Will Maintenance of Oral Hygiene in Nursing Home Residents Prevent Pneumonia?

Mylotte, Joseph M.

doi:10.1111/jgs.15190

Cited by 13 publications

(8 citation statements)

References 40 publications

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“…Most importantly, it was the basis on which NHs were matched and monitored over time, and there is no reason to expect later bias between the study groups. In addition, we are cognizant of a recent critique that called for examination of the etiology of suspected pneumonia and agree that there is more to be learned.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence

et al. 2020

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IMPORTANCE Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia. OBJECTIVE To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents. DESIGN, SETTING, AND PARTICIPANTS This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups. INTERVENTION Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care. MAIN OUTCOMES AND MEASURES Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records. RESULTS Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03). CONCLUSIONS AND RELEVANCE This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year (continued) Key Points Question Can nursing home staff reduce pneumonia by providing mouth care to residents? Findings In this pragmatic cluster randomized trial including 2152 residents from 14 paired nursing homes during 2 years, there was no statistically significant difference in the primary outcome of pneumonia incidence during 2 years. Adjusted post hoc analyses indicated a stat...

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Section: Discussionmentioning

confidence: 99%

Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence

et al. 2020

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“…Oral care is very important to maintain, and the lack of proper oral care in the elderly is associated with increased morbidity and hospitalisation, due to respiratory and other diseases, and increased mortality [ 4 ], [ 5 ], [ 12 ], [ 13 ], [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…A major challenge in caregiving is the more or less sudden changes in the ability of the individual elderly to do oral self-care, especially if the lack of proper self-care has gone unnoticed for a prolonged period of time, after which the damage to the mouth and teeth may cause severe pain and lead to irrevocable damage to the teeth and gums in the oral cavity because of difficulties in dental treatment of such physically and possibly mentally weak elderly persons. Furthermore, poor oral hygiene may lead to other diseases, spreading from the mouth area, including heart and lung infections [ 12 ], [ 13 ], [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Oral-care adherence. Service design for nursing homes – initial caregiver reactions and socio-economic analysis

Wagner

Rosian-Schikuta

Cabral

2022

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Background: Lack of proper oral care among elderly people in nursing homes is associated with increased morbidity and hospitalisation. The ability of the individual to maintain sufficient oral self-care is difficult for caregivers to assess, and thus, caregivers often risk providing suboptimal oral care. Sensor-based tools exist that can support the caregiving staff in achieving a better understanding of who among the elderly are able to perform proper self-care, and who cannot and thus need additional assistance from caregivers. How such systems should be designed and deployed in nursing homes, and how they will be perceived by caregivers has not been investigated sufficiently yet. Objectives: The aim of this study was to gain a better understanding of how caregiving staff perceives the introduction of sensor-based systems that allow the caregivers to automatically discover who among the elderly residents are able to adhere to the given recommendation on daily oral self-care, and who among them are in need of further assistance, as well as whether there is potential for saving costs. Methods: In a mixed methods qualitative study, we visited three nursing homes where we had recently deployed, or were about to deploy, electrical toothbrushes and a basic oral-care adherence aid system. Nursing home staff was interviewed during the field studies about their initial reactions to introducing such a system as part of their daily workflow. The field study was supported by a literature review. Results: Caregiving staff welcomed the introduction of a sensor-based oral-care adherence aid system, which would identify any elderly who could no longer achieve a sufficient level of oral self-care. Improving oral care for the elderly may not only prevent serious consequential diseases, but also generate considerable savings with a return on investment of at least 1:2.5. Conclusion: Sensor-based oral-care adherence aid systems that monitor oral-care adherence, meaning the ability of the individual elderly to properly perform teeth and/or denture brushing as part of normal self-care efforts, appear useful and relevant to introduce. More work is needed to provide a better understanding of the long-term user experience of both caregiving staff and elderly. There is also a need for more high-quality long-term clinical studies of further preventive effects of oral hygiene measures and their economic benefit.

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“…The fundamental idea that you cannot have healthy aging without oral health has led to a focus on geriatric research and policy recommendations that link oral diseases with systemic diseases, predict health outcomes based on oral health status and intervention, and shape the transitions of aging to optimize oral health. In this issue, three articles highlight these areas of focus: Mylotte reviews the evidence of oral hygiene interventions on reducing nursing home pneumonia, Ramsay and colleagues describe longitudinal associations between oral health measures and incident frailty, and Kossioni and colleagues present European geriatric oral health policy recommendations.…”

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confidence: 99%

“…In this issue, Mylotte evaluates the literature on oral hygiene as a risk factor for nursing home‐associated pneumonia (NHAP) and on interventions to improve oral hygiene and reduce the incidence of NHAP. The physical and cognitive impairments of nursing home residents often create dependency on nursing home staff to assist with or deliver oral hygiene.…”

mentioning

confidence: 99%