Examining Oral Health in Nursing Home Residents and Overcoming Mouth Care–Resistive Behaviors
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Nursing home residents are a group with significant health disparities in the area of oral health. Poor oral health can place nursing home residents at risk for developing pneumonia, exhibiting poor glycemic control if already diabetic, and increasing cardiovascular disease. The majority of nursing home residents arrive with some or all of their dentition but without the resources to continue preventive dental care—Medicare does not reimburse for routine dental care and Medicaid either does not reimburse for this service or reimburses so poorly, few providers will accept it. The onus of mouth care falls on nursing assistants; many admit to failing to provide mouth care because of mouth care–resistive behaviors. Clinicians in nursing homes can model specific methods to reduce mouth care–resistive behaviors (for example, bridging, priming, and avoiding elderspeak) and share these techniques with the nursing assistants responsible for providing mouth care. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[1]:21-26)
Introduction
In the United States, nearly 2 million older adults reside in 16,100 nursing homes (NHs).1,2 The majority of these elderly individuals require assistance with activities of daily living (ADL),3 and nursing assistants (NAs) are the predominant providers of this care.4 The National Institute of Dental and Craniofacial Research (NIDCR) recognizes these NH residents as a group with significant health disparities in the area of oral health.5 The existence of acute and chronic diseases may create a negative spiral in which the diseases are worsened by the presence of poor oral health, which deteriorates as their medical problems progress.6 The oral health status of NH residents has been described as “deplorable.”7 There are emerging connections between poor oral health and poor systemic health. The number of residents retaining their natural teeth exacerbates the problem of poor oral care in NH. In the early 1980s, 54% of persons age 65 years or older had some natural teeth; by 2002, the percentage had increased to 70%.5 The purpose of this review is to describe the oral health of elderly NH residents, the effect of mouth care–resistive behaviors on the oral health of these residents, and specific interventions to reduce mouth care–resistive behavior.
General Description of the NH Population
The current NH population is frail and functionally dependent. Ninety-one percent of NH residents are 65 years of age or older, and 46% are 85 years of age or older.3,8 Eighty-three percent require assistance with three or more ADL.9,10 The three most common ADL requiring assistance were bathing or showering (96%), dressing (87%), and eating (45%).3 Oral care was not specifically mentioned in any ADL category, but one could conservatively estimate that the 45% who required assistance with eating would most likely require assistance with mouth care. Self-care is further compromised by cognitive impairment; 70% of NH residents exhibit some form of cognitive impairment regardless of diagnoses.9
Oral Health Affects Systemic Health
Nearly one-third of all older adults experience xerostomia, or dry mouth, due to hyposalivation.11 Xerostomia causes mouth discomfort, interferes with chewing and swallowing, and supports plaque formation.11 Furthermore, saliva has antibacterial properties; diminished saliva production results in increased bacteria in the mouth.
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