Oral care intervention to reduce aspiration pneumonia risk for people living in residential aged care

Name: Oral Health Intervention (for one participant group) Oral health screening for all resident participants. Four measures to be delivered individually to participants in residential aged care by a dentist and a speech pathologist experienced in working with older adults, including adults with dementia. The measures, listed below, will take no longer than 1 hour: (a) Oral Health Assessment Tool: "We will look at your face and lips and then ask you to open your mouth so we can look at your tongue, gums, oral tissues, teeth or dentures, and saliva to rate how healthy they are and whether you need any immediate and specific oral or dental care. We will shine a small light into your mouth so we can see. We also may place a soft wooden tongue depressor on the front of your tongue to keep it steady and gently hold your cheek to one side in the oral examination. If we hold your tongue and/or cheeks in place, we will do this for a short time, only seconds. (b) Mini-Nutritional Assessment (MNA): We will ask you (or your family member, nurse or carer who knows you well) the following questions to determine your risk for being malnourished: • Has your food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties? • Have you lost weight unintentionally during the last 3 months? • How easily are you able to get out of bed and move? • Have you suffered psychological stress or acute distress in the past 3 months? • Are you experiencing any neuropsychological problems such as depression and/or dementia? • What is your height and weight so we can calculate your Body Mass Index (BMI)? (c) Yale Swallow Protocol: We will give you a cup containing 90 mL (3 ounces) of room temperature water and ask you to drink the water through a straw without stopping. If you begin to cough while drinking, we will ask you to stop drinking. This measure helps us determine how well your swallow is coordinated and any risk for material (food, liquid, or saliva) going into your lungs instead of into your stomach. (d) The Euro-Qol-5 Dimension (EQ-5D-3L) Tool: We will ask you (or a family member, nurse, or carer who knows you well) to rate any difficulty you have with mobility (movement), personal care, usual activities (e.g., housework or leisure activities), pain or discomfort, and anxiety or depression. Then we will ask you to draw a line on a scale (rather like a ruler or thermometer) to show us how good, or bad, you feel your health is." All resident participants: Over a 3-month period, all resident participants will undergo 2 minutes of teething cleaning after each meal up to 3 times per day. Ideally the teeth cleaning will be done using a timed electric toothbrush. If residents cannot adjust to the sound or vibration of the electric toothbrush, we will develop 2-minute strategies for using a regular, soft bristled toothbrush, e.g., brushing to series of enjoyed and selected 2-minute recorded songs. If residents wear dentures, these dentures will be cleaned each day and removed for sleep. Residents will be encouraged to participate as actively as possible in cleaning their teeth or dentures, They will be assisted by care staff or family members to ensure this cleaning is done. Adherence to the intervention will be assessed through audits of daily oral care by facility managers, including examination of used toothbrush heads/toothbrushes using a published standardized protocol.. Following the daily intervention period, all resident participants will undergo a repeat of the oral health screening measures.