File(s) under permanent embargo
Effects of oral health screening on aspiration pneumonia risk for adults with dementia in residential aged care
Many adults with dementia in residential aged care are dependent on others for feeding and oral care. Langmore and colleagues in the United States have shown this co-related dependency is a strong predictor for aspiration pneumonia due to pathological oral microorganisms from saliva, tooth decay, and an unclean mouth migrating into the lungs and the inability of adults to cough and clear the aspirated material. The subsequent lung infection frequently results in hospitalisation, increasing frailty, and can cause death. Even when teeth are removed, oral pathogens remain a risk indicator for aspiration pneumonia as they line the mucosa I surface of the oral and pharyngeal cavities, including the tongue. Evidence-based and sustainable oral care needs to be an integral aspect of a paradigm shift to actively promote function, maintain health, and significantly reduce costs associated with ill health and hospitalisation for residents with dementia.
Residents with dementia frequently take many medications that reduce salivary flow or create xerostomia, which increase the pathogenic bacteria. These bacteria cause tooth decay, gum inflammation, gum disease, and painful disruption of the oral mucosa and supporting structures. Chronic inflammation of oral tissues results in bacteria entering the bloodstream with detrimental effects on the body and brain. Associated oral pain frequently necessitates a diet of modified foods, compounding the risk for malnutrition, with associated changes in behaviour, frailty, and a compromised immune system. One potential strategy to prevent this cascade and decrease aspiration pneumonia risk is to screen the oral health and function of adults when they move into care. In Australian residential care communities, oral care for adults with dementia generally is delegated to extended care assistants or personal care workers (carers). Many view oral care as onerous and are reluctant to perform it; many have limited training to respond to changes in behaviour that may· indicate residents' distress; many do not understand how oral care is integral to the work of dentists, speech pathologists, dietitians, physiotherapists, and nurses to promote residents' function and overall health.
In this project, an interdisciplinary team of a speech pathologist, dentist, nutritionist, and pharmacist worked with nurses and carers to screen 142 residents using the Oral Health Assessment Tool (OHAT), the Mini-Nutritional Assessment (MNA), the Yale Swallow Protocol, and the EuroQOL-5D-3L. Residents' diagnoses, age, gender, prescribed medications, and clinical signs of potential aspiration were documented from medical files. The administration of all four screening tools was generally able to be completed in 20 minutes. However, due to the conversations that ensued with residents, the expended time sometimes doubled. These conversations provided valuable insight into issues of concern to residents - information carers and nurses needed to know but often did not.
Of the residents, 78% warranted referral to a dentist; 57% were at risk for malnourishment; 13% were actually malnourished; and 70% failed or refused the swallow protocol, indicating difficulty with, or apprehension about, swallowing thin liquids safely. Self-reported quality of fife ranged from 34-95% (M = 65%). The collaborative interdisciplinary team was instrumental in assisting nurses and carers to screen for, identify, and address issues in oral health and function. Residents are being tracked to determine the outcome of reduced aspiration pneumonia risk. Results will be available by August.
Dementia Collaborative Research Centre
Publication title4th International Conference of Long-term Care Directors & Administrators
Department/SchoolWicking Dementia Research Education Centre
Event title4th International Conference of Long-term Care Directors & Administrators
Event VenueSydney, Australia
Date of Event (Start Date)2018-08-01
Date of Event (End Date)2018-08-03