Original article
Assessment of the oral health knowledge of healthcare providers in geriatric nursing homes: additional training needs required line Catteau1,2, Sophie Piaton2, Emmanuel Nicolas2,3, Martine Hennequin2,3 and Claire Ce Lassauzay2,4,5 1
D epartement Sant e Publique, Facult e de Chirurgie Dentaire, Universite Lille 2, Lille, France; 2Centre de Recherche en Odontologie Clinique, Clermont Universit e, Universit e d’Auvergne, Clermont-Ferrand, France; 3CHU Clermont-Ferrand, Service d’Odontologie, ole Odontologique, CHU Nice, Clermont-Ferrand, France; 4UFR Odontologie, Universite Nice Sophia Antipolis, Nice Cedex 4, France; 5P^ Nice, France
doi: 10.1111/ger.12094 Assessment of the oral health knowledge of healthcare providers in geriatric nursing homes: additional training needs required Objectives: This study was aimed at assessing the knowledge of oral health and training needs of health workers in geriatric nursing homes. Background: Providing daily oral care to dependent elderly people is the best way to prevent oral disorders. Because there are no dental hygienists in France, health workers play an important role in providing oral care in nursing homes and should have correct and adequate knowledge. Materials and methods: Health workers from 8 geriatric nursing homes in Puy de D^ ome (France) completed a 58-item questionnaire. Oral health knowledge regarding dental decay, periodontal diseases, oral hygiene and denture care was assessed. Univariate and bivariate analyses were performed. Results: A total of 99 health workers took part in the study. The total mean score was significantly different if health workers had received training in oral disorders (49.3 11.7 vs. 43.9 10; p < 0.05) or in the maintenance of oral health (50.5 10.5 vs. 42.9 10; p < 0.01). The mean scores obtained in the ‘dental decay’ subsection and in the ‘oral and denture hygiene’ subsection were the lowest. Conclusion: Geriatric nursing home staff need training in understanding the impact of oral health on general health. Theoretical knowledge of oral diseases has to be improved in order for health workers to understand oral hygiene procedures and to help them identify early oral disorders. Keywords: elderly, nursing homes, caregivers, education. Accepted 10 October 2013
Introduction In France, the status of oral health and healthcare needs of institutionalised elderly people are well documented by medical services of the public health office. These studies, such as that of Cohen et al.1 highlighted degraded oral health and the lack of organisations in providing oral and dental care to residents. Several studies have focused on the impact of oral disorders on the general health of patients.2,3 The relationship between poor oral health and aspiration pneumonia in elderly people was studied in particular.4 Indeed, bacterial plaque was
shown to constitute a specific reservoir for respiratory pathogens.5,6 Poor oral health and poor oral hygiene increase the number of oral germs in saliva, which could become a risk factor for respiratory infections if swallowed. In the same way, the role of oral health on nutritional status is well documented: disorders in oral functions are one of the main risk factors for malnutrition, a major problem in the elderly population.3 Finally, oral health can also affect the quality of life. According to McGrath and Bedi 7 72% of elderly people considered oral health important for their quality of life, especially in terms of mastication and comfort.
© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd, Gerodontology 2016; 33: 11–19
11
12
C. Catteau et al.
In the dependent elderly, many factors favour oral health degradation, for instance a modified diet (pureed food), poor or insufficient oral hygiene, mouth dryness, difficulty in obtaining care, and unawareness or inaptitude in expressing discomfort. A daily oral hygiene regimen adapted to each patient is the best way to avoid oral health degradation. However, most of the elderly people in nursing homes are not taught about oral health, and their oral hygiene habits are often inadequate. As there are no dental hygienists in France, health workers in nursing homes assist the elderly in this particular activity, and the importance of this role increases with the level of dependence of the elderly person. Handling oral hygiene is part of the nurse’s responsibility, but auxiliary nurses may carry out this task under the nurse’s supervision.8,9 Hospital agents in charge of maintaining and cleaning facilities and ensuring better comfort for residents 9 often manage both the general hygiene and oral hygiene of the residents, although they may be the staff least well-trained to perform these tasks. Managing another person’s oral hygiene correctly requires appropriate knowledge and adapted skills. In France, unlike English-speaking countries, the evaluation of oral health knowledge of health workers is not documented.10,11 The purpose of this study was to assess the theoretical oral health knowledge of health workers in nursing homes and their training needs, in order to propose appropriate training courses.
Materials and methods
care, and oral hygiene measures provided within the institutions. The third part consisted of one short-answer question to assess the participant’s awareness of the relationship between oral disorders, systemic diseases and medical treatment. This question asked participants to mention systemic diseases and medical treatments known to interact with oral disorders. The fourth part consisted of 30 questions to assess oral health knowledge. The questions were organised into four subsections: ‘dental decay’ (six multiple-choice questions including two questions requiring multiple answers), ‘periodontal diseases’ (seven multiple-choice questions including three questions requiring multiple answers, two short-answer questions asking participants to define gingivitis and periodontitis, respectively), ‘oral and denture hygiene’ (nine multiple-choice questions) and ‘removable dentures’ (six multiple-choice questions). Fifteen minutes was necessary to complete the questionnaire. Data collection After agreement with the appropriate authorities, the questionnaire was distributed to 203 health workers (36 nurses, 76 auxiliary nurses and 91 hospital agents) in eight nursing homes (seven public institutions and one private institution) in Puy de D^ ome (France), comprising a total of 603 residents. Participation was done on a voluntary basis and anonymously. A delay of 2 weeks was given during which time follow-up calls were made to ensure good progress of the study. Questionnaires were deposited anonymously in a box.
The questionnaire The questionnaire used in this study was based on 3 questionnaires previously published in English-speaking countries, which were translated according to the usual process of validation.10–12 The compiled French version was pretested on a panel of health workers from a nursing home (six nurses, eight auxiliary nurses and five hospital agents) to validate the questionnaire and to apply the adjustments required. The final questionnaire including 58 questions consisted of four parts. The first part was related to socio-demographic data (gender, age, professional activity) and their oral health attitudes (visit to dentist and dental anxiety). The second part was related to the nature of oral health training received previously and their interest in training opportunities within their working environment, access by residents to oral health
Scoring knowledge For the purposes of the analysis of part four of the questionnaire, knowledge scores were calculated. For each answer required for the multiplechoice questions, each correct answer was scored ‘+1’, whilst wrong, missing and ‘do not know’ answers were scored ‘0’. For the short-open questions, the answers were regarded as correct and were scored ‘+1’ when gingivitis was globally defined as an inflammation of the gums and periodontitis as a destructive periodontal disease. The number of answers required ranged between 6 and 21, depending on the subsection, with a total of 47. The score of each subsection was weighted by reporting back the number of points to 21. The four scores were then summed to yield a total score varying between 0 and +84.
© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd, Gerodontology 2016; 33: 11–19
Oral health knowledge in nursing homes
Statistical analyses â
Data were analysed using Excel 2007 and IBM SPSSâ Statistic 19 (IBM Corporation, Armonk, NY, USA). Univariate analysis was conducted and results concerning quantitative variables were presented in terms of mean, standard deviation, median, minimum and maximum, whilst qualitative variables were presented in terms of frequency distribution. Bivariate analysis was performed using the Kruskal–Wallis nonparametric test or the Mann–Whitney U test to compare mean scores between independent groups defined by variables of interest (qualification, oral health attitudes, oral health training previously received). p-values
Assessment of the oral health knowledge of healthcare providers in geriatric nursing homes: additional training needs required line Catteau1,2, Sophie Piaton2, Emmanuel Nicolas2,3, Martine Hennequin2,3 and Claire Ce Lassauzay2,4,5 1
D epartement Sant e Publique, Facult e de Chirurgie Dentaire, Universite Lille 2, Lille, France; 2Centre de Recherche en Odontologie Clinique, Clermont Universit e, Universit e d’Auvergne, Clermont-Ferrand, France; 3CHU Clermont-Ferrand, Service d’Odontologie, ole Odontologique, CHU Nice, Clermont-Ferrand, France; 4UFR Odontologie, Universite Nice Sophia Antipolis, Nice Cedex 4, France; 5P^ Nice, France
doi: 10.1111/ger.12094 Assessment of the oral health knowledge of healthcare providers in geriatric nursing homes: additional training needs required Objectives: This study was aimed at assessing the knowledge of oral health and training needs of health workers in geriatric nursing homes. Background: Providing daily oral care to dependent elderly people is the best way to prevent oral disorders. Because there are no dental hygienists in France, health workers play an important role in providing oral care in nursing homes and should have correct and adequate knowledge. Materials and methods: Health workers from 8 geriatric nursing homes in Puy de D^ ome (France) completed a 58-item questionnaire. Oral health knowledge regarding dental decay, periodontal diseases, oral hygiene and denture care was assessed. Univariate and bivariate analyses were performed. Results: A total of 99 health workers took part in the study. The total mean score was significantly different if health workers had received training in oral disorders (49.3 11.7 vs. 43.9 10; p < 0.05) or in the maintenance of oral health (50.5 10.5 vs. 42.9 10; p < 0.01). The mean scores obtained in the ‘dental decay’ subsection and in the ‘oral and denture hygiene’ subsection were the lowest. Conclusion: Geriatric nursing home staff need training in understanding the impact of oral health on general health. Theoretical knowledge of oral diseases has to be improved in order for health workers to understand oral hygiene procedures and to help them identify early oral disorders. Keywords: elderly, nursing homes, caregivers, education. Accepted 10 October 2013
Introduction In France, the status of oral health and healthcare needs of institutionalised elderly people are well documented by medical services of the public health office. These studies, such as that of Cohen et al.1 highlighted degraded oral health and the lack of organisations in providing oral and dental care to residents. Several studies have focused on the impact of oral disorders on the general health of patients.2,3 The relationship between poor oral health and aspiration pneumonia in elderly people was studied in particular.4 Indeed, bacterial plaque was
shown to constitute a specific reservoir for respiratory pathogens.5,6 Poor oral health and poor oral hygiene increase the number of oral germs in saliva, which could become a risk factor for respiratory infections if swallowed. In the same way, the role of oral health on nutritional status is well documented: disorders in oral functions are one of the main risk factors for malnutrition, a major problem in the elderly population.3 Finally, oral health can also affect the quality of life. According to McGrath and Bedi 7 72% of elderly people considered oral health important for their quality of life, especially in terms of mastication and comfort.
© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd, Gerodontology 2016; 33: 11–19
11
12
C. Catteau et al.
In the dependent elderly, many factors favour oral health degradation, for instance a modified diet (pureed food), poor or insufficient oral hygiene, mouth dryness, difficulty in obtaining care, and unawareness or inaptitude in expressing discomfort. A daily oral hygiene regimen adapted to each patient is the best way to avoid oral health degradation. However, most of the elderly people in nursing homes are not taught about oral health, and their oral hygiene habits are often inadequate. As there are no dental hygienists in France, health workers in nursing homes assist the elderly in this particular activity, and the importance of this role increases with the level of dependence of the elderly person. Handling oral hygiene is part of the nurse’s responsibility, but auxiliary nurses may carry out this task under the nurse’s supervision.8,9 Hospital agents in charge of maintaining and cleaning facilities and ensuring better comfort for residents 9 often manage both the general hygiene and oral hygiene of the residents, although they may be the staff least well-trained to perform these tasks. Managing another person’s oral hygiene correctly requires appropriate knowledge and adapted skills. In France, unlike English-speaking countries, the evaluation of oral health knowledge of health workers is not documented.10,11 The purpose of this study was to assess the theoretical oral health knowledge of health workers in nursing homes and their training needs, in order to propose appropriate training courses.
Materials and methods
care, and oral hygiene measures provided within the institutions. The third part consisted of one short-answer question to assess the participant’s awareness of the relationship between oral disorders, systemic diseases and medical treatment. This question asked participants to mention systemic diseases and medical treatments known to interact with oral disorders. The fourth part consisted of 30 questions to assess oral health knowledge. The questions were organised into four subsections: ‘dental decay’ (six multiple-choice questions including two questions requiring multiple answers), ‘periodontal diseases’ (seven multiple-choice questions including three questions requiring multiple answers, two short-answer questions asking participants to define gingivitis and periodontitis, respectively), ‘oral and denture hygiene’ (nine multiple-choice questions) and ‘removable dentures’ (six multiple-choice questions). Fifteen minutes was necessary to complete the questionnaire. Data collection After agreement with the appropriate authorities, the questionnaire was distributed to 203 health workers (36 nurses, 76 auxiliary nurses and 91 hospital agents) in eight nursing homes (seven public institutions and one private institution) in Puy de D^ ome (France), comprising a total of 603 residents. Participation was done on a voluntary basis and anonymously. A delay of 2 weeks was given during which time follow-up calls were made to ensure good progress of the study. Questionnaires were deposited anonymously in a box.
The questionnaire The questionnaire used in this study was based on 3 questionnaires previously published in English-speaking countries, which were translated according to the usual process of validation.10–12 The compiled French version was pretested on a panel of health workers from a nursing home (six nurses, eight auxiliary nurses and five hospital agents) to validate the questionnaire and to apply the adjustments required. The final questionnaire including 58 questions consisted of four parts. The first part was related to socio-demographic data (gender, age, professional activity) and their oral health attitudes (visit to dentist and dental anxiety). The second part was related to the nature of oral health training received previously and their interest in training opportunities within their working environment, access by residents to oral health
Scoring knowledge For the purposes of the analysis of part four of the questionnaire, knowledge scores were calculated. For each answer required for the multiplechoice questions, each correct answer was scored ‘+1’, whilst wrong, missing and ‘do not know’ answers were scored ‘0’. For the short-open questions, the answers were regarded as correct and were scored ‘+1’ when gingivitis was globally defined as an inflammation of the gums and periodontitis as a destructive periodontal disease. The number of answers required ranged between 6 and 21, depending on the subsection, with a total of 47. The score of each subsection was weighted by reporting back the number of points to 21. The four scores were then summed to yield a total score varying between 0 and +84.
© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd, Gerodontology 2016; 33: 11–19
Oral health knowledge in nursing homes
Statistical analyses â
Data were analysed using Excel 2007 and IBM SPSSâ Statistic 19 (IBM Corporation, Armonk, NY, USA). Univariate analysis was conducted and results concerning quantitative variables were presented in terms of mean, standard deviation, median, minimum and maximum, whilst qualitative variables were presented in terms of frequency distribution. Bivariate analysis was performed using the Kruskal–Wallis nonparametric test or the Mann–Whitney U test to compare mean scores between independent groups defined by variables of interest (qualification, oral health attitudes, oral health training previously received). p-values
