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Sustained Effective Oral Care to Significantly Reduce Aspiration Pneumonia experienced by Adults with Dementia in Residential Care

, Prof Andrew Robinson, Prof Elizabeth Beattie
Research Centre DCRC Carers and Consumers
Partner Institution
Project Description

Oral care is critical to keeping the mouth clean and the body and brain as healthy as possible. This is especially the case for adults with dementia who rely on others for care. With poor oral health, harmful bacteria throughout the mouth cause tooth decay, gum inflammation, gum disease, and tooth loss. Frequently adults with dementia take multiple medications and the side-effects of these medications include reducing saliva and drying the mouth which in turn increase the harmful oral bacteria. When these harmful bacteria are breathed (or aspirated) into the lungs, the lungs become infected and aspiration pneumonia results. Adults with dementia, particularly those who live in residential communities, are vulnerable to aspiration pneumonia as they are often frail, not well nourished, have complicating medical conditions such as diabetes, heart disease, lung disease, and swallowing problems, as well as needing help from others for their care.

We know, from published studies, that vulnerable adults who have their own teeth need to brush their teeth for 2 minutes after each meal. Adults who wear dentures need to clean their dentures each day and take them out when they are planning to sleep. Whether they have their own teeth or wear dentures, all adults with dementia also need to rinse their mouth after each meal. Unfortunately, oral care for adults with dementia in residential communities remains inconsistent and fragmentary. Our studies have documented the barriers, real and perceived, that prevent systematic oral care and we have developed a protocol to overcome these barriers. This protocol has five components:

(1) establishment of an innovative Community of Practice (CoP) including healthcare professionals in the community-at-large, consumers, and policy-makers, together with residential care leaders and nurse-carer champion partners to support staff and drive practice change;

(2) education of nurse-carer champions by CoP members;

(3) ongoing education and training of all point-of-care staff by nurse-carer champions as they work with RACF-based dental/oral health therapy students, and are supported by CoP members and online resources;

(4) implementation of daily evidence-based oral care by staff; and

(5) regular audits of daily oral care by nurse-carer champions and the students to ensure its sustained implementation.

To measure the effectiveness of our protocol, we will follow 120 residents in two residential care communities in Tasmania. We will document the number of cases of aspiration pneumonia these residents experience before and after a 3-month period of daily evidence-based oral care (component 4 of the protocol). We also will document the number of times these residents have been transferred to hospital or admitted to hospital before and after the 3-month period of daily oral care. To document improvements in the residents’ oral, nutritional and general health and their quality-of-life (QOL), we will use the following measures that are appropriate for adults with dementia:

(i) Oral Health Assessment Tool (OHAT),

(ii) Mini-Nutritional Assessment (MNA),

(iii) 3-day food record,

(iv) Yale Swallow Protocol that identifies any signs of swallowing difficulty,

(v) Sit-to-Stand Manoeuvre that identifies any difficulties with strength and movement, and

(vi) the EuroQol-5 dimension tool that documents residents’ perceptions of their ability to move, care for themselves, and participate in daily activities along with any pain, discomfort or anxiety they are experiencing.

We will administer these measures to the residents before and after the 3-month period of evidence-based daily oral care. We will analyse the data and write reports about the findings. We will publish these reports in academic journals and magazines that are widely-read by the public. We will network with social media outlets (radio, television, and Facebook sites) and policy-makers to share our findings as widely as possible. We anticipate a successful project that will help to build the evidence-base for systematic changes to care services and continuous improvement in the oral care of adults with dementia and in the knowledge and ability of those who provide care.

Successful DCRC grant recipient 2016

Other team members:

T/L Dr Lynette Goldberg, University of Tasmania
A/Prof Leonard Crocombe, University of Tasmania
Dr Ioan Jones, Oral Health Services Tasmania
Dr Emma Lea, University of Tasmania
Dr Juanita Westbury, University of Tasmania 
Prof Christine Toye, Curtin University
Prof David Brennan, University of Adelaide
Prof Andrew Palmer, University of Tasmania
A/Prof Cynthia Heiss, University of the Incarnate Word
Prof Fran McInerney, University of Tasmania.
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