Status of oral healthcare in long-term care facilities

Oral health, treatment burden and demographics of elders with care-resistant behavior: A cross-sectional study

AIMS

To assess oral health, treatment burden, mortality risk, and demographics in elders with care-resistant behaviors (CRB) in nursing homes (NH) and compare them with those without CRB.

METHODS AND RESULTS

503 participants from eight NH who received dental treatment through a mobile dental clinic were included. Their medical and dental records were screened regarding oral/dental health, treatment history, general health, demographics, and CRB. Statistical analysis was performed to show correlations between CRB and the measured parameters. Data were verified for normal distribution; a point-biserial correlation model was used (95% CI: α = 0.05). No correlation was found between CRB and Decayed Missing Filled Teeth (DMF-T) (rpb = -0.061, p = .177), as well as periodontal status (rpb = 0.004, p = .946). A negative correlation was observed between CRB and the required number of treatment procedures (rpb = -0.181, p < .0001), time (rpb = -0.118, p = .010), and costs (rpb = -0.100, p = .028). Sex predilection for men regarding CRB was evident (rpb = -0.155, p = .01). No correlation appeared between CRB and vital status (rpb = -0.41, p = .355).

CONCLUSION

Oral health seems to be similar in institutionalized elders with or without CRB. Treatment burden was not elevated, but even reduced in elders with CRB, evincing that few/no treatment procedures were performed in those elders. CRB demonstrated a sex predilection for men. An association between CRB and increased mortality was not evident.

Fidelity and sustainability of Mouth Care Without a Battle and lessons for other innovations in care

There are countless efficacious interventions that improve outcomes when conducted in controlled situations. Many fewer are effective when implemented in real-world situations, largely because they are not implemented with fidelity. Still fewer are sustained over time, for reasons including lack of institutional support and fit with existing values, among others. It is especially important to examine fidelity and sustainability when efficacious interventions are being implemented, because these interventions are the ones that hold the most promise. This project examined the fidelity and sustainability of Mouth Care Without a Battle (MCWB), an evidence-based program conducted in a two-year cluster randomized trial in 14 nursing homes. Results that triangulated two sources of data indicated that fidelity decreased after the first year; they provide guidance to promote fidelity and sustainability of this and other new care practices in nursing homes, including ongoing education, coaching, evaluation, feedback, and sufficient resources.

Prevalence of halitosis in elderly living in nursing homes

OBJECTIVES

Halitosis is a concern for many people, but has sparsely been studied in elderly living in nursing homes. The aim of this investigation was to study the prevalence of halitosis in this particular group and factors that could be associated with this condition.

METHOD AND MATERIALS

One hundred and twenty-four residents at three different nursing homes were included in the study. The level of halitosis was assessed using an organoleptic method based on a 6-graded scale. Oral status, including registrations of plaque, gingivitis and assessment of hyposalivation, was performed by two investigators who both examined all patients. Medical history, that is medication, neurological conditions, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD)/asthma, dementia and mental illness, was obtained from the patient files. Registrations of the use of oral hygiene aids, ADL (Activity of Daily Life) and the frequency of contact with dental services were included in the clinical examination.

RESULTS

Halitosis occurred in over 50% of residents living in nursing homes and was found to be associated with the presence of hyposalivation, periodontal disease, calculus, fixed prosthodontics and dementia.

CONCLUSION

Halitosis was a common finding in the elderly living in Swedish nursing homes.

Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes

OBJECTIVES

To develop and test a person-centered, evidence-based mouth care program in nursing homes.

DESIGN

Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site.

SETTING

Three North Carolina nursing homes.

PARTICIPANTS

Ninety-seven residents and six certified nursing assistants (CNAs).

INTERVENTION

CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care.

MEASUREMENTS

Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided.

RESULTS

Outcome scores significantly improved (P < .001 for PI-LTC and GI-LTC; P = .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (P < .001-P = .03) but took more time (P < .001) after training. Consistency of care appeared to be more important for natural teeth than dentures.

CONCLUSION

As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial.

Oral health-related quality of life in patients receiving home-care nursing: associations with aspects of dental status and xerostomia

OBJECTIVE

To explore the differences in oral status, dental attendance and dry mouth problems between patients with long-term disease with high and low scores on Oral Health Impact Profile 14 (OHIP 14) and how patients cope with oral problems such as xerostomia and a reduced ability to brush their teeth.

BACKGROUND

There has been a lack of studies of oral health and oral health-related quality of life in the frail elderly within the community services.

MATERIALS AND METHODS

A cross-sectional questionnaire study was conducted with 137 patients receiving home-care nursing. Structured interviews were conducted by student nurses using OHIP-14, items from the Xerostomia Inventory and questions concerning dental visit habits, brushing of teeth and data from medical records.

RESULTS

Eighty-three per cent of patients had natural teeth and 60% had only natural teeth. 'Natural teeth only' indicated a low score on OHIP-14. Problems with brushing and items concerning xerostomia indicated a high score on OHIP-14. Contrasts in the assessments concerning brushing of teeth and xerostomia indicated low priority from the patients themselves and the nursing staff.

CONCLUSION

Community health services should focus upon oral health. Both patients and nurses should assess the need for regular brushing of teeth carried out by home-care nurses. Assessment and treatment of dry mouth problems should have higher priority.