Pre‐ and post‐training evaluation of dental efficacy and activation measures in carers of adults with disabilities in South Australia – a pilot study

The aim of this pilot study was to train carers to provide oral care for adults with disabilities and to evaluate the training programme. Forty‐one carers of 103 care recipients from three disability organisations in South Australia were trained in providing oral care for adults with disabilities (April 2013–April 2014). The training included an oral presentation and practical session by a special needs dentist on completing oral health assessments (OHA), developing oral healthcare plans, providing oral hygiene care and assessing the need for dental referral. Continued support was provided via home visits by dental hygienists for the first 2 months and a dentist visit at 3 months. At 6 months, agreement on OHAs between the dentist and trained carers was assessed. Pre‐ and post‐training questionnaires (at 6 months) collected information on dental behaviours of carers and psychosocial factors: carer activation measure‐knowledge (CAM‐Knowledge), carer activation measure‐skills (CAM‐Skills), carer activation measure‐confidence (CAM‐Confidence) and carer dental efficacy (CDE) items (carer diligence, self‐efficacy and priority). Post‐training (among 16 retained carers), there were significant increases in the mean scores of CAM‐Knowledge and CAM‐Confidence, but not for CAM‐Skills (paired‐samples t‐tests, α = 0.05). Per cent agreement of CDE items varied little between questionnaires. Carer–dentist agreement on OHAs was generally high with kappa values ranging from 0.63 for the assessment of gums to 1.0 for the assessment of tongue, roof of mouth, denture and dental pain. Further, carers were able to assess the need for referral of their care recipients’ oral health similar to the dentist. These findings suggest that with combined theoretical and practical training and continued support, non‐dental professionals like carers can improve their knowledge and confidence in providing oral care for adults with disabilities. However, the findings of this pilot study need to be confirmed by further research in a larger study.     

Making sense of self‐care practices at the intersection of severe mental illness and physical health—An Australian study

The poor physical health of people who experience severe mental illness (SMI) is an important public health issue that has been acknowledged, yet not properly addressed. People who live with SMI perform a myriad of complex tasks in order to take care of their physical health, while receiving unpredictable levels of support and assistance from health professionals. In this qualitative study, we aimed to uncover the kinds of work people with SMI do in order to look after their physical health. In a metropolitan area in Queensland, Australia, 32 people with lived experience of SMI participated in semi‐structured, face‐to‐face interviews. Data were digitally recorded, transcribed verbatim and open coded. They were then themed using a constant comparative process. We found that people with SMI were engaged in a “rhythm of life with illness” that consisted of relatively short, acute and chaotic cycles of mental and physical illness, accompanied by much longer mental and physical illness recovery cycles. Participants engaged in three specific types of health‐related work to manage these cycles: discovery work (and the associated role of the health professional); sense‐making work to meaningfully interpret health and illness; and embedding work to become engaged self‐managers of illness and producers of health. We discuss how varying levels of support from health professionals impact consumers' self‐management of their physical and mental health; how health professionals influence consumers' experience of treatment burden; and implications for practice.     

A qualitative exploration of oral health care among stroke survivors living in the community

BackgroundDental disease is highly prevalent in people with stroke. Stroke survivors regard oral hygiene as an important, yet neglected, area. The aim was to explore experiences of and barriers to oral care, particularly in relation to oral hygiene practice and dental attendance, among stroke survivors in the community.MethodsThis was a qualitative study incorporating a critical realist approach. Interviews were conducted with community‐dwelling stroke survivors requiring assistance with activities of daily living, and focus groups were held with health and care professionals. Interviews and focus groups were recorded and transcribed verbatim. Thematic analysis was conducted.ResultsTwenty‐three stroke survivors were interviewed, and 19 professionals took part in 3 focus groups. Professionals included nurses, speech and language therapists, occupational therapists, dieticians, professional carers and dental staff. Interviews revealed difficulties in carrying out oral hygiene self‐care due to fatigue, forgetfulness and limb function and dexterity problems. Routine was considered important for oral hygiene self‐care and was disrupted by hospitalization resulting from stroke. Professionals highlighted gaps in staff training and confidence in supporting patients with oral care. Access to dental services appeared particularly problematic for those who were not registered with a dentist pre‐stroke.ConclusionOral hygiene routines may be disrupted by stroke, and resulting disabilities may make regular oral self‐care more difficult. This study has identified specific barriers to oral hygiene self‐care and dental service access. Findings from this study are feeding into the development of an intervention to support stroke survivors with oral care.     

An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

Self‐reported care needs of Dutch homeless people with and without a suspected intellectual disability: a 1.5‐year follow‐up study

Cognitive impairment is a prevalent problem among the homeless and seems related to more psychosocial problems. However, little is known about the care needs of the subgroup of homeless people with an intellectual disability compared to those without an intellectual disability and how their care needs develop over time. This study explores self‐reported care needs within a broad range of life domains among Dutch homeless people with and without a suspected intellectual disability to gain insight into the transition of self‐reported care needs from baseline to follow‐up in both subgroups. This longitudinal study is part of a cohort study among homeless people who had been accepted for an individual programme plan in four major Dutch cities. The initial cohort consisted of 513 participants who were interviewed in 2011. At 1.5‐year follow‐up, 336 participants (65.5%) were also interviewed and screened for intellectual disability. Of these participants, 31% (95% CI 26.2–36.1) had a suspected intellectual disability. For both groups, between baseline and follow‐up, the number of ‘unmet care needs’ decreased significantly and the number of ‘no care needs’ increased significantly, while at follow‐up, participants with a suspected intellectual disability reported ‘no care needs’ on significantly fewer life domains than those without a suspected intellectual disability (mean numbers 16.4 vs. 17.5). Between baseline and follow‐up, ‘met care needs’ decreased significantly on housing for both groups, and increased on finances and dental care for participants with a suspected intellectual disability. At follow‐up, participants with a suspected intellectual disability more often preferred housing support available by appointment than those without a suspected intellectual disability. These findings suggest that homeless people who had been accepted for an individual programme plan with a suspected intellectual disability have care needs for a longer period of time than those without a suspected intellectual disability. Providing care to homeless people with a suspected intellectual disability might require ongoing care and support, also after exiting homelessness. Support services should take this into account when considering their care provision and planning of services.     

东营地区健康教育对儿童口腔保健的干预效果

目的 分析山东省东营地区健康教育对儿童口腔保健的干预效果.方法 采取分层抽样的方法选取2015年6至12月在东营市鸿港医院口腔科检查的7至12岁儿童共310例,将其按照不同口腔保健方法分为对照组与观察组,每组各155例.对照组给予常规口腔保健,观察组在其基础上加用健康教育指导,对比两组干预前后儿童口腔保健知识知晓率、牙龈出血发病率、龋齿发病率、饭后漱口率、正确刷牙率、牙龈指数、菌斑指数.结果 两组干预后分别与干预前相比,口腔保健知识知晓率、饭后漱口率及正确刷牙率均有升高,差异均有统计学意义(χ2=6.78~8.34,均P<0.05).两组干预后分别与干预前相比,牙龈出血发病率、龋齿发病率及龋齿总数均有降低,差异均有统计学意义(χ2值分别为6.45、8.37、6.87、8.29;t值分别为7.33、9.36,均P<0.05).两组干预后分别与干预前相比,牙龈指数与菌斑指数均有降低,差异均有统计学意义(t值分别为4.11、6.89、4.25、6.56,均P<0.05).结论 在儿童口腔保健过程中加用健康教育可提高儿童口腔保健知识知晓率,降低牙龈出血发病率,促进健康口腔行为,改善各观察指标.     

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self‐assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre‐booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.     

Ideal and reality; Community healthcare professionals’ experiences of user‐involvement in reablement

Many welfare states offer reablement, also known as restorative care, as an intervention to promote healthy ageing and support older adults in regaining or maintaining their independence in daily life. Reablement is a time‐limited, intensive, multidisciplinary, person‐centred and goal‐directed rehabilitative intervention. Reablement emanates from the user’s goals, thus user‐involvement is a key factor. The aim of our study was to explore healthcare professionals’ experiences of user‐involvement in reablement. The context for the study was an urban municipality in south‐eastern Norway where reablement had been implemented into home‐care services 1.5 years prior to the study. Eighteen healthcare professionals recruited from home‐care services participated in focus groups. The material was analysed using qualitative content analysis. The findings resulted in one main theme: Transforming user‐involvement from ideal to reality—a demanding process, and four sub‐themes: (a) An ideal of self‐determination and co‐operation; (b) Diverse ability to commit to what user‐involvement requires; (c) Continuous co‐creation processes; and (d) Challenged by old traditions. User‐involvement is a valued ideal that professionals strive towards when providing healthcare. Two main strategies that professionals use to enable user‐involvement were identified here: spending sufficient time and having patience with users during the initial stage of an intervention, and starting an intervention by introducing small tasks that users can master. It was also seen that if the time and arenas for interdisciplinary meetings were lacking, professionals could demonstrate traditional attitudes and practice when faced with limited user‐involvement in the intervention. There is a need for follow‐up over time at the structural, personal, and cultural levels to develop reablement as an intervention with a strong person‐centred approach. The findings of this study have relevance for practice development in several reablement settings.     

Staff perspectives on the barriers and facilitators to exercise implementation in inpatient mental health services: A qualitative study

Exercise has multiple benefits for the physical and mental health of people with severe mental health problems (SMI). However, people with SMI engage in significantly less exercise than the general population and there is an evidence-practice gap regarding the implementation of exercise in clinical services. Mental health staff in inpatient services are well placed to support people with SMI to exercise, yet little is known about staff perspectives on exercise facilitation in inpatient care. This study aimed to explore staff views on role for exercise for people with SMI and the barriers and facilitators to exercise implementation in inpatient services. Qualitative semi-structured interviews were conducted with 25 clinicians working in inpatient mental health settings. Interview topics included the role for exercise in inpatient services, staff roles in relation to exercise, the barriers and facilitators to patients’ engagement in exercise, and promotion of exercise. Interview data were analysed using Thematic Analysis. Four key themes were developed: (i) perceived patient factors, (ii) exercise in the context of relationships, (iii) the ward context, and (iv) the therapeutic role for exercise. Clinicians readily recognised the benefits of service users engaging in exercise, though identified a number of individual, systemic, and organisational barriers to exercise implementation in inpatient services. Organisational prioritisation of exercise and support for staff to develop their skills and confidence in exercise facilitation is required. Enhancing the legitimacy of exercise as a multi-beneficial intervention for people with SMI is essential. Further recommendations for services based on the study findings are provided.     

Impact evaluation of an oral health intervention amongst primary school children in Ireland

A pilot oral health programme was developed which aimed to improve dental health knowledge and behaviour amongst Irish school children aged 7-12 years. The programme comprised two integral components: a television campaign, run over a 6-week period, was incorporated into the children's programme 'Den TV' on national television, with video clips of a member of the music band Boyzone promoting key oral health messages; and a Smile of the Year contest. Concurrently, a dental nurse delivered an interactive talk with pupils, showed a video of the Den TV oral health programme and distributed posters and leaflets. The aim of this study was to assess the impact of the overall intervention on school pupils' dental health knowledge and reported behaviour. Thirty-two primary schools in two health board regions in the Republic of Ireland participated in the study. At baseline and after 6 weeks, 1534 school children completed specially developed questionnaires. There was a positive net effect of the dental nurse intervention in all but one question. The percentage of children who reported using the recommended amount of toothpaste and brushing for 3 min appeared to have been further increased having observed the television campaign. These results are in line with the argument that mass media campaigns work to supplement the one-to-one activities of health professionals in order to effect knowledge and behavioural change.     

Meeting the health needs of older people with intellectual disabilities: exploring the experiences of residential social care staff

Older people with intellectual disabilities often experience high levels of health needs and multiple morbidities but they may be supported by residential care staff with little or no previous experience of identifying and meeting health needs. Little is known regarding how they undertake this health‐related role and this exploratory study seeks to address this gap. A purposive sample of 14 managers of supported living accommodation in Wales were interviewed in 2014 to determine their experiences of supporting tenants in relation to age‐related health needs. The semi‐structured interviews were transcribed and thematically analysed. Three of the emerging themes are reported in this paper: meeting health needs, the consequences of ageing and relationships. Findings indicate that residential care staff support older people with intellectual disabilities with complex and multiple health needs: they monitor health status, support access to healthcare, provide additional support arising from changing health needs and advocate for tenants in the context of healthcare. However, their role is often not understood by healthcare professionals. The importance of staff having a long‐term relationship with those they support was identified as being important to identifying any health‐related changes. The need to develop effective relationships with healthcare staff was also noted. It is concluded that there is a need for better understanding among health staff of the role of residential social care workers and for further research regarding health‐related communication.     

Experiences of home‐care workers with the ‘Stay Active at Home’ programme targeting reablement of community‐living older adults: An exploratory study

To face the challenges of an ageing population, many Western countries nowadays stimulate an ageing in place policy to empower older adults to grow old in their own homes with the highest degree of self‐reliance. However, many community‐living older adults experience limitations in (instrumental) activities of daily living ((I)ADLs), which may result in a need for home‐care services. Unfortunately, home‐care workers often provide support by taking over tasks, as they are used to doing things for older adults rather than with them, which undermines their possibilities to maintain their self‐care capabilities. In contrast, reablement focuses on capabilities and opportunities of older adults, rather than on disease and dependency. Consequently, older adults are stimulated to be as active as possible during daily and physical activities. The 'Stay Active at Home' programme was designed to train home‐care workers to apply reablement in practice. To explore the experiences of home‐care workers with this programme an exploratory study was conducting in the Netherlands, between April and July, 2017. In total, 20 participants were interviewed: nine nurses (including a district nurse), 10 domestic support workers and the manager of the domestic support workers. The semi‐structured interviews focused on the experienced improvements with regard to knowledge, skills, self‐efficacy and social support. Furthermore, the most and least appreciated programme components were identified. The study has shown that home‐care workers perceived the programme as useful to apply reablement. However, they also need more support with mastering particular skills and dealing with challenging situations. Future implementation of the 'Stay Active at Home' programme can potentially benefit from small adaptions. Furthermore, future research is needed to examine whether the programme leads to more (cost‐) effective home care.     

Mundhygiene und Mundgesundheit bei Bewohnern von Altenpflegeheimen

Many studies have shown urgent need in improving oral health hygiene in nursing home residents. Deficits in the knowledge of the personnel in dental and oral hygiene are often cited as one of the causes. Therefore in the spring of 2007 the nursing personnel of three nursing homes attended an oral health education programme. This programme was evaluated by examining the oral and dental health status of the residents, prior to and up to 12 months after the hygiene education. In three nursing homes in the Frankfurt am Main area, the oral health status of 113 residents was examined by a dentist with special education in geriatric dentistry, after receiving informed consent. Mean age was 80±9,2 years (49–97 years, 91 women, 40 men). Before, and 4, 8, and 12 months after education of the caregivers, the following data were recorded in the residents: DMF-T index (decayed, missed, filled teeth), plaque index, sulcus bleeding index (SBI), denture hygiene index (DHI), coating of the tongue. Two-thirds of the residents were dependent on caregivers’ support for dental care. Initially, in two-thirds of the residents, a high plaque index (PLI>2) and denture hygiene index (DHI>4) was found, in 90% of the residents SBI was > 50%, in 74% of them the tongue was partly or totally coated. In 45% of the residents restorative treatment was required. After the education programme for the personnel, good improvement in oral health of the residents could be stated, with 43% residents exhibiting PLI>2 and 77% showing SBI > 50%. The percentage of clean and well cared for dental prostheses had increased from ca. 30% up to 70%. Within the 4 months 29 of 57 residents with recommendations for dental therapy had been seen by the dentist, 12 months after the first examination, dental therapy had to be recommended to only 19 residents. Education of the nursing staff in nursing homes is effective in improving oral health of the residents. Therefore, all residential homes will be offered regular and free education programmes in oral health for their personnel; this programme will be offered by the chamber of dentists in Hessen, Germany, and the public health services, Frankfurt/Main, Germany.     

Preparing Long-Term Care Staff to Meet the Needs of Aging Persons With Serious Mental Illness

ObjectivesIndividuals with serious mental illness (SMI; schizophrenia spectrum disorders and affective psychoses) are increasingly aging into older adulthood and are overrepresented in residential long-term care settings. The present study aimed to examine the preparedness of staff in these settings to care for individuals with SMI.DesignA multidisciplinary US Department of Veterans Affairs (VA) workgroup of professionals with expertise in geriatric mental health collected voluntary feedback via online questionnaire as part of a quality improvement project.Setting and ParticipantsRespondents were mental health providers (N=51) embedded in VA nursing homes called Community Living Centers (CLCs).MeasuresThe questionnaire contained multiple-choice, Likert-type scale, and open-ended questions regarding the opportunities and challenges associated with caring for Veterans with SMI in CLCs.ResultsRespondents identified a lack of training of front-line staff as a key challenge in providing high-quality care to residents with SMI. Specifically, respondents indicated a need to increase staff knowledge about SMI symptoms and diagnoses, to improve staff communication and interactions with residents with SMI, and to decrease mental illness stigma among staff.Conclusions/ImplicationsThe present study revealed significant areas of training need for front-line staff in nursing homes. Many perceived staff training needs overlap with the knowledge and skill set required to provide high-quality dementia care. Integrating training regarding the care of residents with SMI into dementia care training efforts may be a fruitful future direction. Strategies for this and a suggested curriculum are provided.     

Living and dying: responsibility for end‐of‐life care in care homes without on‐site nursing provision ‐ a prospective study

The aim of the study was to describe the expectations and experiences of end‐of‐life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed‐method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were interviewed. The review of care home notes demonstrated that residents had a wide range of healthcare problems. Length of time in the care homes, functional ability or episodes of ill‐health were not necessarily meaningful indicators to staff that a resident was about to die. General Practitioner and district nursing services provided a frequent but episodic service to individual residents. There were two recurring themes that affected how staff engaged with the process of advance care planning with residents; ‘talking about dying’ and ‘integrating living and dying’. All participants stated that they were committed to providing end‐of‐life care and supporting residents to die in the care home, if wanted. However, the process was complicated by an ongoing lack of clarity about roles and responsibilities in providing end‐of‐life care, doubts from care home and primary healthcare staff about their capacity to work together when residents’ trajectories to death were unclear. The findings suggest that to support this population, there is a need for a pattern of working between health and care staff that can encourage review and discussion between multiple participants over sustained periods of time.     

Improving Evidence-Based Oral Health of Nursing Home Residents Through Coaching by Dental Hygienists

Good oral hygiene has an impact on the overall health of residents in long-term care; however, significant improvement is needed in nursing homes. A “boots on the ground” project was developed that incorporates Mouth Care without a Battle, an evidence-based approach to person-centered daily mouth care, into 22 New York State nursing homes using a coaching model with part-time dental hygienists. This report discusses implementation of the quality improvement project, which improved the quality of daily mouth care provided to nursing home residents, as well as changed the knowledge and attitudes of the staff providing their care, all supported by regional dental hygienist coaches.     

Nutritional Implications of Xerostomia and Rampant Caries Caused by Serotonin Reuptake Inhibitors: A Case Study

Serotonin reuptake inhibitors, such as fluoxetine, fenfluramine, and dexfenfluramine, are frequently used to treat obesity, depression, and bulimia. A common side effect of these medications is xerostomia, or dry mouth. A case study demonstrating the impact of drug-induced xerostomia on oral health and subsequent nutrition implications is presented. Rampant caries can result from a combination of xerostomia and inappropriate dietary and oral hygiene habits. Preventive dietary and dental guidelines are presented to assist nutrition and dental professionals in treating and counseling patients with xerostomia.     

Health and social care practitioners' understanding of the problems of people with dementia‐related visual processing impairment

It has been highlighted that health and social care staff need a greater awareness of the needs and problems of those people with young onset dementia in the UK. Symptoms of Alzheimer's disease are relatively well known (memory loss, disorientation, language difficulties and behavioural problems). However, there is less awareness of dementia‐related visual processing impairments in Alzheimer's disease, Dementia with Lewy Bodies or rarer dementia syndromes such as posterior cortical atrophy (PCA), leading to delayed assessment, diagnosis and management. This qualitative study explored health and social care practitioners’ opinions of the needs of people with dementia‐related visual processing impairment (such as individuals with PCA) and identify any training that these practitioners might need. Social workers, occupational therapists, care home staff, rehabilitation workers (visual impairment), optometrists and admiral nurses participated in focus groups or one‐to‐one semi‐structured interviews. All participants were shown video clips of people with dementia‐related visual impairment to facilitate discussion. Sixty‐one participants took part in focus groups or interviews between November 2014 and December 2015. Participants’ experiences and understanding of dementia were explored and thematic analysis of the data identified two major themes. Theme 1 explores participants’ understanding of dementia‐related visual impairments. Theme 2 recounts how participants address and support people with dementia‐related visual impairment and their families. Participants discussed, reflected and critically analysed the video clips during data collection. Most considered new perspectives of their own clients’ difficulties and those participants working with people with rarer dementias consolidated their experiences. However, some participants seemed hesitant to accept the existence of visual processing impairment arising due to dementia, rationalising novel information to existing understanding of memory loss or behavioural problems. This study highlights that health and social care practitioners want more training and better understanding of less well‐recognised symptoms of dementia and rarer syndromes (including PCA) to ensure appropriate, evidence‐based assessment and intervention.