Adapting an Evidence-Based Program that Improves Oral Hygiene and Health for Assisted Living Residents with Dementia

项目概要/摘要 可以说，许多痴呆症护理和护理人员支持干预措施过于有限，仅关注 心理社会和行为问题。这些问题很重要，但人们的身体健康也很重要 痴呆症患者-特别是因为他们的寿命更长，需要更多的医疗保健支持， 日常生活活动。想象一下每天提供的身体保健干预的好处。 例如：刷牙，牙线，牙龈和假牙护理。许多痴呆症患者抗拒口腔 护理-事实上，近90%在疗养院。结果，只有16%的人定期刷牙， 当他们从牙齿，舌头和牙龈吸入细菌时，他们有患吸入性肺炎的风险。2013年， 提交这一提案的研究小组开发了现有的两种针对痴呆症的口腔护理之一， 针对疗养院的计划--不战而战的口腔护理（MCWB）--已经成为一种标准 养老院护理。MCWB改变照顾者的态度和行为，改善口腔健康， 在一项随机分组试验中，由护理助理提供的MCWB使肺炎发病率降低了32%。 下一个前沿是将MCWB扩展到辅助生活（AL），这是主要的长期住宿护理提供者， 痴呆症患者。全国有30，200个AL社区。83.52万人中， AL居民有认知障碍，42%的人患有中度或重度痴呆症（平均5 未经治疗的口腔健康状况/人），这意味着MCWB有潜力改善健康和质量， 每年有超过350，000名AL居民患有痴呆症。这是一个独特而及时的机会， 考虑到北卡罗来纳州卫生与公众服务部（DHHS）的特殊要求， 护理牙科计划在这方面的合作。 这项嵌套队列随机分组试验将应用NIH阶段模型和科学的原则， 行为改变，为MCWB在AL中的实际试验和实际实施奠定基础 老年痴呆症患者及其护理人员。目的是为AL完善MCWB，并检查研究 有效性（与研究牙科医生合作）和真实世界的有效性（与社区公众合作 健康牙科卫生员）在北卡罗来纳州48个AL社区培训个人护理助理，以提供 口腔护理;该项目将包括720名痴呆症患者，348名AL工作人员和24名牙科医生。 评价将涉及：（1）干预措施的范围;（2）对变革的中介者/目标的影响;（3）对变革的影响。 组织和个人水平;（3）结果（口腔卫生，肺炎，住院）;（4）协会 组织和个人层面的变化与结果之间的关系，以及与 AL社区和工作人员的特点;（5）态度，障碍和促进者。 通过这个项目的结论，MCWB将准备在AL居民的实际试验中进行评估， 老年痴呆症和提供护理的工作人员。

Project Summary/Abstract It could be said that many dementia care and caregiver support interventions are too limited, focusing solely on psychosocial and behavioral issues. These issues are important, but so too is the physical health of people with dementia -- especially because they are living longer and require even more support with health care and activities of daily living. Just imagine the benefit of a physical health care intervention provided daily. Case in point: tooth brushing, flossing, and gum and denture care. Many people with dementia resist mouth care – almost 90% in nursing homes, in fact. As a result, only 16% have their teeth brushed regularly, putting them at risk for aspiration pneumonia when they inhale bacteria from their teeth, tongue, and gums. In 2013, the research team submitting this proposal developed one of the two existing dementia-focused mouth care programs for nursing homes -- Mouth Care Without a Battle (MCWB) -- which already has become a standard of nursing home care. MCWB changes caregivers' attitudes and behavior, improves oral health, and in a cluster randomized trial, MCWB provided by nursing assistants reduced pneumonia incidence by 32 percent. The next frontier is to extend MCWB to assisted living (AL), the primary long-term residential care provider for persons with dementia. There are 30,200 AL communities across the country. As many as 90% of the 835,200 AL residents have cognitive impairment, and 42% have moderate or severe dementia (and on average, five untreated oral health conditions/person), meaning MCWB has the potential to improve the health and quality of life of more than 350,000 AL residents with dementia annually. There is a unique and timely opportunity to transform MCWB for AL, given the North Carolina Department of Health and Human Services (DHHS) Special Care Dentistry Program's partnership in this effort. This nested cohort cluster randomized trial will apply the NIH Stage Model and principles of the Science of Behavior Change to lay the groundwork for a pragmatic trial and real-world implementation of MCWB for AL residents with dementia and their caregivers. The aims are to refine MCWB for AL, and examine research efficacy (working with a research dental hygienist) and real-world efficacy (working with community public health dental hygienists) to train personal care aides in 48 AL communities across North Carolina to provide mouth care; the project will include 720 residents with dementia, 348 AL staff, and 24 dental hygienists. Evaluation will address (1) the reach of the intervention; (2) effects on mediators/targets of change at the organizational and individual level; (3) outcomes (oral hygiene, pneumonia, hospitalizations); (4) associations between change at the organizational and individual level and outcomes, and also associations with characteristics of the AL community and staff; and (5) attitudes, barriers, and facilitators. By the conclusion of this project, MCWB will be ready for evaluation in a pragmatic trial of AL residents with dementia and the staff who provide their care.