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

基本信息

批准号：
9789809
负责人：
Sheryl Zimmerman
金额：
$ 52.74万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
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/9789809
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

项目摘要

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.

项目概要/摘要可以说，许多痴呆症护理和护理人员支持干预措施过于有限，仅关注这些问题很重要，但人们的身体健康也很重要。患有痴呆症的人——尤其是因为他们的寿命更长，需要更多的医疗保健支持和想象一下每天提供的身体保健干预措施的好处。例证：刷牙、使用牙线、牙龈和假牙护理许多痴呆症患者抵制口腔。事实上，几乎 90% 的人住在疗养院，因此只有 16% 的人定期刷牙。 2013年，当他们从牙齿、舌头和牙龈中吸入细菌时，他们就有患吸入性肺炎的风险。提交该提案的研究团队开发了现有的两种针对痴呆症的口腔护理产品之一疗养院计划——无需战斗的口腔护理（MCWB）——已经成为标准 MCWB 改变了护理人员的态度和行为，改善了口腔健康，并整群随机试验显示，护理助理提供的 MCWB 使肺炎发病率降低了 32%。下一个前沿领域是将 MCWB 扩展到辅助生活 (AL)，这是主要的长期住宿护理提供者全国 835,200 个社区中有 30,200 个患有痴呆症的人。 AL 居民患有认知障碍，42% 的人患有中度或重度痴呆（平均有 5 名居民患有中度或重度痴呆）未经治疗的口腔健康状况/人），这意味着 MCWB 有潜力改善口腔健康和质量每年有一个独特而及时的机会来帮助超过 350,000 名患有痴呆症的 AL 居民。鉴于北卡罗来纳州卫生与公众服务部 (DHHS) 的特殊要求，将 MCWB 改造为 AL 护理牙科计划在这项工作中的合作伙伴。这项嵌套队列集群随机试验将应用 NIH 阶段模型和科学原理行为改变为 AL 的 MCWB 的务实试验和实际实施奠定基础患有痴呆症的居民及其护理人员的目的是改进 AL 的 MCWB，并检查研究。功效（与研究牙科保健员合作）和现实世界功效（与社区公众合作）健康牙科保健员）将在北卡罗来纳州 48 个 AL 社区培训个人护理助手，以提供口腔护理；该项目将包括 720 名患有痴呆症的居民、348 名 AL 工作人员和 24 名牙科保健员。评估将涉及 (1) 干预的范围；(2) 对变革的调解者/目标的影响。组织和个人层面；(3) 结果（口腔卫生、肺炎、住院）；组织和个人层面的变革和结果之间的关系，以及与 AL 社区和员工的特征；(5) 态度、障碍和促进者。在该项目结束时，MCWB 将准备好在 AL 居民的务实试验中进行评估痴呆症和为他们提供护理的工作人员。