Feasibility of Providing Safe Mouth Care and Collecting Oral and Fecal Microbiome Samples from Nursing Home Residents with Dysphagia: Proof of Concept Study

Abstract

Individuals with dysphagia who reside in nursing homes often receive inadequate mouth care and experience poor oral health. From a policy perspective, the combination of absent evidence-based mouth care protocols coupled with insufficient dental coverage create a pool of individuals at great risk for preventable infectious illnesses that contribute to high health care costs. The purpose of the current study was to determine (a) the safety of a mouth care protocol tailored for individuals with dysphagia residing in nursing homes without access to suction equipment, and (b) the feasibility of collecting oral and fecal samples for microbiota analyses. The mouth care protocol resulted in improved oral hygiene without aspiration, and oral and fecal samples were safely collected from participants. Policies supporting ongoing testing of evidence-based mouth care protocols for individuals with dysphagia are important to improve quality, demonstrate efficacy, and save health care costs. [Journal of Gerontological Nursing, 43(9), 9-15.].

Interventions for Nursing Home Residents with Dysphagia—A Scoping Review

“…Due to the heterogeneity of the included studies reviewed, the intervention categories are broad with some overlap. Three studies described a feeding intervention [32,38,41], two studies focused on oral hygiene [40,42], two studies on stimulation (taste and smell) [30,31], two studies on training [28,29], two studies on a caregiver algorithm [35,36], [43], one study focused on teaching the residents compensatory strategies [37], one study focused on mobilization of the spine [33], and one study focused on positioning, oral hygiene, and teaching swallowing techniques [34].…”

“…In two studies, the focus was on oral hygiene [39,40]. A controlled clinical trial evaluated the effect of adding a 0.05% chlorhexidine-containing solution to daily oral hygiene care, but no significant difference in the incidence of pneumonia was documented [39].…”

“…A controlled clinical trial evaluated the effect of adding a 0.05% chlorhexidine-containing solution to daily oral hygiene care, but no significant difference in the incidence of pneumonia was documented [39]. A feasibility study including four nursing home residents tested a mouth care protocol, including mouth care twice daily and once on day 6, which resulted in improved oral hygiene without aspiration [40]. Thus, the role of nurses in providing oral care seems of importance for resident safety, i.e., for protection against aspiration.…”

Psychometric properties of the Oral Health Assessment Tool Turkish Version

“…Nursing home research, especially research conducted by doctorally-prepared nurses, is in its infancy in Turkey. We opted, for this study, to exclude cognitively impaired residents due to systemimposed barriers for obtaining consent from family members or legally-authorized representatives, as is routinely done in the United States 28,32 . The primary author plans to repeat aspects of this study and including cognitively-impaired nursing home residents.…”

“…According to the Kappa statistic and percent agreement, OHAT evaluation showed a moderate, substantial and almost perfect agreement between the evaluations by nurse 1 and nurse 2. It was showed that kappa statistics being considered moderate of OHAT Portuguese and Japanese versions [31][32] .…”