Diversity supplement to the U01 project-Care partner assisted intervention to improve oral health for person with mild dementia

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Summary (Abstract) of Parent Grant (1U01DE027512-01) : Close to 9% of adults age 65 and older in the U.S. have dementia and individuals with dementia have significantly poorer oral health than cognitively intact older adults. Even individuals with mild dementia 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. A few studies conducted in nursing homes have shown that with routine oral hygiene care, the oral health of persons with dementia improves notably in a short period of time. Most individuals with mild dementia live at home where family members (i.e. care partners) provide supervision or assistance with daily activities, but often neglect oral hygiene. Because care partners play an essential role in supervising and caring for individuals with mild dementia at home, an intervention with both individuals with mild dementia and their care partners to improve oral self-care may have long term oral health benefits for the individuals with mild dementia. Yet, few interventions have addressed oral health problems among older adults in general and among individuals with mild dementia in particular, and to our knowledge, no oral health interventions have been conducted among community dwelling individuals with mild dementia. To address this gap in knowledge, we propose a novel intervention to help care partners learn how to adapt methods for guiding the individuals with mild dementia in carrying out oral hygiene. Mild dementia is an ideal time to intervene because individuals with mild dementia 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 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 individuals with mild dementia 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 to maintain independence in completing daily activities and quality of life for an extended period of time.