1
|
El Gedaily M, Spatzier H, Srinivasan M. Oral health, treatment burden and demographics of elders with care-resistant behavior: A cross-sectional study. SPECIAL CARE IN DENTISTRY 2024. [PMID: 39230355 DOI: 10.1111/scd.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024]
Abstract
AIMS To assess oral health, treatment burden, mortality risk, and demographics in elders with care-resistant behaviors (CRB) in nursing homes (NH) and compare them with those without CRB. METHODS AND RESULTS 503 participants from eight NH who received dental treatment through a mobile dental clinic were included. Their medical and dental records were screened regarding oral/dental health, treatment history, general health, demographics, and CRB. Statistical analysis was performed to show correlations between CRB and the measured parameters. Data were verified for normal distribution; a point-biserial correlation model was used (95% CI: α = 0.05). No correlation was found between CRB and Decayed Missing Filled Teeth (DMF-T) (rpb = -0.061, p = .177), as well as periodontal status (rpb = 0.004, p = .946). A negative correlation was observed between CRB and the required number of treatment procedures (rpb = -0.181, p < .0001), time (rpb = -0.118, p = .010), and costs (rpb = -0.100, p = .028). Sex predilection for men regarding CRB was evident (rpb = -0.155, p = .01). No correlation appeared between CRB and vital status (rpb = -0.41, p = .355). CONCLUSION Oral health seems to be similar in institutionalized elders with or without CRB. Treatment burden was not elevated, but even reduced in elders with CRB, evincing that few/no treatment procedures were performed in those elders. CRB demonstrated a sex predilection for men. An association between CRB and increased mortality was not evident.
Collapse
Affiliation(s)
- Mohamed El Gedaily
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hansmartin Spatzier
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Salazar J, Andersen C, Øzhayat EB. Effect of oral health interventions for dependent older people-A systematic review. Gerodontology 2024; 41:200-219. [PMID: 37847812 DOI: 10.1111/ger.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health. OBJECTIVE The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people. METHODS We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system. RESULTS We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system. CONCLUSION Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people. PROSPERO ID CRD42021231721.
Collapse
Affiliation(s)
- Josefina Salazar
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Andersen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Esben Boeskov Øzhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Hillebrecht AL, Höfer K, Blasi A, Wicht MJ, Barbe AG. Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review. Gerodontology 2024; 41:111-124. [PMID: 36924414 DOI: 10.1111/ger.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures. BACKGROUND Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries. METHODS We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used. RESULTS Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people. CONCLUSIONS Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.
Collapse
Affiliation(s)
- Anna-Lena Hillebrecht
- Department of Prosthetic Dentistry, Centre for Dental Medicine, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Karolin Höfer
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Alicia Blasi
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Michael J Wicht
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| |
Collapse
|
4
|
Bryant AL, Hirschey R, Caiola CE, Chan YN, Cho Y, Plassman BL, Wu B, Anderson RA, Bailey DE. Care partners experience of an oral health intervention for individuals with mild cognitive impairment and mild dementia using behavior change technique: A qualitative study. Geriatr Nurs 2024; 56:40-45. [PMID: 38237339 PMCID: PMC10990823 DOI: 10.1016/j.gerinurse.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024]
Abstract
Oral health declines in older adults with cognitive impairment. We aimed to improve oral hygiene outcomes for individuals with mild cognitive impairment (MCI) or mild dementia (MD) by fostering behavior changes among carepartners assisting them. We used qualitative data of verbatim transcripts of coaching sessions with carepartners (n = 17 dyads:10 dyads for MCI, 7 dyads for MD). Directed and emergent coding were used to understand behavior change techniques (BCTs). BCTs were compared with carepartners of participants with MCI and MD. Most frequently used BCTs in both groups: prompts and cues, instruction on how to perform the behavior, review behavioral goal, and problem solving. Different BCTs emerged in study: social support-unspecified of the MCI group and credible source for MD group. Findings clarified active intervention components, common BCTs used by carepartners, and different BCT approaches for both participants. Findings help to elucidate the mechanisms of changes in individuals' behaviors in these interventions.
Collapse
Affiliation(s)
- Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ya-Ning Chan
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Youngmin Cho
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brenda L Plassman
- Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York City, New York, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | |
Collapse
|
5
|
Lee HH, Melbye EL. Nursing home caregivers' acceptance of, and experiences with, a new digital intervention for oral healthcare: A qualitative feasibility study. Gerodontology 2024; 41:68-82. [PMID: 37294037 DOI: 10.1111/ger.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The objectives of the present study were to qualitatively investigate nursing home caregivers' acceptance of, and experiences with, a new digital intervention for oral healthcare after a period of real-life testing in three nursing homes located in Rogaland county, Norway. BACKGROUND Nursing home caregivers report numerous barriers when it comes to provision of adequate oral care for care-dependent older adults. Among the reported barriers are lack of knowledge and skills, care-resistant behaviours, lack of adequate routines and documentation systems for oral health, a high workload, and unclear responsibilities. To overcome these barriers, a digital tool named SmartJournal was developed to assist caregivers in preserving nursing home residents' oral health. MATERIALS AND METHODS Semistructured interviews were performed with selected caregivers (n = 12) taking part in SmartJournal testing. A theory-driven thematic analysis based on technology acceptance model was conducted. RESULTS SmartJournal was generally described as a userfriendly and useful tool. The initial reaction of the participants was mixed; some were positive, some had concerns, but many seemed to have a neutral stance to the intervention. Both barriers and facilitating factors for SmartJournal usage were revealed. Interestingly, the usage gradually changed from norm-based to routine-based behaviour during the test period. Although the tool was well-accepted, as demonstrated with study participants' willingness to use it in the future, they had several suggestions for improvements to further adapt it to a nursing home setting. CONCLUSION Results from the present study provide valuable information on questions about SmartJournal acceptance and intervention delivery, thereby preparing the ground for a larger scale evaluation study assessing measurable effects of SmartJournal usage in nursing homes.
Collapse
|
6
|
Roche L, Longacre ML. Nonpharmacological interventions in dementia and diversity of samples: A scoping review. Geriatr Nurs 2024; 55:311-326. [PMID: 38142547 DOI: 10.1016/j.gerinurse.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND A public health priority is the increasing number of people with dementia (PwD), and nonpharmacological interventions (NPIs) might offer support. We sought to synthesize types of NPIs tested among PwD and explore sample characteristics. METHODS This study was a scoping literature review. Eligible articles were identified using the search terms "nonpharmacological intervention" and "dementia". RESULTS 36 articles were included. Psychosocial NPIs were implemented the most (n=24) and music-based interventions were found to be the most effective. Gender, race, and ethnicity were not consistently reported (n=30, n=24, and n=6, respectively). White PwD had higher representation, with only 62.5% of studies including Black participants and 25% including Hispanic/Latino participants. Women made up a majority (>50%) of the sample in a greater number of studies (n=20). CONCLUSION Findings suggest that future studies need to be intentional about improving diversity of the sample, particularly with respect to including persons identifying as Black or Hispanic/Latino.
Collapse
Affiliation(s)
- L Roche
- College of Health Sciences, 241 Easton Hall, Arcadia University, 450 S. Easton Rd., Glenside, PA 19038, United States
| | - M L Longacre
- College of Health Sciences, 241 Easton Hall, Arcadia University, 450 S. Easton Rd., Glenside, PA 19038, United States.
| |
Collapse
|
7
|
Melbye EL, Bull VH, Hidle KS. Assessment of the SmartJournal Intervention for Improved Oral Care in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46926. [PMID: 37801358 PMCID: PMC10589829 DOI: 10.2196/46926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Poor oral health is common in nursing home residents, and health care professionals report numerous barriers when it comes to the provision of oral care for care-dependent older adults, such as a lack of oral health knowledge and skills, care-resistant behaviors in residents, lack of adequate oral care routines, insufficient systems for documentation of issues related to oral health, a high workload, and unclear responsibilities. An intervention, SmartJournal, has been developed to assist health personnel in preserving older patients' oral health. SmartJournal is a digital tool with three components: (1) documentation of oral hygiene routines; (2) monthly oral health assessment; and (3) education on geriatric oral care. An updated framework for research on complex interventions has been used to guide the various phases in the development of this intervention. This study focuses on the evaluation phase. OBJECTIVE We aim to assess (1) the effectiveness of SmartJournal use in enhancing nursing home caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) whether SmartJournal use results in improved oral health for nursing home residents. METHODS We will use a cluster randomized controlled trial to assess impacts of SmartJournal use as specified under study objectives. Nursing homes located in Rogaland, Norway, will be recruited and randomly assigned to an intervention and a control group. The intervention group will be provided with tablets containing SmartJournal and support from research staff, while the control group will continue with existing oral care routines. Both groups will receive oral hygiene packages. The intervention will last for 12 weeks. Measurements will be performed in both groups at baseline, 3 months, and 9 months and include (1) a survey assessing caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) assessment of oral health status in residents using mucosal-plaque score as a primary outcome measure. Analyses will include descriptive statistics and statistical techniques to look for changes and differences in the study variables within and between the intervention and control groups throughout the study period. Associations between study variables will also be investigated. RESULTS Recruitment of nursing homes for the intervention and control groups was completed in February 2023. Recruitment of individual participants (ie, nursing home residents and caregivers) is ongoing, and baseline measurements are being performed consecutively. Results are expected to be ready for analyses in fall 2024. CONCLUSIONS We aim to assess the effects of SmartJournal use on oral care and oral health in nursing homes. Results from this work may inform further development and implementation of SmartJournal and similar digital tools aiming to enhance health care services offered to care-dependent people. Finally, SmartJournal may have potential as a learning tool in educational programs for nurses and other health care professionals. TRIAL REGISTRATION ClinicalTrials.gov NCT05724043; https://clinicaltrials.gov/study/NCT05724043. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46926.
Collapse
Affiliation(s)
| | - Vibeke Hervik Bull
- Research Department, Oral Health Centre of Expertise Rogaland, Stavanger, Norway
| | | |
Collapse
|
8
|
Willems MS, Hollaar VRY, van der Maarel-Wierink CD, van der Putten GJ, Satink T. Care-resistant behaviour during oral examination in Dutch nursing home residents with dementia. Gerodontology 2023; 40:299-307. [PMID: 36000466 DOI: 10.1111/ger.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the occurrence and associations of verbal and non-verbal care-resistant behaviour (CRB) during oral examination by a dental hygienist in nursing home residents with dementia. BACKGROUND CRB is a barrier to providing professional oral care and daily oral hygiene care. Understanding the predictors of CRB might help care professionals in learning to anticipate this behaviour. METHODS In this multicentre cross-sectional study signs of verbal and non-verbal CRB were reported during the oral examination. Data collection occurred in the psychogeriatrics wards of 14 different nursing homes in the Netherlands (N = 367). RESULTS A total of 367 residents were included. CRB was evident in 82 residents (22.3%), of whom 45 (55%) showed verbal and 37 (45%) non-verbal CRB. Associated with CRB were age >85 years, duration of residential stay longer than 2 years, and having Korsakov dementia. Other factors associated with CRB were duration of residential stay (categories ">2 and ≤4 years" or ">4 years") and having a natural dentition (P = .043-.005, OR = 1.20-1.33, 95% CI = 1.00-8.48). Significant associations for verbal and non-verbal CRB were age between 76 and 85 years, vascular dementia and Korsakov dementia (P = .031-.006, OR = .020-1.49, 95% CI = 0.43-2.15). CONCLUSION The occurrence of CRB was 22.3% and was associated with older age and longer duration of residential stay, Vascular and Korsakov dementia and natural dentition.
Collapse
Affiliation(s)
- Malou S Willems
- Education of Dental Hygiene, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Vanessa R Y Hollaar
- Education of Dental Hygiene, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Flemish-Netherlands Geriatric Oral Research Group, BENECOMO, Ghent, Belgium
- Flemish-Netherlands Geriatric Oral Research Group, BENECOMO, Nijmegen, The Netherlands
| | - Claar D van der Maarel-Wierink
- Flemish-Netherlands Geriatric Oral Research Group, BENECOMO, Ghent, Belgium
- Flemish-Netherlands Geriatric Oral Research Group, BENECOMO, Nijmegen, The Netherlands
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gert-Jan van der Putten
- Flemish-Netherlands Geriatric Oral Research Group, BENECOMO, Ghent, Belgium
- Flemish-Netherlands Geriatric Oral Research Group, BENECOMO, Nijmegen, The Netherlands
- Department of Oral Function, Radboud University Nijmegen, Nijmegen, The Netherlands
- Medical Department, Orpea Dagelijks Leven, Apeldoorn, The Netherlands
| | - Ton Satink
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- European Master of Science in Occupational Therapy, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Desai JP, Nair RU. Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review. J Clin Med 2023; 12:jcm12093202. [PMID: 37176641 PMCID: PMC10179735 DOI: 10.3390/jcm12093202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.
Collapse
Affiliation(s)
- Jhanvi P Desai
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA 52242, USA
| | - Rohit U Nair
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA 52242, USA
| |
Collapse
|
10
|
Shirobe M, Edahiro A, Motokawa K, Morishita S, Ohara Y, Motohashi Y, Iwasaki M, Watanabe Y, Hirano H. Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3841. [PMID: 36900852 PMCID: PMC10001667 DOI: 10.3390/ijerph20053841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.
Collapse
Affiliation(s)
- Maki Shirobe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shiho Morishita
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- School of Health Sciences, Meikai University, 1 Meikai, Urayasu-shi, Chiba 279-8550, Japan
| | - Yuki Ohara
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yoshiko Motohashi
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Gerodontology, Department of Oral Health Science, Hokkaido University, Kita 13-jo Nishi 7-chome, Kita-ku, Sapporo-shi, Hokkaido 060-8586, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| |
Collapse
|
11
|
Matsuda S, Yoshimura H. Impact of oral health management on mental health and psychological disease: a scoping review. J Int Med Res 2023; 51:3000605221147186. [PMID: 36594601 PMCID: PMC9827524 DOI: 10.1177/03000605221147186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The relationship between oral and mental health has been controversial. Few studies have assessed the direct effects of oral health management on mental health and psychological disease. Using evidence from the last 5 years, this scoping review aimed to map and discuss recent progress in understanding this relationship. METHODS Electronic literature searches were performed using PubMed, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature databases. An additional manual search was performed using Google Scholar databases. Studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram. RESULTS An eligibility review process identified three randomized controlled trials for inclusion in this review. The oral health interventions and participants' target age, mental health status, and psychological diseases varied across these studies. The only study that reported an improvement included psychosocial support integrated with educational components of oral health as the intervention. The remaining two studies detected no significant impact of oral health interventions on mental health and psychological disease. CONCLUSIONS Evidence of the impact of oral health management on mental health and psychological disease is insufficient in studies published between 2017 and 2021.
Collapse
Affiliation(s)
- Shinpei Matsuda
- Shinpei Matsuda, Department of Dentistry
and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine,
Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki,
Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
| | | |
Collapse
|
12
|
Jonker M, Engelsma C, Manton DJ, Visser A. Decision-Making concerning Involuntary Oral Care for Older Individuals with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16655. [PMID: 36554537 PMCID: PMC9779801 DOI: 10.3390/ijerph192416655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Many older individuals with dementia (OIWD) show care-resistant behavior for oral care. Providing care despite resistance is considered to be involuntary care. Although involuntary care should be minimized, in some OIWD it may be necessary to avoid health risks. This study aims to assess the attitudes of healthcare providers with regard to involuntary oral care provision for OIWD who show care-resistant behavior. An online questionnaire consisting of general questions and case specific questions was administered via social media and networking to individuals involved in the oral care of OIWD. A total of 309 participants were included in this study. The outcomes of the questionnaires were categorized per case. In all cases, a discrepancy was seen between the assessment of oral health problems as potentially harmful (range: 73.1-93.5%) and the willingness to provide involuntary care (range: 31.1-63.4%). Hence, many healthcare providers are aware of the subsequent potential health risks related to not providing care, but are still reluctant to provide involuntary oral care. Therefore, many OIWD who show care-resistant behavior potentially do not receive the necessary oral care they require.
Collapse
Affiliation(s)
- Maud Jonker
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Coos Engelsma
- Medical Ethics and Decision Making, Department of Ethics, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - David J. Manton
- Department of Cariology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Anita Visser
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Gerodontology, Faculty for Dentistry, Radboud University Medical Center, Radboud University Nijmegen, 6525 EX Nijmegen, The Netherlands
| |
Collapse
|
13
|
Barry BJ, McConnell ES, Duea SR, Blodgett NP. A Standardized Positive Physical Approach to Improve Oral Hygiene for Nursing Home Residents With Alzheimer's Disease and Related Dementias. J Gerontol Nurs 2022; 48:15-20. [DOI: 10.3928/00989134-20221003-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
Oda K, Boyd M, Parsons J, Smith M. Integrating oral care into nursing practice in care homes. Nurs Older People 2022; 34:27-34. [PMID: 35730481 DOI: 10.7748/nop.2022.e1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 01/31/2023]
Abstract
This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.
Collapse
Affiliation(s)
- Keiko Oda
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John Parsons
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
15
|
Wu B, Plassman BL, Poole P, Siamdoust S, Bunn M, Burwell B, Pei Y, Downey C, Gomes D, Kamer A, Yu G, Leak Bryant A, Anderson RA. Study protocol for a randomised controlled trial of a care partner assisted intervention to improve oral health of individuals with mild dementia. BMJ Open 2022; 12:e057099. [PMID: 35732396 PMCID: PMC9226943 DOI: 10.1136/bmjopen-2021-057099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Individuals with mild dementia are at high risk of poor oral health outcomes. To address this issue, we describe an intervention to teach care partners skills to guide individuals with mild dementia in proper oral hygiene techniques and provide reminders to practice oral hygiene care. By providing support to perform these tasks successfully, we aim to delay oral health decline among this vulnerable population. METHODS AND ANALYSIS This multisite study is a three-arm randomised controlled trial. The primary objective is to evaluate the efficacy of an intervention to improve oral hygiene outcomes by promoting positive oral hygiene behaviours and skills among individuals with mild dementia. Care partners' behaviour factors, such as oral care self-efficacy and implementation of the care plan, serve as mediators of the intervention. Participant-care partner dyads will be randomly assigned to either Treatment Group 1, Treatment Group 2 or the Control Group. All groups will receive an educational booklet. Treatment Group 1 and Treatment Group 2 will receive a smart electronic toothbrush. Treatment Group 2 (the intervention group) will also receive an oral hygiene care skill assessment, personalised oral hygiene instruction and treatment plan; and care partners will receive in-home and telephone coaching on behaviour change. Oral health outcomes will be compared across the three groups. The duration of the active intervention is 3 months, with an additional 3-month maintenance phase. Data collection will involve three home visits: baseline, 3 months and 6 months. The study enrollment started in November 2021, and the data collection will end in Spring 2024. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board of the NYU Grossman School of Medicine and Duke University, and is registered at Clinicaltrials.gov. A Data Safety Monitoring Board has been constituted. The study findings will be disseminated via peer-reviewed publications, conference presentations and social media. TRIAL REGISTRATION NUMBER NCT04390750.
Collapse
Affiliation(s)
- Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Brenda L Plassman
- Departments of Psychiatry and Neurology, Duke University, Durham, North Carolina, USA
| | - Patricia Poole
- Departments of Psychiatry and Neurology, Duke University, Durham, North Carolina, USA
| | - Shahrzad Siamdoust
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Melanie Bunn
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bobbi Burwell
- Departments of Psychiatry and Neurology, Duke University, Durham, North Carolina, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Christine Downey
- Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danni Gomes
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Angela Kamer
- Department of Periodontology and Implant Dentistry, New York University, New York, New York, USA
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - A Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
16
|
Gomez-Rossi J, Schwartzkopff J, Müller A, Hertrampf K, Abraham J, Gassmann G, Schlattmann P, Göstemeyer G, Schwendicke F. Health policy analysis on barriers and facilitators for better oral health in German care homes: a qualitative study. BMJ Open 2022; 12:e049306. [PMID: 35351692 PMCID: PMC8966571 DOI: 10.1136/bmjopen-2021-049306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess possible health policy interventions derived from the theoretical domains framework (TDF) by studying barriers and facilitators on the delivery of oral healthcare and oral hygiene in German care homes using a behavioural change framework. DESIGN Qualitative correlational study to evaluate a national intervention programme. SETTING Primary healthcare in two care homes in rural Germany. PARTICIPANTS Eleven stakeholders participating in the delivery of oral healthcare (hygiene, treatment) to older people, including two care home managers, four section managers, two nurses/carers and three dentists. INTERVENTIONS Semistructured interviews conducted in person in the care homes or by phone. A questionnaire developed along the domains of the TDF and the Capabilities, Opportunities and Motivations influencing Behaviours model was used to guide the interviews. Interviews were transcribed and systematised using Mayring's content analysis along the TDF. RESULTS 860 statements were collected. We identified 19 barriers, facilitators and conflicting themes related to capabilities, 34 to opportunities and 24 to motivation. The lack of access to professional dental care was confirmed by all stakeholders as a major limitation hampering better oral health. PRIMARY OUTCOME A range of interventions can be discussed with the methodology we utilised. In our interviews, lack of dentists willing to treat patients at these facilities was the most discussed barrier for improving oral health of nursing home residents. SECONDARY OUTCOMES Dentists highlighted the need for better incentives and facilities to deliver oral healthcare in these institutions. Differences with urban settings regarding access to healthcare were frequently discussed by our study participants. CONCLUSIONS Within our sample, greater capacitation of care home staff, better financial incentives for dentists and increased cooperation between the two stakeholders should be considered when designing interventions to tackle oral health of care home residents in Germany.
Collapse
Affiliation(s)
- Jesus Gomez-Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charite University Medical Center 3 Dental Oral and Maxillary Medicine, Berlin, Germany
| | | | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charite University Medical Center 3 Dental Oral and Maxillary Medicine, Berlin, Germany
| | - Katrin Hertrampf
- Department of Oral and Maxillofacial Surgery, Kiel University, Kiel, Germany
| | - Jens Abraham
- University Halle, Martin Luther University Halle-Wittenberg Institute of Health and Nursing Sciences, Halle, Germany
| | - Georg Gassmann
- Dentalhygiene & Präventionsmanagement, Europaische Fachhochschule, Bruhl, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics and Data Science - Universitätsklinikum Jena, Germany, Jena, Germany
| | - Gerd Göstemeyer
- Department for Operative and Preventive Dentistry, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Falk Schwendicke
- Zahnerhaltung, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
17
|
Impact of an Oral Hygiene Intervention in People with and without Dementia on Oral Health Parameters-Results from the Oral Health, Bite Force, and Dementia (OrBiD) Pilot Study. J Clin Med 2022; 11:jcm11051356. [PMID: 35268447 PMCID: PMC8911423 DOI: 10.3390/jcm11051356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/20/2022] Open
Abstract
This study aimed to assess the influence of an oral hygiene intervention on oral health, depending on the degree of dementia. A clinical evaluation of oral health parameters (index of decayed, missing, and filled teeth (DMFT-index), periodontal screening index (PSI), oral hygiene index (OHI), and bleeding on probing (BOP)) was performed in 120 subjects assigned to five groups, based on the mini mental state examination (MMSE) at baseline and after 12 months. Each MMSE group (no dementia (noDem, MMSE 28–30), mild cognitive impairment (mCI, MMSE 25–27), mild dementia (mDem, MMSE 18–24), moderate dementia (modDem, MMSE 10–17), and severe dementia (sDem, MMSE ≤ 9)) was split into control (no intervention) and experimental groups (intervention on oral hygiene: increased frequency, daily usage of high-fluoride toothpaste). In total, 99 out of 120 subjects were included in the analysis. The dropout rate was high in subjects with modDem and sDem due to death. In subjects with noDem, mCI, and mDem, no changes in the DMFT were found, but improvements in the OHI, BOP, and PSI were observed. Subjects with modDem or sDem demonstrated a deterioration in DMFT; however, in these patients, OHI improved in all control and experimental groups, BOP improved in the experimental group only, and PSI did not improve at all. The scope of improving oral health parameters by increasing the recall frequency and by continuously using high fluoride toothpaste is at its limits in people with severe dementia. Multidimensional approaches should be sought to improve the oral health of vulnerable older patients.
Collapse
|
18
|
Andersson M, Persenius M. Good in Providing Oral Care, but we Could be Better-Nursing Staff Identification of Improvement Areas in Oral Care. SAGE Open Nurs 2021; 7:23779608211045258. [PMID: 34632061 PMCID: PMC8495511 DOI: 10.1177/23779608211045258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/23/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Oral care to older people in short-term care units is a complex and challenging everyday practice for nursing staff. Oral care research and knowledge about prerequisites and obstacles is extensive. However, there is a lack of knowledge about how nursing staff in short-term care units describe their satisfaction about provided oral care in order to maintain older people's oral health. Objective The purpose of this study was to describe how nursing staff perceive their satisfaction of oral care provided for older people in short-term care units and to identify oral care improvements. Methods This study reports on the results of two open-ended questions that were part of a larger study. Informants (n = 54) were nursing staff working in the involved short-term care units in municipalities from both densely and sparsely populated regions in central and northern Sweden. The answers to the open-ended questions were analyzed using content analysis. Results The analysis yielded one main category; “Working together to improve satisfaction with older people's oral care” and four subcategories: “Older people's oral health,” “Consideration and respect for the older person's autonomy,” “Having access to adequate products,” and “Working together in the same direction.” Conclusion Identification of older people's oral health problems together with adequate nursing intervention will increase older people's health outcomes and quality of life. However, regardless of work role, the nursing staff might have difficulty changing their behavior or transforming intentions into actions. Oral care is a complicated and proactive practice that requires nursing staff's attention as well as both educational and organizational initiatives. Working in a supportive and collaborative relationship provides prerequisites for optimal oral care in short-term care units.
Collapse
Affiliation(s)
- Maria Andersson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Mona Persenius
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
19
|
Griffiths AW, Devi R, Cheetham B, Heaton L, Randle A, Ellwood A, Douglas GVA, Csikar J, Vinall-Collier K, Wright J, Spilsbury K. Maintaining and improving mouth care for care home residents: A participatory research project. Int J Older People Nurs 2021; 16:e12394. [PMID: 34164930 DOI: 10.1111/opn.12394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many people residing in nursing or residential care homes (also called long-term care facilities) live with physical or cognitive difficulties. Staff working in these environments often help residents (particularly those with more advanced dementia) with their personal care needs, including maintaining mouth care and health. Poor oral health is associated with many difficulties, including increased risk of respiratory problems, pain and discomfort. Yet, concerns have been raised that staff may not have the knowledge and skills to effectively support residents with oral care and health. There is therefore an important gap between what is known about the importance of maintaining oral health (scientific evidence) and daily practice in long-term care environments. OBJECTIVES To work with care home staff: (1) to create a learning culture to address how to promote mouth care for residents, particularly when a resident resists support with this aspect of care; and (2) to effect mouth care practice changes (if required) using participatory and inclusive research cycles. METHODS AND RESULTS We conducted a participatory research project to address this important area of care. Four participatory research 'cycles' were conducted. Cycle one explored existing literature to develop accessible guidance on strategies that staff could use to support residents to maintain and improve oral care, particularly when a resident may resist such care. Cycle two built on this review to determine knowledge levels within the care team. This highlighted deficiencies in staff knowledge, skills and competence for providing mouth care and their need for training to address this. Cycle three identified evidence-based strategies to develop staff understanding and knowledge. Cycle four brought together experts from nursing, dentistry, behaviour change, systematic reviews and care homes research to develop a grant application to progress this work further. CONCLUSION This paper provides an example of the processes undertaken in a participatory research project, bringing together science and practice to improve an essential area of care. IMPLICATIONS FOR PRACTICE Using participatory research approaches in this setting can allow the effective translation of uncertainties in care and practice into questions that can be addressed by research, leading to meaningful outcomes for those living and working in care homes.
Collapse
Affiliation(s)
- Alys Wyn Griffiths
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK.,Institute of Population Health, University of Liverpool, Liverpool, UK.,NICHE-Leeds, University of Leeds and Leeds Care Association, Leeds, UK
| | - Reena Devi
- NICHE-Leeds, University of Leeds and Leeds Care Association, Leeds, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Biddy Cheetham
- NICHE-Leeds, University of Leeds and Leeds Care Association, Leeds, UK.,Westward Healthcare, Leeds, UK
| | - Lisa Heaton
- NICHE-Leeds, University of Leeds and Leeds Care Association, Leeds, UK.,Westward Healthcare, Leeds, UK
| | - Angela Randle
- NICHE-Leeds, University of Leeds and Leeds Care Association, Leeds, UK.,Springfield Healthcare, Leeds, UK
| | - Alison Ellwood
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | | | - Julia Csikar
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Karen Spilsbury
- NICHE-Leeds, University of Leeds and Leeds Care Association, Leeds, UK.,School of Healthcare, University of Leeds, Leeds, UK
| |
Collapse
|
20
|
Kim B, Lee KH, Cho E, Kim H. Behaviors of care providers and resistiveness to oral care of persons living with dementia. Geriatr Nurs 2021; 42:915-918. [PMID: 34098445 DOI: 10.1016/j.gerinurse.2021.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
Since care providers' behavior could be related to resistiveness to care (RTC) among persons living with dementia, developing care providers' behavioral strategies to reduce or prevent RTC is required. This study examined whether care providers' person-centered or task-centered behaviors were related to RTC. A secondary data analysis was conducted using 70 videos of 23 persons living with dementia who received routine oral care in long-term care settings. Data were analyzed using linear mixed models. Among task-centered behaviors, "physically controlling" significantly increased RTC. For person-centered behaviors, "cooperatively negotiating" increased RTC, while "assessing comfort" decreased RTC. Care providers need to consider the comfort or needs of persons living with dementia rather than physically controlling them in oral care situations. These findings may offer insight into the context of RTC occurrences to provide more comfortable oral care for persons living with dementia.
Collapse
Affiliation(s)
- Bora Kim
- Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea; Brain Korea 21 FOUR Project, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea
| | - Kyung Hee Lee
- Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea.
| | - Eunhee Cho
- Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea
| | - Heejung Kim
- Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea
| |
Collapse
|
21
|
Kobayashi M, Ito M, Iwasa Y, Motohashi Y, Edahiro A, Shirobe M, Hirano H, Gineste Y, Honda M. The effect of multimodal comprehensive care methodology training on oral health care professionals' empathy for patients with dementia. BMC MEDICAL EDUCATION 2021; 21:315. [PMID: 34082730 PMCID: PMC8176594 DOI: 10.1186/s12909-021-02760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. METHODS This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants' empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). RESULTS The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. CONCLUSIONS The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals' empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687 . Registered 4 September 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586.
Collapse
Affiliation(s)
- Masaki Kobayashi
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Mio Ito
- Gunma University Graduate School of Health Science, Maebashi-City, Gunma, 371-8514, Japan
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka-City, Fukuoka, 813-8588, Japan
| | - Yoshiko Motohashi
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yves Gineste
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan
- IGM-France, 66250, Saint-Laurent-de-la-Salanque, France
| | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan
| |
Collapse
|
22
|
Kistler CE, Scott J, Ward K, Zeigler R, Sullivan L, Tomlinson SE, Wretman CJ, Zimmerman S. Mouth Care in Assisted Living: Potential Areas for Improvement. J Am Med Dir Assoc 2020; 22:1190-1193.e2. [PMID: 33385333 DOI: 10.1016/j.jamda.2020.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor oral care may lead to systemic disease, and there is evidence that assisted living (AL) residents lack quality oral care; in AL, poor care may be due to staff knowledge and attitudes, as well as organizational barriers to providing care. OBJECTIVES Determine AL staff knowledge and attitudes regarding mouth care and barriers to changing care. DESIGN Self-administered repeated-measures questionnaires completed before and after oral care training. SETTING AND PARTICIPANTS A total of 2012 direct care staff and administrators from 180 AL communities. METHODS Nine knowledge questions and 8 attitude and practice intention questions, and open-ended questions regarding training and obstacles to providing oral care. RESULTS Overall, 2012 participants completed pretraining questionnaires, and 1977 completed posttraining questionnaires. Baseline knowledge was high, but staff were not uniformly aware of the systemic-oral link whereby mouth care affects pneumonia and diabetes. Almost all staff reported learning a new technique (96%), including for residents who resist care (95%). Suggested areas to improve mouth care included having more hands-on experience. The primary perceived obstacles to care centered around residents who resist care and a lack of time. CONCLUSIONS AND IMPLICATIONS Based on reports of having benefitted from training, AL staff overwhelmingly noted that new knowledge was helpful, suggesting the benefit of skills-based training, especially in dementia care. Mouth care in AL has been sorely understudied, and merits additional attention.
Collapse
Affiliation(s)
- Christine E Kistler
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jessica Scott
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robin Zeigler
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Louise Sullivan
- College of Nursing, Salve Regina University, Newport, RI, USA
| | - Sarah E Tomlinson
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Christopher J Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
23
|
Krausch-Hofmann S, Palmers E, Declerck D, Duyck J. Development of practice guidelines for daily oral care in care-dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach. Int J Older People Nurs 2020; 16:e12351. [PMID: 33074589 PMCID: PMC7816227 DOI: 10.1111/opn.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 01/11/2023]
Abstract
Aim To develop practice guidelines for nursing assistants who provide daily oral care to older adults. Background The interRAI suite of instruments is internationally used in professional health care to assess the needs of care‐dependent older persons. An optimised oral health section was developed recently to identify care clients with poor oral health and hygiene. Internationally shared guidelines for daily oral care are needed to complement the optimised oral health section of the interRAI suite of instruments. Material and methods The modified Delphi approach started with the preparation of an initial draft. Subsequently, an online survey and a face‐to‐face discussion were conducted with international experts. Their feedback was used to revise the draft. Two additional online surveys were conducted with the experts to reach consensus agreement for each item of the revised version. The same group of experts was invited to the different study phases. Results The three surveys were completed by 26, 27 and 23 international experts, respectively. A group of 18 experts completed each survey, whereof a subgroup of 11 experts also took part in the face‐to‐face discussion. Experts were dental hygienists, dentists, nursing scientists, physicians and psychologists from 14 different countries. After the final survey, consensus agreement was reached for 54 of the 57 (94.7%) items, representing the final version of the guidelines. Conclusion Available evidence was combined with practical feedback from international experts to develop clear and concise practice guidelines for daily oral care in older adults. Implications for practice The guidelines will help to improve knowledge and reduce barriers of nursing assistants to provide daily oral care.
Collapse
Affiliation(s)
- Stefanie Krausch-Hofmann
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Ellen Palmers
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Biomaterials/BIOMAT, KU Leuven, Leuven, Belgium
| |
Collapse
|
24
|
Chebib N, Waldburger TC, Boire S, Prendki V, Maniewicz S, Philippe M, Müller F. Oral care knowledge, attitude and practice: Caregivers' survey and observation. Gerodontology 2020; 38:95-103. [PMID: 33073432 DOI: 10.1111/ger.12502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study aims to assess caregivers' knowledge, perception and perceived barriers as well as their daily usual practice concerning oral care provision in a geriatric hospital. METHODS A semi-structured questionnaire was developed and administered to caregivers in a geriatric ward. Furthermore, oral care delivery to dependent and independent patients was clinically observed. RESULTS One hundred and fifty-two caregivers (60% nurses, 40% nursing aids) completed the survey (78% response rate). Clinical oral care was observed in 97 inpatients. Observations revealed that brushing was done in 94% of opportunities in independent patients but in only 55% of dependent patients. This corresponded to the frequency indicated in the questionnaire for independent elders (97%, n.s.), whereas it was significantly different for dependent elders (89%, P < .001). 95% of caregivers stated in the questionnaire never verifying self-administered oral care, whereas 12.3% were actually observed verifying intraorally its efficiency (P = .07 chi-squared test). 71% of the respondents stated storing the prostheses dry, and 8% stated that they reinserted it after cleaning. Caregivers' observation revealed that 35.1% of prostheses were reinserted in the mouth, indicating a significantly higher rate than in the questionnaire (P < .05). Respondents felt that their training to perform oral hygiene measures was suboptimal (VAS 48 ± 34.4). Patients verbally refusing oral care were stated as a barrier by 14% of respondents and were witnessed in 15.6% of observation opportunities (n.s). CONCLUSION Various measures, such as hospital health policy, improved logistics or advanced hands-on training, might help to converge the clinical practice towards the theoretical knowledge.
Collapse
Affiliation(s)
- Najla Chebib
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Talina Clizia Waldburger
- Undergraduate Student, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Boire
- Division of Internal Medicine of the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Thônex, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine of the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Thônex, Switzerland
| | - Sabrina Maniewicz
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Mojon Philippe
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Thônex, Switzerland
| |
Collapse
|
25
|
Delwel S, Maier AB, Parvaneh D, Meijers J, Scherder EJA, Lobbezoo F. Chewing Efficiency, Global Cognitive Functioning, and Dentition: A Cross-sectional Observational Study in Older People With Mild Cognitive Impairment or Mild to Moderate Dementia. Front Aging Neurosci 2020; 12:225. [PMID: 33033478 PMCID: PMC7510165 DOI: 10.3389/fnagi.2020.00225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction: Previous studies suggest an association between poor mastication and cognitive impairment. The role of chewing efficiency and dentition in this relation is unclear. The aim was to examine global cognitive functioning and dentition as predictors for chewing efficiency, in older people with mild cognitive impairment (MCI) or dementia. Methods: In this observational cross-sectional study, 136 people with MCI or dementia were included. The chewing efficiency was assessed with a two-colored chewing gum and analyzed with the Chewing Efficiency Analysis software. The level of global cognitive functioning was measured with the Mini Mental State Examination (MMSE) by trained clinical staff. An oral examination was performed by a dentist and included the number of present teeth, the number of occluding pairs, and the presence of prostheses. Age, gender, and educational years were derived from the medical records. Univariate and multivariate backward stepwise linear regression analyses were used to evaluate global cognitive functioning and dentition as predictors for chewing efficiency. Results: The mean age of the participants was 82.1 (SD 5.8) years, and 74 (54.4%) were female. The participants had a median MMSE score of 22.4 (IQR 18.0–26.0) and a median Chewing Efficiency Analysis score of 0.46 (IQR 0.14–0.59). The median number of teeth was 13.0 (IQR 0.0–23.0), and the median number of occluding pairs was 0.0 (IQR 0.0–7.0). Sixty-four (47.4%) of the participants wore full prosthesis in the upper jaw. In univariate linear regression analyses, predictive factors for the Chewing Efficiency Analysis score were age, MMSE score, full prosthesis in the upper jaw, number of present teeth, and number of occluding pairs. In the multivariate model, full prosthesis in the upper jaw and number of occluding pairs were significant predictors for the Chewing Efficiency Analysis score. Participants with full prosthesis in the upper jaw had a lower Chewing Efficiency Analysis score than participants with natural dentition in the upper jaw. Conclusion: Better mastication is associated with a higher number of occluding pairs. Full prosthesis in the upper jaw is related to a lower chewing efficiency. Global cognitive functioning is not associated with mastication in older people with MCI or mild-to-moderate dementia. This might be explained by sufficient capacity for compensation of reduced mastication in this group.
Collapse
Affiliation(s)
- Suzanne Delwel
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Donya Parvaneh
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Erik J A Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
26
|
Backhouse T, Dudzinski E, Killett A, Mioshi E. Strategies and interventions to reduce or manage refusals in personal care in dementia: A systematic review. Int J Nurs Stud 2020; 109:103640. [DOI: 10.1016/j.ijnurstu.2020.103640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022]
|
27
|
Interventions to improve oral health of older people: A scoping review. J Dent 2020; 101:103451. [PMID: 32810577 DOI: 10.1016/j.jdent.2020.103451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES A range of interventions have been tested to improve oral health of older people. We performed a scoping review to map interventions' aims, outcome measures and findings, and to locate them on different levels of care. DATA We systematically screened for (1) controlled studies on (2) people over 65 years of age, (3) comparing at least two interventions to improve oral health. Interventions were summarized according to their aims and the employed intervention type, mapped on their level of action, and classified as primary/secondary/tertiary prevention. SOURCES Studies retrieved via MEDLINE, EMBASE, CINAHL. STUDY SELECTION Eighty-one studies (published 1997-2019, conducted mainly in high-income countries) were included. Sample sizes varied (n = 24-1987). Follow-up was 0.25-60 months. Most studies (64/81) found a statistically significant benefit of the intervention. A total of 13 different aims were identified, and a range of intervention types employed (e.g. educational interventions, professional oral healthcare, restorative treatment, fluoride application and, generally, dentifrices, mouthwashes, chewing gums/food supplements). Most studies were located on the carer/patient level (56/81 studies) or the system/policy-maker level (44/81). The majority of studies aimed for primary prevention (64/81). CONCLUSIONS Oral health improvement interventions are widely studied. However, study aims, methods and outcome measures are highly heterogeneous, which limits the ability for robust conclusions. Current research focusses on primary prevention on the level of patients/carers or system/policy-maker level. Future studies may want to consider interventions on dentists' level focussing on secondary prevention. These studies should rely on a core set of comprehensive, standardized set of outcome measures. CLINICAL SIGNIFICANCE While specific interventions seem efficacious to improve older people's oral health, the current body of evidence is neither comprehensive (significant gaps exists in relevant levels of the care process) nor comparable enough to draw robust conclusions.
Collapse
|
28
|
Zimmerman S, Sloane PD, Ward K, Wretman CJ, Stearns SC, Poole P, Preisser JS. Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial. JAMA Netw Open 2020; 3:e204321. [PMID: 32558913 PMCID: PMC7305523 DOI: 10.1001/jamanetworkopen.2020.4321] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/01/2020] [Indexed: 12/30/2022] Open
Abstract
Importance Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia. Objective To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents. Design, Setting, and Participants This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups. Intervention Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care. Main Outcomes and Measures Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records. Results Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03). Conclusions and Relevance This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year may be associated with sustainability. Improving mouth care in US NHs may require the presence and support of dedicated oral care aides. Trial Registration ClinicalTrials.gov Identifier: NCT03817450.
Collapse
Affiliation(s)
- Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- School of Social Work, University of North Carolina at Chapel Hill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Philip D. Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christopher J. Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- School of Social Work, University of North Carolina at Chapel Hill
| | - Sally C. Stearns
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Patricia Poole
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - John S. Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
29
|
Barbe AG, Küpeli LS, Hamacher S, Noack MJ. Impact of regular professional toothbrushing on oral health, related quality of life, and nutritional and cognitive status in nursing home residents. Int J Dent Hyg 2020; 18:238-250. [DOI: 10.1111/idh.12439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/06/2020] [Accepted: 04/20/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Anna Greta Barbe
- Centre of Dental Medicine Department of Operative Dentistry and Periodontology Faculty of Medicine University of Cologne Köln Germany
| | - Lydia Suzan Küpeli
- Centre of Dental Medicine Department of Operative Dentistry and Periodontology Faculty of Medicine University of Cologne Köln Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology Faculty of Medicine University Hospital Cologne University of Cologne Cologne Germany
| | - Michael Johannes Noack
- Centre of Dental Medicine Department of Operative Dentistry and Periodontology Faculty of Medicine University of Cologne Köln Germany
| |
Collapse
|
30
|
Red A, O'Neal PV. Implementation of an Evidence-Based Oral Care Protocol to Improve the Delivery of Mouth Care in Nursing Home Residents. J Gerontol Nurs 2020; 46:33-39. [PMID: 32324893 DOI: 10.3928/00989134-20200316-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022]
Abstract
The current project assessed the oral health of residents in a long-term care (LTC) facility, implemented a new evidence-based oral care protocol, and trained nursing staff about oral hygiene for older adults. A pre-/post-intervention design was used to measure knowledge, skills, and attitudes among 29 staff members. The oral health outcomes of 10 LTC residents without dysphagia were assessed after 14 days of protocol use. Knowledge improved from a mean total pre-test score of 88.8 to a mean total post-test score of 97.7 (Z = -2.308, p = 0.021). The Oral Health Assessment Tool measured oral health outcomes at three time points in 10 older adults, and statistically significant improvement in oral health was identified (p = 0.001). Nursing home staff play an important role in improving oral hygiene of older adults in LTC facilities by routinely using an easy to follow oral health protocol twice daily. [Journal of Gerontological Nursing, 46(5), 33-39.].
Collapse
|
31
|
Coll PP, Lindsay A, Meng J, Gopalakrishna A, Raghavendra S, Bysani P, O'Brien D. The Prevention of Infections in Older Adults: Oral Health. J Am Geriatr Soc 2019; 68:411-416. [PMID: 31479533 DOI: 10.1111/jgs.16154] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 12/17/2022]
Abstract
The oral cavity is exposed to the external environment and from a very young age is colonized by infectious agents. Under certain circumstances including poor oral hygiene, dry mouth, trauma, and the use of antibiotics, oral infections can occur. They can result in damage to the oral cavity including teeth and their support structures. Oral infections can also lead to the extension of infection into surrounding tissues and to systemic infections. Chronic oral infection is a recognized risk factor for heart disease. Older adults are at high risk for oral infections and associated complications. Tooth loss, for which infection is the most significant cause, leads to cosmetic changes and a decreased ability to masticate certain foods that can lead to malnutrition. Chronic oral infections and the manipulation of teeth and supporting structures can lead to the hematogenous spread of infection including the infection of artificial joints and endocardial implants. Good oral hygiene, the use of fluoride, regular dental care, and the appropriate use of antibiotics can all reduce oral infections and their associated complications. J Am Geriatr Soc 68:411-416, 2020.
Collapse
Affiliation(s)
- Patrick P Coll
- Department of Family Medicine & Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Adam Lindsay
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut
| | - Joyce Meng
- Department of Medicine, Division of Cardiology, University of Connecticut Health Center, Farmington, Connecticut
| | - Aadarsh Gopalakrishna
- Division of General Dentistry, University of Connecticut Health Center, Farmington, Connecticut
| | - Sree Raghavendra
- Division of General Dentistry, University of Connecticut Health Center, Farmington, Connecticut
| | - Pooja Bysani
- Division of General Dentistry, University of Connecticut Health Center, Farmington, Connecticut
| | - Daniel O'Brien
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut
| |
Collapse
|
32
|
Description of Process and Content of Online Dementia Coaching for Family Caregivers of Persons with Dementia. Healthcare (Basel) 2019; 7:healthcare7010013. [PMID: 30669444 PMCID: PMC6473308 DOI: 10.3390/healthcare7010013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 11/21/2022] Open
Abstract
Family caregivers of persons with dementia encounter resistance to care behaviors (RCBs). The purpose of this methods paper was to describe the process and content of six weekly 60-min caregiver coaching sessions delivered synchronously through an online platform to 26 family caregivers of persons with dementia. All session notes were analyzed for process; two coaching sessions from five purposely-selected participants were transcribed and analyzed thematically for content. The six sessions followed an overall pattern. The first session included the most teaching and goal-setting; the coaches also queried the family caregiver about the premorbid personality, work history, and interpersonal attributes of the person with dementia. Sessions two through five were the most active coaching sessions; previously suggested strategies were evaluated and tailored; caregivers also role-played with the coaches and developed scripts designed to curtail RCB. The sixth session served as a review of successful caregiver strategies and concluded the coaching relationship. Four primary content themes emerged in the coaching process: (1) education; (2) caregiver communication; (3) affirmation of the caregiver; and (4) individualized strategies. These four content categories were used throughout the coaching process and were interwoven with each other so that the participant knew why the behavior was occurring, how to verbally address it, how to use a strategy effectively, and affirmation of the result. The coaching process and content demonstrated alignment with person-centered practices and relationship-centered care.
Collapse
|
33
|
Barbe AG, Kottmann HE, Müller D, Simic D, Derman SHM, Wicht MJ, Noack MJ. Evaluation of time and resources required for professional dental cleaning in nursing home residents. SPECIAL CARE IN DENTISTRY 2019; 39:89-96. [PMID: 30604877 DOI: 10.1111/scd.12352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/16/2022]
Abstract
AIM We aimed to describe time requirements and costs associated with professional dental cleaning (PDC) performed by a dental nurse in one German nursing home, and to reveal potential differences in required time for demented versus nondemented and mobile versus immobile residents. METHODS AND RESULTS We performed a retrospective, cross-sectional analysis of treatment time and costs, including a transparent, easily adaptable path of action that allows implementation of PDC in nursing homes. Total mean (±SD) treatment time for one session per resident was documented, including differences in demented and immobile residents, and projected treatment costs (€/$) per resident. We found no differences in required time for one PDC (37 ± 11 minutes) in residents with or without dementia (P = 0.803) or, immobile versus mobile residents (P = 0.396). Mean projected treatment costs of PDC were €14.98/$17.07 per resident per cleaning session, resulting in total costs of €13.5 million ($15.4 million). CONCLUSION Cognitive status and mobility does not affect the mean time required to perform PDC by a dental nurse in nursing home residents. Main cost factor is working time of dental staff; consumable supplies have less impact. Our data may stimulate to include PDC as initial step toward implementation of long-term oral hygiene strategies.
Collapse
Affiliation(s)
- Anna Greta Barbe
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | - Hannah Elisa Kottmann
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Dusan Simic
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Sonja Henny Maria Derman
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | - Michael Jochen Wicht
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | - Michael Johannes Noack
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| |
Collapse
|