NSG 6999 W6 D16 -Dementia Patients

NSG 6999 W6 D16 -Dementia Patients

NSG 6999 W6 D16 -Dementia Patients

PICOT Question: In community dementia patients (P) how does an intensified health care routine (I) compared with regular oral care (C) decrease the incidence of aspiration pneumonia (O) in twenty-four months period of time (T)?

Aspiration Pneumonia (AP) is one of the most devastating diseases in terms of mortality in the elderly. Poor dental hygiene and altered mental status (e.g., dementia) are major risk factors associated with AP (van der Maarel?Wierink et al., 2013). Maintaining the cleanliness of the teeth and mouth including preventing the buildup of plaque on the teeth can help reduce the risk of developing AP. Oral hygiene, using mouthwash, gel, toothbrush, or a combination of the above can reduce the risk of AP in such patients (Izumi, Takeuchi, Ganaha, Akifusa, & Yamashita, 2016; Müller, 2015).

Study efforts are directed to address the effectiveness of these prevention strategies. A multicenter cluster randomized controlled clinical trial was completed in 2017 to study the effects of a daily application of 0.05% chlorhexidine on the incidence of aspiration pneumonia in residents living in care facilities in addition to the standard daily oral hygiene (Hollaar et al., 2017). For one year, the interventional group of 500 care home residents was treated with a twice/day 0.05% of chlorhexidine solution in addition to regular oral care. The intended outcome was the incidence of aspiration pneumonia diagnosed by a physician, using a set of strict criteria established by a Delphi panel of experts. The results were compared with the control group that only received regular oral care.

The effect of the intervention on the incidence of pneumonia was determined using a Cox regression analysis and as a result, was found to reduce the incidence of aspiration pneumonia. According to the rating system for the hierarchy of evidence for intervention questions, this large multi-center RCT has a Level of Evidence II (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010). A second investigation examined the effectiveness of oral hygiene for bedridden and tube-fed patients at an increased risk of pneumonia for two years (Maeda & Akagi, 2014). The oral care intervention consisted of tongue brushing using a toothbrush, and oral mucosa brushing using a sponge brush, a 0.2 % chlorhexidine solution, moisturizing the inner mouth with a gel; and a salivary gland massage after cleaning and moisturizing.

Thirty-one patients from the interventional group followed this routine and thirty-two patients were part of the control group. The statistical analysis showed that a planned oral hygiene implementation reduced the rate of pneumonia and reduced costs among patients not able to receive food by mouth. This article has a Level of Evidence IV since it is an RCT design (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010).

 

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References

Hollaar, V. R. Y., van der Putten, G.-J., van der Maarel-Wierink, C. D., Bronkhorst, E. M., de Swart, B. J. M., & Creugers, N. H. J. (2017). The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study. BMC Geriatrics, 17, 1–11. https://doi.org/10.1186/s12877-017-0519-z

Izumi, M., Takeuchi, K., Ganaha, S., Akifusa, S., & Yamashita, Y. (2016). Effects of oral care with tongue cleaning on coughing ability in geriatric care facilities: A randomised controlled trial. Journal of Oral Rehabilitation, 43(12), 953-959. doi:10.1111/joor.12451

Maeda, K., & Akagi, J. (2014). Oral Care May Reduce Pneumonia in the Tube-fed Elderly: A Preliminary Study. Dysphagia (0179051X), 29(5), 616. Retrieved from https://searchebscohostcom.southuniversity.libproxy.edmc.edu/login.aspx? direct=true&db=edb&AN=98581101&site=eds-live

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. American Journal of Nursing, 110(1), 51-53. doi:10.1097/01.naj.0000366056.06605.d2

Müller, F. (2015). Oral hygiene reduces the mortality from aspiration pneumonia in frail elders. Journal of dental research, 94(3_suppl), 14S-16S.

van der Maarel?Wierink, C. D., Vanobbergen, J. N., Bronkhorst, E. M., Schols, J. M., & de Baat, C. (2013). Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology, 30(1), 3-9.

NSG 6999 W6 D16 -Dementia Patients.