Adapting an Evidence-Based Program that Improves Oral Hygiene and Health for Assisted Living Residents with Dementia

采用循证计划，改善患有痴呆症的辅助生活居民的口腔卫生和健康

• 批准号: 9974464
• 负责人: Sheryl Zimmerman
• 金额: $ 51.63万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974464
• 关键词: Activities of Daily Living; Address; Administrator; Aspiration Pneumonia; Assisted Living Facilities; Attitude; Bacteria; Behavior; Behavioral; Caregiver support; Caregivers; Caring; Characteristics; Cluster randomized trial; Communities; Country; Dementia; Dementia caregivers; Dental Hygiene; Dental Hygienists; Dental Research; Dentistry; Dentures; Discipline of Nursing; Effectiveness; Evaluation; Evidence based program; Family; Health; Healthcare; Healthcare Activity; Home Nursing Care; Hospitalization; Hour; Impaired cognition; Incidence; Individual; Inhalation; Internet; Intervention; Interview; Lead; Learning; Manuals; Mediator of activation protein; Methods; Modeling; Modification; North Carolina; Nursing Homes; Oral cavity; Oral health; Outcome; Persons; Pneumonia; Provider; Public Health; Quality of life; Randomized; Research; Risk; Sampling; Science; Self Care; Self Efficacy; Structure; Time; Tongue; Tooth structure; Toothbrushing; Training; Training Support; United States Dept. of Health and Human Services; United States National Institutes of Health; Video Recording; base; behavior change; care providers; cohort; community living; dementia care; efficacy research; efficacy testing; experience; frontier; improved; nursing standards; physical conditioning; pragmatic trial; programs; psychosocial; residential care facility; social

Project Summary/Abstract It could be said that many dementia care and caregiver support interventions are too limited, focusing solely on psychosocial and behavioral issues. These issues are important, but so too is the physical health of people with dementia -- especially because they are living longer and require even more support with health care and activities of daily living. Just imagine the benefit of a physical health care intervention provided daily. Case in point: tooth brushing, flossing, and gum and denture care. Many people with dementia resist mouth care – almost 90% in nursing homes, in fact. As a result, only 16% have their teeth brushed regularly, putting them at risk for aspiration pneumonia when they inhale bacteria from their teeth, tongue, and gums. In 2013, the research team submitting this proposal developed one of the two existing dementia-focused mouth care programs for nursing homes -- Mouth Care Without a Battle (MCWB) -- which already has become a standard of nursing home care. MCWB changes caregivers' attitudes and behavior, improves oral health, and in a cluster randomized trial, MCWB provided by nursing assistants reduced pneumonia incidence by 32 percent. The next frontier is to extend MCWB to assisted living (AL), the primary long-term residential care provider for persons with dementia. There are 30,200 AL communities across the country. As many as 90% of the 835,200 AL residents have cognitive impairment, and 42% have moderate or severe dementia (and on average, five untreated oral health conditions/person), meaning MCWB has the potential to improve the health and quality of life of more than 350,000 AL residents with dementia annually. There is a unique and timely opportunity to transform MCWB for AL, given the North Carolina Department of Health and Human Services (DHHS) Special Care Dentistry Program's partnership in this effort. This nested cohort cluster randomized trial will apply the NIH Stage Model and principles of the Science of Behavior Change to lay the groundwork for a pragmatic trial and real-world implementation of MCWB for AL residents with dementia and their caregivers. The aims are to refine MCWB for AL, and examine research efficacy (working with a research dental hygienist) and real-world efficacy (working with community public health dental hygienists) to train personal care aides in 48 AL communities across North Carolina to provide mouth care; the project will include 720 residents with dementia, 348 AL staff, and 24 dental hygienists. Evaluation will address (1) the reach of the intervention; (2) effects on mediators/targets of change at the organizational and individual level; (3) outcomes (oral hygiene, pneumonia, hospitalizations); (4) associations between change at the organizational and individual level and outcomes, and also associations with characteristics of the AL community and staff; and (5) attitudes, barriers, and facilitators. By the conclusion of this project, MCWB will be ready for evaluation in a pragmatic trial of AL residents with dementia and the staff who provide their care.

项目摘要/摘要 可以说，许多痴呆症护理和护理人员的支持干预措施过于限制，仅关注 社会心理和行为问题。这些问题很重要，但是人们的身体健康也很重要 患有痴呆症 - 尤其是因为他们的寿命更长，需要更多的支持，以提供医疗保健和 日常生活的活动。试想一下每天提供的物理医疗干预的好处。 例如：刷牙，牙线，口香糖和牙齿护理。许多患有痴呆症的人 护理 - 实际上，近90％的护士房屋。结果，只有16％的牙齿定期刷牙，放置 当他们从牙齿，舌头和牙龈中吸入细菌时，他们有肺炎的危险。 2013年， 提交该建议的研究团队开发了两个现有的以痴呆症为中心的口腔护理之一 护士房屋的计划 - 没有战斗的口腔护理（MCWB） - 已经成为标准 护士家庭护理。 MCWB改变了看护人的参加和行为，改善了口腔健康，并且 簇随机试验，由护士助理提供的MCWB将肺炎事件降低了32％。 下一个边界是将MCWB扩展到辅助生活（AL），这是主要的长期居民护理提供者 患有痴呆症的人。全国有30,200个社区。多达835,200的90％ AL居民的认知障碍，42％的居民患有中度或严重的痴呆症（平均而言，五个 未经治疗的口腔健康状况/人），这意味着MCWB有可能提高健康和质量 每年有350,000多名AL居民的寿命。有一个独特而及时的机会 鉴于北卡罗来纳州卫生与公共服务部（DHHS）特殊 护理牙科计划在这项工作中的合作伙伴关系。 这个嵌套的队列群集随机试验将应用NIH阶段模型和科学原理 行为改变为务实的审判和MCWB实施现实世界实施的基础 患有痴呆症及其护理人员的居民。目的是完善MCWB，并检查研究 效率（与研究牙科卫生员一起工作）和现实世界的效率（与社区公众合作 卫生牙科卫生员）培训北卡罗来纳州48个AL社区的个人护理助手 嘴巴护理；该项目将包括720名患有痴呆症的居民，348名AL员工和24名牙科卫生员。 评估将解决（1）干预措施； （2）对调解人/变革目标的影响 组织和个人层面； （3）结果（口腔卫生，肺炎，住院）； （4）协会 在组织和个人层面的变化以及成果之间，以及与 AL社区和员工的特征； （5）与会者，障碍和促进者。 通过该项目的结论，MCWB将在AL居民的务实审判中进行评估 痴呆症和提供护理的工作人员。