An intervention to reduce care‐resistant behavior in persons with dementia during oral hygiene: a pilot study

The primary purpose of this pilot study was to test the feasibility of an intervention designed to reduce care‐resistant behaviors (CRBs) in persons with moderate‐to‐severe dementia during oral hygiene activities.The intervention, Managing Oral Hygiene Using Threat Reduction (MOUTh), combined best oral hygiene practices with CRB reduction techniques. Oral health was operationalized as the total score obtained from the Oral Health Assessment Tool (OHAT). CRB was measured using a refinement of the Resistiveness to Care Scale. Seven nursing home residents with dementia received twice daily mouth care for 14 days. The baseline OHAT mean score of 7.29 (SD = 1.25) improved to 1.00 (SD = 1.26, p < .001); CRB improved from 2.43 CRBs/minute (SD = 4.26) to 1.09 CRBs/minute (SD = 1.56, t = 1.97, df 41, p= .06).The findings from this pilot study suggest that the MOUTh intervention is feasible and reduced CRBs, thus allowing more effective oral care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110640/1/j.1754-4505.2011.00190.x.pd

Reducing care-resistant behaviors during oral hygiene in persons with dementia

Abstract Background Nursing home residents with dementia are often dependent on others for mouth care, yet will react with care-resistant behavior when receiving assistance. The oral health of these elders deteriorates in the absence of daily oral hygiene, predisposing them to harmful systemic problems such as pneumonia, hyperglycemia, cardiac disease, and cerebral vascular accidents. The purpose of this study is to determine whether care-resistant behaviors can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response. The intervention, called Managing Oral Hygiene Using Threat Reduction, combines best mouth care practices with a constellation of behavioral techniques that reduce threat perception and thereby prevent or de-escalate care-resistant behaviors. Methods/Design Using a randomized repeated measures design, 80 elders with dementia from 5 different nursing homes will be randomized at the individual level to the experimental group, which will receive the intervention, or to the control group, which will receive standard mouth care from research team members who receive training in the proper methods for providing mouth care but no training in resistance recognition or prevention/mediation. Oral health assessments and care-resistant behavior measurements will be obtained during a 7-day observation period and a 21-day intervention period. Individual growth models using multilevel analysis will be used to estimate the efficacy of the intervention for reducing care-resistant behaviors in persons with dementia, and to estimate the overall efficacy of the intervention using oral health outcomes. Activity-based costing methods will be used to determine the cost of the proposed intervention. Discussion At the conclusion of this study, the research team anticipates having a proven intervention that prevents and reduces care-resistant within the context of mouth care. Long-term objectives include testing the effect of the intervention on systemic illnesses among persons with dementia; examining the transferability of this intervention to other activities of daily living; and disseminating threat reduction interventions to nursing home staff, which may radically change the manner in which care is provided to persons with dementia. Trial Registration ClinicalTrials.gov: NCT01363258http://deepblue.lib.umich.edu/bitstream/2027.42/112778/1/12903_2011_Article_198.pd

Working Memory, Cues, and Wayfinding in Older Women

Individuals create cognitive maps based on relationships between cues in the environment. Older individuals are often impaired in wayfinding, especially in environments that lack distinctive features. This study examines how working memory ability in older women is related to wayfinding performance in the presence of salient (distinctive, prominent) or nonsalient cues. The degree of salient cue complexity is also examined, thus leading to the hypothesis that salient, complex cues are important in wayfinding and that working memory capacity is related to wayfinding performance. The virtual computer-generated arena is used to test this hypothesis in 20 healthy older women in three different environmental cue conditions varying in salience and complexity. Data analyses indicate that older women perform best in salient cue conditions. A greater working memory capacity is related to improved performance in the nonsalient cue condition. These findings offer preliminary evidence that cue salience is especially important in wayfinding