Action planning for daily mouth care in long-term care: the brushing up on mouth care project

Oral health matters in cognitive impaired aged residents in geriatric care facilities: A cross-sectional survey

AIMS

To investigate the oral health status of aged residents and explore the possible factors associated with oral health and the effect of cognitive impairment (CI) on it in geriatric care facilities (GCF) using oral health assessment tool (OHAT) in Shanghai, China.

BACKGROUND

Oral health is closely associated with overall health. Problems like missing teeth, dental caries, dental pain, periodontal diseases, oral infections and dysphagia are common in GCFs. Furthermore, residents in GCFs with CI are becoming a dominant group and this prevalence increases with age. Detection of oral problems earlier and taking oral care actions is required for these special populations.

METHODS

The study was an observational cross-sectional study conducted in 42 GCFs. Data were collected from 657 subjects, including oral health assessment (OHAT), cognitive impairment (Mini-Mental State Examination, MMSE) and respondents' characteristics. The subjects were divided into CI group and non-CI group based on MMSE. Oral health conditions were compared between the two groups.

RESULTS

Oral health status in the CI group was significantly worse than that in the non-CI group (p < .001) with four OHAT dimensions (tongue (p = .0007), saliva (p = .0011), natural teeth (p = .0155) and oral cleanliness (p < .001)). The worst dimension was natural teeth. Debris and plaque index (p < .001), oral odour (p < .001), chewing function (p = .0151) and swallowing function (p = .0405) were worse in CI group than those in non-CI group. In the CI group, providing oral care was a protective factor in oral health (OR = 0.600 95CI% (0.39-0.92)) and wearing dentures was a risk factor (OR = 2.09, 95CI% (1.31-3.32)), while the similar effects were not found in non-CI group.

CONCLUSIONS

Oral health status among aged residents in GCFs in China was worse among individuals with CI. Caregivers in GCFs should focus more on seniors' oral health with CI.

RELEVANCE TO CLINICAL PRACTICE

Residents who are suffering from CI are more vulnerable to have oral problems. Regular and proper oral health check-ups in daily nursing work to define oral problems of residents are significant. Nursing staff should pay more attention to oral assessment and effective intervention.

Implementation of an Evidence-Based Oral Care Protocol to Improve the Delivery of Mouth Care in Nursing Home Residents

The current project assessed the oral health of residents in a long-term care (LTC) facility, implemented a new evidence-based oral care protocol, and trained nursing staff about oral hygiene for older adults. A pre-/post-intervention design was used to measure knowledge, skills, and attitudes among 29 staff members. The oral health outcomes of 10 LTC residents without dysphagia were assessed after 14 days of protocol use. Knowledge improved from a mean total pre-test score of 88.8 to a mean total post-test score of 97.7 (Z = -2.308, p = 0.021). The Oral Health Assessment Tool measured oral health outcomes at three time points in 10 older adults, and statistically significant improvement in oral health was identified (p = 0.001). Nursing home staff play an important role in improving oral hygiene of older adults in LTC facilities by routinely using an easy to follow oral health protocol twice daily. [Journal of Gerontological Nursing, 46(5), 33-39.].

Oral Health and Its Associated Factors Among Older Institutionalized Residents-A Systematic Review

The oral health of an ageing population, especially that of the institutionalized elderly population, constitutes a significant concern because it is closely linked to general health and the quality of life. Shared common risk factors drive the development and worsening of poor oral health and non-communicable diseases, which eventually lead to self-care inability. Several studies have reported on the poor oral health of the institutionalized elderly population. However, few comprehensive reports exist regarding the relationship between poor oral health, the oral health-related quality of life (OHRQoL) and the associated factors in this specific population. Objective: The objective is to describe recently reported oral health levels, the OHRQoL and the associated factors among older institutional residents. Methods: Studies published between July 2009 and June 2019 in MEDLINE, EMBASE and CINAHL were searched. The population, intervention, comparison and outcome (PICO) strategy was used as a guide. The reported factors related to poor oral health were identified (i.e., age, gender, educational level, acquired systemic conditions or dementia/cognitive impairment). Results: Twenty-five surveys (or study series) from 19 countries were included. The level of evidence reported by these studies was generally moderate to strong. The reported oral cleanliness and health of the surveyed institutionalized elderly were poor (>50% of residents had calculus; denture hygiene index > 80%). Gum (approximately 30% of dentate residents had moderate to severe periodontitis), teeth (decayed, missing or filled teeth >20), mucosa (>10% had mucosal lesions) and denture problems (up to 40%) were prevalent and were associated with a poor OHRQoL, especially in females, socially deprived residents or those with mild or above cognitive impairment. Those with a poor OHRQoL might show signs of poor nutrition. Conclusions: This report reviewed evidence-based knowledge on oral health, the OHRQoL and the associated factors among elderly institutional residents. Further research is needed to confirm these observations. For improved oral health, a better OHRQoL and the general well-being of older residents, clinical trials are needed, targeting modifiable factors, such as social inequality, oral healthcare accessibility, and/or nursing home service quality. The relationship between oral health, the OHRQoL and nutrition in this at-risk population also warrants exploration.

Evaluating student learning outcomes in oral health knowledge and skills

AIMS AND OBJECTIVES

To evaluate whether a set of oral health resources designed for workforce training was relevant for students undertaking an entry-level nursing or aged care qualification.

BACKGROUND

Oral health is one of the most neglected aspects of nursing care experienced by older people. Despite efforts to improve aged care worker oral health knowledge and skills, one-off training and rapid staff turnover have hindered the success of workplace programmes. Inadequate oral health content in entry-level nursing and aged care qualifications has perpetuated this.

DESIGN

Kirkpatrick's training and evaluation model was used to evaluate the resources developed by a project called Building Better Oral Health Communities. Students used them as prescribed study materials and completed pre- and postintervention questionnaires. Educators were interviewed to obtain their feedback. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were collated according to relevance to learning, presentation style and interest.

RESULTS

Evaluation showed high levels of student and educator satisfaction. Student learning outcomes demonstrated consistently positive attitudes and significant self-reported improvements in oral health knowledge and skills. Irrespective of course type, students gained similar levels of oral health knowledge and skills following use of the resources.

CONCLUSION

Nurses and care workers must be able to provide consistent standards of oral health care as a fundamental part of caring for patients. Validated as an effective learning and teaching package, it is recommended that these resources be used to strengthen the oral health content of entry-level nursing and aged care qualifications.

RELEVANCE TO CLINICAL PRACTICE

Building the oral health capacity of nurses and care workers is one way of reversing oral health neglect and improving the quality of care provided to older people.