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

采用循证计划，改善患有痴呆症的辅助生活居民的口腔卫生和健康

• 批准号: 10470713
• 负责人: Sheryl Zimmerman
• 金额: $ 50.61万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10470713
• 关键词: Activities of Daily Living; Address; Administrator; Aspiration Pneumonia; Assisted Living Facilities; Attitude; Bacteria; Behavior; Behavioral; Caregiver support; Caregivers; Caring; Characteristics; Cluster randomized trial; Communities; Country; Dementia; Dementia caregivers; Dental Hygiene; Dental Hygienists; Dental Research; Dentistry; Dentures; Discipline of Nursing; Evaluation; Evidence based program; Family; Health; Healthcare; Healthcare Activity; Home Nursing Care; Hospitalization; Hour; Impaired cognition; Incidence; Individual; Inhalation; Internet; Intervention; Interview; Lead; Learning; Manuals; Mediator of activation protein; Methods; Modeling; Modification; North Carolina; Nursing Homes; Oral cavity; Oral health; Outcome; Persons; Pneumonia; Provider; Public Health; Quality of life; Randomized; Research; Risk; Sampling; Science; Self Care; Self Efficacy; Time; Tongue; Tooth structure; Toothbrushing; Training; Training Support; United States Dept. of Health and Human Services; United States National Institutes of Health; Video Recording; base; behavior change; care providers; cohort; community living; dementia care; effectiveness outcome; efficacy research; efficacy testing; experience; frontier; implementation outcomes; improved; nursing standards; physical conditioning; pragmatic trial; programs; psychosocial; residential care facility; social; stakeholder perspectives

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.

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 患有痴呆症的人——尤其是因为他们的寿命更长，需要更多的医疗保健支持和 日常生活活动。想象一下每天提供的身体保健干预措施的好处。 典型的例子：刷牙、使用牙线、牙龈和假牙护理。许多痴呆症患者抵制嘴巴 事实上，几乎 90% 的护理都在疗养院进行。因此，只有 16% 的人定期刷牙，这使得 当他们从牙齿、舌头和牙龈吸入细菌时，就有患吸入性肺炎的风险。 2013年， 提交该提案的研究团队开发了现有的两种针对痴呆症的口腔护理产品之一 疗养院计划——无需战斗的口腔护理（MCWB）——已经成为标准 的疗养院护理。 MCWB 改变护理人员的态度和行为，改善口腔健康，并在 整群随机试验显示，护理助理提供的 MCWB 使肺炎发病率降低了 32%。 下一个前沿领域是将 MCWB 扩展到辅助生活 (AL)，这是主要的长期住宿护理提供者 患有痴呆症的人。全国有 30,200 个 AL 社区。 835,200 人中的 90% AL 居民患有认知障碍，42% 的人患有中度或重度痴呆（平均有 5 名居民患有中度或重度痴呆） 未经治疗的口腔健康状况/人），这意味着 MCWB 有潜力改善口腔健康和质量 每年超过 350,000 名患有痴呆症的阿拉巴马州居民的生活。有一个独特而及时的机会 鉴于北卡罗来纳州卫生与公众服务部 (DHHS) 的特殊要求，将 MCWB 改造为 AL 护理牙科计划在这项工作中的合作伙伴。 这项嵌套队列集群随机试验将应用 NIH 阶段模型和科学原理 行为改变为 AL MCWB 的务实试验和实际实施奠定基础 患有痴呆症的居民及其照顾者。目的是完善 AL 的 MCWB，并检查研究 功效（与研究牙科保健员合作）和现实世界功效（与社区公众合作） 健康牙科保健员）将在北卡罗来纳州 48 个 AL 社区培训个人护理助手，以提供 口腔护理；该项目将包括 720 名患有痴呆症的居民、348 名 AL 工作人员和 24 名牙科保健员。 评估将涉及 (1) 干预措施的范围； (2) 变革对调解者/目标的影响 组织和个人层面； (3) 结果（口腔卫生、肺炎、住院）； (4) 协会 组织和个人层面的变革和结果之间的关系，以及与 AL 社区和员工的特征； (5) 态度、障碍和促进因素。 在该项目结束时，MCWB 将准备好在 AL 居民的务实试验中进行评估 痴呆症和为他们提供护理的工作人员。

项目成果

Mouth Care in Assisted Living: Potential Areas for Improvement.

辅助生活中的口腔护理：改进的潜在领域。

• DOI: 10.1016/j.jamda.2020.11.038
• 发表时间: 2021-06
• 期刊: Journal of the American Medical Directors Association
• 影响因子: 7.6
• 作者: Kistler CE;Scott J;Ward K;Zeigler R;Sullivan L;Tomlinson SE;Wretman CJ;Zimmerman S
• 通讯作者: Zimmerman S

Family perceptions of mouth care for assisted living residents with dementia: Implications for care.

• DOI: 10.1016/j.gerinurse.2021.05.002
• 发表时间: 2021-07
• 期刊: GERIATRIC NURSING
• 影响因子: 2.7
• 作者: Lowman, Sarah G.;Zimmerman, Sheryl;Ward, Kimberly;Weintraub, Jane A.
• 通讯作者: Weintraub, Jane A.