Persons with dementia (PWD) gradually lose their ability to perform oral self-care, leading to poor oral hygiene. Poor oral hygiene increases the risks of dental caries, periodontal disease and other oral pathologies, and initiates a cascade of oral health decline among PWD, which in turn may accelerate cognitive decline. Importantly, these changes often begin before nursing home (NH) placement. Besides pain and discomfort, poor oral health can lead to agitation and delirium and increase caregiver (CG) stress. It can also affect quality of life, cause malnutrition, increase insulin resistance, and lead to aspiration pneumonia, cardiovascular complications, and other life-threatening conditions in these vulnerable individuals. Early intervention is essential to stop/slow down the oral health decline and its cognitive/systemic impacts in PWD. Existing oral hygiene interventions have demonstrated efficacy in improving oral health, reducing aspiration pneumonia and even slowing down cognitive decline. However, these programs were designed for NH residents and are not tailored for the great majority of PWD, who reside in the community. As such, they fail to account for the reciprocal physical and emotional relationship between the PWD and their family caregivers and its influence on oral care. Furthermore, although oral hygiene education is a standard component of dementia dental care, it is usually not tailored to each patient's level of oral self-care function. In response to these gaps, we propose a study to develop and evaluate a functionally-tailored oral hygiene intervention to improve oral health for community-dwelling PWD while reducing caregiver burdens and improving care partner relationships. The study consists of two phases corresponding to two aims.
For Aim 1 we will develop a modularized, functionally-tailorable oral care intervention based on literature review and CG interview input. We anticipate eight training modules that can be used alone or in varying combinations to provide functionally- appropriate oral care rehabilitation for PWD and need-based skills training their family CGs. These will be adapted from Mouth Care Without a Battle, a validated oral hygiene intervention developed for NH residents with dementia.
Aim 2 will examine the efficacy and feasibility of the proposed intervention using a randomized controlled design among 40 PWD/CG pairs. After baseline assessment, a 4-week, dyadic, hand-on, functionally-tailored oral care intervention will be delivered to 20 PWD/CG dyads. Control group participants (n=20) will receive the standard oral hygiene education currently provided to PWD during dental care. Data collection will occur at baseline, 4-weeks and 3 months. Differences between the control and intervention groups with regard to PWD outcomes (e.g., oral hygiene and behavior symptoms during oral care), caregiver outcomes (e.g., burden, self-efficacy) and the care partner relationship will be explored. The proposed study is expected to help addressing the critical but neglected oral hygiene needs of community-dwelling PWD while reducing CG burden and improving care partner relationships. It will also provide preliminary data for designing a full scale R01/U01 study to more formally examine the effects of the proposed intervention on oral and systemic health and psychosocial well-being in PWD and their family caregivers.
The proposed study aims to develop a modularized, functionally-tailored oral hygiene intervention for community- dwelling persons with dementia and their caregivers, in order to improve oral health in persons with dementia, reduce oral care burden in family caregivers, and improve care partner relationships.
