Effect of a Person-Centered Mouth Care Intervention on Care Processes and Outcomes in Three Nursing Homes

Authors

  • Philip D. Sloane MD, MPH,

    Corresponding author
    1. Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Sheryl Zimmerman PhD,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    2. School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Xi Chen DDS, PhD,

    1. School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Ann L. Barrick PhD,

    1. Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    2. Central Regional Hospital, Butner, North Carolina
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  • Patricia Poole RDH, MS,

    1. School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • David Reed PhD,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Madeline Mitchell MURP,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Lauren W. Cohen MA

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Address correspondence to Philip D. Sloane, Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr., Blvd, Chapel Hill, NC 27599. E-mail: psloane@med.unc.edu

Abstract

Objectives

To develop and test a person-centered, evidence-based mouth care program in nursing homes.

Design

Pre–post assessment, with an 8-week intervention period and a pilot 6-month extension at one site.

Setting

Three North Carolina nursing homes.

Participants

Ninety-seven residents and six certified nursing assistants (CNAs).

Intervention

CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care.

Measurements

Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided.

Results

Outcome scores significantly improved (< .001 for PI-LTC and GI-LTC;= .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (< .001–= .03) but took more time (< .001) after training. Consistency of care appeared to be more important for natural teeth than dentures.

Conclusion

As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial.

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