Institutionalized old people, depressive disorders, and dental issues: what is the state of the art?

Lopes, Luiza Guilhermina de Oliveira; Santos, Camila Mello dos; Bulgarelli, Alexandre Fávero

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Revista Brasileira de Geriatria e Gerontologia

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Review Articles • Rev. bras. geriatr. gerontol. 24 (1) • 2021 • https://doi.org/10.1590/1981-22562021024.200351 copy

Institutionalized old people, depressive disorders, and dental issues: what is the state of the art?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To map and discuss scientific knowledge involving the research object Oral health conditions and depression in institutionalized old people.

Method

Scope review of the literature mapping type. The mapping of the selected data was done using the data systematization technique through the Summative Content Analysis from the perspective of Manifest Themes in the texts. After the exclusions, 27 articles were selected.

Results

With the analysis of the articles it was possible to divide them into two themes. All continents have publications on the topic. Regarding its methodology, a lot of research with the design of deductive studies was carried out and few researches were developed with inductive methods.

Conclusion

The present study identified that there is a communication between some oral health conditions (xerostomia and tooth loss) and the prevalence of depressive disorders in institutionalized old people.

Keywords
Homes for the Aged; Oral Health; Depression; Review Literature as Topic

Themes	Subthemes
1-Oral health condition: LTCF, depressive disorders and pluralities	Xerostomia, dysphagia, mucosal lesions and chewing depression, oral condition and cognitive impairment, dysphagia, need for multiprofessional training and access to dental care
	Cortisol in saliva, depression diagnostic tools
	Life histories, oral health needs of institutionalized old people
	Masticatory skills, implants, oral health conditions and quality of life
2-Depression in institutionalized old people: medicalization, oral health conditions and subjectivities	Medications, dysphagia, depression and behaviors
	Depression in life transition to a care facility
	Interprofessional care, recreational activities, physical exercise, nutritional intervention and depression care
	Social activities and care and reduction of institutionalization
	Depression prevention actions
	Access to oral health services
	Cancer, tooth loss and depression

Year of Publication / Author(s) / Country of origin of the research	Objective of the study	Methodological approach	Depression-related issue addressed	Oral health-related issue addressed
2009/De Mello ALSF, Padilha DMP/ Brazil²²22 de Mello ALSF, Padilha DMP. Oral health care in private and small long-term care facilities: a qualitative study. Gerodontology. 2009;26(1):53-7. Disponível em: https://doi.org/10.1111/j.1741-2358.2008.00238.x .	To identify the characteristics of oral health care for institutionalized old people.	Qualitative/ Thematic analysis	-	Oral hygiene, dental care.
2009/Ferreira RC, et al. / Brazil²³23 Ferreira RC, Magalhães CSD, Rocha ES, Schwambach CW, Moreira AN. Saúde bucal de idosos residentes em instituições de longa permanência de Belo Horizonte, Minas Gerais, Brasil. Cad Saúde Pública. 2009;25(11):2375-85. Disponível em: https://doi.org/10.1590/S0102-311X2009001100008	To describe the oral health of the institutionalized old people regarding dental cavities, oral hygiene and periodontal disease.	Quantitative / Descriptive study	-	Oral hygiene, coronary and root tooth decay and periodontal disease.
2009/Haumschild MS, Haumschild RJ/ USA²⁴24 Haumschild MS, Haumschild RJ. The importance of oral health in long-term care. J Am Med Dir Assoc. 2009;10(9):667-71. Disponível em: https://doi.org/10.1016/j.jamda.2009.01.002 .	To assess the importance of long-term oral health care and its relationship to maintaining general health.	Qualitative / Narrative analysis	-	Oral hygiene and periodontitis.
2009/Isaksson R, et al. / Sweden²⁵25 Isaksson R, Becktor JP, Brown A, Laurizohn C, Isaksson S. Oral health and oral implant status in edentulous patients with implant-supported dental prostheses who are receiving long-term nursing care. Gerodontology. 2009;26(4):245-9. Disponível em: https://doi.org/10.1111/j.1741-2358.2009.00275.x .	To investigate oral health and the status of oral implants in patients who receive long-term care or who are institutionalized, all with prostheses.	Quantitative / Cohort study	-	Stomatitis, dental care for old people, edentulism, dental prosthesis supported by implant and dental plaque.
2009/Kim HY, et al. / South Korea²⁶26 Kim HY, Jang MS, Chung CP, Paik DI, Park YD, Patton LL, et al. Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders. Community Dent Oral Epidemiol. 2009;37(5):468-76. Disponível em: https://doi.org/10.1111/j.1600-0528.2009.00489.x .	To assess the association between masticatory capacity and quality of life related to oral health, associating it with other factors.	Quantitative / Descriptive study with secondary data	-	Masticatory capacity, edentulism and self-perception in oral health.
2010/Bush HM, et al./ USA²⁷27 Bush HM, Dickens NE, Henry RG, Durham L, Sallee N, Skelton J, et al. Oral health status of older adults in Kentucky: results from the Kentucky Elder Oral Health Survey. Spec Care Dentist. 2010;30(5):185-92. Disponível em: https://doi.org/10.1111/j.1754-4505.2010.00154.x .	To assess the oral health status of old people.	Quantitative / Descriptive study with secondary data	-	General oral health status (pain, bleeding gums and tooth loss, use of dentures) and access to dental services.
2010/De Visschere L, et al. J./ Belgium²⁸28 de Visschere L, Schols J, Van der Putten GJ, de Baat C, Vanobbergen J. Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial. Gerodontology. 2012;29(2):96-106. Disponível em: https://doi.org/10.1111/j.1741-2358.2010.00418.x .	To compare a supervised versus an unsupervised implementation of an oral health guideline.	Quantitative / Randomized clinical trial	-	Oral hygiene.
2011/Ozkan Y, et al / Turkey²⁹29 Ozkan Y, Özcan M, Kulak Y, Kazazoglu E, Arikan A. General health, dental status and perceived dental treatment needs of an elderly population in Istanbul. Gerodontology. 2011;28(1):28-36. Disponível em: https://doi.org/10.1111/j.1741-2358.2010.00363.x .	To determine the health status, in addition to treatment needs, in institutionalized old people.	Quantitative/ Descriptive study	-	Access to dental services, current dental status, use and status of prostheses, oral hygiene and edentulism.
2012/Mozafari PM, et al/ Iran³⁰30 Mozafari PM, Dalirsani Z, Delavarian Z, Amirchaghmaghi M, Shakeri MT, Esfandyari A, et al. Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran. Gerodontology. 2012;29(2):930-4. Disponível em: https://doi.org/10.1111/j.1741-2358.2011.00588.x .	To determine the prevalence of lesions of the oral mucosa in institutionalized old people.	Quantitative/ Analytical study	-	Lesions of the oral mucosa.
2014/Pretty IA/ England³¹31 Pretty IA. The life course, care pathways and elements of vulnerability. A picture of health needs in a vulnerable population. Gerodontology. 2014;31(1):1-8. Disponível em: https://doi.org/10.1111/ger.12092 .	To address the assessment of oral health needs based on the course of life and vulnerability in institutionalized old people.	Quantitative/ Descriptive study	Depression as a comorbidity	Use of prostheses, presence of pain, access to oral health services, self-care in oral health.
2018/Cocco F, et al/ Italy³²32 Cocco F, Campus G, Strohmenger L, Ardizzone VC, Cagetti MG. The burden of tooth loss in Italian elderly population living in nursing homes. BMC Geriatr. 2018;18(1):1-9. Disponível em: https://doi.org/10.1186/s12877-018-0760-0 .	To assess the prevalence and severity of tooth loss in institutionalized old people and associate other data.	Descriptive observational quantitative sectional study with primary and secondary data	Depression as a comorbidity	Tooth Loss
2018/Machado ACB/ Brazil³³33 Machado ACB. Concentração de cortisol salivar, saúde bucal e qualidade de vida de idosos [dissertação]. Araçatuba: Universidade Estadual Paulista; 2018.	To analyze the salivary cortisol concentrations of institutionalized and non-institutionalized old people and verify the conditions of oral health and physical dependence.	Cross-sectional, descriptive and analytical study	Depression as a central object	Use and need of dental prosthesis
2019/Recker E, et al/ Brazil and USA³⁴34 Recker E, Mendes MSS, Blanchette D, Dawson DV, Cowen H, Hartshorn J, et al. Systemic health characteristics and self-reported xerostomia among nursing facility residents in Iowa-US and Sao Paulo-Brazil. Braz Dent Sci. 2019;22(1):103-10. Disponível em: https://doi.org/10.14295/bds.2019.v22i1.1677 .	To describe and compare xerostomia and general health in institutionalized old people.	Descriptive quantitative study with secondary data	Depression as a comorbidity	Xerostomia

Year of Publication / Author(s) / Country of origin of the research	Objective of the study	Methodological approach	Depression-related issue addressed	Oral health-related issue addressed
2012/Cassie KM, Cassie WE./ USA³⁵35 Anand S, Ravallion M. Human development in poor countries: on the role of private incomes and public services. J Econ Perspect. 1993;7(1):133-50.	To analyze the effect of culture and climate on depressive symptoms among institutionalized old people.	Quantitative / Descriptive study with secondary data	Depression as a central object	-
2012/Davison TE, et al./ Australia³⁶36 Davison TE, Snowdon J, Castle N, McCabe MP, Mellor D, Karantzas G, et al. An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities. Int Psychogeriatr. 2012;24(4):1-9. Disponível em: https://doi.org/10.1017/S1041610211002146 .	To examine the use of the Cornell Scale in care facilities in Sydney and Melbourne, Australia, for depressed residents.	Quantitative / Descriptive study	Depression as a central object	-
2013/Bomfim FMS, Chiari BM, Roque FP/ Brazil³⁷37 Organização Mundial da Saúde [Internet]. Gênova: WHO; 2019 [acesso em 12 fev. 2021]. Number of nursing and elderly home beds. Disponível em: https://gateway.euro.who.int/en/indicators/hfa_491-5101-number-of-nursing-and-elderly-home-beds/ . https://gateway.euro.who.int/en/indicato...	To identify the factors associated with signs suggestive of oropharyngeal dysphagia in institutionalized old women.	Quantitative / Descriptive study	Depression as a comorbidity	Number of teeth in mouth
2013/Drageset J, Eide GE, Ranhoff AH/ Norway³⁸38 Drageset J, Eide GE, Ranhoff AH. Anxiety and depression and mortality among cognitively intact nursing home residents with and without a cancer diagnosis: a 5-year follow-up study. Cancer Nurs. 2013;36(4):68-74. Disponível em: https://doi.org/10.1097/NCC.0b013e31826fcb11 .	To analyze the hypothesis that anxiety or depression is related to the survival of patients with and without cancer.	Quantitative / Cohort study	Depression as a central object	-
2013/Underwood M, et al./ United Kingdom³⁹39 Underwood M, Lamb SE, Eldridge S, Sheehan B, Slowther AM, Spencer A, et al. Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial. Lancet. 2013;382(9886):41-9. Disponível em: https://doi.org/10.1016/S0140-6736(13)60649-2 .	To test the hypothesis that an exercise program would reduce depressive symptoms.	Quantitative / Randomized clinical trial	Depression as a comorbidity	-
2014/Miller LM, et al./ USA⁴⁰40 Miller LM, Dieckmann NF, Mattek NC, Lyons KS, Kaye JA. Social activity decreases risk of placement in a long-term care facility for a prospective sample of community-dwelling older adults. Res Gerontol Nurs. 2014;7(3):106-12. Disponível em: https://doi.org/10.3928/19404921-20140110-02 .	To determine the role of physical activities in the risk of placement in LTCF.	Quantitative / Cohort study	Depression as a comorbidity	-
2014/Van Schaik DJ, et al./ Netherlands⁴¹41 van Schaik DJ, Dozeman E, van Marwijk HW, Stek ML, Smit F, Beekman AT, et al. Preventing depression in homes for older adults: are effects sustained over 2 years? Int J Geriatr Psychiatry. 2014;29(2):191-7. Disponível em: https://doi.org/10.1002/gps.3989	To assess the effects of an intensive care program to prevent the onset of depression in institutionalized old people.	Quantitative / Randomized clinical trial	Depression as a central object	-
2015/Chesler J, et al./ Australia⁴²42 Chesler J, McLaren S, Klein B, Watson S. The effects of playing Nintendo Wii on depression, sense of belonging and social support in Australian aged care residents: a protocol study of a mixed methods intervention trial. BMC Geriatr. 2015;15(1):1-8. Disponível em: https://doi.org/10.1186/s12877-015-0107-z	To investigate an intervention program designed to promote relationships between old people in care.	Mixed study	Depression as a comorbidity	-
2016/Bali V, et al./ USA⁴³43 Shokry AAE, Adel MR, Rashad AESA. Educational program to improve quality of life among elderly regarding oral health. Futur Dent J. 2018;4(2):211-5. Disponível em: https://doi.org/10.1016/j.fdj.2018.07.002 .	To analyze the risk of dementia with anticholinergic use in old people with depression living in nursing homes.	Quantitative / Case control study	Depression as a central object	-
2016/Menezes AV, et al./ Brazil⁴⁴44 Menezes AV, Aguiar ADSD, Alves EF, Quadros LBD, Bezerra PP. Efetividade de uma intervenção fisioterapêutica cognitivo-motora em idosos institucionalizados com comprometimento cognitivo leve e demência leve. Ciênc Saúde Colet. 2016;21(11):3459-67. Disponível em: https://doi.org/10.1590/1413-812320152111.17892015 .	To verify the effectiveness of physical therapy intervention on cognition, mobility and functional independence of institutionalized old people.	Quantitative / Randomized clinical trial	Depression as a comorbidity	-
2016/Mountford CG, et al./ United Kingdom⁴⁵45 Mountford CG, Okonkwo AC, Hart K, Thompson NP. Managing malnutrition in older persons residing in care homes: nutritional and clinical outcomes following a screening and intervention program. J Nutr Gerontol Geriatr. 2016;35(1):52-66. Disponível em: https://doi.org/10.1080/21551197.2015.1131797 .	To establish the prevalence of malnutrition and investigate the effectiveness of a nutritional intervention program	Descriptive quantitative observational cohort study	Depression as a comorbidity	-
2018/Byers AL, Lui et al./ USA⁴⁶46 Byers AL, Lui LY, Vittinghoff E, Covinsky KE, Ensrud KE, Taylor B, et al. Burden of depressive symptoms over 2 decades and risk of nursing home placement in older women. J Am Geriatr Soc. 2018;66(10):1895-1901. Disponível em: https://doi.org/10.1111/jgs.15496 .	To determine the association between cumulative burden of depressive symptoms and risk of placement in LTCF.	Analytical quantitative observational cohort study	Depression as a central object	-
2019/Ozaki T, Katsumata Y, Arai A/ Japan⁴⁷47 Cassie KM, Cassie WE. Organizational and individual conditions associated with depressive symptoms among nursing home residents over time. Gerontologist. 2012;52(6):812-21. Disponível em: https://doi.org/10.1093/geront/gns059 .	To investigate the association between changes in the use of psychotropic drugs and psychological symptoms of dementia.	Analytical quantitative observational cohort study	Depression as a comorbidity	-

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[1] Correspondence Alexandre Fávero Bulgarelli alexandre.bulgarelli@ufrgs.br