Maturation of the MOUTh Intervention: From Reducing Threat to Relationship-Centered Care

Abstract

The purpose of the current article is to describe a personalized practice originally conceived as a way to prevent and minimize care-resistant behavior to provide mouth care to older adult with dementia. The original intervention, Managing Oral Hygiene Using Threat Reduction Strategies (MOUTh), matured during the clinical trial study into a relationship-centered intervention with emphasis on developing strategies that support residents behavioral health and staff involved in care. Relationships that were initially pragmatic (i.e., focused on the task of completing mouth care) developed into more personal and responsive relationships that involved deeper engagement between mouth care providers and nursing home (NH) residents. Mouth care was accomplished and completed in a manner enjoyable to NH residents and mouth care providers. The MOUTh intervention may also concurrently affirm the dignity and personhood of the care recipient because of its emphasis on connecting with older adults.

What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

“…Six articles surveyed the opinions of carers of people with intellectual disabilities in relation to assessing, monitoring and promoting health 37‐42 and one was a systematic review of this topic 43 . The remaining 23 oral hygiene interventions included in the review were of populations other than those with intellectual disabilities only, elderly people 44‐56 , people with dementia 57‐62 or people with disabilities (physical, mixed or unspecified) 63‐66 . The remaining articles were reviews and qualitative studies on the topic of providing oral hygiene care to others 67‐81 .…”

Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care

“…The MOUTh intervention was originally conceptualised as a “toolbox” of strategies to prevent and reduce CRBs, which were initially derived from 2 sources: existing practices culled from extant nursing and dental literature and new techniques developed within pilot work . These strategies included establishing rapport by approaching the resident at or below eye level with a pleasant and calm demeanour; providing mouth care in front of a sink and in front of a mirror (to access procedural or implicit memories); avoiding elderspeak, a type of sing‐song “baby talk”; chaining, which involved starting the mouth care and having the older adult finish the task; cueing using gestures, pantomimes and short, 1‐step commands; distraction; bridging, where the older adult was asked to hold a toothbrush during mouth care; rescue, where a second experimental mouth‐care provider replaced the first experimental mouth‐care provider if CRBs were escalating; and hand‐over‐hand, which involved either the older adult placing his or her hand over that of the experimental mouth‐care provider, or the experimental mouth‐care provider gently guiding the older adult's hands . The experimental mouth‐care providers were expected to select strategies on a trial and error basis.…”

Psychometric properties of the Oral Health Assessment Tool Turkish Version

“…Nurse 1 was the principal investigator. She had been trained in the administration and scoring of the English OHAT while a visiting scholar and a member of a research team in the United States that had extensively used the English OHAT 28,29 . Nurse 2 was a bachelor's prepared nurse with 11 years' experience in working at the nursing home.…”