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

• Author / Creator

  Cobban, Sandra J

• 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.

• Subjects / Keywords

  • Systematic reviews
  • Long-term care
  • Oral health

• Graduation date

  Spring 2012

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R32D3R

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.