Last year, 2017 marked the 30th anniversary of the enactment of the Nursing Home Reform Act as part of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), that established standards focused on quality of life in Long-term Care Facilities (LTCFs), that require LTCFs to provide comprehensive data collection to be reimbursed by Medicare and Medicaid. 15 According to the most current report conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), nearly 8 million older adults in the United States received services from Long-Term Care Facilities (LTCFs) such as adult day services centers, residential care communities, home health agencies, hospices, and nursing homes. This total number of Americans in need of long-term care is projected to more than double to 27 million in 2050. Shocking estimates of the annual amount spent on long-term services are between $10.9 billion and $306 billion. 16 The NCHS report profiles users of Long-Term Care services (by gender, with users overwhelmingly women (72.0%), followed by race and functional characteristics. At least three-quarters of users are Non-Hispanic white persons with Alzheimer’s disease or other dementias and depression. Most of these elderly individuals require assistance with activities of daily living such as bathing, dressing, toileting (personal hygiene), oral hygiene, and eating. 20-22   Alarmingly, Washington State’s national daily use of residential care communities by residents aged 65 and over was significantly higher than that of the national rate (Figure 17). 16 Unregulated care aids, known as certified nursing assistants (CNAs) are the predominant providers (up to 80%) of direct resident care in LTCFs (Figures 6 & 8). 14- 17,23  These frontline caregivers have little formal training, manage high workloads, and frequently experience responsive behavior from residents. 17 Further they are faced with tremendous challenges each day to provide high-quality care to clients, unrealistic expectations of brushing every resident’s teeth three times a day and flossing once a day is impossible. No wonder LTCFs are plagued with an inability to recruit and retain nursing assistants. Turnover among direct care workers is reported as has high as 100 percent in some organizations. 17   According to the Federal government, LTCFs must provide routine oral care and emergency dental services to Medicaid residents. 16, 18  Most long-term older patients are medically compromised or frail, unable to provide oral hygiene self-care and often resistant to mouth care from nursing assistants. 15-18 Many CNAs admit to failing to provide this service because of this resistive behavior. 16 Not surprising oral health status of nursing home residents has been described as poor and even “deplorable”. 19 In addition to LTC residents having greater oral hygiene needs than any other segment of the population including fungal infections, xerostomia, root caries, periodontal disease, and other oral health concerns, more residents are living longer with natural teeth 18-20 restored with expensive crown and bridge work, and infection vulnerable implants. 24 Now is the time to develop collaborative practice models for oral health promotion and disease prevention in these primary care facilities, utilizing educational resources such as Smiles for Life curriculum and mobile dental professionals. Action needs to be taken to improve frontline caregiver’s knowledge in oral health practices, motivate LTCFs residents in oral healthcare and develop strategies to reduce resistive behaviors.  Regular assessments, monitoring and management of oral care through routine dental care provided by mobile dental hygienists will improve oral quality of life, with direct effects on general quality of life and well-being. 21  Improvement of LTCFs resident’s oral health will require interdisciplinary training and the collaboration of dental health professionals and LTCF primary healthcare teams. 26,27 Together we can have Washington State ready to meet the needs of this projected “silver tsunami” both in primary care and oral care!
© Copyright 2000 Alliance of Dental Hygiene Practitioners. All rights reserved.
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Our Aging Population and Oral Health Challenges
Long-Term Care Settings and Oral Care Call-to-Action
(MacEntee, M. I., Müller, F., & Wyatt, C., 2011)
1. Colby, L., & Ortman, J. M. (2014). The baby boom cohort in the United States: 2012 to 2060, Current Population Reports: P25-1141. U.S. Census Bureau, Washington, DC. Retrieved from: https://www.census.gov/content/dam/Census/library/publications/2014/demo/p25-1141.pdf. 2. Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: The older population in the United States, Current Population Reports: P25-1140.  U.S. Census Bureau, Washington, DC. Accessed February 15, 2018. Retrieved from: https://www.census.gov/library/publications/2014/demo/p25-1140.html 3. Administration on Aging. (2013) Aging Statistics. Retrieved from: www.aoa.acl.gov/Aging_Statistics_growth/future_growth.aspx#age. 4. Shrestha, L.B., & Heisler, E. J. (2011). The changing demographic profile of the United States. Washington, DC: Congress Research Service. Retrieved from: https://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1830&context=key_workplace 5. Jacobsen, L. A., Kent, M., Lee, M., & Mathers (2011). America’s aging population: Population Bulletin 66, no. 1. Retrieved from: www.prb.org/pdf11/aging-in-america.pdf 6. Stone, A. (2015). Dying from dirty teeth: Why the lack of proper oral care is killing nursing home residents and how to prevent it. Oceanside, CA: Indie Books International, LLC. 7. Jeffcoat, M. K., Jeffcoat, R. L., Gladowski, P. A., Bramson, J. B., & Blum, J. J. (2014). Impact of periodontal therapy on general health: Evidence from insurance date for five systemic conditions. Am J Prev Med; 47(2): 166-174. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0749379714001536 8. Seymour, G.J., Ford, P.J., Cullinan, M. P., Leishman, S., & Yamazaki, K. (2007). Relationship between periodontal infections and systemic disease. European Society of Clinical Microbiology and Infectious Diseases, CMI, 13 (Suppl. 4), 3-10. Retrieved from: http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)62459-9/pdf 9. Xiaojing L., Kolltveit, K. M., Tronstad, L., & Olsen, I. (2000). Systemic diseases caused by oral infection. Clin Microbiol Rev. Oct; 13(4): 547–558. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88948/pdf/cm000547.pdf 10. Kim, J., & Amar, S. (2006). Periodontal disease and systemic conditions: A bidirectional relationship. Odontology: 94(1): 10-21. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443711/pdf/nihms-13055.pdf 11. Bale, B.F., Doneen, A. L., & Vigerust, D.J. (2016). High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgradmedj-2016-134279. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520251/. 12. U.S. Department of Health and Human Services (2000). Oral health in America: A report of the surgeon general. U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, Rockville, Md. Retrieved from: https://www.nidcr.nih.gov/research/data-statistics/surgeon-general. 13. Oral Health America (2016). A state of decay: Are older Americans coming of age without oral healthcare? Wisdom Tooth Project: Vol. 3. Retrieved from: https://oralhealthamerica.org/our-work/advocacy/a-state-of-decay/download/. 14. Marek, K. D., & Antle, L. (2008). Patient safety and quality: An evidence-based handbook for nurses. Chapter 18: Medication management of the community-dwelling older adult. Rockville, MD: Agency for Healthcare Research and Quality (US). Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2670/ 15. MacEntee, M. I., Müller, F., & Wyatt, C. (2011). Oral healthcare and the frail elder: A clinical perspective. Hoboken, NY: Blackwell Publishing, Ltd. 16. Harris-Kojetin, L., Sengupt, M., Park-Lee, E., & Valverde, R. (2013). Long-term care services in the United States: 2013 overview. National Center for Health Statistics. Vital Health Sat: 3(37). Retrieved from: http://www.cdc.gov/nchs/data/series/sr_03/sr03_037.pdf. 17. Gil-Montoya, J. A., Mello, A. L., Barrios, R., Gonzales-Moles, M. A., & Bravo, M. (2015). Oral health in the elderly patient and its impact on general well-being: A nonsystematic review. Clinical Interventions in Aging: 10 461-467. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334280/pdf/cia-10-461.pdf 18. Wiener, J. M., Freiman, M. P., & Brown, D. (2007). Nursing home care quality: Twenty years after the Omnibus Budget Reconciliation Act of 1987. The Henry J. Kaiser Family Foundation. Retrieved from: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7717.pdf 19. Jablonski, R. A. (2010). Examining oral health in nursing home residents and overcoming mouth care-resistive behaviors. Annals of Long-Term Care: Clinical Care and Aging: 18[1]:21-26. Retrieved January 2018 from: https://www.managedhealthcareconnect.com/article/examining-oral-health-nursing-home-residents-and-overcoming-mouth-care-resistive-behaviors. 20. Razak, P. A., Richard, K. M., Thankachan, R. P., Hafiz, H. A., Kumar, K. N., & Sameer, K. M. (2014). Geriatric oral health: A review article. J Int Oral Health; 6(6): 110-6. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295446/. 21. Squillace, M. R., Remsburg, R. E., Bercovitz, A., Rosenoff, E., & Branden, L. (2007). An introduction to the National Nursing Assistant Survey. National Center for Health Statistics. Vital Health Stat: 1(44). Retrieved from: https://www.cdc.gov/nchs/data/series/sr_01/sr01_044.pdf. 22. Delgado, A. M., Prihoda, T., Nguyen C., Hicks, B., Smiley, L., & Taverna, M. (2016). Professional caregivers’ oral care practices and beliefs for elderly clients aging in place. The Journal of Dental Hygiene: 90(4). Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjxu8G27srZAhUU_2MKHTASDj4QFggxMAE&url=http%3A%2F%2Fjdh.adha.org%2Fcontent%2F90%2F4%2F244.full&usg=AOvVaw2 KkL5srAU3pIfS81jFzf1j 23. Dahm, T. S., Bruhn, A., & LeMaster, M. (2015). Oral care in the long-term care of older patients: How can the dental hygienist meet the need? The Journal of Dental Hygiene: 89(4). Retrieved from: http://jdh.adha.org/content/89/4/229.full.pdf 24. Ikebe, K., Wada, M., Kagawa, R., & Maeda, Y. (2009). Is old age a risk factor for dental implants? Japanese Dental Science Review: 45, 59-64. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1882761609000039. 25. Jablonski, R. A., Therrien, B., & Kolanowski, A. (2011). No more fighting and biting during mouth care: Applying the theoretical constructs of threat perception to clinical practice. Res Theory Nurs Pract; 25(3):21-26. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298085/. 26. Griffin, S. O., Jones, J. A., Brunson, D., Griffin, P. M., & Bailey, W. D. (2012). Burden of oral disease among older adults and implications for public health priorities. American Journal of Public Health; 102(3):411- 418. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487659/. 27. Porter, J., Ntouva, A., Read, A., Murdoch, M., Ola, D., & Tsakos, G. (2015). The impact of oral health on the quality of life of nursing home residents. Health and Quality of Life Outcomes; 13:102. Retrieved from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501060/pdf/12955_2015_Article_300.pdf
References
© Copyright 2000 Alliance of Dental Hygiene Practitioners. All rights reserved.
April 13 - 14, 2018 at Bellevue Embassy Suites in Bellevue, Washington. Earn up to 15+ CE units over the two-day event.
Our Aging Population and Oral Health Challenges
Long-Term Care Settings and Oral Care Call-to-Action
Last year, 2017 marked the 30th anniversary of the enactment of the Nursing Home Reform Act as part of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), that established standards focused on quality of life in Long-term Care Facilities (LTCFs), that require LTCFs to provide comprehensive data collection to be reimbursed by Medicare and Medicaid. 15 According to the most current report conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), nearly 8 million older adults in the United States received services from Long-Term Care Facilities (LTCFs) such as adult day services centers, residential care communities, home health agencies, hospices, and nursing homes. This total number of Americans in need of long-term care is projected to more than double to 27 million in 2050. Shocking estimates of the annual amount spent on long- term services are between $10.9 billion and $306 billion. 16 The NCHS report profiles users of Long-Term Care services (by gender, with users overwhelmingly women (72.0%), followed by race and functional characteristics. At least three-quarters of users are Non-Hispanic white persons with Alzheimer’s disease or other dementias and depression. Most of these elderly individuals require assistance with activities of daily living such as bathing, dressing, toileting (personal hygiene), oral hygiene, and eating. 20-22  Alarmingly, Washington State’s national daily use of residential care communities by residents aged 65 and over was significantly higher than that of the national rate (Figure 17). 16 Unregulated care aids, known as certified nursing assistants (CNAs) are the predominant providers (up to 80%) of direct resident care in LTCFs (Figures 6 & 8). 14-17,23  These frontline caregivers have little formal training, manage high workloads, and frequently experience responsive behavior from residents.17 Further they are faced with tremendous challenges each day to provide high- quality care to clients, unrealistic expectations of brushing every resident’s teeth three times a day and flossing once a day is impossible. No wonder LTCFs are plagued with an inability to recruit and retain nursing assistants. Turnover among direct care workers is reported as has high as 100 percent in some organizations. 17   According to the Federal government, LTCFs must provide routine oral care and emergency dental services to Medicaid residents. 16, 18  Most long-term older patients are medically compromised or frail, unable to provide oral hygiene self- care and often resistant to mouth care from nursing assistants. 15-18 Many CNAs admit to failing to provide this service because of this resistive behavior. 16 Not surprising oral health status of nursing home residents has been described as poor and even “deplorable”. 19 In addition to LTC residents having greater oral hygiene needs than any other segment of the population including fungal infections, xerostomia, root caries, periodontal disease, and other oral health concerns, more residents are living longer with natural teeth 18-20 restored with expensive crown and bridge work, and infection vulnerable implants. 24 Now is the time to develop collaborative practice models for oral health promotion and disease prevention in these primary care facilities, utilizing educational resources such as Smiles for Life curriculum and mobile dental professionals. Action needs to be taken to improve frontline caregiver’s knowledge in oral health practices, motivate LTCFs residents in oral healthcare and develop strategies to reduce resistive behaviors.  Regular assessments, monitoring and management of oral care through routine dental care provided by mobile dental hygienists will improve oral quality of life, with direct effects on general quality of life and well-being. 21  Improvement of LTCFs resident’s oral health will require interdisciplinary training and the collaboration of dental health professionals and LTCF primary healthcare teams. 26,27 Together we can have Washington State ready to meet the needs of this projected “silver tsunami” both in primary care and oral care!
(MacEntee, M. I., Müller, F., & Wyatt, C., 2011)