Oral Care in Long-Term Care Residents with Dementia
Creators: name: James R.BatemanIII
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2011

description: Manuscript Abstract Introduction: Poor oral health can lead to a number of health concerns, including pain, loss of teeth, and increased risk for pneumonia and heart disease. These issues are particularly salient for residents of long-term care facilities with a dementia diagnosis. Residents with dementia often require assistance with personal care, including oral hygiene, but may demonstrate agitated or resistive behaviors when care assistants attempt to provide care. Prior work on the related care activity of bathing has been done using person-centered care approaches and been found to effectively reduce levels of agitation and aggression. To determine whether an intervention is successful it is important to be able to reliably and validly measure components of care. The research design proposed herein proposes to characterize three measurements videotaped encounters of oral care provision in long-term care residents with dementia: a task completion form (TCF), caregiver behavior scale (CGBS), and a measure of resident behaviors during care (CAREBA-OC). Instrument Development: The included measures will be completed by raters who undergo extensive training on how to behaviorally code videotaped encounters. The framework for the TCF, CGBS, and CAREBA-OC is from a prior bathing study, and we describe how the original bathing measurement forms were altered to adequately measure similar behaviors and task components observed during oral care. Instrument Characterization: Each instrument will be evaluated for measures of reliability and validity. The TCF will undergo evaluation for face validity, inter-rater reliability, and within-rater reliability. The CGBS will under evaluation for face validity, inter-rater reliability, within-rater reliability, and internal consistency. The CAREBA-OC will be evaluated for face validity, concurrent criterion validity, inter-rater reliability, and within-rater reliability. Discussion: The proposed psychometric characterization will provide evidence of the usefulness of the included forms. While it is not possible to know precisely what the proposed measures of reliability and validity will be when actual measurement occurs, knowing the characteristics of the related bathing forms provides us with some general idea of what to expect. Furthermore, we are prepared to alter the forms and training procedure if any psychometric properties do not meet our predefined standards. Literature Review Abstract Objective: To conduct a brief review of the literature on nonpharmocologic strategies for reducing agitation and aggression during ADL provision in a long-term care setting in persons with dementia. Data Sources: PubMED and CINHAL were searched for English-language articles and papers published between 1990 and 2010. Bibliographies from articles identified through the included search strategies were then hand-searched to identify additional articles for inclusion. Data Selection: All original research designs, with the exception of case studies, were included due to the low number of clinical trials. Articles were selected for inclusion if they were original research; published in a peer-reviewed publication; targeted persons with dementia living in long-term or residential care facilities; addressed interventions to reduce agitation, aggression, and/or resistance to care during the provision of activities of daily living; and involved nonpharmacologic methods Results: A total of 6 articles were included which can be broadly categorized in three intervention types: the playing of preferred music, abilities-focused interventions which draw on occupational therapy techniques, and psychosocial/person-centered approaches. The heterogeneity of measurement, overall poor methods of selection, and lack of control for important confounding factors resulted in an overall limited quality of evidence for most approaches. The one exception to this trend was an article that which employed a person-centered approach to care provision, and was found to have low potentials for selection and measurement bias, and a medium potential for selection bias. Conclusions: While the quality of the research into nonpharmacologic research to improve agitation in long-term care residents with dementia was found to be lacking in a majority of included articles, it is possible to address these deficiencies and improve the state of knowledge in this area. Area for improvement are discussed, including improving the description of participant selection, reducing heterogeneity of measurement, and employing more robust research methodologies. The process of providing care for agitated persons with dementia is discussed in relation to the need-driven behaviors framework. This theoretical framework of understanding behaviors provides a strong foundation for psychosocial and person-centered care initiatives, which were the most numerous of the included intervention types.