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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.
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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
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Gibson BJ, Kettle JE, Robinson PG, Walls A, Warren L. Oral care as a life course project: A qualitative grounded theory study. Gerodontology 2018; 36:8-17. [DOI: 10.1111/ger.12372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Barry J. Gibson
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry University of Sheffield Sheffield UK
| | - Jennifer E. Kettle
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry University of Sheffield Sheffield UK
| | | | | | - Lorna Warren
- Department of Sociological Studies University of Sheffield Sheffield UK
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3
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Alhajji D, Amaral Mendes R. Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective. BMJ Case Rep 2017; 2017:bcr-2017-221539. [PMID: 29103008 DOI: 10.1136/bcr-2017-221539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old institutionalised woman presented to our clinic for the management of black hairy tongue. Despite the predictable outcome in treating this disease, this case presents multiple challenges such as the patients' cognitive impairment, her family dynamics, social factors and the health system as a whole, that makes it difficult to treat.
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Affiliation(s)
- Dalal Alhajji
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, USA
| | - Rui Amaral Mendes
- Adjunct Professor, Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, USA.,Centre for Research in Higher Education Policies, University of Porto, Porto, Portugal
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4
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Walsh LJ. Minimal intervention management of the older patient. Br Dent J 2017; 223:151-161. [DOI: 10.1038/sj.bdj.2017.660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 01/08/2023]
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Brocklehurst P, Williams L, Hoare Z, Goodwin T, McKenna G, Tsakos G, Chestnutt IG, Pretty I, Wassall R, Jerković-Ćosić K, Hayes M, Watt RG, Burton C. Strategies to prevent oral disease in dependent older people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paul Brocklehurst
- Bangor University; North Wales Organisation for Randomised Trials in Health; Y Wern (Normal Site) Holyhead Road Bangor UK LL57 2PZ
| | - Lynne Williams
- Bangor University; School of Healthcare Sciences; Fron Heulog Bangor UK
| | - Zoe Hoare
- Bangor University; North Wales Organisation for Randomised Trials in Health; Y Wern (Normal Site) Holyhead Road Bangor UK LL57 2PZ
| | - Tom Goodwin
- University of Manchester; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health; Manchester UK
| | - Gerry McKenna
- Queen's University Belfast; Centre for Public Health; Belfast Northern Ireland UK
| | | | - Ivor G Chestnutt
- Cardiff University Dental School; Applied Clinical Research and Public Health; Heath Park Cardiff UK CF14 4XY
| | - Iain Pretty
- The University of Manchester; The Dental Health Unit; Williams House Lloyd Street North Manchester UK M15 6SE
| | - Rebecca Wassall
- Newcastle University; Restorative Dentistry School of Dental Sciences; Framlington Place NE2 4BW Newcastle Upon Tyne UK
| | - Katarina Jerković-Ćosić
- University of Applied Sciences Utrecht; Research Centre Innovations in Healthcare; Bolognalaan 101 Utrecht Netherlands 3584 CJ
| | - Martina Hayes
- University College Cork; Dental School & Hospital; Cork Ireland
| | - Richard G Watt
- University College London; Department of Epidemiology & Public Health; 1-19 Torrington Place London UK WC1E 7HB
| | - Christopher Burton
- University of Bangor; Centre for Health-Related Research; Fron Heulog Bangor Wales UK
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Implementing Oral Care Practices and Policy Into Long-Term Care: The Brushing up on Mouth Care Project. J Am Med Dir Assoc 2015; 16:200-7. [DOI: 10.1016/j.jamda.2014.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 11/21/2022]
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Fjeld KG, Mowe M, Eide H, Willumsen T. Effect of electric toothbrush on residents' oral hygiene: a randomized clinical trial in nursing homes. Eur J Oral Sci 2014; 122:142-8. [DOI: 10.1111/eos.12113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | - Morten Mowe
- Medical Clinic; Institution of Clinical Medicine; Oslo University Hospital; University of Oslo; Oslo Norway
| | - Hilde Eide
- Faculty of Health Sciences; Buskerud University College; Drammen Norway
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Action planning for daily mouth care in long-term care: the brushing up on mouth care project. Nurs Res Pract 2012; 2012:368356. [PMID: 22550572 PMCID: PMC3328160 DOI: 10.1155/2012/368356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/19/2012] [Indexed: 11/17/2022] Open
Abstract
Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.
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Austin RS, Olley RC, Ray-Chaudhuri A, Gallagher JE. Oral Disease Prevention for Older People. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/2050168411os1800302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This opinion paper reviews trends in oral disease and its management in older people, in response to a challenge, in an editorial in The Lancet, to the traditional curative model of dentistry and the publication of the most recent Adult Dental Health Survey. It highlights the challenge of an ageing population and its oral health needs and management. Professional issues in relation to preventive care are discussed with emphasis on the importance of identifying patient risk and providing preventive care, together with improving the uptake of dental care among older people.
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Affiliation(s)
- Rupert S Austin
- Primary Dental Care, King's College London Dental Institute, London, UK
| | - Ryan C Olley
- Department of Prosthodontics, King's College London Dental Institute, London, UK
| | - Arijit Ray-Chaudhuri
- Restorative Dentistry, King's College Hospital NHS Foundation Trust and St George's Healthcare Trust, London, UK
| | - Jennifer E Gallagher
- Dental Public Health, Oral Health Services Research and Dental Public Health, King's College London Dental Institute, London, UK
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Zuluaga DJM, Ferreira J, Montoya JAG, Willumsen T. Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment. Gerodontology 2011; 29:e420-6. [PMID: 21564272 DOI: 10.1111/j.1741-2358.2011.00490.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Investigating oral health's relationship with dependency and cognitive state. BACKGROUND Oral hygiene is poor in the institutionalised elderly. There are problems regarding the oral care of residents having poor mobility or cognitive impairment. MATERIAL AND METHODS Cross-sectional study involving 135 participants (mean age 85.7, SD 8.8 years) in two categories: nurses doing tooth cleaning and residents doing tooth cleaning. Those cleaned by nurses were categorised as co-operative or unco-operative. The oral hygiene status, presence of caries, retained roots and denture-related stomatitis were recorded. RESULTS Of the participants, 70% had only natural teeth. The prevalence of caries was 28%. A significant correlation showed that having more teeth gave a poorer Simplified Oral Hygiene Index (OHI-S) (p = 0.018). The number of retained roots increased with the severity of cognitive impairment (p < 0.05). Significant differences were found between nurses or residents doing the tooth cleaning on the OHI-S (p = 0.05) and percentage of dental plaque (p = 0.003). Unco-operative residents had poorer oral hygiene (p = 0.028), more caries (p = 0.008) and were more often moderate-severe cognitive impaired (p = 0.016). CONCLUSIONS A high percentage of participants had unacceptable oral hygiene. Residents whose teeth were cleaned by the nurses had poorer oral hygiene. Unco-operative residents had the worst oral hygiene and more caries.
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Affiliation(s)
- Dairo J Marín Zuluaga
- Oral Health Department, Faculty of Dentistry, National University of Colombia, Bogotá, Colombia.
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Nunez B, Chalmers J, Warren J, Ettinger RL, Qian F. Opinions on the provision of dental care in Iowa nursing homes. SPECIAL CARE IN DENTISTRY 2010; 31:33-40. [PMID: 21235612 DOI: 10.1111/j.1754-4505.2010.00170.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three-quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentist's preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on-site at Iowa nursing homes.
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12
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Gonçalves LHT, Mello ALSFD, Zimermann K. Validação de instrumento de avaliação das condições de saúde bucal de idosos institucionalizados. ESCOLA ANNA NERY 2010. [DOI: 10.1590/s1414-81452010000400026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivou-se trazer para a realidade brasileira, via tradução e validação, o instrumento Oral Health Assessment Tool, de Chalmers et al. (2005), que propõe instrumentalizar profissionais da enfermagem a averiguarem as condições de saúde bucal de idosos institucionalizados e, em sequência, definir a necessidade de cuidados diários e de encaminhamento para realização de procedimentos odontológicos específicos. O instrumento, em inglês, foi traduzido para a língua portuguesa. Seguiram-se as etapas de tradução reversa e análise por comitê de 10 experts convidados a validar o instrumento segundo as equivalências semântica, idiomática, cultural e conceitual. Na sequência, o instrumento foi submetido à análise por 21 profissionais de enfermagem de uma instituição de longa permanência, para que manifestassem suas opiniões sobre conteúdo, apresentação, leitura/clareza e aplicação prática do instrumento. Apresenta-se aos profissionais de enfermagem uma ferramenta de diagnóstico e encaminhamento de idosos com relação às demandas de saúde bucal em instituições de longa permanência.
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13
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Mello ALSFD, Erdmann AL, Brondani M. Oral health care in long-term care facilities for elderly people in southern Brazil: a conceptual framework. Gerodontology 2010; 27:41-6. [DOI: 10.1111/j.1741-2358.2009.00280.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mello ALSFD, Montoya JAG, Erdmann AL, Padilha DMP. Assistência à saúde bucal em residências geriátricas de Granada, Espanha e Santa Catarina, Brasil*. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2009. [DOI: 10.1590/1809-9823.200912012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Descrever a assistência à saúde bucal nas residências geriátricas da Província de Granada, Espanha, e Estado de Santa Catarina, Brasil, e comparar os dados obtidos. Metodologia: Trata-se de estudo exploratório, transversal. Os dados foram coletados por meio de questionário fechado, enviado pelo correio, para todas as residências geriátricas cadastradas em Granada (99) e Santa Catarina (78), em 2005. Resultados: O perfil das residências (29 em SC e 30 em Granada) foi semelhante, com predominância de instituições privadas. Não houve diferenças estatísticas significativas quanto aos residentes, exceto quanto ao número de instituições acima da mediana combinada para quantidade de mulheres e idosos totalmente dependentes, superiores em Granada. Embora as residências granadinas apresentassem maior número de profissionais da saúde, não houve diferenças quanto à insuficiente assistência à saúde bucal aos idosos, considerados: registro das condições de saúde bucal, circunstâncias em que essas condições são (re)avaliadas e realização sistemática de higiene bucal. Em face de um problema de saúde bucal apresentado pelo idoso, a família é comunicada, com maior frequência, nas residências granadinas. Conclusões: A assistência à saúde bucal não é prática sistemática nas instituições investigadas, em ambas as regiões, que transferem à família ou aos serviços locais de saúde o encaminhamento quando surgem problemas. Os procedimentos de higiene mais apontados foram escovação de dentes e próteses, porém práticas ineficazes são citadas. Foi frequente a alegação de falta de cooperação dos idosos para justificar a ausência de uma higiene bucal sistemática, revelando transferência de responsabilidades das instituições e cuidadores para o idoso.
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Young BC, Murray CA, Thomson J. Care home staff knowledge of oral care compared to best practice: a West of Scotland pilot study. Br Dent J 2008; 205:E15; discussion 450-1. [PMID: 18841164 DOI: 10.1038/sj.bdj.2008.894] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2008] [Indexed: 11/09/2022]
Abstract
AIM To evaluate care home (N) staff knowledge of oral care provision for dependent older people in comparison to guidelines from NHS Quality Improvement Scotland (NHSQIS). This pilot study also aimed to identify barriers to delivering oral care and determine if oral health educator (OHE) training had an effect upon staff knowledge of oral care delivery. SETTING This cross-sectional analytic investigation was undertaken within the Greater Glasgow & Clyde area between 2005 and 2007. METHODS From 33 care homes (N), 28 participated in data gathering through an interview schedule involving 109 staff. A 'knowledge check-list' founded upon daily oral care guidelines from the NHSQIS best practice statement (BPS) served as a template for knowledge assessment. An OHE undertook small group discussions related to the BPS in a sub-group of original participants and a second round of data was collected. RESULTS The majority of surveyed staff (n = 86, 79%) agreed that residents required assistance with oral care and placed oral care (n = 85, 78%) in a moderate to high priority. However, only 57% of managers and 49% of nurses had received training in oral care provision. Most staff (79% of managers, 85% of nurses) were unaware of the NHSQIS BPS. Deficiencies in knowledge were identified in several areas of the BPS. In particular, knowledge in the care of the natural dentition was inadequate. Between pre- and post-OHE training, the research suggests the following areas are liable to change: prioritisation given to oral care (p = 0.01), perceived competence (p <0.0001) and confidence in providing oral care advice (p <0.0001). Following OHE intervention, staff knowledge in oral care procedures compliant with best practice guidelines increased by 45%. CONCLUSIONS Knowledge of oral health provision by those responsible for the care of home residents was deficient. An OHE training programme structured around the NHSQIS BPS demonstrated a measurable increase in levels of staff knowledge of oral care procedures.
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Affiliation(s)
- B C Young
- University of Glasgow Dental Hospital and School, Restorative Section, Level 6, 378 Sauchiehall Street, Glasgow, G2 3JZ.
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Chalmers JM, Ettinger RL. Public health issues in geriatric dentistry in the United States. Dent Clin North Am 2008; 52:423-viii. [PMID: 18329452 DOI: 10.1016/j.cden.2007.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aging United States population living in the new millennium has dental needs that are very different and more complex than those experienced by previous older adult cohorts during the twentieth century. The type of dental care to be provided for older Americans goes way beyond emergency care, extractions and denture care. Dental caries is still clearly a public health problem for subgroups of older Americans, such as those of lower socioeconomic status, with dementia, who are homebound and who are institutionalized. These are also the subgroups experiencing greater barriers to accessing dental care. Stakeholders, including dental professionals and the dental benefits industry, need to work together to develop innovative dental financing programs that will increase older Americans access to dental care.
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Affiliation(s)
- J M Chalmers
- Department of Preventive and Community Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA 52242, USA.
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Abstract
AIM This paper presents a literature review of oral hygiene care for adults with dementia in residential aged care facilities, including evidence for: (1) prevalence, incidence, experiences and increments of oral diseases; (2) use of assessment tools to evaluate residents' oral health; (3) preventive oral hygiene care strategies; and (4) provision of dental treatment. BACKGROUND The impact of dementia on residential care is ever-increasing and regular oral hygiene care provision is challenging for cognitively impaired residents. Although an abundance of oral hygiene care recommendations for older people have been published, the supporting evidence has not been clearly delineated. METHODS A review was conducted of English language publications (1980-2002), using a two-step approach (keyword electronic database search, supplemented with secondary search of cited references). All 306 selected articles were critically reviewed and systematically categorized. RESULTS Evidence confirmed clinicians' observations of poor oral health in older residents with dementia. Possible risk factors identified were: salivary dysfunction, polypharmacy, medical conditions, swallowing and dietary problems, functional dependence, oral hygiene care assistance and poor use of dental care. One comprehensive, reliable and validated oral assessment screening tool for residents with dementia had been published. Expert opinion indicated that oral assessment screening by staff and a dentist would be ideal at admission and regularly thereafter. Clinicians and researchers suggested that oral hygiene care strategies were effective in preventing oral diseases and appropriate for residents with dementia. CONCLUSION These literature review findings supported the use of oral assessment screening tools by staff and efficacious preventive oral hygiene care strategies/products for adults with dementia in residential care facilities. Further research with this population is needed to develop and validate oral assessment tools and staff education programmes, trial preventive oral hygiene care strategies/products and trial dementia-focused behaviour management and communication strategies.
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Affiliation(s)
- Jane Chalmers
- Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa city, Iowa 52242-1010, USA.
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Chalmers JM, Robinson J, Nankivell N. The practical oral care video--evaluation of a dental awareness month initiative. Aust Dent J 2005; 50:75-80. [PMID: 16050085 DOI: 10.1111/j.1834-7819.2005.tb00344.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A collaborative effort for the Australian Dental Association's Dental Awareness Month in 2002 included the production of 'Practical Oral Care - a video for residential care staff'. This evaluation of the project aimed to profile the video purchasers, evaluate the usefulness and appropriateness of the video and accompanying booklet using a mailed questionnaire, and elicit appropriate and practical themes for future geriatric oral health promotion and research. METHODS A national mail-out of evaluation questionnaires was undertaken to all purchasers of the video. RESULTS Of the 792 purchasers at the time of the project, 294 questionnaires were returned with 83.7 per cent from residential aged care facilities, 12.6 per cent from dental professionals and 3.7 per cent from health educators. The great majority of purchasers agreed or strongly agreed that the booklet was practical and useful, video was the best format, video length was appropriate, content was realistic, the video assisted staff to identify residents at risk for dental problems and better meet their oral care needs, and improved awareness about oral care issues. Analysis of purchasers' comments highlighted the need for the production of videos on more specific practical oral care issues with behaviourally difficult residents and residents with dementia, to be supplemented with a self-directed learning package. CONCLUSIONS The Practical Oral Care video was a successful national collaborative geriatric oral health promotion initiative and provided the opportunity to increase awareness about oral care issues in residential care.
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Affiliation(s)
- J M Chalmers
- Preventive and Community Dentistry, The University of Iowa, USA.
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Pyle MA, Jasinevicius TR, Sawyer DR, Madsen J. Nursing home executive directors' perception of oral care in long-term care facilities. SPECIAL CARE IN DENTISTRY 2005; 25:111-7. [PMID: 15856918 DOI: 10.1111/j.1754-4505.2005.tb01420.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oral health in long-term care (LTC) facilities has been repeatedly documented as less than ideal. The complex nature of this environment has made it difficult to understand and improve the oral health status of residents through education and training. The purpose of the study was to investigate how the executive directors (EDs) of LTC facilities value oral health and to determine facility variables, which may influence how oral care is delivered. A mail survey of the EDs of all LTC facilities in Ohio (n = 1018) was conducted with 338 responses received after secondary follow-up (33.2% response rate). The 30-item survey included information concerning the nursing facility, the EDs, the EDs' perception of the level of oral health care, and value statements rated on a Likert-like scale. The results of the survey showed that more than two-thirds of the EDs were female and that most facilities were proprietary (70.3%). ED gender was not statistically associated with any of the oral health variables. Fifty-three percent of the EDs rated their residents' oral health as fair or poor but were still satisfied with the oral care provided at their facilities. The apparent discontinuity between perceived levels of oral health and satisfaction with oral care suggests that EDs are distanced from the oral care of their residents or they do not acknowledge oral health care needs. While the survey results revealed important facility characteristics and administrators' perceptions about oral health, the most important aspect of this project was the low response rate despite secondary follow-up. That, coupled with the negativity expressed upon follow-up, suggests a larger issue that may affect oral health in nursing facilities: oral health continues to have a low priority in this setting. Continuing efforts to improve oral health and educate LTC professionals about oral health's influence on general health is critical for managing the oral health of future generations of aging adults.
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Affiliation(s)
- Marsha A Pyle
- Department of Oral Diagnosis & Radiology, Case School of Dental Medicine, West Richland, WA, USA.
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Abstract
Patient and caregiver education and other interventions targeted toward risk factors or types of abuse or neglect play an invaluable role in preventing elder abuse and mistreatment.
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Affiliation(s)
- Seema Joshi
- Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, 1402 South Grand Boulevard, Room M238, St. Louis, MO 63104, USA.
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Slaughter YA, Malamud D. Oral diagnostics for the geriatric populations: current status and future prospects. Dent Clin North Am 2005; 49:445-61. [PMID: 15755415 DOI: 10.1016/j.cden.2004.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Because it is a noninvasive technique, there is growing interest in replacing blood with oral-based methods of diagnostics. Oral diagnostics may be used for diagnosis and therapeutic drug monitoring of both oral diseases (eg, caries, periodontal disease,oral lesions, oral cancer) and systemic diseases (eg, infectious diseases, including HIV and AIDS, autoimmune diseases, cancer,and endocrine disorders). The authors address both existing techniques and oral-based diagnostics that will be applicable to the aging population in the future. They also highlight those techniques that are uniquely suited to point-of-care applications.
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Affiliation(s)
- Yolanda Ann Slaughter
- Department of Preventative and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA
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Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1479-6988.2004.00009.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities. ACTA ACUST UNITED AC 2004. [DOI: 10.11124/jbisrir-2004-378] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities. ACTA ACUST UNITED AC 2004; 2:1-89. [PMID: 27820001 DOI: 10.11124/01938924-200402030-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: INCLUSION CRITERIA: This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to:1 quantify the oral health status of older adults living in residential aged care facilities;2 quantify the oral health status of adults with dementia living in the community and in residential aged care facilities;3 evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities;4 evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and5 evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities.Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics. SEARCH STRATEGY The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents. METHODOLOGICAL QUALITY All selected studies were critically appraised by two reviewers prior to inclusion in the review. RESULTS In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions. CONCLUSIONS This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.
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Affiliation(s)
- Alan Pearson
- 1The Joanna Briggs Institute, Adelaide, South Australia, Professor of Nursing, La Trobe University, Melbourne, Victoria, and Adjunct Professor, The University of Adelaide, Adelaide, South Australia, Australia 2Preventive and Community Dentistry, The University of Iowa, Iowa City, Iowa, USA Associate Professor Jane Chalmers, Preventive and Community Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA 52242-1010, USA
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Maupomé G, Wyatt CCL, Williams PM, Aickin M, Gullion CM. Oral disorders in institution-dwelling elderly adults: a graphic representation. SPECIAL CARE IN DENTISTRY 2002; 22:194-200. [PMID: 12580358 DOI: 10.1111/j.1754-4505.2002.tb00270.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was conducted to assess the oral health status and dental care needs of elderly adults living in long-term care facilities. Dentists examined 601 elderly adults, living in one of six extended-or intermediate-care facilities, between September 1999 and May 2000. Data from 532 of the subjects were analyzed with descriptive statistics and zero-order inverse polynomials. Using a computer program, the authors compiled summaries of oral health data on individuals and institutional levels. This study suggests that there are numerous unmet dental needs among elderly adults who live in institutions. The CODE index used to assess the oral health of these residents offers a systematic portrayal of oral disorders in terms of severity. As the authors demonstrated, this index can be readily analyzed using zero-order inverse polynomials to summarize collected data into a graphic description, which can be helpful in managing and administrating oral health care interventions in long-term care facilities.
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Affiliation(s)
- Gerardo Maupomé
- Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA.
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Coleman P. Improving oral health care for the frail elderly: a review of widespread problems and best practices. Geriatr Nurs 2002; 23:189-99. [PMID: 12183742 DOI: 10.1067/mgn.2002.126964] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral health is an important component of overall health, well-being, and quality of life for institutionalized elders. Despite reports by nurses of the importance of oral hygiene, empirical evidence shows that daily oral care interventions have not been effective in safeguarding the oral and general health of this vulnerable population. Effective practice must involve not only recognizing its importance but also ensuring that daily oral hygiene receives the same priority as other care practices.
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Affiliation(s)
- Patricia Coleman
- Syracuse University School of Nursing and the Center for Clinical Research on Aging, University of Rochester School of Nursing, in Rochester, N.Y., USA
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Abstract
Reduced chewing function in community-dwelling older people with adequate general health is linked to having fewer than 20 teeth present or to wearing removable dentures. By chewing for longer periods of time or swallowing larger food particles they are normally able to compensate for the impaired function. The masticatory function can be restored by adequate prosthetic therapy, which results in increased activity of the masticatory muscles during chewing and reduces the chewing time and the number of chewing strokes until swallowing. In frail or dependent elderly people undernutrition is prevalent because of health problems, reduced appetite and poor quality of life. Poor oral health and xerostomia are often associated with a reduced body mass index and serum albumin level and the avoidance of difficult-to-chew foods. Maintenance or re-establishment of masticatory function is an integral part of the medical health care of these patients, with the aim of improving their nutritional status and quality of life.
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Affiliation(s)
- E Budtz-Jørgensen
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, 19 rue Barthélemy-Menn, CH-1205 Geneva, Switzerland
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