overview of oral health improvement initiatives for older
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Maura EdwardsConsultant in Dental Public Health
Chair of National Older People’s Oral Health Improvement Group
NHS Ayrshire and Arran
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Overview of
for Oral Health Improvement
Initiatives for Older People
Maura Edwards Consultant in Dental Public Health
NHS Ayrshire & Arran
01292 [email protected]
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2005Scottish Dental Action Plan
Targets for older people“All NHS Boards will have oral health care and support programmes for care homes”
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National Groups
Scottish Dental Needs Assessment Programme (2006)
Subgroup on domiciliary dental careMulti-disciplinary membership
Role of care staff in preventing dental disease Establish National Older People’s Oral Health
Improvement Group (NOP OHIG) Focus on preventive rather than service aspects
Each has effect on the other, both are required to improve oral health
Public Health Researcher – for evaluation
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Equally Well
Ministerial Task Force Report - June 2008 Implementation Plan – Dec 2008 Improve dental health of vulnerable groups
(older people, prisoners and homeless people)
“NHS AA will determine good practice in the oral health of older people”
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NHS QIS (2005) Best Practice Statement (BPS) Working with Dependent Older People to Achieve Good Oral Health
Raising nurses’ awareness of the need to promote good oral health
Assessment Care of the mouth and teeth Education and training
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MPH Study on BPS (2006-7)Aim To describe current levels of oral care in care
homes
Explore Use that homes make of QIS BPS
Oral health assessments undertakenRole of care staff in oral assistanceStaff training Importance of oral health to managers
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MPH Study on BPSResults Homes less aware of oral health BPS Assessments
Only half did within week Only quarter said staff trained
Assistance Less than half of staff trained in oral care
Care homes with Registered Nurse more likely to do assessments/training
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MPH Study on BPS Overwhelming requests for:
better access to dentists to provide: “screening” emergency treatment
training on: oral health assessments oral care
Further work to be undertaken to support homes to implement current guidance
Poster
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Consultants in Dental Public Health
Quality Improvement Group (QIG)Audit (2006) Older people in local oral health strategy? Oral health improvement activity?
Most areas Oral health in Single Shared Assessment? Engaging with Care Commission locally?
Most not Focus on care homes – most vulnerable
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Oral health improvement activity Local projects in Scotland
Lothian - Lifesmile Fife – Care Home Award Ayrshire & Arran – North Ayrshire Pilot Highland – MSc – Home Carers
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1. Establish facts about population
2. Establish facts about health status
3. Develop pilot
4. Evaluate
5. Refine project
NHS Ayrshire & Arran Oral Health Needs Assessment (2006)
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North Ayrshire Pilot Project
Running since late 2007
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Aims of North Ayrshire Pilot
To make referral pathway to primary care salaried dental service clearer
A5 laminated cards with phone numberCarbonised referral pads
To develop oral health risk assessments for nurses and carers
For initial and ongoing assessment
To deliver OHP training to care home and hospital staff
Include information on how to access salaried dental service Denture marking kitDaily oral care recording charts
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Evaluation Ayrshire Central Hospital Phase
• Audit paperwork Aug & Dec 2007
• All initial oral assessments completed
• Compliance with 4-weekly reviews reduced over time
• Referral of patients to SDS also fell
• Documentation of daily mouthcare only partially implemented
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Interim Conclusions
One-off training not sufficient Must be part of ongoing programme
All staff require trainingCascade not fully effective
Staff positive about changesBut takes time to be fully adopted
Amending and refining procedures as a result
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Highland MSc - Remote and Rural Fellowship
Myra Morrison (nee O'Boyle) Lorna Macpherson Petrina Sweeney
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Highland – home carers
Assessed baseline and post-oral health training knowledgeattitude behaviour
Assessed oral health status of 60 older people receiving care
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Highland – home carers
Findings Little difference post-training in knowledge,
attitude or behaviour of home carers in relation to oral care
Older people receiving care showedhigh levels of edentulism - xerostomia, fungal
growth, poor denture hygieneamong dentate individuals - high levels of
plaque and caries
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Highland – home carers Conclusions Despite high levels of disease, many older
people not receiving help with oral care Many reported they did not want
assistance Further work required with older people
and carers to increaseawareness of oral health understanding of attitudes
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SQA Donna Kirk - NOP OHIG All care staff required to be qualified and
registered with Scottish Social Services Council (SSSC) by 2012
Potential for oral health training to be included in their generic training
Add oral health to SVQ level 2 Currently, oral health not included until
level 3
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National Oral Health & Nutrition Reference Group Agree common messages
e.g. cheese, crisps Life stages – older people
MalnutritionDehydration vs. growing population of dentate older people
Mitigation – increase prevention High fluoride toothpaste, more intensive oral care
Poor OH can lead to nutritional problems
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National OH & N Reference GroupDiet and nutrition advice for older people
Best practice advice for snacks and drinks in relation to oral health may not be appropriate for older people in care homes.
Oral health advice given with understanding ofdietary needs of older people risks to older people
Inappropriate advice could compromise hydration, nutrition and social enjoyment
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Dehydration Loss of fluid from the body, through illness or not
drinking enough Serious consequences for health and wellbeing
of older people. Can contribute to: increased confusionconstipationpressure ulcersurine infections
Older people in care homes at increased risk of dehydration
Care Commission report - dehydration made up largest number of complaints received about eating and drinking The Care Commission (2009). Eating well in care homes for older people
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Under-nutrition and unplanned weight loss Under-nutrition often unrecognised and
untreated in care homes Not enough calories unplanned weight loss. Survey - nutrition screening among people
admitted to hospitals and care homesoverall risk of under-nutrition - 28%.
BAPEN (2007). Nutrition Screening Survey in the UK in 2007: Nutrition Screening Survey and Audit of Adults on Admission to Hospitals, Care Homes and Mental Health Units.
But….could this be due to oral health problems?
Care Commission receives complaints about unplanned weight loss The Care Commission (2009). Eating well in care homes for older people
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Social enjoyment
Important to take into account that eating and drinking is one of life’s pleasures
Key social opportunity for older people in care homes.
Marjorie Thomson, Nutrition Adviser, Care Commission
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Care Commission Highlighted in CDPH QIG audit Meetings to discuss joint working “Three questions”
What should Care Commission staff expect to see re oral health at inspection
What does the carer need to know? What does the nurse need to know?
External Quality & Consistency Forum
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Single Shared Assessment
From CDPH QIG audit Joint health and social work documentation
Wash hair?Cook meal?
Not oral health! Next national revision - 2012 SG suggested pilot in East Renfrewshire – ongoing
East Renfrewshire is test site for electronic SSA
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Single Shared Assessment Oral health questions
Does the person have any of their own natural teeth?
Does the person have full and/or partial dentures?
Does the person have any problems with their mouth or teeth?
Has the person been seen by a dentist? Is the person housebound?
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Single Shared Assessment Personal Care Score
A: Without difficultyB: Without difficulty using equipment or an
adaptationC: Has difficulty even if using equipment or
adaptationD: Requires prompting, guidance, supervision
or encouragementE: Cannot do without assistance from others
East Renfrewshire are evaluating
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In conclusion….
Lots of work ongoing Need to keep joined up Training is important, but only first step Determine good practice Roll into National Programme