Making Sense of Best Practice Guidelines

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Making Sense of Best Practice Guidelines Powered By Docstoc
					What about older persons
in long-term care homes?
Commitment to their oral health

International Symposium on Dental Hygiene
Panel Discussion on
Positioning Dental Hygiene in Health Care
Toronto, Ontario
Friday July 20, 2007
                  Mary-Lou van der Horst, RN, BScN, MScN, MBA
                       Regional Best Practice Coordinator in LTC
                              Central South Region, Ontario Canada
Long-Term Care Reality… …
  Deteriorating oral health starts before older persons
  are admitted to LTC homes and continues to decline

  Interrelationship between oral health and general
  health is pronounced among older persons

  The oral health issues
   • Are progressive and cumulative
   • Profoundly affect quality of life
   • Have significant consequences
   • May become more critical as more older persons
     have teeth on admission to LTC
Long-Term Care Reality………
  The probability is high that the majority of LTC
  residents will be in a high risk group and experience
  severe oral diseases at some time during their stay

   • Poor oral health and plaque-related oral diseases are
      • Preventable
      • Not due to aging
      • Increases risk to general health and well-being
   • Similarly, systemic diseases and adverse effects of
     treatments/medication can lead to increased risk for
     oral diseases
High Risk for Oral Diseases… …
  Residents who are at higher risk of developing oral diseases:
   •   Are cognitively impaired
   •   Are functionally impaired
   •   Require assistance with daily oral hygiene
   •   Are completely dependent
   •   Are complaining of a dry mouth
   •   Have medical conditions that affect their mouths
   •   Take medications with adverse oral side effects
   •   Have nutritional problems
   •   Have swallowing problems and/or
   • History of oral health problems (periodontal pocketing, denture-
       related problems, poor oral hygiene, dental caries, infections)
Barriers/Challenges… …
• Perception that oral health professionals are not interested
  in the Long-Term Care sector and won’t come into LTC
  homes. Where are you, can’t find you?

• Access to affordable oral health care professionals. Few
  publicly funded programs for older persons. Older persons
  are not priority clients.

• Lack oral health and oral care information for LTC health
  care providers so it’s not a critical care issue. Oral health
  assessments are about whether they do or don’t have teeth.

• Oral care low and/or conflicting priority within health care
  organizations. It’s separate and not part of general health
  care – mouth is not part of the body myth.
  Organizations don’t show the same level of
  commitment and accountability to quality oral health
  care as they do to other health care issues as most
  don’t have oral care standards, guidelines, policies,
   • Lack of specific and measurable standards on
     multiple levels

   • Need commitment and assistance from
     governments, associations, organizations,
     accreditation, LTC homes
     …… and oral health professionals
  Oral health education for LTC staff
     • LTC nurse maybe the first health professional to identify
       oral hygiene care concerns
     • Limited oral health continuing education and skills training
       available for LTC staff
     • Misinformation about interrelationship between oral health
       and general health
     • Use ‘dental services’ on urgent/crisis basis

  Limited oral health education in health care professional
    education and training programs
  Limited geriatric and LTC exposure in oral health
    professional education and training programs
New Opportunities… …
  The WHO Oral Health Report (2003) supports cost-
  effective interventions and strengthening intersectoral
  collaboration that is sustainable and reduces inequities

  New Opportunities . . .
  • Multidisciplinary comprehensive approaches to improving
    oral health care in LTC. Gap analysis on models that
    work in or could be adapted to LTC – where are they?

  • Shared and affordable approaches that support the
     • effective use of expertise and
     • efficient use of resources to maximize oral health
       care benefits to LTC residents
New Opportunities… …
  • Improve knowledge and awareness and move oral
    care practices in LTC closer to best practice.
    Create guidelines for LTC
    Create education resources for LTC –paper and online

  • Assist to eliminate situations in LTC that result in
    needing costly and intensive crisis management
    approaches to oral care

  • Assist academic and training programs for health care
    professionals and providers to improve oral health
    knowledge, care and skills content
Ultimate Challenge:
Enhance Quality of Life… …
 For LTC residents their oral cavity is a conduit for essential
 nutrition, for communicating, for social connection and self-esteem.

 Ultimate Challenge to Oral Health Professionals
 … … enhance residents’ quality of life
 TIP from LTC:
 Oral health care initiatives will be most successful when adapted
 to the resident population, the long-term care setting and its
 health care providers . Remember the “A’s”
  • Accessible
  • Available
  • Affordable
  • Appropriate and acceptable
  • Associative approaches
 Fallon, T., Buikstra, E., Cameron, M., Hegney, D., Mackenzie, D., March, J., Moloney, C., & Pitt,
      J. (2006). Implementation of oral health recommendation into two residential aged care
      facilities in a regional Australian city. International Journal of Evidence-Based Healthcare, 4,
 Federal, Provincial and Territorial Dental Directors. (2005). A Canadian oral health strategy.
    Accessed January 4, 2007. Available at:
 Frenkel, HF., Harvey, I., & Needs, KM. (2002). Oral health care education and its effect on
     caregivers’ knowledge and attitudes: a randomised controlled trial. Community Dentistry and
     oral Epidemiology, 30, 91-100.
 Frenkel, H., Harvey, I., & Newcombe, RG. (2001). Improving oral health in institutionalised
     elderly people by educating caregivers: a randomised controlled trial, 29, 289-297.
 Nicol, R., Sweney, MP., McHugh, S., & Bagg, J. (2005). Effectiveness of health care worker
     training on the oral health of elderly residents of nursing homes. Community Dentistry and
     Oral Epidemiology, 33, 115-124.
 Pearson, A. & Chalmers, J. (2004). Oral hygiene care for adults with dementia in residential
    aged care facilities. Systematic review. JBI Reports, 2, 65-113.
 Seniors Oral Health Collaboration for the Nova Scotia Department of Health (SOHC). (2006).
     The oral health of seniors in Nova Scotia. Policy Scan and Analysis: Synthesis report.
     Accessed January 15, 2007. Available at:
 Thorne SE, Kazanjian A, & MacEntee. (2001). Oral health in long term care: The implications of
     organisational culture. Journal of Aging Studies, 15, 271-283.

 US Department of Health and Human Services (US DHHS) (2000). Oral Health in America: A
    Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial
    Research, National Institutes of Health. Accessed January 15, 2007. Available at:
 Wardh, I., Hallberg, L., Berggren, U., & Sorensen, S. (2003). Oral health education for nursing
    personnel: experiences among specially trained oral care aides: One-year follow-up
    interviews with oral care aides at a nursing facility. Scandanavian Journal of Caring Science,
    17, 250-256.
 WHO. (2003). The world oral health report. Continuous improvement of oral health in the 21st
   century – the approach of the WHO Global Oral Health Programme. Geneva, SW: author.
   Accessed: January 15, 2007. Available at:
Best Practice Resources……
 The Registered Nurses Association of Ontario (Summer 2007). Oral health. Nursing
     assessment and interventions. Toronto, ON: Author.
 The Registered Nurses Association of Ontario and Halton Region Health Department (Summer
     2007). Oral care for resident with dementia (DVD)Toronto, ON: Author. or
     phone Dir: (416) 907-7965 Fax:(416) 907-7962 $15 CDN
 ML vanderHorst (April 2007). The BP Blogger. Myth busting: The mouth issue. Monthly
     newsletter for LTC that dispels care myths with evidence from best practice guidelines.
     Available at:
 Halton Region Health Department (2006). Dental health manual for LTC home staff. Halton oral
     health outreach project. Oakville, ON: Author.
 Centre for Community Oral Health- Long Term Care Fact Sheets. Nov 2006
 The University of Iowa College of Nursing (2002). Oral hygiene care for functionally dependent
     and cognitively impaired older adults. Evidence-based practice guideline. Iowa City, Iowa:
     Author/Gerontological Nursing Interventions Research Center.
 Joanna Briggs Institute (2004). Oral hygiene care for adults with dementia in residential aged
     care facilities. Best Practice, 8(4). Adelaide, Australia: Author.
Contact information……
  Mary-Lou van der Horst, RN, BScN, MScN, MBA
  Regional Best Practice Coordinator Long-Term Care
  Central South Region-Ministry of Health and Long-Term Care

  Village of Wentworth Heights
  1620 Upper Wentworth Street
  Hamilton, ON L9B 2W3

   cell:   905.541.0656
    fax:   905.575.4450

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