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Evaluation of Better Oral Health in Long Term Care Program

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October 24th 2017

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Evaluation of Better Oral Health in Long Term Care Program

  1. 1. Maryam Jafari, MPH Evaluation of the Oral Health Status of Saskatchewan LTC Home Residents Following the Implementation of Better Oral Health in Long Term Care Program
  2. 2. Overview • Background Aging Population, Oral Health and Overall Health • BOH in LTC Program Background History, Overview, Impact • Evaluation of BOH in LTC Program Materials and Methods, Results, Recommendations
  3. 3. Overview 1- Background Aging Population, Oral Health and Overall Health BOH in LTC Program Background History, Overview, Impact Evaluation of BOH in LTC Program Materials and Methods, Results, Recommendations
  4. 4. LTC Homes SK, 2015-2016: The total number of residential-based continuing care homes: 155 , with 12,718 residents (90% ≥ 65y. and 55% ≥85 y) Poor Oral Health Status • Pre-existing medical conditions • Limited access to oral health professionals • Dependence on caregivers for performing daily oral care.
  5. 5. Poor Oral Health Status • Tooth decay • Gingivitis • Periodontitis • Denture stomatitis • Not named dentures • Xerostomia=dry mouth Denture Stomatitis
  6. 6. Importance of Oral Health • An important part of overall health A healthy body cannot be achieved without a healthy mouth • A determinant of quality of life • Links between oral disease and systemic conditions
  7. 7. Cardiovascular Disease Diabetes Aspiration Pneumonia 10% Morbidity/Mortality Net benefit US $300 million
  8. 8. Overview Background Aging Population, Oral Health and Overall Health 2- Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Program History, Overview, Impact Evaluation of BOH in LTC Program Materials and Methods, Results, Recommendations
  9. 9. History: • Since 2011, SOHC and SOHP have collaborated to develop a model for oral heath care in LTC homes. “BOH in LTC” has been adapted from the Australian Better Oral Health in Residential Care. • In 2014, the Program was focus tested at Parkridge Centre in SHR. • In 2015, SHR hired a dental assistant into the LTC Oral Health Coordinator (LTC-OHC) position to implement and maintain the program in LTC homes. • LTC-OHC audited and refreshed staff at the Parkridge Centre. • In 2016, LTC-OHC has fully implemented the Program at two LTC homes (Sherbrooke Community Centre and Sunny Side Adventist Centre) in SHR.
  10. 10. Educator's Portfolio For Education/Training Professional Portfolio For Nurses Staff Portfolio For Care Aides Overview:
  11. 11. 4 Key Processes Description 1. Oral Health Assessment Performed by a Licensed Oral Health Professional 2. Oral Health Care Plan Developed by Oral Health Care Team and residents 3. Daily Oral Hygiene Maintained by Care Aides 4. Oral Health Treatment Referrals made for a comprehensive examination/treatment
  12. 12. Impact: The majority of Saskatchewan health regions have expressed interest in or implemented BOH in LTC program.
  13. 13. Overview Background Aging Population, Oral Health and Overall Health BOH in LTC Program Background History, Overview, Impact 3- Evaluation of BOH in LTC Program Materials and Methods, Results, Recommendations
  14. 14. Materials and Methods: 1-Staff Training • Mangers, • Registered Nurses (RNs), • Continuing Care Aides (CCAs)  Pre test  A 3-hour learning module  A 3-hour hands-on session  Post test Sherbrooke Community Centre Sunny Side Adventist Centre
  15. 15. 2-Initial Oral Health Assessment: LTC-OHC or Trained RN Healthy Changes Unhealthy Exterior of face Lips Tongue Gum and tissues Oral cleanliness Teeth Denture(s) Saliva Dental pain Oral Health Assessment Tool (OHAT)
  16. 16. 3- Oral Health Care Plan: LTC-OHC, RN, CCAs
  17. 17. 4- Oral Health Care Delivery: CCAs Basic Oral Health Supplies For Edentulous Residents For Dentate Residents Not Requiring Assistance For Dentate Residents Requiring Assistance /w. Swallowing Difficulties Perivex RNs followed up with checking the daily oral care that the CCAs provided
  18. 18. 5-Follow-up Oral Health Assessment (after 6 months) LTC-OHC or Trained RN Healthy Changes Unhealthy Exterior of face Lips Tongue Gum and tissues Oral cleanliness Teeth Denture(s) Saliva Dental pain
  19. 19. 6- Oral Health Treatment •LTC-OHC/ RNs completed consents for referrals to a dentist. •Fee-for-service dentistry was provided either on-site or the residents’ private practice dentist.
  20. 20. 7- Statistical Analysis • Wilcoxon Signed Rank Test • P-value <0.05 was significant
  21. 21. Results: Training LTC Home Number of Staff Trained Sherbrooke Community Centre 39 •1 Leadership Manager of Learning and Growth/ Training and development •7 Neighbourhood Team Mangers •9 Registered Nurses •22 Continuing Care Aides Sunny Side Adventist Centre 10 •1 Director of care •1 Leadership Director of Education and Safety •1 Resident Care Coordinator •2 Registered Nurses •5 Continuing Care Aides Total 49
  22. 22. Demographics and Oral Heath Status •177 residents (initially 252) •Females (52%) and Males (48%) •76.24±17.65 years •111 Dentate (62.72%), 66 Edentulous (37.28%) ≥65 y. 75.15%
  23. 23. In total: (83 out of 177) 47% had partial/complete dentures 80.3%
  24. 24. OHAT Scores: The scores of 6 aspects significantly changed after 6 months. Lips Tongue Gum and tissues Oral cleanliness Denture(s) Saliva
  25. 25. • Following 6 months: 29.72% more residents had healthy lips
  26. 26. • Following 6 months: 27.45% more residents had healthy tongue.
  27. 27. • Following 6 months: 28.76% more residents had healthy gum(s). • Following 6 months: 68.40 % fewer residents had unhealthy gum(s)
  28. 28. • Following 6 months: 9.81% more residents had healthy saliva
  29. 29. • Following 6 months: 40.62% more residents had clean mouth • Following 6 months: 72.27 % fewer residents had food particles, tartar and plaque in their mouth.
  30. 30. • Following 6 months: 18.64% more residents had healthy dentures
  31. 31. OHAT Scores: The scores of 3 aspects did not significantly change after 6 months. Face Teeth : 30% of dentate did not consent for referrals Dental Pain
  32. 32. Referrals Required Referrals Made Referrals 84 (47.45%) 71 dentate, 13 edentulous 55 (31.07%) 48 dentate, 7 edentulous 55 of those (65.5%) completed consent and were seen by a dental team for comprehensive exam/treatment. 23 (30%) were not seen by dental team
  33. 33. Conclusion: • Within the limitations of this study, residents who received care under BOH in LTC Program showed an improvement in their oral health status. • The results also signifies the multidisciplinary approach and role of LTC-OHC, who works collaboratively with the LTC team, in improving the oral health care.
  34. 34. Recommendations: • To emphasize the 10 recommendations that was previously developed/endorsed by SOHC and SOHP for consideration and action by the SK Ministry of Health • a LTC-OHC should be employed in each health region to facilitate the delivery of initial oral assessments, dental examinations and treatment, daily oral hygiene for residents and oral health education. • That SOHC and SOHP continue data collection (quantitatively and qualitatively) with longer follow up periods.
  35. 35. • To establish an effective data collection and information systems, and provincial oral health surveillance system. • To establish a provincial legislation for an oral screening and care plans for LTC residents. • To implement the Program across the province.
  36. 36. 51st Canadian Association of Public Health Dentistry Conference (Toronto: Sep 22-23, 2017)
  37. 37. • Leslie Topola Manager, Population and Public Health, SHR • Kerrie Krieg Long Term Care Oral Health Coordinator, SHR • Vanessa Ripley Manager, Seniors’ Health and Continuing Care, SHR • Dr. Raju Bhargava (Varsity Dental Group) Dentist, SHR • Sherbrooke and Sunnyside staff • Saskatoon Health Region • Saskatchewan Oral Health Coalition • Saskatchewan Oral Health Professions
  38. 38. maryam.jafari@usask.ca Maryam Jafari

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