Reducing Care-Resistant Behaviors During Oral Hygiene in Persons with Dementia

减少痴呆症患者口腔卫生期间的抗护理行为

• 批准号: 8577243
• 负责人: RITA A JABLONSKI
• 金额: $ 34.32万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-11-03 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8577243
• 关键词: Activities of Daily Living; Admission activity; Affect; Behavior; Behavioral; Caregiver Burden; Caregivers; Caring; Cerebral cortex; Clinical; Clinical Research; Communities; Control Groups; Data; Dementia; Dental Hygiene; Dentures; Educational process of instructing; Elderly; Exhibits; Fright; Future; Gingivitis; Growth; Health; Health Care Costs; Heart Diseases; Heart Rate; Hemorrhage; Hippocampus (Brain); Hospitals; Hyperglycemia; Incidence; Individual; Intervention; Lip structure; Measures; Mediation; Methods; Modeling; Mucous Membrane; Neurobiology; Nurses; Nursing Homes; Oral; Oral cavity; Oral health; Oral mucous membrane structure; Organism; Outcome; Perception; Persons; Pneumonia; Prevention; Procedures; Qualifying; Randomized; Research; Research Personnel; Resistance; Resolution; Risk; Saliva; Salivary; Severities; Stroke; Sweat; Sweating; Swelling; Systemic disease; Techniques; Testing; Time; Tooth structure; Toothbrushing; Training; Treatment Efficacy; base; behavior measurement; clinical care; cost; design; experience; fighting; improved; innovation; intervention effect; member; multilevel analysis; novel; prevent; public health relevance; research study; response; toothbrush; treatment as usual; trend

DESCRIPTION (provided by applicant): Nursing home (NH) residents with dementia are often dependent on others for mouth care, yet will react with care-resistant behavior (CRB) when receiving assistance. The oral health of these elders deteriorates in the absence of daily oral hygiene, predisposing them to harmful systemic problems such as pneumonia, hyperglycemia, cardiac disease, and cerebral vascular accidents. The purpose of this study is to determine whether CRBs can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response. When faced with a threat, all organisms react with "flight-fight" responses. These responses are both autonomic (e.g. elevated heart rate, sweating) and behavioral (e.g. moving away, attacking). Persons with dementia have heightened threat perception as a result of neurobiological changes that affect the cerebral cortex, hippocampus, and amygdale.16 These individuals may interpret mouth care as a threatening action by threatening people. The intervention, called Managing Oral Hygiene Using Threat Reduction (MOUTh), combines best mouth care practices with a constellation of behavioral techniques that reduce threat perception and thereby prevent or de-escalate CRB. The primary specific aims of the study are to: 1)Evaluate the efficacy of the MOUTh intervention for reducing CRBs in persons with dementia; 2)Validate the overall efficacy of the MOUTh intervention using nurse-sensitive oral health outcomes--swollen and bleeding gums, cleanliness of the oral cavity, saliva, and integrity of the lips and oral mucosa; and 3)Calculate the cost of the MOUTh intervention. Using a randomized repeated measures design, 80 elders with dementia from 5 different NHs will be randomized at the individual level to the experimental group, which will receive the intervention, or to the control group, which will receive standard mouth care from research team members who receive training in the proper methods for providing mouth care but no training in resistance recognition or prevention/mediation. Oral health assessments and CRB measurements will be obtained during a 7-day observation period and a 21-day intervention period. Individual growth models using multilevel analysis will be used to estimate the efficacy of the intervention for reducing CRBs in persons with dementia, and to estimate the overall efficacy of the intervention using oral health outcomes. Activity-based costing methods will be used to determine the cost of the MOUTh intervention. At the end of this study, the research team anticipates having a proven intervention that prevents and reduces CRB within the context of mouth care. Long-term objectives include testing the effect of the intervention on systemic illnesses among persons with dementia; examining the transferability of this intervention to other activities of daily living; and disseminating threat reduction interventions to NH staff, which may radically change the way care is provided to persons with dementia.

描述(申请人提供)：养老院(NH)患有痴呆症的居民经常依赖他人进行口腔护理，但在接受帮助时会出现抵抗行为(CRB)。在缺乏日常口腔卫生的情况下，这些老年人的口腔健康会恶化，使他们容易患上肺炎、高血糖、心脏病和脑血管意外等有害的系统性问题。这项研究的目的是确定是否可以通过应用基于威胁感知和恐惧反应的神经生物学原理的干预措施来减少CRB，并改善口腔健康。当面临威胁时，所有的生物都会做出“逃跑-战斗”的反应。这些反应既是自主的(例如心率加快、出汗)，也是行为的(例如离开、攻击)。由于影响大脑皮层、海马体和杏仁核的神经生物学变化，痴呆症患者的威胁知觉增强。16这些人可能会将口腔护理解读为威胁他人的威胁行为。这项名为使用威胁减少(MILE)管理口腔卫生的干预措施将最佳口腔护理实践与一系列行为技术相结合，这些技术可以降低威胁感知，从而防止或降低CRB的升级。这项研究的主要具体目标是：1)评估口腔干预对减少痴呆症患者CRB的有效性；2)使用护士敏感的口腔健康结果--牙床肿胀和出血、口腔清洁程度、唾液以及嘴唇和口腔粘膜的完整性--来验证口腔干预的整体效果；以及3)计算口腔干预的成本。采用随机重复测量设计，将来自5个不同NHS的80名痴呆症老年人在个体水平上随机分配到接受干预的试验组，或接受研究团队成员标准口腔护理的对照组，研究团队成员接受提供口腔护理的适当方法的培训，但没有接受耐药性识别或预防/调解方面的培训。口腔健康评估和CRB测量将在7天的观察期和21天的干预期内获得。使用多水平分析的个体生长模型将用于评估减少痴呆症患者CRB的干预效果，并使用口腔健康结果评估干预的总体效果。将使用基于活动的成本计算方法来确定口腔干预的成本。在这项研究结束时，研究小组期望在口腔护理的背景下有一个有效的干预措施来预防和减少CRB。长期目标包括测试干预措施对痴呆症患者的系统性疾病的效果；研究这种干预措施是否可以转移到其他日常生活活动中；以及向保健中心工作人员传播减少威胁的干预措施，这可能从根本上改变向痴呆症患者提供护理的方式。