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: 8081634
• 负责人: RITA A JABLONSKI
• 金额: $ 36.27万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8081634
• 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; 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. PUBLIC HEALTH RELEVANCE: Nursing home residents with dementia may react with fear during mouth care, making it difficult for caregivers to brush teeth or remove dentures. Without daily mouth care, the mouth becomes diseased and places the elder at risk for other illnesses such as pneumonia. This study will examine if a method for providing mouth care in a non-threatening way improves the oral health of nursing home residents with dementia.

描述（由申请人提供）：患有痴呆症的疗养院（NH）居民通常依赖他人进行口腔护理，但在接受援助时会出现护理抵抗行为（CRB）。这些长者的口腔健康因缺乏日常口腔卫生而恶化，容易引致肺炎、高血糖、心脏病及脑血管意外等有害的全身问题。本研究的目的是确定是否可以减少CRBs，并改善口腔健康，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。当面临威胁时，所有生物体都会做出“逃跑-战斗”反应。这些反应既有自主性的（例如心率加快、出汗），也有行为性的（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，痴呆症患者的威胁感增强。16这些人可能将口腔护理解释为威胁他人的威胁行为。这项名为“使用威胁减少管理口腔卫生”（MOUTh）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，这些技术可以减少威胁感知，从而预防或降低CRB。该研究的主要具体目的是：1）评估MOUTh干预对减少痴呆症患者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，口腔清洁度，唾液以及嘴唇和口腔粘膜的完整性-验证MOUTh干预的总体疗效; 3）计算MOUTh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名患有痴呆症的老年人在个体水平上随机分配到实验组，该实验组将接受干预，或控制组，该控制组将接受研究团队成员的标准口腔护理，这些研究团队成员接受提供口腔护理的适当方法的培训，但没有抵抗识别或预防/调解的培训。将在7天观察期和21天干预期内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评估干预措施减少痴呆患者CRB的疗效，并使用口腔健康结果评估干预措施的总体疗效。将使用基于活动的成本计算方法来确定MOUTh干预措施的成本。在这项研究结束时，研究小组预计有一个行之有效的干预措施，防止和减少口腔护理的背景下CRB。长期目标包括测试干预措施对痴呆症患者全身性疾病的影响;检查这种干预措施对其他日常生活活动的可转移性;向卫生部工作人员传播减少威胁的干预措施，这可能会从根本上改变向痴呆症患者提供护理的方式。 公共卫生相关性：患有痴呆症的养老院居民在口腔护理过程中可能会产生恐惧反应，使护理人员难以刷牙或取出假牙。如果没有日常的口腔护理，口腔就会生病，并使老年人面临患肺炎等其他疾病的风险。本研究将探讨一种以非威胁性方式提供口腔护理的方法是否能改善老年痴呆症疗养院居民的口腔健康。