Functionally-tailored Oral Care Intervention for Community-dwelling Older Adults with Dementia and Their Caregivers

7.项目总结 痴呆症患者(PWD)逐渐失去进行口腔自我护理的能力，导致口腔卫生不良。口齿不好 卫生增加了龋齿、牙周病和其他口腔疾病的风险，并引发了一连串的口腔疾病。 PWD的健康下降，这反过来可能会加速认知下降。重要的是，这些变化通常开始于 在安置养老院(NH)之前。除了疼痛和不适外，口腔健康状况不佳还会导致躁动和精神错乱 增加照顾者(CG)的压力。它还会影响生活质量，导致营养不良，增加胰岛素抵抗，并导致 吸入性肺炎、心血管并发症和其他危及生命的疾病。 早期干预是阻止/减缓PWD患者口腔健康下降及其认知/系统影响的关键。 现有的口腔卫生干预措施在改善口腔健康、减少吸入性肺炎方面证明是有效的。 甚至延缓认知能力的下降。然而，这些计划是为NH居民设计的，并不是量身定做的 对于居住在社区中的绝大多数残疾人士来说。因此，他们没有考虑到身体上的相互作用和 残障人士与家庭照顾者的情绪关系及其对口腔护理的影响。此外，尽管 口腔卫生教育是痴呆症牙齿护理的标准组成部分，通常不是针对每个患者的水平量身定做的 口腔自理功能。为了应对这些差距，我们提出了一项研究，以开发和评估功能定制的口语 卫生干预，以改善社区居住的残障人士的口腔健康，同时减轻照顾者负担和 改善护理伙伴关系。本研究分为两个阶段，分别对应于两个目标。对于目标1，我们将 基于文献回顾和CG访谈输入，开发模块化的、功能可定制的口腔护理干预措施。 我们预计将有八个培训模块，可以单独使用或以不同的组合使用，以提供功能- 为残疾患者提供适当的口腔护理康复，并根据需要对其家庭CGs进行技能培训。这些将改编自 没有战斗的口腔护理，一种为NH痴呆症患者开发的有效的口腔卫生干预措施。目标2将 采用随机对照设计，在40名受试者中检验拟议干预措施的有效性和可行性 PWD/CG对。在基线评估后，将进行为期4周的二元、动手、功能定制的口腔护理干预 交付给20个PWD/CG二联体。对照组(n=20)接受标准口腔卫生教育 目前在牙科护理期间提供给残障人士。数据收集将在基线、4周和3个月进行。差异 对照组和干预组之间关于PWD结果的差异(例如，口腔卫生和行为症状 在口腔护理期间)，照顾者的结果(例如，负担，自我效能)和护理伙伴的关系将被探讨。 这项拟议的研究预计将有助于解决社区居民关键但被忽视的口腔卫生需求 同时减轻CG负担和改善护理伙伴关系。它还将为以下项目提供初步数据 设计一项全面的R01/U01研究，以更正式地检查拟议的干预措施对口腔和 残障人士及其家庭照顾者的全身健康和心理社会健康状况。

7. PROJECT SUMMARY Persons with dementia (PWD) gradually lose their ability to perform oral self-care, leading to poor oral hygiene. Poor oral hygiene increases the risks of dental caries, periodontal disease and other oral pathologies, and initiates a cascade of oral health decline among PWD, which in turn may accelerate cognitive decline. Importantly, these changes often begin before nursing home (NH) placement. Besides pain and discomfort, poor oral health can lead to agitation and delirium and increase caregiver (CG) stress. It can also affect quality of life, cause malnutrition, increase insulin resistance, and lead to aspiration pneumonia, cardiovascular complications, and other life-threatening conditions in these vulnerable individuals. Early intervention is essential to stop/slow down the oral health decline and its cognitive/systemic impacts in PWD. Existing oral hygiene interventions have demonstrated efficacy in improving oral health, reducing aspiration pneumonia and even slowing down cognitive decline. However, these programs were designed for NH residents and are not tailored for the great majority of PWD, who reside in the community. As such, they fail to account for the reciprocal physical and emotional relationship between the PWD and their family caregivers and its influence on oral care. Furthermore, although oral hygiene education is a standard component of dementia dental care, it is usually not tailored to each patient's level of oral self-care function. In response to these gaps, we propose a study to develop and evaluate a functionally-tailored oral hygiene intervention to improve oral health for community-dwelling PWD while reducing caregiver burdens and improving care partner relationships. The study consists of two phases corresponding to two aims. For Aim 1 we will develop a modularized, functionally-tailorable oral care intervention based on literature review and CG interview input. We anticipate eight training modules that can be used alone or in varying combinations to provide functionally- appropriate oral care rehabilitation for PWD and need-based skills training their family CGs. These will be adapted from Mouth Care Without a Battle, a validated oral hygiene intervention developed for NH residents with dementia. Aim 2 will examine the efficacy and feasibility of the proposed intervention using a randomized controlled design among 40 PWD/CG pairs. After baseline assessment, a 4-week, dyadic, hand-on, functionally-tailored oral care intervention will be delivered to 20 PWD/CG dyads. Control group participants (n=20) will receive the standard oral hygiene education currently provided to PWD during dental care. Data collection will occur at baseline, 4-weeks and 3 months. Differences between the control and intervention groups with regard to PWD outcomes (e.g., oral hygiene and behavior symptoms during oral care), caregiver outcomes (e.g., burden, self-efficacy) and the care partner relationship will be explored. The proposed study is expected to help addressing the critical but neglected oral hygiene needs of community-dwelling PWD while reducing CG burden and improving care partner relationships. It will also provide preliminary data for designing a full scale R01/U01 study to more formally examine the effects of the proposed intervention on oral and systemic health and psychosocial well-being in PWD and their family caregivers.