Effectiveness on oral cleanliness of long-term immobile patients with cognitive impairments on a caregiver bedside oral care coaching program

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Authors (including presenting author) :
C IP, KH Ting, T Yu
Affiliation :
Rehabilitation Department, Kowloon Hospital Rehabilitation Building
Introduction :
Long-term immobile patients reside in a variety of setting, e.g. hospital, home, or long-term care (LTC) facility. Advocating for oral health in long-term immobile patients is of increasing important as mouth care is at risk of widespread neglect, especially when oral health professionals are typically not part of the health team (Wener ME, et al 2015). Since poor oral health (accumulated plaque, phlegm, caries and periodonitis) exerts a negative impact on the general health (such as cardiovascular diseases, stroke, DM and pneumonia) of the long-term immobile patients, and increases the cost of their care, effective methods that improve their oral health is warranted. Caregivers oral care education is always believed that to be one of the promising approaches to improve the oral health for immobile patients. However, in a systematic review and meta-analysis by Wang et al in 2105, it points out that there is only limited evidence for that and concluded “oral health education for caregivers may be effective for improving the oral health of the elderly”. Hence, a bedside oral care coaching program is designed for family caregivers in my working place (a rehab setting) to ensure the positive outcomes.
Objectives :
This paper is to evaluate 1) the effectiveness of the bedside oral care coaching program for family caregivers in terms of mouth cleanliness; 2) caregivers’ perception of understanding of the skills, confidence to complete the oral care and satisfaction level.
Methodology :
Family caregivers who offered regular oral care to immobile patients with cognitive impairment in the rehab setting were recruited to join this program. By individual appointment, the bedside oral care would be demonstrated for their care recipients by a nurse. Then, the caregivers would do two return-demonstrations with nurse’s supervision on the same day and several days or weeks later. A 5-item evaluation form is designed to measure the oral cleanliness level after the return-demonstration of oral care. And, a 5-item 10-point scale questionnaire is designed to evaluate the caregivers’ perception.
Result & Outcome :
From May to November 2018, 14 caregivers completed this program. Characteristics of caregivers were:- daughter: 10 (71.4%), secondary education: 8 (57.1%), mean age: 48.7. Characteristics of patients were:- sex: female 11 (78.6%), mean age: 82.9, stroke: 5 (35.7%), dentate: 11 (78.6%), care resistant behaviours (CRBs): 5 (35.7%). For mouth cleanliness, at 1st and 2nd evaluation, patients who had teeth plaque decrease were: 11 out of 12 (91.7%), 12 out of 12 (100%); decrease of phlegm at palate: 10 out of 13 (76.9%), 6 out of 9 (66.7%); tongue coating: 13 out of 13 (100%), 7 out of 9 (77.8%). Patients with zero plaque, or phlegm or coating after oral care, the percentage was from 33.3% to 75%. At two evaluation time, the mean oral care time was 48.6 and 36.5 minutes, the mean number of helpers was 2.4, 2.3. For caregivers’ perception at two evaluation times, the mean score of their skills control was: 8.7, 9; confidence to do the care: 5.9, 7.8; procedure satisfaction: 8.9, 9; overall program satisfaction 9.2, 9.3 respectively. After the mouth care return-demonstration by the caregivers, most patients had significant mouth cleanliness. Besides, the caregivers had perception of good to high skills control, self-confidence in providing oral care, and satisfaction. However, the management of CRBs (affect 35% of patients) still required a lot of time and effort. So, more researches are suggested to manage this issue. To conclude, it is recommended to extend this programme to different wards and community, e.g. CNS and RCHEs for enhancing the engagement of devoted caregivers in quality oral care.

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