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Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults.

ABSTRACT: Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS). Individual logistic regression was performed for all predictors in relation to GI and PS. Multiple logistic regression was performed with significant predictors of GI and PS only. Greater locus of control and more brushing predicted lower GI; greater locus of control predicted lower PS. Both cognitive and behavioral domains impact GI, requiring more prolonged effort for improvement while locus of control, a cognitive variable, predicts PS, immediately improved by daily brushing/flossing. A streamlined IM including locus of control and tooth brushing should improve oral hygiene of low-income older adults.

SUBMITTER: Schensul JJ

PROVIDER: S-EPMC8184860 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults.

Schensul Jean J JJ Salvi Apoorva A Ha Toan T Grady James J Li Jianghong J Reisine Susan S

Journal of applied gerontology : the official journal of the Southern Gerontological Society 20201208 1

Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS). Individual logistic reg ...[more]

PMID: 33292050

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Project description:BackgroundThis paper compares the relationship between theoretically-driven mechanisms of change and clinical outcomes across two different interventions to improve oral hygiene of older adults participating in a group randomized trial.MethodsSix low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs). Both were based on Fishbein's Integrated Model. 331 participants were recruited at baseline and 306 completed the post-assessment one month after intervention. Clinical outcomes were Gingival Index (GI) and Plaque score (PS), collected by calibrated dental hygienists. Surveys obtained data on patient background characteristics and ten mechanisms of change including oral health beliefs, attitudes, norms and behaviors. GLMM was used to assess the effects of time, intervention arm, participant characteristics, intervention mechanisms and differences between the two interventions over time in relation to outcomes.ResultsAt baseline, both groups had similar background characteristics. Both groups improved significantly in outcomes. Overall GI scores changed from baseline mean of 0.38 (SD = .032) to .26 (SD = .025) and PS scores changed from baseline mean of 71.4 (SD = 18%) to 59.1% (SD = 21%). T-tests showed that fears of oral disease, oral health intentionality, oral health norms, worries about self-management of oral health, flossing frequency and sugar control improved significantly in both interventions from baseline to post intervention. Oral health self-efficacy, perceived risk of oral health problems, oral health locus of control and brushing frequency improved significantly only in the counseling intervention. GLMM models showed that the significant predictors of GI improvement were intentionality to perform oral hygiene, locus of control, and improvement in frequency of brushing and flossing in association with the counseling intervention. Predictors of PS improvement were worries about oral hygiene self-management and fear of oral diseases, in association with the counseling intervention. In the reduced final models, only oral health locus of control (predicting GI) and fears of oral diseases (predicting PS) were significant in association with the counseling intervention. Locus of control, a key concept in oral hygiene interventions including the IM was the main contributing mechanism for GI improvement. Fear, an emotional response, drove improvement in PS, reinforcing the importance of cognitive/emotional mechanisms in oral hygiene interventions.ConclusionsThough both groups improved in outcomes, GI and PS outcomes improved more in response to the counseling intervention than the campaign. The counseling intervention had an impact on more mechanisms of change than the campaign. Improvements in intervention mechanisms across both interventions however, suggest a closer examination of the campaign intervention impact on outcomes over time.Trial registrationClinicaltrials.gov NCT02419144, first posted April 17, 2015.

Project description:The links between emotions, bio-regulatory processes, and economic decision-making are well-established in the context of age-related changes in fluid, real-time, decision competency. The objective of the research reported here is to assess the relative contributions, interactions, and impacts of affective and cognitive intelligence in economic, value-based decision-making amongst older adults. Additionally, we explored this decision-making competency in the context of the neurobiology of aging by examining the neuroanatomical correlates of intelligence and decision-making in an aging cohort. Thirty-nine, healthy, community dwelling older adults were administered the Iowa Gambling Task (IGT), an ecologically valid laboratory measure of complex, economic decision-making; along with standardized, performance-based measures of cognitive and emotional intelligence (EI). A smaller subset of this group underwent structural brain scans from which thicknesses of the frontal, parietal, temporal, occipital, cingulate cortices and their sub-sections, were computed. Fluid (online processing) aspects of Perceptual Reasoning cognitive intelligence predicted superior choices on the IGT. However, older adults with higher overall emotional intelligence (EI) and higher Experiential EI area/sub-scores learned faster to make better choices on the IGT, even after controlling for cognitive intelligence and its area scores. Thickness of the left rostral anterior cingulate (associated with fluid affective, processing) mediated the relationship between age and Experiential EI. Thickness of the right transverse temporal gyrus moderated the rate of learning on the IGT. In conclusion, our data suggest that fluid processing, which involves "online," bottom-up, cognitive processing, predicts value-based decision-making amongst older adults, while crystallized intelligence, which relies on "offline" previously acquired knowledge, does not. However, only emotional intelligence, especially its fluid "online" aspects of affective processing predicts the rate of learning in situations of complex choice, especially when there is a paucity of cues/information available to guide decision-making. Age-related effects on these cognitive, affective and decision mechanisms may have neuroanatomical correlates, especially in regions that form a subset of the human mirror-neuron and mentalizing systems. While superior decision-making may be stereotypically associated with "smarter people" (i.e., higher cognitive intelligence), our data indicate that emotional intelligence has a significant role to play in the economic decisions of older adults.

Dataset Information

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults.

Publications

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults.

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