Improving the oral health of older people in hospital

Abstract

The aim of this research was to improve oral health outcomes for older people whilst they are in an acute care ward of a hospital. Whilst a number of studies had looked at the oral health of older people, there has been a limited number undertaken in an acute care setting and none that looked specifically at the role of nurses in the delivery of oral health care procedures. Four studies were therefore undertaken in two major tertiary referral hospitals in Sydney NSW. The first study involved a survey of nurses and found a combination of patient, nurse and systems barriers impacting oral hygiene practices. The second study sought to determine the prevalence of poor oral health among older patients upon admission to acute care wards and again seven days into their hospitalization. It found that, for the majority, oral health did not improve during their stay. As a result of these two studies two interventions were undertaken. The initial intervention introduced an oral hygiene procedure that met the needs of both the patient (best practice based on dental evidence) and the nurses in an attempt to address some of the barriers identified. An Oral Health Therapist (OHT) conducted a once daily oral hygiene routine (mouth, teeth, dentures) to ascertain the most efficacious oral-care procedures. Oral health was assessed at admission and day 7. The results showed a significant improvement in oral health specifically oral cleanliness over the period. Based on these findings, the OHT then trained the nurses in the oral health routine identified and the nurses undertook the same procedure over the same time frame. The results again showed a significant improvement in the patients’ oral health between admission and day seven demonstrating that, given direct education and training in the correct procedures, nurses could improve oral cleanliness to the same degree as an OHT. As part of nursing lead intervention, we developed a nurse education and training program that enabled nurses to deliver such care aided when necessary by a dental professional. This thesis has therefore shown that the barriers to nurse led oral health care on an acute ward can be overcome with the training and support of a dental professional. It has also provided guidance on how such a training program should be designed. Key words- dental care, aged, inpatients, oral health, patient care, nurse education and training