People with dementia may soon have improved oral hygiene because of a five-year, $1.4 million National Institutes of Health grant to Rita A. Jablonski, Assistant Professor of Nursing at Penn State.
Cardiovascular disease, pneumonia and periodontal disease all have been linked to poor oral hygiene. Patients with dementia can be especially hard to care for because they often are no longer able to distinguish low or non-threatening situations from highly threatening situations -- leading to their resisting care by pushing the nurse away or fighting with their caregiver.
Jablonski and colleagues previously conducted a pilot study on strategies for reducing care-resistant behavior in patients with dementia during oral hygiene activities. "We have come up with 15 strategies -- techniques to help reduce threat perception," said Jablonski. Combined, these strategies make up the oral hygiene approach called Managing Oral Hygiene Using Threat Reduction (MOUTh).
The primary technique involves approach and environment. Many of the strategies focus on making the patient feel more comfortable before and while care is provided. Examples include approaching patients at eye level if they are seated, smiling while interacting, pantomiming, gesturing, and guiding patients to perform their own care by placing a hand over the patient’s hand and leading. One photo illustrates the “hand-over-hand” technique where a nurse is assisting an elder to remove his dentures. The other photo shows another modification where an elder puts her hands over the nurse’s hands allowing the elder to feel in control of brushing her teeth because her hands are “guiding” the nurse’s hands. The environment is important because it cues the elder to what is going on, and one is less likely to see care-resistant behavior.
The grant will allow the researchers to evaluate and validate the effectiveness of the MOUTh strategy, as well as calculate the cost. "The purpose of this study is to determine whether care-resistant behaviors can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response," said Jablonski.
In addition to Jablonski, other researchers on the grant include Ann Kowlanowski, Elouise Ross Eberly Professor of Nursing, Penn State; Douglas Leslie, Professor in Public Health Sciences, Penn State College of Medicine; Barbara Therrien, Associate Professor of Nursing, University of Michigan; Ellen K. Mahoney, Associate Professor of Nursing, Boston College; and Cathy Kassab of By the Numbers.