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

描述（由申请人提供）：养老院（NH）的痴呆症患者通常依赖他人进行口腔护理，但在接受帮助时会出现护理抵抗行为（CRB）。由于缺乏日常的口腔卫生，这些老年人的口腔健康状况恶化，使他们容易出现有害的全身问题，如肺炎、高血糖、心脏病和脑血管意外。本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来减少crb，并改善口腔健康。当面临威胁时，所有生物都会做出“逃跑-战斗”的反应。这些反应既有自主反应（如心率加快、出汗），也有行为反应（如走开、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，痴呆症患者具有更高的威胁感知这些人可能会把口腔护理理解为威胁他人的威胁行为。这项干预措施被称为“通过减少威胁（口腔）来管理口腔卫生”，它将最佳口腔保健实践与一系列行为技术结合起来，减少威胁感知，从而预防或减少CRB的恶化。本研究的主要具体目的是：1)评估MOUTh干预对降低痴呆患者crb的疗效；2)使用护士敏感的口腔健康结果（牙龈肿胀和出血、口腔清洁、唾液、嘴唇和口腔粘膜的完整性）验证口腔干预的总体效果；3)计算MOUTh干预的成本。采用随机重复测量设计，来自5个不同NHs的80名老年痴呆症患者将在个人水平上随机分为实验组，实验组将接受干预，对照组将接受研究团队成员的标准口腔护理，研究团队成员接受适当的口腔护理方法培训，但没有接受抵抗识别或预防/调解方面的培训。在7天的观察期和21天的干预期进行口腔健康评估和CRB测量。使用多水平分析的个体生长模型将用于估计减少痴呆患者crb的干预效果，并使用口腔健康结果估计干预的总体效果。作业成本法将用于确定口腔干预的成本。在本研究结束时，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患者全身性疾病的影响；检查这种干预对其他日常生活活动的可转移性；向国家卫生机构工作人员传播减少威胁干预措施，这可能从根本上改变向痴呆症患者提供护理的方式。

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.