Healthy Lifesmiles Development of an Oral Health Promotion training programme for nurses and carers of older people in Co. Meath Mary O’Farrell, Carmel Parnell, HSE Dublin North East

Background Increasing aging dentate population

Numbers aged 65+

Numbers aged 65+ and 80+

Age 80+ as a proportion of age 65+

% dentate aged 65+ Whelton et al., 2007

Background Oral health of older people in residential care is poor Training of carers essential North East Healthy Aging (2002) recognised need for oral health care for older people in residential care

Background St Joseph’s Hospital, Trim, Co. Meath Residential and Day Care Unit Pilot oral health needs assessment, 2004

Pilot study 254 older people examined o 104 residents, 150 Day Care users Poorer oral health status among residents o Fewer teeth but more decay o No dentures High need for denture treatment for both groups

Pilot study Questionnaire to staff (n=54: 66% response rate) o Most were involved in oral health care o 1 in 5 had received training in oral health care o 98% interested in receiving training in oral health care for older people o Low staff turnover

Development of Programme 2007: Pilot oral health programme developed in partnership with: o HSE Meath Dental Services o HSE Meath Oral Health Promoter o HSE Management o St Joseph’s Director of Nursing, senior nursing and health promotion staff

Aim Improve the skills of hospital staff in providing oral health care for residents

Objectives Develop Model of Good Practice o Establish ethos and standards for oral health Develop structured training programme for nurses and carers o OHP resource pack o OH aids Provide denture marking Evaluate training programme

Model of Good Practice “These Oral Health Standards are driven by a respect for the rights of older people and the principle that older people in residential care settings should be able to lead full lives that reflect, as far as possible, the lives they led prior to admission into what will be their home - the residential care setting. Consequently, the standards promote a person-centred ethos and culture that should govern the provision of residential care for older people.”

Summary of Standards 1.Oral health assessment on admission 2.Denture labelling with the owner’s consent 3.Suitable facilities for on-site dental treatment 4.Arrangements for emergency and routine dental care for residents 5.Suitable environment in which residents are able to maintain their oral health 6.Structured Training for Nursing and Care staff in oral health care for residents 7.Introduction of a healthy eating policy 8.Regular ongoing oral care from nursing, care and public dental service staff for residents with dementia

Training Programme 90 nurses and carers Interactive workshops

Healthy Lifesmiles Resource pack for staff o Information pack o Tutor’s guide o 12 Information cards o Guide to oral hygiene aids o CD Oral Health packs

Evaluation Pre and post training questionnaires to workshop participants o Highlighted low awareness of oral health care prior to training Staff very positive about training programme

Evaluation “We are very tuned in now to what food we are giving the patients and tuned in to why patients may be having problems. We are bringing them regularly to the dentist and we are carrying out all the oral assessments”

Evaluation Appreciation of oral health in context of general health “ …the dietician visits the wards every week, so I don’t see it any different that the dentist should visit the ward, and that would help the transition from education for us” “ So, it (poor oral health) really does impact on them. And the pork chop is gone, and the dinner is gone to custard, you know.”

Ways forward New oral health policy for older people Dissemination Ongoing evaluation

Acknowledgements The Team: Mary Carr Dorothy Halpin Rosarii Mc Cafferty Mairin Mc Inerney Liz O’Reilly Rita O’Toole Declan Quinn Staff and clients of St Joseph’s hospital, Trim