An interprofessional educational approach to oral health care in the geriatric population

Educating long-term care staff on older adult oral health: Maine's oral team-based initiative vital access to education (MOTIVATE) program

INTRODUCTION

The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team-Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in-person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes.

METHODS

Learning outcomes were assessed via a three-part timed series survey. A set of self-report assessment items measured skills implemented at baseline and post-training.

RESULTS

Learning domain scores increased over time from baseline to post-training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team.

DISCUSSION

The MOTIVATE program is an effective collaborative-based model for developing oral health competencies and promoting evidence-based oral health care in nursing homes.

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Evaluation of student-perceived competence of interprofessional working in Gerodontology

OBJECTIVE

To evaluate pharmacy, dental and dental therapy undergraduate students' perceived competence of interprofessional working before and after attending an interprofessional education (IPE) Gerodontology workshop.

BACKGROUND

Whilst there is international recognition of the importance of collaboration between the dental profession and systemic healthcare providers to enhance patient care, there remains a paucity of research into IPE in Gerodontology.

MATERIALS AND METHODS

Pharmacy, dental and dental therapy undergraduate students attended a 2-hour Gerodontology case-based workshop. Students completed anonymised Interprofessional Collaborative Competencies Attainment Surveys (ICCAS) before and after attendance.

RESULTS

108 questionnaires were received, 7 were withdrawn (1 incomplete with only pre-workshop side completed, 6 did not identify degree programme). From 101 included questionnaires, 37 were from pharmacy, 56 dental and 8 dental therapy students resulting in response rates of 84%, 82% and 67%, respectively. Each student group recorded an increase in positive reflective competence median (IQR) after taking part in the workshop. Overall median (IQR) reflective competence before the workshop was 6 (1), 5 (2) and 6 (2) for pharmacy, dental and dental therapy students, respectively, which increased to 7 (1) for all groups. There was variability in reflective competence before attending the workshop between dental and pharmacy students for two questions, and dental and dental therapy students for two different questions.

CONCLUSION

All students reported increased reflective competence of interprofessional working following the workshop. These findings suggest that introduction of IPE events into Gerodontology curricula may improve student understanding and appreciation of interprofessional working when providing care for older people.

Oral Care in Hospital Settings: Breaking the Vicious Circle of Older Adult Deconditioning

Hospitalized older adults frequently develop aspiration pneumonia, swallowing dys-function (dysphagia), and sarcopenia. In the current study, we propose a framework that incorporates these three factors into a vicious circle that leads to deconditioning, a condition frequently experienced by this vulnerable population. Viewing aspiration pneumonia, dysphagia, and sarcopenia, along with their interrelationships through the lens of this vicious circle, illuminates the critical role that oral health plays in deconditioning. Moreover, this framework highlights oral care as a key nursing intervention for reducing deconditioning in hospitalized older adults. Supporting this view, several studies have shown that oral care can improve health outcomes for hospitalized older adults. However, despite oral care being an essential nursing intervention that restores oral function and promotes patient wellness, it is one of the most neglected nursing interventions. Missed oral care occurs due to staff's limited awareness of its significance for care-dependent older adults in hospital settings. We hope that this vicious circle paradigm helps raise awareness of the significance of oral care to prevent deconditioning in hospitalized older adults. [Journal of Gerontological Nursing, 47(6), 7-12.].

Home care aides' attitudes to training on oral health care

This study investigated home care aides' (HCAs) oral health care experience, knowledge, and their intention to receive professional training, to explain and predict factors of their intention to receive such training. This cross-sectional study collected data through a structured questionnaire. HCAs affiliated with home care agencies in Taichung, Taiwan were recruited through purposive sampling. A total of 487 questionnaires were distributed from September to December 2015 with 280 valid responses collected (57.4%).This study predicted the factors of HCAs' intention to receive oral health care training through a decision tree analysis. The decision tree model classified the respondents with an accuracy of 77.5%. The optimal predictor variable was oral health care knowledge (χ2 = 66.662, p < 0.0001). Among the low-scoring respondents on oral health care knowledge, 76.4% were classified in the "uninterested" group, whereas 84.8% of the high scorers were classified in the "interested" group. The second best predictor variable was whether oral health care is part of the job responsibility (χ2 = 7.979, p = 0.007). Among those who answered Yes, 92.9% were in the interested group, as were 76.5% of those who answered No. It is recommended to add "disease and oral care-related content" and "safety protection, assessment, and usage of oral care tools during practical oral care process" to the oral healthcare training course content for HCAs in order to improve HCAs' oral healthcare knowledge and oral care skills. These research findings are valuable and may be taken into account in the future development of the in-service educational training of oral healthcare for HCAs.

Interprofessional education - a case for Gerodontology training

Increasing life expectancy, concepts of patient well-being, and the multiplicity of needs of the geriatric population, demand contribution, and collaboration of physicians, dentists, psychologists, pharmacists, and other allied health disciplines, to provide quality care to patients. Interprofessional education (IPE) is an approach to education that improves collaboration among health professionals and it can aid in better management of geriatric patients. Communication and cooperation affect health care performance and hence, influence patient outcomes. Currently, each of the disciplines mentioned has customized undergraduate and/or postgraduate training in geriatric care. Though a uni-disciplinary educational approach increases knowledge and skills of individual professions separately, IPE offers significant advantages. IPE seeks to have students learning together, as well as from each other to develop exemplary collaborative practice. The World Health Organization (WHO) has proposed that IPE will ensure optimum health care. However, IPE is yet to find its proper place in dental education. It would help dental students to develop a positive attitude toward geriatric patients and increase their empathy and efficiency in the management of these patients. This manuscript seeks to highlight the concept of interprofessional education (IPE) in gerodontology and develop recommendations for implementation of IPE in India.

Evaluation of an Oral Hygiene Education Program for Staff Providing Long-Term Care Services: A Mixed Methods Study

Background: Oral hygiene is often neglected in clients receiving long-term care, suggesting that long-term care workers require formal oral hygiene education. Thus, the aim of this study was to investigate the effects of oral hygiene education on long-term care workers. Methods: This study utilized a mixed methods design. Eighty long-term care workers were recruited for participation in the oral hygiene education program, which employed three teaching methods: narration with multimedia presentation, demonstration, and teach-back. The effect of the education program on the participants’ level of oral hygiene knowledge, attitudes, and skills was measured using a structured questionnaire that was administered both pre- and post-delivery of the education program. Three months later, all participants submitted a self-report of their oral hygiene skills, and six participants completed a telephone interview. Quantitative data were analyzed using paired t-tests, and qualitative data were manually analyzed and coded. Results: Scores of oral hygiene knowledge (p < 0.001), attitudes (p = 0.001), and oral cleaning daily frequency for clients (p < 0.001), were significantly higher three months after undertaking the educational program. Conclusions: This preliminary study suggests that oral hygiene education may be effective in improving oral hygiene knowledge, attitudes, and skills among long-term care staff.

Management of Large Residual Cyst in Elderly Patient with Decompression Alone: Case Report

Background/Aim:Residual cysts comprise approximately 10% of all odontogenic cysts. They are more commonly seen in 4th-6th decades of life, and occur due to incomplete previous surgical removal of a radicular cyst; or due to left epithelial remnants stimulated by tooth extraction. These lesions are often treated with enucleation. However, this procedure is not always the ideal treatment solution for elderly people due to the presence of physical and mental disorders, and risk of jaw fracture.

Case Report: In this case report, the successful treatment of a large residual cyst in the symphysis of a 93 year-old female patient by performing decompression alone is presented. A plastic drain was placed on the wall of the cyst to allow irrigation. Regeneration was observed in the cyst cavity 3 months after surgery. The 1-year follow up showed that the majority of the cyst cavity was filled with new bone.

Conclusions: In elderly patients, large inflammatory cysts can be successfully treated with decompression considering the limited regeneration capacity and difficulties in follow-up.

Dental students' reflections about long-term care experiences through an existing model of oral health

OBJECTIVE

The aim of this study was to explore students' reflective thinking about long-term care experiences from the perspective of a model of oral health.

MATERIALS AND METHODS

A total of 186 reflections from 193 second-year undergraduate dental students enrolled between 2011/12 and 2014/15 at the University of British Columbia were explored qualitatively. Reflections had a word limit of 300, and students were asked to relate an existing model of oral health to their long-term care experiences. We have identified the main ideas via a thematic analysis related to the geriatric dentistry experience in long-term care.

RESULTS

The thematic analysis revealed that students attempted to demystify their pre-conceived ideas about older people and long-term care facilities, to think outside the box, for example away from a typical dental office, and to consider caring for elderly people from an interprofessional lens. According to some students, not all domains from the existing model of oral health were directly relevant to their geriatric experience while other domains, including interprofessionalism and cognition, were missing. While some participants had a positive attitude towards caring for this cohort of the population, others did not take this educational activity as a constructive experience.

CONCLUSIONS

The nature of most students' reflective thinking within a long-term care experience showed to be related to an existing model of oral health. This model can help to give meaning to the dental geriatric experience of an undergraduate curriculum. Such experience has been instrumental in overcoming potential misconceptions about long-term care and geriatric dentistry.

Exploring dental student participation in interdisciplinary care team conferences in long-term care

OBJECTIVE

The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team.

BACKGROUND

Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams. As an educational intervention, dental hygiene students, in addition to providing clinical care to residents and education to staff in a LTC facility, have been participating in interdisciplinary care conferences for 4 years.

METHODS

Nine LTC facility staff and eight students participated in two focus groups and five personal interviews to discuss their experiences of the care conferences. Narratives were transcribed verbatim and thematic analysis was conducted.

RESULTS

Four major themes emerged that described the essence of the experience of involving dental professionals within interdisciplinary care conference: (i) addressing oral health, (ii) reciprocal learning, (iii) dealing with complexity and (iv) impact of collaborative care.

CONCLUSION

Overall, students found the educational intervention to be worthwhile that allowed for the development of interdisciplinary skills and a greater understanding of dental geriatrics. The dental support in care conferences was welcomed by the staff as it facilitated a new way of exchanging knowledge and experiences so that a more holistic approach to care could be undertaken by all.