Assessment of oral health in older adults by non-dental professional caregivers—development and validation of a photograph-supported oral health–related section for the interRAI suite of instruments

Abstract

Objectives An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. Methods The optimized oral health–related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). Results Mean kappa values and percent agreement between caregivers and dentist ranged between κ = 0.60 (80.2%) for dry mouth and κ = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with κ = 0.63 [95% CI: 0.56–0.70] (81.6%), while for the item palate/lips/cheeks only κ = 0.27 [95% CI: 0.18–0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between κ = 0.93 [95% CI: 0.79–1.00] (96.4%) for dry mouth and κ = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. Conclusions Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved. Clinical Relevance Valid assessment of oral health by professional caregivers is essential due to the impaired accessibility of regular dental care for care-dependent older adults.

A systematic review of measurement instruments for oral health assessment of older adults in long‐term care facilities by nondental professionals

“…Most instruments use a three‐point response scale (healthy, changes and, unhealthy) 1,3,4,15–24 accompanied by criteria that define each response option. For example, the Tongue category of OHAT is defined as “healthy” (normal, moist roughness, pink); “changes” (patchy, fissured, red, coated) and “unhealthy” (a patch that is red and/or white, ulcerated, swollen).…”

Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES)

“…Assessment of oral health in older adults by non-dental professional caregivers requires intensive training. 41 In one pilot study with four nurses, an intensive training of 12 hours resulted in high agreements on oral care plans with an oral health professional. 42 The validity and reliability of present oral health assessment tools especially when used by nonoral health professionals need to be further researched.…”

“…According to Chalmers 2005, 40 as the existing geriatric dental trained workforce cannot meet the existing needs, nurses, and other care providers in long‐term facilities need to be trained to assess oral needs and refer to the dentist as appropriate. Assessment of oral health in older adults by non‐dental professional caregivers requires intensive training 41 . In one pilot study with four nurses, an intensive training of 12 hours resulted in high agreements on oral care plans with an oral health professional 42 .…”

Development of practice guidelines for daily oral care in care‐dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach

“…Recently, an optimised oral health section was developed for the interRAI suite of instruments that is internationally used to assess needs and capacities of care‐dependent individuals (InterRAI, 2020; Krausch‐Hofmann et al, 2020). When clients with insufficient oral hygiene are detected, practice guidelines should be available for nursing assistants who often provide direct hygiene care tasks.…”

“…An optimised version of this oral health section was recently developed. One of its aims is the identification of clients with non‐acceptable oral hygiene (Krausch‐Hofmann et al, 2020). To complement this optimised oral health interRAI section, practice guidelines for daily oral care were developed in the present study.…”