Saúde bucal e condição funcional de idosos que vivem em instituições de longa permanência

Abstract

This research was conducted among older people living in philanthropic Long-Term Care Facilities (LTCF) in Belo Horizonte, Minas Gerais. The cross-sectional study investigated the association between oral health indicators, oral hygiene, and the level of dependence on oral hygiene with the nutritional condition and functional status of older peoples aged 60 years or more living in LTCF. Data collection involved reviewing medical records, conducting interviews with the elderly residents or their proxies, and performing physical and oral examinations. These examinations were carried out by six trained researchers (kappa: 0.73-0.95). The dependent variable was the functional condition of the elderly, which was determined through the assessment of frailty, impairment in activities and participation, level of functional dependence, and sarcopenia. The functional status served as the dependent variable, evaluated as a latent construct resulting from frailty, disability, functional dependence, and sarcopenia. Meanwhile, calf circumference indicated the nutritional condition. The oral health variables included the number of natural teeth, oral hygiene, chewing performance, and dependence on oral hygiene. Gender, age, and the number of comorbidities were considered as covariates. The relationships between these variables were assessed using structural equation modeling. Out of the 307 identified older people, 295 had their functional condition assessed, and 194 underwent oral examinations. The majority of the older people were either frail or pre-frail, with a high degree of disability and dependence, and half of them exhibited low muscle strength. The analysis revealed that dependence on brushing and the accumulation of biofilm were associated with greater functional impairment. Additionally, a larger calf circumference was linked to less functional decline. A higher number of natural teeth was positively related to better chewing performance, which, in turn, was associated with a larger calf circumference. There was a significant indirect relationship between the number of natural teeth and calf circumference, mediated by chewing performance. It can be concluded that a poor oral health condition is associated with worse functional status in older peolpe living in LTCF. Six researchers documented their personal impressions about the fieldwork in a diary, which was used as the corpus for the qualitative study analysis. Researchers filled out a questionnaire with open-ended questions, reporting their significant experiences during the last month of data collection. The material was subjected to content analysis by two researchers. The identified themes included: LTCF adherence to the research; institutional routine in the research process; an approach guided by clinical-functional profiles; the central role of caregivers; researcher skills, and oral care in LTCF. Research in the context of LTCF among elderly individuals with clinical-functional impairments presents specific methodological and operational challenges, requiring a diverse skill set from the researche.