process. Collectively, these studies provide invaluable insights into factors influencing deprescribing decisions, obstacles to implementing deprescribing practices, and potential strategies to optimize medication management in older adults. The major takeaway from these studies is that addressing these factors leads to more informed decisions among healthcare professionals and patients - potentially leading to improved patient outcomes, ensure the ongoing effectiveness of deprescribing initiatives among older adults, and the promotion of health equity throughout the deprescribing process.9 0