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Kengne Talla P, Rodrigues A, Hachey S, Affoo R, Basiren Q, Bouferguene S, Syed M, Emami E. Oral health care and living environment for older people: a scoping review protocol. JBI Evid Synth 2024; 22:314-324. [PMID: 37799097 DOI: 10.11124/jbies-22-00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE This scoping review will map the literature on the extent of knowledge on living environment oral health care (LIVEOR) by examining its different terminologies, its description, the stakeholders involved, the implementation characteristics, and the outcomes reported by the authors. INTRODUCTION Older people want to receive oral health care in their current living environment. Although several authors have explored some aspects of LIVEOR for older people, there are still inconsistent findings regarding the extent of this model of care. INCLUSION CRITERIA This scoping review will include quantitative, qualitative, and mixed method studies, as well as any type of knowledge synthesis on LIVEOR involving people aged 60 years and over. The search will not be limited by language, time frame, geographic location, or publication date. METHODS We will use the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The search will include MEDLINE, CINAHL, Embase, Web of Science, and the Cochrane Library. A hand-search of the references of the included studies, and a gray literature search will also be conducted. Two independent reviewers will screen titles, abstracts, and full texts of selected studies, and perform data extraction. Findings are expected to explore what is known of LIVEOR targeting older people and to identify any knowledge gaps for future studies. We will disseminate our findings mostly through peer-reviewed publications. REVIEW REGISTRATION Open Science Framework https://osf.io/e7fm2.
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Affiliation(s)
- Pascaline Kengne Talla
- Faculty of Dental Medicine and Oral Health Sciences, Université McGill University, Montreal, QC, Canada
| | - Anisha Rodrigues
- Faculty of Dental Medicine and Oral Health Sciences, Université McGill University, Montreal, QC, Canada
| | - Shauna Hachey
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Quentin Basiren
- Faculty of Dental Medicine and Oral Health Sciences, Université McGill University, Montreal, QC, Canada
| | - Sabrina Bouferguene
- Faculty of Dental Medicine and Oral Health Sciences, Université McGill University, Montreal, QC, Canada
| | - Mahidul Syed
- Faculty of Dental Medicine and Oral Health Sciences, Université McGill University, Montreal, QC, Canada
| | - Elham Emami
- Faculty of Dental Medicine and Oral Health Sciences, Université McGill University, Montreal, QC, Canada
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Kalideen L, Govender P, van Wyk JM. Standards and quality of care for older persons in long term care facilities: a scoping review. BMC Geriatr 2022; 22:226. [PMID: 35303830 PMCID: PMC8933989 DOI: 10.1186/s12877-022-02892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for older persons has become a global necessity to ensure functional ability and healthy ageing. It is of paramount importance that standards of care are monitored, especially for older persons who live in long term care facilities (LTCF). We, therefore, scoped and summarised evidence relating to standards and the quality of care for older persons in LTCFs in gerontological literature globally. METHODS We conducted a scoping review using Askey and O'Malley's framework, including Levac et al. recommendations. PubMed, CINAHL, Health Sources, Scopus, Cochrane Library, and Google Scholar were searched with no date limitation up to May 2020 using keywords, Boolean terms, and medical subject headings. We also consulted the World Health Organization website and the reference list of included articles for evidence sources. This review also included peer-reviewed publications and grey literature in English that focused on standards and quality of care for older residents in LTCFs. Two reviewers independently screened the title, abstract, and full-text of evidence sources screening stages and performed the data extraction. Thematic content analysis was used, and a summary of the findings are reported narratively. RESULTS Sixteen evidence sources published from 1989 to 2017 met this study's eligibility criteria out of 73,845 citations obtained from the broader search. The majority of the studies were conducted in the USA 56% (9/16), and others were from Canada, Hong Kong, Ireland, Norway, Israel, Japan, and France. The included studies presented evidence on the effectiveness of prompted voiding intervention for urinary incontinence in LTCFs (37.5%), the efficacy of professional support to LTCF staff (18.8%), and the prevention-effectiveness of a pressure ulcer programme in LTCFs (6.3%). Others presented evidence on regulation and quality of care (12.5%); nursing documentation and quality of care (6.3%); medical, nursing, and psychosocial standards on the quality of care (6.3%); medication safety using the Beer criteria (6.3%); and the quality of morning care provision (6.3%). CONCLUSION This study suggests most studies relating to standards and quality of care in LTCFs focus on effectiveness of interventions, few on people-centredness and safety, and are mainly conducted in European countries and the United States of America. Future studies on people-centerdness, safety, and geographical settings with limited or no evidence are recommended.
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Affiliation(s)
- Letasha Kalideen
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.
| | - Pragashnie Govender
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Jacqueline Marina van Wyk
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
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Kenny A, Dickson-Swift V, Chan CKY, Masood M, Gussy M, Christian B, Hodge B, Furness S, Hanson LC, Clune S, Zadow E, Knevel RJ. Oral health interventions for older people in residential aged care facilities: a protocol for a realist systematic review. BMJ Open 2021; 11:e042937. [PMID: 33952539 PMCID: PMC8103368 DOI: 10.1136/bmjopen-2020-042937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Poor oral health among older people is a global problem impacting on health and well-being. The economic cost to the health system is significant. An ageing population is intensifying the urgency for action. However, poor oral health, particularly for those in residential aged care facilities, continues to be highly resistant to resolution. The overall aims of this realist review are to: (A) explore and synthesise evidence on oral health interventions for older people in residential aged care facilities, (B) produce a causal theory on how contextual factors and mechanisms interact to produce outcomes, and (C) produce guidelines/policies to inform high-quality oral health interventions to improve older people's oral health in residential aged care facilities. METHODS AND ANALYSIS The review is guided by the RAMESES publication standards for realist synthesis. Participants include older people in residential aged care facilities, the aged care workforce, carers and families. Interventions include oral healthcare, oral health education, policy interventions and oral health promotion. The five-step realist review process of Pawson et al will guide the review: clarification of scope and development of initial framework, systematic searches, study appraisal and data extraction, synthesising evidence, drawing conclusions, and dissemination, implementation and evaluation. Expert input with key stakeholders will occur through a blog. Stakeholders will examine consistencies across studies and an explanatory causal theory will be developed to guide policy and practice. ETHICS AND DISSEMINATION Formal ethical approval was granted by the La Trobe University Ethics Committee HREC 20144. The developed theory will guide education, practice and policy decisions about interventions and the factors that impact on implementation. Using an integrated knowledge translation approach, traditional research outputs such as international conference presentations and publications will be supplemented with stakeholder forums, infographics, blogs, social media postings, webinars, podcasts and writing for web-based independent outlets. PROSPERO REGISTRATION NUMBER CRD42021155658.
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Affiliation(s)
- Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | | | - Carina Ka Yee Chan
- School of Psychology and Public Health, La Trobe University College of Science, Health and Engineering, Bendigo, Victoria, Australia
| | - Mohd Masood
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Bradley Christian
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Brad Hodge
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Susan Furness
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Lisa C Hanson
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Samantha Clune
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Emma Zadow
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Ron J Knevel
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Che Musa MF, Bernabé E, Gallagher JE. The dental workforce in Malaysia: drivers for change from the perspectives of key stakeholders. Int Dent J 2020; 70:360-373. [PMID: 32476143 DOI: 10.1111/idj.12575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The dental workforce is facing unprecedented change globally as a result of multiple influences. There is a need for research informed action to map possible drivers for change at the national level and examine their potential implications in order to shape the dental workforce to serve population needs. The objective of this study was to explore key stakeholders' views on the drivers for change for the Malaysian dental workforce and their potential implications. METHOD Stakeholders from key dental organisations/professions in Malaysia were purposively sampled and invited to participate in a semi-structured interview (n = 20) using a pre-tested topic guide. Interviews were recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS Drivers for workforce were identified across four main domains: policy-politics; trends in demography; social and economic; and, technology-scientific development. The pace of change and possible interplay between drivers, most notably government policy, liberalisation of education and health services and challenges of workforce governance, followed by Malaysian demography and health trends. Implications for the future, including possible uncertainties, particularly in relation to specialisation and privatisation were identified, together in balancing and meeting public health needs/demands with professional career expectations. CONCLUSION Stakeholders' views on the high-level drivers for change broadly mirror those of high-income countries; however, specific challenges for Malaysia relate to rapid expansion of dental education and a young workforce with significant career aspirations, together with imbalances in the health care system. The impact of these drivers was perceived as leading to greatest uncertainty around specialisation and privatisation of the future workforce.
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Affiliation(s)
- Muhd Firdaus Che Musa
- Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Centre for Host-Microbiome Interactions, Dental Public Health, London, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Centre for Host-Microbiome Interactions, Dental Public Health, London, UK
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Chen R, Irving M, Clive Wright FA, Cunich M. An evaluation of health workforce models addressing oral health in residential aged care facilities: A systematic review of the literature. Gerodontology 2020; 37:222-232. [PMID: 32478960 DOI: 10.1111/ger.12475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/20/2020] [Accepted: 05/03/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND In Australia and globally, there is an increasing problem of unmet oral health needs of older people above 65 residing in aged care facilities. Various workforce models have been trialled to implement oral health care programmes in aged care facilities, but the evidence behind these programmes and their underlying workforce models is not known. OBJECTIVE To systematically review the literature on the effectiveness, and economic feasibility of the current workforce models addressing oral care in aged care facilities. METHODS CINAHL, Cochrane CENTRAL, MEDLINE, EMBASE, EMB Reviews, NHS Economic Evaluation Database and grey literature were searched. Studies were included if they described an oral health workforce model with a clinical intervention and defined oral health outcome measures. Analysis was conducted using the NHMRC guidelines for scientific and economic evaluations. RESULTS Twenty-eight studies were included. Four distinct workforce models of care were identified. 60% of the studies demonstrated short-term effectiveness in clinical measures. Workforce models were similar in their effectiveness, with varying levels of quality within each model. Although three studies considered individual components of economic feasibility, only one provided a comprehensive economic analysis of both the costs and health outcomes. CONCLUSIONS IMPLICATIONS OF FINDINGS All workforce models of care had some positive impact on oral health for residents of aged care. Oral health should be included as a health focus in age care facilities. Future studies should include longer-term health outcomes with rigorous economic analysis to ensure sustainably delivered workforce models of care for oral health management within aged care.
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Affiliation(s)
- Rebecca Chen
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Irving
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - F A Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Aged Care and Rehabilitation, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Michelle Cunich
- Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
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Marti KC, Mylonas AI, MacEachern M, Gruppen L. Humanities in Predoctoral Dental Education: A Scoping Review. J Dent Educ 2019; 83:1174-1198. [DOI: 10.21815/jde.019.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/17/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Kyriaki C. Marti
- Departments of Oral and Maxillofacial Surgery, Periodontics and Oral Medicine; Cariology, Restorative Sciences, and Endodontics; University of Michigan School of Dentistry
| | - Anastassios I. Mylonas
- Departments of History and Philosophy of Medicine and Oral and Maxillofacial Surgery; Schools of Medicine and Dentistry; National and Kapodistrian University of Athens; Metropolitan Hospital
| | | | - Larry Gruppen
- Department of Learning Health Sciences; University of Michigan Medical School
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Kishimoto N, Stegaroiu R, Shibata S, Otsuka H, Ohuchi A. Income from nutrition and oral health management among long-term care insurance facilities in Niigata Prefecture, Japan. Gerodontology 2018; 36:55-62. [PMID: 30350429 DOI: 10.1111/ger.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/26/2018] [Accepted: 09/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine recent insurance claim rates for, facility income from, and the roles of professionals associated with management of nutrition, oral ingestion and oral health maintenance in long-term care insurance facilities (LTCIFs) in Niigata Prefecture. METHODS A questionnaire on current staffing, oral health professional (OHP) utilisation, and claims for insured benefits for the investigated services was mailed to all LTCIFs in Niigata Prefecture, Japan (n = 304). Claim rates for and average facility income from these benefits were calculated. Facility income was compared between facilities with and without employed OHPs. Statistically significant factors associated with claims for investigated benefits were identified by logistic regression. RESULTS Responses from 111 facilities indicated that they made insurance claims for nutrition management (95%), transition from tube feeding to oral ingestion (9%), basic maintenance of oral ingestion (39%), additional services for maintenance of oral ingestion (23%), oral health management system (68%), and oral health management (17%). Most facilities established collaborations with private dental clinics, but only 16% of facilities employed OHPs. Facility income was significantly higher (P = 0.005) for facilities that employed OHPs. OHP employment by facilities was associated with claims for four of the six benefits (P < 0.05). CONCLUSIONS Most facilities consulted with private dental clinics, and 16% of the facilities employed dentists or dental hygienists to help residents manage oral ingestion problems and oral health maintenance. The facility income associated with management of these problems was significantly higher in facilities employing dental professionals.
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Affiliation(s)
- Natsuki Kishimoto
- Doctor's Program of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Roxana Stegaroiu
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoko Shibata
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiromi Otsuka
- Doctor's Program of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akitsugu Ohuchi
- Division of Welfare, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Marchini L, Recker E, Hartshorn J, Cowen H, Lynch D, Drake D, Blanchette DR, Dawson DV, Kanellis M, Caplan D. Iowa nursing facility oral hygiene (INFOH) intervention: A clinical and microbiological pilot randomized trial. SPECIAL CARE IN DENTISTRY 2018; 38:345-355. [PMID: 30194737 DOI: 10.1111/scd.12327] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/12/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE/AIM The aim of this pilot study was to evaluate feasibility and gather initial data for a definitive study to test the clinical and microbiological effectiveness of a nursing facility (NF) customized oral hygiene protocol, intended to be delivered by dental hygienists and NF personnel. MATERIALS AND METHODS A convenience sample of 8 Eastern Iowa NFs was recruited, and each NF was assigned to one of three intervention groups: (1) control (current oral hygiene practice), (2) educational program only, and (3) educational program plus 1% chlorhexidine varnish monthly application. Demographic information, systemic health data, patient centered data, oral health data, and microbiology samples were collected at baseline and after 6 months. RESULTS Recruitment response rates were 21% for NFs and 23% for residents. A total of 81 residents were examined at baseline and of those, 49 were examined at 6 months (39.5% attrition). There were no statistically or clinically significant differences among the intervention groups at 6 months for any of the recorded clinical or microbiological outcomes. CONCLUSIONS Recruitment and retention posed a significant challenge to this trial, even with a relatively short observation period. Results from this pilot study did not encourage further investigation of this customized oral hygiene protocol.
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Affiliation(s)
- Leonardo Marchini
- Assistant Professor, Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Erica Recker
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Jennifer Hartshorn
- Clinical Assistant Professor, Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Howard Cowen
- Clinical Professor, Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - David Lynch
- Post-Doctoral Fellow, Iowa Institute for Oral Health Research, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - David Drake
- Professor, Iowa Institute for Oral Health Research, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Derek R Blanchette
- Biostatistician, Division of Biostatistics and Computational Biology, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Deborah V Dawson
- Morris Bernstein Professor of Dentistry, Professor of Biostatistics, Iowa Institute for Oral Health Research and the Departments of Pediatric Dentistry & Biostatistics, and the Interdisciplinary Programs in Genetics and in Informatics, University of Iowa, Iowa City, IA, USA
| | - Michael Kanellis
- Associate Dean for Patient Care, Professor, Department of Pediatric Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Daniel Caplan
- Professor and Head, Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
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LAGO JD, FAIS LMG, MONTANDON AAB, PINELLI LAP. Educational program in oral health for caregivers on the oral hygiene of dependent elders. REVISTA DE ODONTOLOGIA DA UNESP 2017. [DOI: 10.1590/1807-2577.23916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective Due increased number of elders living in long-term care institutions, actions designs to improve their oral health are essential. Thus, the aim of this study was to evaluate the impact of an educational program for the caregivers through the assessment of the oral hygiene of institutionalized elders. Material and method The education program consisted in lectures to caregivers about oral health that were performed once a month. The subjects were 40 functionally dependent institutionalized elders and 14 caregivers. Hygiene habits, plaque index, and tongue coating/discoloration of the elders were measured before the educational program (baseline- T0) and after 6 (T1), 12 (T2), 18 (T3) and 24 months (T4). Caregivers answered questions about their knowledge, doubts and implementation of dental care (T0 to T4). Result After analyzing the data (Friedman, Chi-square and Spearman α = 0.05), a gradual improvement in the oral hygiene of the subjects was observed, with an increased frequency of brushing (p=0.0005), a change in the brush type (p=0.0065) and a reduction in the plaque index (p<0.05) and tongue coating (p<0.05). Caregivers showed a marked improvement in their dental care knowledge. Conclusion It was concluded that the educational program for caregivers had a positive impact in the oral health of institutionalized elderly observed by the increased in the effectiveness of oral hygiene parameters such as plaque index and tongue coating, contributing to the knowledge gain in hygiene by caregivers.
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Goodman C, Davies SL, Gordon AL, Dening T, Gage H, Meyer J, Schneider J, Bell B, Jordan J, Martin F, Iliffe S, Bowman C, Gladman JRF, Victor C, Mayrhofer A, Handley M, Zubair M. Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05290] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCare homes are the institutional providers of long-term care for older people. The OPTIMAL study argued that it is probable that there are key activities within different models of health-care provision that are important for residents’ health care.ObjectivesTo understand ‘what works, for whom, why and in what circumstances?’. Study questions focused on how different mechanisms within the various models of service delivery act as the ‘active ingredients’ associated with positive health-related outcomes for care home residents.MethodsUsing realist methods we focused on five outcomes: (1) medication use and review; (2) use of out-of-hours services; (3) hospital admissions, including emergency department attendances and length of hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed the evidence to develop an explanatory theory of what supported good health-care provision for further testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents. The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care provision to care homes was distinctive in each site.FindingsPhase 1 found that health-care provision to care homes is reactive and inequitable. The realist review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and implement agreed approaches to health care. Phase 2 tested this further and found that, although there were few differences between the sites in residents’ use of resources, the differences in service integration between the NHS and care homes did reflect how these institutions approached activities that supported relational working. Key to this was how much time NHS staff and care home staff had had to learn how to work together and if the work was seen as legitimate, requiring ongoing investment by commissioners and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work. Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care home staff were equipped to provide appropriate care.LimitationsFindings were constrained by the numbers of residents recruited and retained in phase 2 for the 12 months of data collection.ConclusionsNHS services work well with care homes when payments and role specification endorse the importance of this work at an institutional level as well as with individual residents. GP involvement is important but needs additional support from other services to be sustainable. A focus on strategies that promote co-design-based approaches between the NHS and care homes has the potential to improve residents’ access to and experience of health care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Sue L Davies
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Adam L Gordon
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, UK
| | - Julienne Meyer
- School of Health Sciences, City, University of London, London, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Brian Bell
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jake Jordan
- School of Economics, University of Surrey, Guildford, UK
| | | | - Steve Iliffe
- Research Department of Primary Care and Population Health (PCPH), University College London, London, UK
| | - Clive Bowman
- School of Health Sciences, City, University of London, London, UK
| | - John RF Gladman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christina Victor
- Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Andrea Mayrhofer
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Melanie Handley
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Maria Zubair
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Wright FAC, Law G, Chu SKY, Cullen JS, Le Couteur DG. Residential age care and domiciliary oral health services: Reach-OHT-The development of a metropolitan oral health programme in Sydney, Australia. Gerodontology 2017; 34:420-426. [PMID: 28722250 DOI: 10.1111/ger.12282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe an oral health care programme for older people in Residential Aged Care Facilities (RACFs) to improve access to care and support facilities. INTRODUCTION Different models of residential care have been proposed, but few have been comprehensive (providing on-site health promotion and service delivery) or sustainable. METHODS A partnership model of oral health care, with dental services plus oral health education, was integrated into the community outreach services of a metropolitan hospital department of aged care. The programme provided annual oral health education and training to staff, and on-site dental care to 10 (RACFs). RESULTS None of the RACFs had received organised education or on-site dental service care prior to the programme. At the completion of the third year of the programme, 607 residents (75% of the total bed capacity for the 10 RACFs) had received an annual oral health assessment, and 271 (46.5%) had received on-site dental care. More than 120 nursing and allied health staff had received education and training in oral health support to residents. Oral cleanliness, the proportion not experiencing dental pain and referral for additional care decreased significantly over the period, but dental caries experience and periodontal conditions remained a concern. CONCLUSIONS Sustainable domiciliary oral health services and oral health education are feasible and practical using a partnership model within the Australian health system. Adaptability, continuity and the use of oral health therapists/dental hygienists in the coordination and management of the programme further contribute to viability.
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Affiliation(s)
- F A Clive Wright
- Centre for Education and Research on Ageing, Aged Chronic Care and Rehabilitation, Concord Clinical Medical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - Garry Law
- Centre for Education and Research on Ageing, Aged Chronic Care and Rehabilitation, Concord Clinical Medical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - Steven K-Y Chu
- Centre for Education and Research on Ageing, Aged Chronic Care and Rehabilitation, Concord Clinical Medical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - John S Cullen
- Centre for Education and Research on Ageing, Aged Chronic Care and Rehabilitation, Concord Clinical Medical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Aged Chronic Care and Rehabilitation, Concord Clinical Medical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
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Hoben M, Poss JW, Norton PG, Estabrooks CA. Oral/dental items in the resident assessment instrument - minimum Data Set 2.0 lack validity: results of a retrospective, longitudinal validation study. Popul Health Metr 2016; 14:36. [PMID: 27785121 PMCID: PMC5073836 DOI: 10.1186/s12963-016-0108-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/10/2016] [Indexed: 01/13/2023] Open
Abstract
Background Oral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. However, psychometric properties of RAI-MDS 2.0 oral/dental items have been challenged and criterion validity of these items has never been assessed. Methods We used 73,829 RAI-MDS 2.0 records (13,118 residents), collected in a stratified random sample of 30 urban nursing homes in Western Canada (2007–2012). We derived a subsample of all residents (n = 2,711) with an admission and two or more subsequent annual assessments. Using Generalized Estimating Equations, adjusted for known covariates of nursing home residents’ oral health, we assessed the association of oral/dental problems with time, dentate status, dementia, debris, and daily cleaning. Results Prevalence of oral/dental problems fluctuated (4.8 %–5.6 %) with no significant differences across time. This range of prevalence is substantially smaller than the ones reported by studies using clinical assessments by dental professionals. Denture wearers were less likely than dentate residents to have oral/dental problems (adjusted odds ratio [OR] = 0.458, 95 % confidence interval [CI]: 0.308, 0.680). Residents lacking teeth and not wearing dentures had higher odds than dentate residents of oral/dental problems (adjusted OR = 2.718, 95 % CI: 1.845, 4.003). Oral/dental problems were more prevalent in persons with debris (OR = 2.187, 95 % CI: 1.565, 3.057). Of the other variables assessed, only age at assessment was significantly associated with oral/dental problems. Conclusions Robust, reliable RAI-MDS 2.0 oral health indicators are vital to monitoring and improving oral health related quality and safety in nursing homes. However, severe underdetection of oral/dental problems and lack of association of well-known oral health predictors with oral/dental problems suggest validity problems. Lacking teeth and not wearing dentures should be considered an indicator for urgent oral/dental treatment needs. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0108-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Hoben
- Knowledge Utilization Studies Program (KUSP), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB Canada
| | - Carole A Estabrooks
- Knowledge Utilization Studies Program (KUSP), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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MacEntee MI, Mathu-Muju KR. Confronting dental uncertainty in old age. Gerodontology 2015; 31 Suppl 1:37-43. [PMID: 24446978 DOI: 10.1111/ger.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To provide an overview of the literature about uncertainty in health care and how it relates to the oral health care of older people. BACKGROUND The medical literature describes uncertainty in health care from the initial informed-consent to its impact on a patient's ability to cope with undesirable outcomes. METHODS A narrative review of the medical, dental and psychological literature was conducted to identify pertinent information on the theory and implications of uncertainty in healthcare. The findings are infused into a case-report illustrating the recurrence of uncertainty experienced by an older woman who had multiple treatments over several years to restore her dentition damaged severely by dental caries. RESULTS Uncertainty originates from inadequate understanding, incomplete information and undifferentiated alternatives leading to unnecessary diagnostic tests and healthcare costs. A conceptual taxonomy clarifies the characteristics of uncertainty in the context of scientific, practical or personal sources and offers management possibilities through effective communications to identify choices and probabilities that help patients to adapt and cope with adverse events. CONCLUSIONS Uncertainty pervades healthcare. It can lead patients to self-blame, anger and withdrawal from care unless it is communicated effectively so that they can adapt and cope with the disappointment of adversity and continue with alternative approaches to care.
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Affiliation(s)
- Michael I MacEntee
- Faculty of Dentistry, Department of Oral Health Sciences, University of British Columbia, Vancouver, BC, Canada
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Hearn L, Slack-Smith L. Oral health care in residential aged care services: barriers to engaging health-care providers. Aust J Prim Health 2015; 21:148-56. [PMID: 25155109 DOI: 10.1071/py14029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 07/17/2014] [Indexed: 01/25/2023]
Abstract
The oral health of older people living in residential aged care facilities has been widely recognised as inadequate. The aim of this paper is to identify barriers to effective engagement of health-care providers in oral care in residential aged care facilities. A literature review was conducted using MEDline, CINAHL, Web of Science, Academic Search Complete and PsychInfo between 2000 and 2013, with a grey literature search of government and non-government organisation policy papers, conference proceedings and theses. Keywords included: dental/oral care, residential aged care, health-care providers, barriers, constraints, and limitations. A thematic framework was used to synthesise the literature according to a series of oral health-care provision barriers, health-care provider barriers, and cross-sector collaborative barriers. A range of system, service and practitioner level barriers were identified that could impede effective communication/collaboration between different health-care providers, residents and carers regarding oral care, and these were further impeded by internal barriers at each level. Findings indicated several areas for investigation and consideration regarding policy and practice improvements. While further research is required, some key areas should be addressed if oral health care in residential aged care services is to be improved.
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Donnelly LR, Clarke LH, Phinney A, MacEntee MI. The impact of oral health on body image and social interactions among elders in long-term care. Gerodontology 2015; 33:480-489. [PMID: 25664900 DOI: 10.1111/ger.12187] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to explore how social interactions and body image are influenced by perceived oral health among older people who live in long-term care facilities. BACKGROUND Social interactions among frail elders in long-term care (LTC) facilities are limited, but to what extent body image and oral health influence their social relations is poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health and well-being irrespective of age. However, as frailty increases, it is unclear whether appearance and oral health priorities remain stable. MATERIALS AND METHODS Open-ended interviews were conducted with a purposefully selected group of cognitively intact, older men and women who exhibited varying degrees of frailty, social engagement and oral health conditions and lived in one of seven long-term care facilities. The interviews were analysed using a constant comparative technique, and a second interview with participants checked the trustworthiness of the analysis. RESULTS Three major categories were expressed by the participants: (1) My mouth is fine; (2) It depends; and (3) Not that important. Within each category, there were several contributing and influencing factors. CONCLUSIONS Social interactions among residents in LTC may be negatively impacted by poor oral health, but only if other personal and social issues are less bothersome than conditions with the mouth.
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Affiliation(s)
- Leeann R Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.
| | - Laura Hurd Clarke
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Alison Phinney
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Michael I MacEntee
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Tan CM, Tsoi JKH, Seneviratne CJ, Matinlinna JP. Evaluation of the Candida albicans removal and mechanical properties of denture acrylics cleaned by a low-cost powered toothbrush. J Prosthodont Res 2014; 58:243-51. [DOI: 10.1016/j.jpor.2014.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/27/2014] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
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Amerine C, Boyd L, Bowen DM, Neill K, Johnson T, Peterson T. Oral health champions in long-term care facilities-a pilot study. SPECIAL CARE IN DENTISTRY 2013; 34:164-70. [DOI: 10.1111/scd.12048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carol Amerine
- Program Manager; Office of Oral Health; Arkansas Department of Health; Little Rock Arkansas
| | - Linda Boyd
- Dean and Professor, Forsyth School of Dental Hygiene; Massachusetts College of Pharmacy & Health Sciences; Boston Massachusetts
| | - Denise M. Bowen
- Professor Emerita; Department of Dental Hygiene; Idaho State University; Pocatello Idaho
| | - Karen Neill
- Professor; Associate Director for Graduate Studies; School of Nursing; Idaho State University; Pocatello Idaho
| | - Tara Johnson
- Assistant Professor; Department of Dental Hygiene; Idaho State University; Pocatello Idaho
| | - Teri Peterson
- Statistician, Idaho Committee on Health Research; Idaho State University; Pocatello Idaho
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