Care-Partner Assisted Intervention To Improve Oral Health for Individuals with Mild Dementia

护理伙伴协助干预以改善轻度痴呆症患者的口腔健康

• 批准号: 10544210
• 负责人: RUTH A ANDERSON
• 金额: $ 19.86万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-21 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10544210
• 关键词: Address; Adult; Affect; Alzheimer' s Disease; Behavior; Behavior Therapy; Behavioral; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Cognition; Cognitive; Communication; Communities; Control Groups; Deglutition; Dementia; Dental Hygiene; Dental Hygienists; Dental caries; Deterioration; Diabetes Mellitus; Disease; Elderly; Evaluation; Family Caregiver; Family member; Frequencies; Gingival Indexes; Health; Health Benefit; Home; Home Health Aides; Impairment; Individual; Interdisciplinary Study; Intervention; Knowledge; Leadership; Learning; Length; Maintenance; Mastication; Measures; Mediating; Mediator of activation protein; Methods; National Institute of Dental and Craniofacial Research; New York City; North Carolina; Nurses; Nursing Homes; Oral; Oral health; Outcome; Pain; Participant; Periodontitis; Persons; Phase; Pilot Projects; Play; Process; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Role; Self Care; Self Efficacy; Supervision; Systemic disease; Target Populations; Time; Tooth structure; Toothbrushing; Visit; Work; active method; associated symptom; cognitive ability; dementia care; design; effectiveness evaluation; experience; follow-up; group intervention; health knowledge; high risk; human old age (65+); improved; indexing; innovation; mortality; neglect; novel; oral care; oral plaque; prevent; public health relevance; symptom management; treatment group

Persons with Alzheimer’s disease and related disorders (ADRD) have significantly poorer oral health (e.g., more oral plaque, more severe periodontitis, more caries, and fewer teeth) than cognitively intact older adults. Even individuals with mild dementia (IMD) 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 and general overall health for persons with ADRD. A few studies conducted in nursing homes have shown that with routine oral hygiene care, the oral health of persons with ADRD improves notably in a short period of time. However, family members who provide care (i.e. care partners) to individuals living at home with mild dementia, provide supervision or assistance with other daily activities, but often neglect oral hygiene. Because care partners play an essential role in supervising and caring for IMD at home, an intervention with both IMD and their care partners to improve oral self-care may have long term oral health benefits for the IMD. Yet, few interventions have addressed oral health problems among older adults in general and among IMD in particular, and to our knowledge, no oral health interventions have been conducted among community-dwelling IMD. To address this gap in knowledge, we propose a novel intervention to help care partners learn how to adapt methods for guiding the IMD in carrying out oral hygiene. Mild dementia is an ideal time to intervene because IMD 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 and finalized 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 participants 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 of those with ADRD to maintain independence in completing daily activities and quality of life for an extended period of time.

与认知完整的老年人相比，患有阿尔茨海默氏病和相关疾病的人（ADRD）的口腔健康状况明显较差（例如，更多的口腔斑块，更严重的牙周炎，更多的龋齿和更少的牙齿）。即使患有轻度痴呆症（IMD）的人也面临口腔健康不良的风险更高，并且有证据表明，口腔卫生实践不足是主要因素的主要因素。保持良好的口腔卫生是防止ADRD患者的口腔健康和总体健康的定义的关键步骤。在护士家庭中进行的一些研究表明，通过常规的口腔卫生护理，ADRD患者的口腔健康在短时间内显着改善。但是，为患有轻度痴呆症的人提供护理（即护理伙伴）的家庭成员（即护理伙伴），在其他日常活动中提供监督或帮助，但经常忽略口腔卫生。由于护理合作伙伴在监督和照顾国内的IMD中发挥了重要作用，因此与IMD及其护理伙伴改善口头自我保健的干预可能会对IMD带来长期的口服健康益处。然而，很少有干预措施解决一般的老年人，尤其是IMD中的口腔健康问题，据我们所知，在社区住宅IMD中没有采取口腔健康干预措施。为了解决知识的这一差距，我们提出了一种新颖的干预措施，以帮助护理伙伴学习如何适应指导IMD进行口腔卫生的方法。轻度痴呆是干预的理想时机，因为IMD仍然保留足够的认知能力，可以通过最少的援助成功地执行口腔卫生任务。利用我们进行的试点研究的结果，我们开发了干预方案并确定了我们的多学科研究团队（NIDCR 1R34DE023881）。我们的试点研究的结果有很大的迹象表明，我们的护理伙伴辅助干预将产生积极的口服健康结果。我们的团队准备在纽约市和北卡罗来纳州实施U01随机控制试验（RCT）。该干预措施既包括量身定制的口腔护理计划，也包括使用适用于慢性疾病的自适应领导力框架来管理与慢性病有关的症状，例如痴呆症（例如痴呆症）。具体目的是：目标1：评估护理伙伴辅助干预措施的有效性，以改善轻度痴呆症患者的口腔卫生和口腔卫生行为。 AIM 2：评估中介因素/过程结果的变化，包括二元组之间的交流，口腔健康知识之间的交流以及参与者和护理伙伴都了解干预机制的自我有效。这种创新的护理伴侣辅助口腔护理行为干预将有助于IMD和护理伙伴实施合作的口腔卫生护理计划，以防止口腔健康定义，这反过来将有助于我们有针对性的ADRD的目标人群，以保持独立性在长时间内完成日常活动和生活质量。