Evaluation of the implementation of an ‘oral hygiene protocol’ in nursing homes: a 5-year longitudinal study (original) (raw)
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Oral hygiene of elderly people in long-term care institutions ? a cross-sectional study
Gerodontology, 2006
Oral hygiene of elderly people in long-term care institutions -a cross-sectional study Objective: The aim of this cross-sectional study was to assess the level of oral hygiene in elderly people living in long-term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score ¼ 3) and the mean denture plaque score was 2.13 (maximum possible score ¼ 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long-term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.
Oral hygiene and the need for treatment of the dependent institutionalised elderly
Gerodontology, 2006
Oral hygiene and the need for treatment of the dependent institutionalised elderly Objective: To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background: For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods: From 2003 to 2004, a cross-sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results: The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion: The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.
Improving Nursing Home Residents' Oral Hygiene: Results of a Cluster Randomized Intervention Trial
Journal of the American Medical Directors Association
Objective: A two-year cluster randomized trial of Mouth Care Without a Battle © (MCWB) was conducted in nursing homes (NHs) to determine if recommended mouth care practices provided by NH staff could improve residents' oral hygiene and denture outcomes. Design: Cluster randomized trial of NHs. Setting and Participants: Seven MCWB NHs and six control NHs. A total of 219 NH residents completed baseline and 24-month oral exams and if applicable, denture assessments (control=98, intervention=121). Intervention: The intervention consisted of training NH staff in the MCWB protocol, and providing support in its use for two years. Measures: Descriptive data from the Minimum Data Set and clinical oral health assessments: the Plaque Index for Long-Term Care (range 0-3; PI-LTC), the Gingival Index for Long-Term Care (range 0-4; GI-LTC), and the Denture Plaque Index (range 0-4, DPI), with lower scores indicating better oral health. Results: There were no significant demographic or health differences between groups at baseline. Residents' mean age (SD) was 77.6 (13.7), 71% were female, and 49% had cognitive impairment. At 24 months, there were significant improvements in oral and denture hygiene in the intervention group compared to control (all p < .05) with mean changes in indices that were 0.44 (PI-LTC), 0.55 (GI-LTC), and 0.67 (DPI) points lower in intervention NHs than control NHs.
A concept analysis of oral hygiene care in dependent older adults
Journal of Advanced Nursing, 2013
Aim. To report a concept analysis of oral hygiene care. Background. Oral hygiene care, as it is provided to older patients in hospital and long-term care settings by nurses and their delegates, has the potential to contribute to the oral health of patients while preventing aspiration pneumonia as well as periodontitis, which itself has been associated with several systemic diseases. However, the state of oral cleanliness in such patients tends to be poor and despite the existence of guidelines, nursing care practices may be inadequate and not reflective of recent advances in knowledge. Design. Concept analysis. Data sources. A search of electronic databases (2002-2012), use of internet search engines, and hand searching yielded an international data set of 66 research studies, reviews, and practice guidelines. Review methods. The concept analysis method of Walker and Avant was used to explore the concept of oral hygiene care in the context of frail older patients. Results. Oral hygiene care involves approaches informed by knowing the patient, inspecting the oral cavity, removing plaque, cleansing the oral tissues, decontaminating the oral cavity, using fluoride products and maintaining oral tissue moisture. Those attributes, along with their antecedents and consequences, form a conceptual framework from which a middle-range theory of nurseadministered oral hygiene care is derived that could be tested, evaluated, modified, and translated into practice. Conclusions. Clarity around the concept of oral hygiene care as a nursing intervention could enable nurses to impact oral health outcomes and possibly prevent systemic diseases in older patients.
Nursing Open, 2021
The percentages of older people is increasing in Sweden and worldwide (United Nations, 2015). Between the years 2015-2035, the forecast increase in those aged ≥ 80 years in Sweden is 76%, which indicates a need for an extensive expansion of the nursing care for older people (Statistics Sweden, (2016). In 2018, among adults ≥ 80 years old, 14% were living permanently in nursing homes and 29% were receiving home help services in ordinary housing (National Board of Health & Welfare, 2019). With increasing frailty in older adults, many become dependent on care from the society. The group of older people moving to nursing homes can be described as the most dependent, who in most cases have multimorbidity and/or substantial impairments in their functional status. Oral health problems, including poor oral hygiene, are commonly seen among older adults in nursing homes, with high prevalence of caries, periodontal disease and ill-fitting prosthetics (Andersson et al., 2017; Murray Thomson, 2014). It is therefore important to find ways to include oral health and oral care as a natural part of nursing work.
(Lack of) oral hygiene care for hospitalized elderly patients
2021
OBJECTIVE to analyze the oral hygiene care for hospitalized elderly patients provided by the nursing staff. METHOD this is a qualitative, exploratory-descriptive study carried out in a university hospital, with the participation of 35 professionals from the nursing staff. Data collection was carried out through semi-structured interviews, explored through thematic content analysis. RESULTS two categories emerged: The oral hygiene of hospitalized elderly patients as an extension of body care and Barriers in (lack of) care with the oral hygiene of hospitalized elderly patients, with two subcategories: The oral hygiene and dental prosthesis technique performed divergently; Care hampered by deficit of materials and human resources. FINAL CONSIDERATIONS this study showed weaknesses in the oral hygiene care of hospitalized elderly patients, promoting reflections on the practice informed in data and management actions, allowing recommendations of care standards for the nursing staff.
Gerodontology, 2013
Objective: The goal of this study was to determine the impact of an oral hygiene education programme for caregivers on the oral health of institutionalised elderly and to examine the effect of disability and low muscle strength on programme outcomes. Materials and methods: The subjects of this study were geriatric patients (n = 80) from a nursing home. Katz Index for activities of daily living, handgrip strength and mucosal-plaque score (MPS) was evaluated at baseline and 1 year after intervention. The intervention consisted of an educational programme and specific guidelines for caregivers (to perform oral hygiene for dependent elderly and to supervise the independent elderly during oral hygiene practices). Differences on MPS were evaluated using a paired-sample t-test. A stratified analysis was carried out to identify differences in response to the programme according to the Katz Index and handgrip strength of elderly. Results: The MPS was significantly reduced (p = 0.001) at follow-up; however, a separate analysis showed that only the independent elderly (p = 0.002) and those with normal muscle strength (p = 0.006) showed a reduction in MPS during the follow-up examination. Conclusion: The oral hygiene education programme for caregivers resulted in a positive impact on oral hygiene of the independent and functional elderly.
Gerodontology, 2018
Objectives-The purpose of this study was to test the efficacy of MOUTh (Managing Oral Hygiene Using Threat Reduction), a non-pharmacologic, relationship-based intervention versus control on 2 primary outcomes for nursing home (NH) residents with dementia who resisted mouth care: 1) reduction in the occurrence and intensity of care-resistant behaviors (CRBs), and 2) improvement in oral health. Two secondary outcomes were also examined, 1) the duration of mouth care and 2) the completion of oral hygiene activities. Background-Persons with dementia who exhibit care-resistant behaviors (CRBs) are at risk for inadequate mouth care and subsequent systemic illnesses. Materials and methods-The study used a randomized repeated measures design. Recruitment occurred in 9 nursing homes that varied in size, ownership, reimbursement patterns, and location. 101 nursing home residents with dementia were randomized at the individual level to experimental (n=55) or control groups (n=46). 100 participants provided data for the analyses. Results-Compared to the control group, persons in the experimental group had twice the odds of allowing mouth care and completing oral hygiene activities; they also allowed longer duration 205-975-9019,