Title: Opportunity-Led Dr Gary Mitchell - A. Development of a Digital Intervention to Improve Oral Health for Older People Living with Complex Needs in the community B. Co-development of a Digital Intervention to reduce Restrictive Practices in Care Homes
Funder: Public Health Agency, NI

Abstract: Project A: Globally oral disease affects almost 4 billion people worldwide. Poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience, and the prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer (WHO, 2018). The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed. As well as causing pain and making it difficult to speak, eat and take medication, poor oral health is linked to conditions such as malnutrition and aspiration pneumonia. Across England, Wales, and Northern Ireland at least 1.8 million people aged 65 and over could have an urgent dental condition such as dental pain, oral sepsis, or extensive decay in untreated teeth. By 2040, this number could increase by more than 50% (Royal College of Surgeons, 2017). There are major challenges in translating this knowledge into action for the oral health of older people. There is also a plethora of evidence that suggests that older people, living with complex needs, struggle to access dentistry services (Health Education England, 2017). The needs for oral care are highest among those older people who live with complex comorbidities (i.e. dementia, heart failure, COPD, frailty, and diabetes) and are unable to regularly visit their dentist (Public Health England, 2015). Education and continuous training must ensure that oral health care providers have skills in and a profound understanding of the biomedical and psychosocial aspects of care for older people (NICE, 2016). The demand for dental services will increase as people continue to grow older and healthcare professional education programmes must evaluate their curricula to reflect older people’s changing needs in relation to oral care. This project will seek to provide front-line district and community nurses with a digital resource, which will support the assessment and management of oral care for older adults living in the community. This patient group is currently very underserved as they may no longer access services from General Dental Practitioners (family dentists) whilst Community Dental Services struggle to provide domiciliary care (Petersen et al. 2010). Promotion of optimal oral health can indeed improve and maintain the overall health and wellbeing of an older person. Therefore, ensuring basic oral health care for patients in community nursing care is unquestionably a professional responsibility for nurses as part of a multidisciplinary approach (Garry & Boran 2017). Project B: In the United Kingdom (UK) there are approximately 500,000 older people who live in more than 17,000 care homes (Laing, 2013). This now accounts for a greater population of people than are served daily within the National Health Service (NHS) (Care Quality 2014). Living safely within care homes is a priority for residents, their family members and care home nurses. Within the UK there have been several high-profile reports about abuse taking place in care homes over the past few years (COPNI, 2018). Internationally, the term ‘elder abuse’ refers to a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person (WHO, 2017). Maintaining safety can be challenging for care homes due to the range of complex medical conditions with which their residents live (e.g. dementia, frailty, complex mental health behaviours and learning disabilities). Sometimes care home staff utilise the practice of restraint with the primary purpose of ensuring the safety of their residents. Nonetheless, they must remain cognisant about the regional, national, and international legislation relating to the use of restraint (General Assembly of the United Nations, 1948; Council of Europe, 1950; Donald et al. 2009; Freeman, 2011). As such, practice may indeed improve resident safety, but it is very often something which also deprives people of their freedom. Restraint within care home settings is a complex issue for the care home organisations, the care home staff, their residents and relatives. There have been limited educational interventions which have supported care home nurses to recognise restraint in their practice and provide practical, evidence-based solutions for safe effective restraint-reduction practices. Both projects will use similar co-design methodology (i.e. inclusion of older people, informal caregivers, and expert healthcare professionals) to develop freely accessible digital interventions that provide education, appropriate risk assessment/care-planning tools and case-studies. The digital interventions will provide an immediate resource to support the care of older people in relation to oral health or restrictive practice. The overall objective of these projects is to improve the care of older people.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE;MUSCULOSKELETAL