Care-Partner Assisted Intervention To Improve Oral Health for Individuals with Mild Dementia

患有阿尔茨海默病和相关疾病（ADRD）的人的口腔健康明显较差（例如，更多的口腔菌斑，更严重的牙周炎，更多的龋齿，更少的牙齿）比认知完整的老年人。即使患有轻度痴呆症（IMD）的人也有更高的口腔健康风险，有证据表明口腔卫生习惯不足是一个主要因素。保持良好的口腔卫生是预防ADRD患者口腔健康和一般整体健康恶化的关键步骤。 在疗养院进行的一些研究表明，通过常规的口腔卫生护理，ADRD患者的口腔健康在短时间内得到显著改善。然而，为轻度痴呆症患者提供护理的家庭成员（即护理伙伴），在其他日常活动方面提供监督或帮助，但往往忽视口腔卫生。由于护理伙伴在家中监督和护理IMD方面发挥着至关重要的作用，因此IMD及其护理伙伴改善口腔自我护理的干预措施可能对IMD的口腔健康有长期益处。 然而，很少有干预措施解决口腔健康问题的老年人一般，特别是在IMD，据我们所知，没有口腔健康干预已进行社区居住IMD。 为了解决这一知识差距，我们提出了一种新的干预措施，以帮助护理合作伙伴学习如何适应指导IMD进行口腔卫生的方法。轻度痴呆是进行干预的理想时机，因为IMD仍然保持足够的认知能力，可以在最小的帮助下成功完成口腔卫生任务。利用我们进行的试点研究的结果，我们制定并最终确定了干预方案，并建立了我们的多学科研究团队（NIDCR 1 R34 DE 023881）。我们的试点研究结果有力地表明，我们的护理伙伴辅助干预将产生积极的口腔健康结果。我们的团队准备在纽约市和北卡罗来纳州实施U 01随机对照试验（RCT）。 该干预措施包括量身定制的口腔护理计划和使用慢性病适应性领导框架的行为组成部分，我们的团队引入该框架来管理与慢性病相关的症状，如痴呆症。 具体目标是：目标1：评估护理伙伴辅助干预对改善轻度痴呆患者口腔卫生和口腔卫生行为的有效性。目标二：评估中介因素/过程结果的变化，包括参与者和护理伙伴之间的沟通，口腔健康知识和自我效能，以了解干预机制。这种创新的护理伙伴辅助口腔护理行为干预将帮助IMD和护理伙伴实施合作口腔卫生护理计划，以防止口腔健康恶化，这反过来又将帮助我们的目标人群ADRD患者在较长时间内保持独立完成日常活动和生活质量。

Persons with Alzheimer’s disease and related disorders (ADRD) have significantly poorer oral health (e.g., more oral plaque, more severe periodontitis, more caries, and fewer teeth) than cognitively intact older adults. Even individuals with mild dementia (IMD) are at higher risk of poor oral health and evidence is strong to suggest that inadequate oral hygiene practices are a major contributing factor. Maintaining good oral hygiene is a critical step in preventing deterioration of oral health and general overall health for persons with ADRD. A few studies conducted in nursing homes have shown that with routine oral hygiene care, the oral health of persons with ADRD improves notably in a short period of time. However, family members who provide care (i.e. care partners) to individuals living at home with mild dementia, provide supervision or assistance with other daily activities, but often neglect oral hygiene. Because care partners play an essential role in supervising and caring for IMD at home, an intervention with both IMD and their care partners to improve oral self-care may have long term oral health benefits for the IMD. Yet, few interventions have addressed oral health problems among older adults in general and among IMD in particular, and to our knowledge, no oral health interventions have been conducted among community-dwelling IMD. To address this gap in knowledge, we propose a novel intervention to help care partners learn how to adapt methods for guiding the IMD in carrying out oral hygiene. Mild dementia is an ideal time to intervene because IMD still retain sufficient cognitive ability to perform oral hygiene tasks successfully with minimal assistance. Using the results from a pilot study we conducted, we developed and finalized the intervention protocol and established our multidisciplinary research team (NIDCR 1R34DE023881). The results from our pilot study provide strong indication that our care partner-assisted intervention will generate positive oral health outcomes. Our team is ready to implement a U01 randomized control trial (RCT) in New York City and North Carolina. The intervention includes both a tailored oral care plan and a behavioral component using the Adaptive Leadership Framework for Chronic Disease that our team introduced to manage symptoms associated with chronic conditions, such as dementia. The specific aims are to: Aim 1: Evaluate the effectiveness of a care partner-assisted intervention to improve oral hygiene and oral hygiene behaviors in individuals with mild dementia. Aim 2: Assess changes in mediating factors/process outcomes, including communication between the dyads, oral health knowledge, and self-efficacy for both participants and care partners to understand mechanisms of the intervention. This innovative care partner-assisted oral care behavior intervention will assist IMD and care partners in implementing a cooperative oral hygiene care plan to prevent deterioration of oral health, which in turn, will help our targeted population of those with ADRD to maintain independence in completing daily activities and quality of life for an extended period of time.