Oral health problems (i.e. missing teeth, dental caries, and periodontal diseases) accumulate throughout the life span but occur with increasing frequency in later life. These problems arise in the context of increasing numbers of older adults retaining their natural teeth and can seriously impact the individual's life, causing pain as well as impairment of important functions such as speaking, chewing, and swallowing. Individuals with dementia have been shown to have significantly more oral plaque, more severe periodontal disease, more caries, and fewer teeth than cognitively intact older adults. Our current study shows that even individuals with mild dementia have an increased risk of poor oral health mainly due to brushing their teeth less frequently than cognitively normal older individuals. Maintaining good oral hygiene is a critical step in preventing deterioration of oral health. But individuals with mild dementia and their informal caregivers, who provide supervision or assistance with other daily activities, often neglect oral hygiene. Few interventions have addressed oral health problems among older adults in general and among individuals with dementia in particular, and to our knowledge, no oral health interventions have been conducted among community-dwelling individuals with mild dementia. To address this gap in knowledge we propose an adaptive intervention focused on mild dementia because individuals with this level of impairment still retain sufficient cognitive ability to perform oral hygiene tasks successfully with minimal assistance. Guided by the Adaptive Leadership Framework, our intervention is designed to work with those with mild dementia and caregivers to identify technical and adaptive challenges in oral care and assist them to improve the demented individuals'ability to engage in effective oral care. Over the past several years, we have conducted preliminary studies that support our proposed intervention. As the next step toward our long-term goal of conducting an intervention study, we are proposing a one-year planning project with the following aims: 1) Finalize the behavioral intervention protocol;2) Establish project infrastructure for the future U01 project, and 3) Prepare a U01 application for the intervention. This project will provide the infrastructure and the intervention materials to facilitate swift implementation of a future U01 project.
The aim of the U01 application will be to conduct an innovative caregiver- and technology-assisted oral care behavior intervention for individuals with mild dementia.. The project, if successful, will create an innovative approach to assist individuals with mild dementia and their caregivers in implementing a cooperative oral hygiene care plan to prevent deterioration of oral health, which in turn, will help individuals with dementia maintain independence and quality of life for an extended period of time.

Public Health Relevance

Oral health worsens in individuals with dementia. The growing number of individuals with dementia in the U.S. makes geriatric oral health an increasingly important public health issue that this study will address. The intervention we propose for this study could be incorporated into clinical practice by developing toolkits that dental or non-dental health professionals could use to educate and train older individuals with and without cognitive impairment to maintain and improve oral health. ! !"""""""" """"""""

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Planning Grant (R34)
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Special Emphasis Panel (ZDE1)
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Riddle, Melissa
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Duke University
Schools of Nursing
United States
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