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Improving Oral Health for Elderly Residents of Long-Term Care Facilities Open Access


Other title
oral health
long-term care
systematic review
Type of item
Degree grantor
University of Alberta
Author or creator
Cobban, Sandra J
Supervisor and department
Estabrooks, Carole (Nursing)
Examining committee member and department
Hayduk, Les (Sociology)
Cummings, Greta (Nursing)
Clovis, Joanne (School of Dental Hygiene, Dalhousie University)
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Background: Demographics in residential care facilities for the aged have changed, such that residents are older, more functionally dependent, more cognitively impaired upon admission, and more of the elderly are entering these facilities with some or all of their natural dentition, rather than dentures as in decades past. This has posed problems with maintaining oral health, and studies have shown that these problems are significant. Purpose: The purpose of this thesis was to assess the research evidence for the effectiveness of various interventions targeted at improving oral health of elderly residents in long-term care facilities, focusing on interventions that improve daily mouth care that are or can be provided by health care aides. Methods: A preliminary scoping review determined that there were sufficient randomized controlled trials to proceed with a systematic review. This scoping review led to development of a protocol for a systematic review, which I proceeded to implement. Quality assessment and data extraction were completed independently by two reviewers, with disagreement resolved by consensus. Findings: A comprehensive search yielded 2239 records, with 686 records remaining after de-duplication. Five randomised trials met inclusion criteria representing an occupational therapy intervention, a chewing gum intervention, and three educational interventions. Quality assessment revealed two strong studies and three moderate studies. Four studies had significant positive findings. Methodological weaknesses identified include: 1) unit of analysis errors which may have inflated effect sizes; 2) failure to provide power calculations; 3) variation in outcome measures precluding meta-analysis; we could not determine an effect size with precision; and 4) failure to include participants with a variety of cognitive disorders, limiting application of the findings to only a segment of the range of residents found in long-term care. More research is needed. Discussion: Use of theory can inform study design. Further studies in this field should be framed with the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework and Rogers’ theory of diffusion of innovations to aid in the design and development of interventions, or to guide measurement of study outcomes. A tool that can measure context can also contribute to intervention selection.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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