A Focus on Oral Health in Long-Term Care
Evidence has shown that poor oral health practices contribute to negative health outcomes for residents of long-term care (LTC) facilities. The association between poor oral health and several systemic diseases, including pneumonia and respiratory tract infection, among older adults in nursing homes or hospitals has received increasing attention.
There is a need for improved oral hygiene among older adults, especially those residing in LTC facilities. This population faces challenges with self-care due to sensory, mobility, endurance, and cognitive deficits, and oral health literacy among people over the age of 65 has been found to be lacking, contributing significantly to the prevalence of oral disease in this population. Two articles in this issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC) focus on this important aspect of caring for older adults in the LTC setting.
The first article highlights the susceptibility of residents recieving palliative care to oral problems that may lead to oral dysfunction, which can cause unnecessary pain and discomfort, thereby affecting their quality of life. The oral care that dentists provide to palliative care patients can play an important role in the overall provision of healthcare to these patients. Adina C. Jucan, DDS, and Ralph H. Saunders, DDS, MS, summarize the current information regarding the most common oral problems of patients receiving palliative care, their prevalence and etiology, and recommendations for their management in LTC.
The availability of oral healthcare to the LTC population is limited, partially because facility administrators often presume that only a dentist can provide oral healthcare services to their residents. Diana Macri, DSDH, MSEd, AADH, points out in her article that many alternative options for providing oral care in the LTC setting are available, including the utilization of dental hygienists. In assisted living and LTC facilities, the contributions the dental hygienist can make in reducing the incidence of oral disease and, consequently, the incidence of systemic disease, have been well documented. Dental hygienists are oral disease prevention specialists and are trained to perform dental procedures that significantly improve a person’s oral health. In her article, Macri reviews models of collaboration between LTC facilities and dental hygienists that have proven efficacious in enhancing overall health outcomes for residents.
Other articles included in this issue focus on the important subject of advance care planning and the assessment of residents’ capacity to make important decisions about their health and end-of-life care. James T. Crosby provides a Tip Sheet for conducting an advance care planning meeting with residents and their families, highlighting the most important steps and considerations for these sensitive conversations. In Ask the Expert, we interview Jennifer Moye, PhD, about considerations for assessing the decision-making capacity of older adults, as well as the ethical and legal implications of impaired decision-making capacity. These issues are timely, as the Centers for Medicare and Medicaid Services have recently introduced new CPT billing codes to cover discussions of advance directives with patients, their family members, or surrogates.
Finally, a Case Report is presented by Bharat Humar, MD, that exemplifies how a rare neurological disorder called steroid-responsive encephalopathy with associated thyroiditis (SREAT) may be misidentified as dementia in LTC residents.
Please email your comments to our Managing Editor, Kara Rosania, at krosania@hmpcommunications.com.
Thank you for reading!
