Oral care for nursing home residents

shutterstock_50920687 nurse and elderly patient holding hands

Residents of long-term care facilities and nursing homes are prone to poorer oral health.  They often need additional care and support to maintain good oral hygiene. The incidence of community acquired pneumonia can be up to 10 times higher amongst the nursing home residents than in community dwelling older people.  Recent evidence has suggested that poor oral hygiene may be an additional risk factor for pneumonia in this group.

The aim of this Cochrane review was to assess effects of oral care measures for preventing nursing home-acquired pneumonia in residents of nursing homes and other long-term care facilities.

Methods

Searches were conducted in the Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, the Sciencepaper Online, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform. Randomised controlled trials (RCTs) evaluating the effects of oral care measures (brushing, swabbing, denture cleaning mouthrinse, or combination) in residents of any age in nursing homes and other long-term care facilities were considered.

At least to reviewers independently selected studies extracted data and assessed risk bias from individual studies. Dato from studies with similar interventions and outcomes was pooled, dichotomous outcomes were reported as risk ratios (RR) continuous outcomes as mean difference (MD) and hazard ratio (HR) for time-to-event outcomes.

Results

  • 4 RCTs involving 3905 patients were included.
  • All for RCTs were considered to be at high risk of bias.
  • One study was stopped before completion so was not included in the quantitative analysis.
  • It was not possible to determine whether professional oral care resulted in
    • a lower incidence rate of pneumonia compared with usual oral care over an 18-month period; HR = 0.65 (95%CI; 0.29 to 1.46); one study, 2513 participants analysed; low-quality evidence).
    • in a lower number of first episodes of pneumonia compared with usual care over a 24-month period; RR=0.61 (95%CI; 0.37 to 1.01); one study, 366 participants analysed; low-quality evidence).
  • There was low-quality evidence from 2 studies that professional oral care may reduce the risk of pneumonia-associated mortality compared with usual oral care at 24-month follow-up: RR= 0.41(95%CI; 0.24 to 0.72) 507 participants analysed).
  • It is uncertain whether or not professional oral care may reduce all-cause mortality compared to usual care, when measured at 24- month follow-up; RR = 0.55 (95%CI; 0.27 to 1.15); one study, 141 participants analysed; very low-quality evidence).
  • Only one study (834 participants randomised) measured adverse effects of the interventions.  There were no serious events and 64 non-serious events, the most common of which were oral cavity disturbances (not defined) and dental staining.
  • No studies evaluated oral care versus no oral care.

Conclusions

The authors concluded: –

Although low-quality evidence suggests that professional oral care could reduce mortality due to pneumonia in nursing home residents when compared to usual care, this finding must be considered with caution. Evidence for other outcomes is inconclusive. We found no high-quality evidence to determine which oral care measures are most effective for reducing nursing home-acquired pneumonia. Further trials are needed to draw reliable conclusions.

Comments

Oral health is an integral part of general health and wellbeing and a basic human right. The recent NICE guideline (Dental Elf – 11th July 2016) recommended that care home policies should promote and protect residents oral health. So, while this review sought to determine whether professional oral care had a beneficial effect on nursing home acquired pneumonia with the findings suggesting that  professional care may reduce mortality due to pneumonia  the available evidence is of low quality and should be interpreted cautiously. However, it is important to emphasise that good oral care should be a key component of nursing home care notwithstanding any potential additional benefits to general health.

Links

Primary Paper

 Liu C, Cao Y, Lin J, Ng L, Needleman I, Walsh T, Li C.
Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD012416. DOI: 10.1002/14651858.CD012416.pub2.

Other references

Cochrane Oral Health Group Blog Professional oral mouth care for nursing home residents: is it more effective than usual care?

Dental Elf – 30th Jun 2017

Oral care in nursing homes

 

Dental Elf – 11h Jul 2016

Oral Health should have same priority as general health in care homes says NICE

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