Subjectively reported oral health status in an adult population

This study describes the subjectively reported oral health status of an adult population aged 18 yr and over. The study used measures of the functional, social and psychological impact of oral disorders, originally developed for surveys of older adults, and aimed to determine whether or not they were sensitive to the oral health concerns of younger adults. It compared four age groups (18-29 yr; 30-49 yr; 50-64 yr; 65 yr and over) in terms of the following subjective oral health indicators: ability to chew, problems speaking, oral and facial pain; other oral symptoms; problems eating; problems with communication-social relations; limitations in activities of daily living and worry and concern. The initial hypothesis that few younger subjects would report the kinds of problems documented by these indicators was not supported. On all measures except ability to chew, younger subjects were as likely to be compromised by oral conditions as older subjects.     

Using subjective oral health status indicators to screen for dental care needs in older adults

A study was undertaken to assess the ability of a number of subjective oral health status indicators to identify community-dwelling older adults who need dental treatment. The indicators consisted of a single-item self-rating of treatment need, a 15-item psychosocial impact index and the 49-item Oral Health Impact Profile (OHIP). Data for the study were collected as part of an oral health survey of Canadians aged 50 years and over. The associations between these subjective indicators and clinically defined dental treatment needs were assessed using statistics for determining the predictive power of a diagnostic test. Although there were statistically significant associations between the subjective and clinical measures, values for statistics such as sensitivity, positive predictive values and positive likelihood ratios were low. Although the measures did not perform well as screening tests, they did identify a sub-group of individuals whose clinical conditions impacted significantly on daily life and who would probably benefit the most from dental treatment. In this respect, the subjective measures assessed here can themselves be interpreted as indicators of need which complement conventional clinical measures of needs for dental care.     

Multidimensionality of oral health in dentate adults

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.     

Developing a tool for measuring the decision-making competence of older adults.

The authors evaluated the reliability and validity of a tool for measuring older adults' decision-making competence (DMC). A sample of 205 younger adults (25–45 years), 208 young-older adults (65–74 years), and 198 old-older adults (75–97 years) made judgments and decisions related to health, finance, and nutrition. Reliable indices of comprehension, dimension weighting, and cognitive reflection were developed. Comparison of the performance of old-older and young-older adults was possible in this study, unlike previous research. As hypothesized, old-older adults performed more poorly than young-older adults; both groups of older adults performed more poorly than younger adults. Hierarchical regression analyses showed that a large amount of variance in decision performance across age groups (including mean trends) could be accounted for by social variables, health measures, basic cognitive skills, attitudinal measures, and numeracy. Structural equation modeling revealed significant pathways from 3 exogenous latent factors (crystallized intelligence, other cognitive abilities, and age) to the endogenous DMC latent factor. Further research is needed to validate the meaning of performance on these tasks for real-life decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Older Adult Disability Scale: Development and validation.

Examined the development and validity of the Older Adult Disability Scale (OADS), a self-report instrument designed to measure attitudes toward older adults (aged 60 yrs and older) with physical disabilities. Data from a community sample (n ?=?207) were used for alpha coefficients, subscale intercorrelations, demographic correlations, and factor analyses. Data from a reliability sample (n ?=?27) were used for a 2-week test-retest reliability check; and data from an identified "positive attitude" sample of health care professionals and students (n ?=?57) were used to test construct validity. Exploratory and confirmatory factor analyses were performed resulting in a 36-item instrument with four subscales of Cranky Dependency, Discomfort with Aging, Positive Attributes of Aging, and Negative Expectations of Disability. Satisfactory internal consistency, high test-retest reliability, and moderately high subscale intercorrelations were found. Validity was supported by the highly significant differences in OADS scores between the "positive attitude" and community samples. In conclusion, the OADS provides a promising measure of attitudes toward older adults with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Test-retest reliability of three aphasia tests: performance of non-brain-damaged older adults

This study was designed to assess the test-retest reliability of three aphasia tests. The Auditory Comprehension Test for Sentences (ACTS), the Boston Naming Test (BNT), and the Reading Comprehension Battery for Aphasia (RCBA) were administered on two separate occasions to 31 non-brain-damaged adults aged 50 to 76 years. The results showed acceptable score stability for all three aphasia tests. Sixty-eight percent of the time, older non-brain-damaged adults would be expected to score within 4.0% or less of the total number of test items on repeated testing.     

Predicting impending death: Inconsistency in speed is a selective and early marker.

Among older adults, deficits in both level and variability of speeded performance are linked to neurological impairment. This study examined whether and when speed (rate), speed (inconsistency), and traditional accuracy-based markers of cognitive performance foreshadow terminal decline and impending death. Victoria Longitudinal Study data spanning 12 years (5 waves) of measurement were assembled for 707 adults aged 59 to 95 years. Whereas 442 survivors completed all waves and relevant measures, 265 decedents participated on at least 1 occasion and subsequently died. Four main results were observed. First, Cox regressions evaluating the 3 cognitive predictors of mortality replicated previous results for cognitive accuracy predictors. Second, level (rate) of speeded performance predicted survival independent of demographic indicators, cardiovascular health, and cognitive performance level. Third, inconsistency in speed predicted survival independent of all influences combined. Fourth, follow-up random-effects models revealed increases in inconsistency in speed per year closer to death, with advancing age further moderating the accelerated growth. Hierarchical prediction patterns support the view that inconsistency in speed is an early behavioral marker of neurological dysfunction associated with impending death. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adults

OBJECTIVES: The Quality of Well-Being questionnaire is a measure of health-related quality of life (HRQoL) that has several desirable properties. Its widespread use has been hindered because it is difficult to administer. To overcome this limitation, a new self-administered form has recently been developed. This study examined the feasibility of using the Quality of Well-Being-Self-Administered (QWB-SA) questionnaire in an older population. METHODS: The Quality of Well-Being-Self-Administered questionnaire was sent to 430 community-dwelling individuals aged 65 years and older who were randomly selected from primary care physicians' offices. Response patterns, scaling distributions, and the acceptability of the survey were examined for all respondents. The results of the QWB-SA questionnaire were compared to the Sickness Impact Profile (SIP) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) for those individuals who also had completed the latter two surveys approximately 10 months earlier and whose health had not changed substantially in the meantime. RESULTS: Three hundred and one older adults (70%) responded. The mean QWB-SA questionnaire score was 0.7035. The scores were not skewed, and there were no floor or ceiling effects. The mean time to complete the QWB-SA questionnaire was 14.2 minutes, which was significantly shorter than for the SIP (19.3 minutes) but significantly longer than for the SF-36 (12.5 minutes). Subjects rated their satisfaction with the QWB-SA questionnaire somewhat lower than for the SIP and similar to SF-36. Correlations between the QWB-SA questionnaire and the SIP and SF-36 were moderate and were generally stronger for measures of physical health than for other domains such as mental health. CONCLUSIONS: The self-administered QWB questionnaire was acceptable to older respondents, and it correlated with other measures of health-related quality of life. It can be considered as a candidate for some research applications among older adults.     

Validity of two methods for assessing oral health status of populations

OBJECTIVE: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual-only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent- or guardian-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. METHODS: Following training and calibration, data were collected over an eight-day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual-tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent-completed questionnaire. RESULTS: Validity was high for screening for caries and treatment needs (> 90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data--mainly an effect of false negatives--were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One-third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. CONCLUSIONS: Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent-completed questionnaire is less effective than visual screening for evaluating oral health status in children.     

Age, time of testing, and proactive interference.

A four-list version of a release from proactive interference paradigm was used to assess the degree to which older (aged 58-78 yrs) and younger adults (aged 18-32 yrs) tested at optimal and nonoptimal times of day are vulnerable to interference effects in memory, effects that may increase at nonoptimal times. Morning type older adults and Evening type younger adults were tested either early in the morning or late in the afternoon. Standard buildup and release effects were shown for all age groups except for older adults tested in the afternoon; they failed to show release. Recall and intrusion data suggested that older adults are more vulnerable to proactive interference than younger adults and that for older adults at least, interference effects are heightened at nonoptimal times of day. The data are discussed in terms of an inhibitory model of control over the contents of working memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Knowledge, opinions, and practices related to oral cancer: results of three elderly racial groups

A study of 204 inner-city, senior center participants (ages ranged from 41-96 years) was conducted to assess their knowledge, opinions, and practices related to oral cancer. Participants were either White, African-American, or of Korean descent. The interview/questionnaire revealed this cohort to lack correct knowledge of the signs, symptoms, and risk factors of oral cancer, and to have had risk behaviors associated with oral cancer. Given that oral cancer is most frequently diagnosed in those aged 65 years and older, and that this cohort tends not to obtain routine preventive oral health care, it is imperative that these seniors be educated about the risks associated with oral cancer and their need for routine oral examinations.     

Personality disorder in older adults: Assessment challenges and strategies.

Might some older persons experienced as difficult by their health care providers be exhibiting signs of maladaptive personality functioning? Personality disorder may be a more significant problem among treatment-seeking older adults than was previously believed. Psychologists seeking to assess personality disorder must confront several challenges, including their own beliefs regarding personality and aging, criteria sets of uncertain validity for the older persons, and the limitations of current assessment tools. Empirically informed assessment of personality disorder in older adults may be enhanced by reviewing evidence regarding the prevalence, associated demographic and clinical features, and natural history of personality pathology across the life span. This review also describes how assessing personality disorder in older adults poses unique diagnostic difficulties and proposes practical strategies for evaluating this challenging client group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America

The goal of orthopaedic interventions is to improve the functional health of patients, particularly physical function. The American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America (POSNA) commissioned a work group to construct functional health outcomes scales for children and adolescents, focusing on musculoskeletal health. The work group developed scales assessing upper extremity function, transfers and mobility, physical function and sports, comfort (pain free), happiness and satisfaction, and expectations for treatment. Parent and adolescent self-report forms were developed and tested on 470 subjects aged 2-18 years. The POSNA scales demonstrated good reliability, construct validity, sensitivity to change over a 9-month period, and ability to outperform a standard instrument, the Child Health Questionnaire physical functioning scale. They were useful for a wide variety of ages and diagnoses. They appear to be ideally suited for orthopaedic surgeons to assess the functional health and efficacy of treatment of their patients at baseline and follow-up.     

Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model.

The assessment of worry among older adults typically has involved measures designed with younger cohorts. Because of special concerns in assessing older adults, modifications to existing instruments may be necessary. Addressing equivocal factor analytic data on the Penn State Worry Questionnaire (PSWQ) among younger adults, the authors conducted confirmatory factor analyses to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Data fit poorly with established single- and two-factor models. The single-factor model was modified, resulting in the elimination of 8 items, strong fit indices, high internal consistency, adequate test-retest reliability, and good convergent and divergent validity. Further psychometric work is required to assess whether the revised model is a more parsimonious method to assess late-life anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Isometric pinch force control and learning in older adults

The learning of a dynamic isometric pinch force task was investigated in young adults (aged 19 to 29 years) and older adults (aged 64 to 75 years) through use of a visuo-motor tracking paradigm. Both groups significantly improved performance over trials, retained what was learned 1 week later, successfully transferred to a new target, and demonstrated interlimb transfer of training effects, reflecting a strong central component to this task that is apparently intact in older adults. However, performance differences between the two groups remained throughout the trials. Although it appeared that older adults were able to utilize a model-based strategy to predict the target path, as evidenced by minimal response lag, their absolute performance was inferior to that of young adults relative to an overall root mean square error score, a correlation coefficient, and their increased use of high-frequency components in the tracking signal. The age-related performance differences may be attributable to a peripheral decrement in tactile sensibility and/or muscle reorganization as well as a slowness in processing afferent information.     

Age differences in social preferences among Taiwanese and mainland Chinese: The role of perceived time.

Socioemotional selectivity theory holds that as people recognize the inevitable constraint of time imposed by mortality, their social goals change, motivating them to limit social contacts to those with whom they are emotionally close. This theory was tested among Taiwanese and Mainland Chinese. As predicted, results showed that older adults (aged 60–90 years) in both cultures were more likely than younger adults (aged 18–30 years) to prefer familiar social partners who were most likely to provide emotionally close social interactions. Mainland Chinese, who as a group have shorter actuarial life expectancy, were more likely to prefer familiar social partners than were Taiwanese. These age and cultural differences were eliminated when differences in perceived time were statistically controlled for. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflecting on self-relevant experiences: Adult age differences.

A broad array of research findings suggest that older adults, as compared with younger adults, have a more positive sense of self and possibly a clearer and more consistent sense of self. Further, older adults report lower motivation to construct or maintain a sense of self. In the present study, we examined whether such differences in self-views were reflected in features of older and younger adults’ narratives and narrating practices around recent, self-relevant events. Narratives about self-discrepant and self-confirming events were elicited from a sample of younger (18–37 years of age; n = 115) and older (58–90 years of age; n = 62) adults and were compared for indicators of engagement in self-construction, meanings, and emotionality. Older adults’ narratives contained significantly fewer self-focused pronouns, less present tense, and less emotional language, and they were significantly less likely to articulate and resolve challenges to their self-concepts. These findings, as well as others, are consistent with the idea that older adults are less engaged in self-construction in narrating everyday events, perhaps especially for self-discrepant events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of familiarity of task and choice on the functional performance of younger and older adults.

An experiment was conducted to compare the functional performance of younger and older adults on familiar and unfamiliar tasks under 2 conditions of perceived control. Specifically, the relation between age and motor and process skills was examined. The familiar tasks were simple cooking tasks, whereas the unfamiliar tasks were contrived, meaningless tasks developed for this study. Younger and older adults did not differ in the ratings of the familiarity of the tasks, but results from 2 Age?×?Task?×?Choice analyses of variance demonstrated a significant age difference for motor and process skills under all conditions. This suggests that older adults demonstrate age-related decline, even with activities that take motivational, experiential, and ecological validity components into account. For the process skills scale, there was also a significant main effect for choice. These results support the concept that perceived control may improve performance, but not differentially for older adults; that is, younger and older adults both demonstrated improved process performance when given their choice of tasks. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Temperature-related expression of the vacuolar aspartic proteinase (APR1) gene and beta-N-acetylglucosaminidase (HEX1) gene during Candida albicans morphogenesis

An experiment was conducted to compare the functional performance of younger and older adults on familiar and unfamiliar tasks under 2 conditions of perceived control. Specifically, the relation between age and motor and process skills was examined. The familiar tasks were simple cooking tasks, whereas the unfamiliar tasks were contrived, meaningless tasks developed for this study. Younger and older adults did not differ in the ratings of the familiarity of the tasks, but results from 2 Age x Task x Choice analyses of variance demonstrated a significant age difference for motor and process skills under all conditions. This suggests that older adults demonstrate age-related decline, even with activities that take motivational, experiential, and ecological validity components into account. For the process skills scale, there was also a significant main effect for choice. These results support the concept that perceived control may improve performance, but not differentially for older adults; that is, younger and older adults both demonstrated improved process performance when given their choice of tasks.