The Hospice Patient's Right to Oral Care: Making Time for the Mouth

Oral symptoms in dying nursing home patients. Results from the prospective REDIC study

BACKGROUND

The mouth is a central organ for communication and fluid intake, also for dying nursing home patients. This study describes the prevalence and severity of oral symptoms from nursing home admission until the day of perceived dying and the day of death.

METHODS

A prospective, longitudinal cohort study including 696 patients who were admitted to 47 Norwegian nursing homes in 35 municipalities. During the first year of their stay, 189 died (27%), of whom 82 participants were assessed on the day they were perceived as dying and 134 on the day of death. Mouth care, nutrition, and bedsores were assessed with the Residents' Assessment Instrument for nursing homes (RAI-NH) and palliative care (RAI-PC). Pain intensity was assessed with the Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale (MOBID-2).

RESULTS

The proportion of patients with ≥ 6 oral symptoms increased from 16% when perceived as dying to 20% on the day of death (P = 0.001). On the day of death, xerostomia (66%), dysphagia (59%), and mastication problems (50%) were the most frequently observed oral symptoms. Only 16% received mouth care every hour and 12% were in pain during this procedure. Compared to people without dementia, those with a diagnosis of dementia at admission (N = 112, 86%) had xerostomia and mastication problems more frequently (50% vs. 73%; 32% vs. 56% (P = 0.038), respectively) on the day of death.

CONCLUSIONS

The high extent of oral symptoms such as xerostomia, dysphagia, and mastication problems underline the need for systematic assessment and improved oral palliative care for dying nursing home patients with dementia.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01920100 08/08/2013. First submission to BMC oral 15/03/2023.

Children's hospices: an opportunity to put the mouth back in the body

Introduction The children and young people who utilise hospice services often have additional oral health care needs and may present with additional challenges in regard to mouth care. Hospice colleagues need support and would benefit from national direction in providing mouth care for this important group.Methods Questionnaires were provided to hospice nursing colleagues, parents and carers to assess current knowledge and confidence around mouth care and diet. An audit was also completed on hospice records to assess the recording of mouth care provision prior to the introduction of Mini Mouth Care Matters. Training was then provided to colleagues in the form of a virtual interactive learning session and a re-audit of hospice records was then completed.Results Almost 30% of colleagues had never received mouth care training and two-thirds of colleagues faced barriers in providing daily mouth care. Overall, 11% of children who accessed hospice services had never visited a dentist and nearly half of the children brushed less than twice a day. The Mini Mouth Care Matters assessment tool resulted in an increase in assessment of the mouth of children using the hospice, along with early identification of problems and improving daily mouth care.Conclusion Mini Mouth Care Matters is transferable to children's hospices and should be extended to all children's hospices nationally.

The need for oral assessment and referral practices tool for palliative patients in Brunei Darussalam: A cross-sectional study

Aim

This study aimed to investigate knowledge, experiences, perceptions and barriers of healthcare professionals regarding palliative oral care.

Methods

The study involved 169 palliative care professionals in Brunei. Data collection tool was pretested, validated and self-administered with sections on demographics; knowledge, attitude and practices; referral of patients; perspectives; and barriers to oral palliative care.

Results

97.3% of participants believed that palliative patients need oral care, and 11.6% of participants were trained in this area. 43.8% were unsure about referral process, and 66.1% of participants had never used a tool to assess oral conditions of palliative patients. Most common oral condition encountered was mucositis (54.5%). 74.1% of participants expected family members to be responsible, and the absence of proper guidelines for assessment (66.1%) was the top challenge in providing oral care for palliative patients.

Conclusion

This study highlights perceptions and experiences of healthcare professionals and need for improved care through development of oral assessment and referral practices tool for palliative patients.

Why oral palliative care takes a backseat? A national focus group study on experiences of palliative doctors, nurses and dentists

Aim

Poor oral care among frail older people at the end of life endangers quality of life. However, only few dying people have access to oral palliative care services. Therefore, this study aimed to investigate oral palliative care practices and referral patterns for palliative patients in the Brunei healthcare settings.

Design

An exploratory qualitative study.

Methods

Five focus groups were conducted among palliative care nurses (N = 7), palliative medicine doctors (N = 4), dentists (N = 6), oncologists (N = 4) and oncology nurses (N = 4). Verbatim was analysed using qualitative thematic analysis.

Results

Analyses revealed four distinct themes emerging as current oral palliative care assessment and referral practice in the Brunei healthcare settings: "taking a back seat," "opportunistic oral care," "they refused and refused" and "challenging healthcare resources and oral palliative care."