Improving the implementation of oral hygiene care in resistant-to-care clients with dementia
Orlov, Roman (2024)
2024
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https://urn.fi/URN:NBN:fi:amk-2024112831019
https://urn.fi/URN:NBN:fi:amk-2024112831019
Tiivistelmä
Dementia, particularly Alzheimer's disease, presents significant challenges to oral health maintenance due to cognitive decline and behavioural symptoms, such as care-resistant behaviours (CRBs). Patients with dementia often experience a deterioration in oral health as their ability to manage daily activities declines, resulting in increased plaque buildup, poor periodontal health, and a lower quality of life. Nurses and nursing students face particular difficulties in maintaining oral hygiene for these patients, as resistance to care and uncooperativeness are common, especially in the later stages of the disease. This review aimed to identify practical strategies that nurses and nursing students can adopt to improve the delivery of oral hygiene routines for dementia patients exhibiting CRBs, which is essential for the patient’s well-being and the reduction of caregiver burden.
The study used a descriptive review method, collecting data between June and August 2024 from databases including PubMed, CINAHL, Cochrane Library, and Google Scholar. A total of nine studies were selected, with the thematic analysis used for data analysis and the CASP tool was applied to evaluate the quality of the studies. The review identified a combination of verbal and non-verbal communication strategies, along with the concept of timing, as critical in reducing CRBs.
Verbal strategies such as using clear, simple language, avoiding elderspeak, and offering one-step instructions are highlighted as effective in minimizing confusion and creating a sense of comfort for the patient. Non-verbal approaches, including gentle touch, hand-over-hand guidance, and the “mirror-mirror” technique, further enhance patient cooperation. Additionally, providing care during optimal times, particularly when patients are calmer, such as in the morning, has been shown to significantly reduce resistance.
However, the literature also reveals differing views on certain strategies, particularly the use of distractions and closed-ended questions. While some studies support these techniques, others caution that distractions can sometimes lead to overstimulation and increased confusion. This variation underscores the importance of personalized care, where nurses must adapt their approach based on individual patient needs.
This review provides practical ways that can improve oral hygiene care for uncooperative dementia patients, highlighting the need for tailored, patient-centred approaches. The findings emphasize the role of effective communication, non-verbal cues, and timing in reducing CRBs, offering practical guidance for nurses and nursing students. Implementing these strategies can lead to better health outcomes for patients while also reducing the physical and psychological strain on caregivers.
The study used a descriptive review method, collecting data between June and August 2024 from databases including PubMed, CINAHL, Cochrane Library, and Google Scholar. A total of nine studies were selected, with the thematic analysis used for data analysis and the CASP tool was applied to evaluate the quality of the studies. The review identified a combination of verbal and non-verbal communication strategies, along with the concept of timing, as critical in reducing CRBs.
Verbal strategies such as using clear, simple language, avoiding elderspeak, and offering one-step instructions are highlighted as effective in minimizing confusion and creating a sense of comfort for the patient. Non-verbal approaches, including gentle touch, hand-over-hand guidance, and the “mirror-mirror” technique, further enhance patient cooperation. Additionally, providing care during optimal times, particularly when patients are calmer, such as in the morning, has been shown to significantly reduce resistance.
However, the literature also reveals differing views on certain strategies, particularly the use of distractions and closed-ended questions. While some studies support these techniques, others caution that distractions can sometimes lead to overstimulation and increased confusion. This variation underscores the importance of personalized care, where nurses must adapt their approach based on individual patient needs.
This review provides practical ways that can improve oral hygiene care for uncooperative dementia patients, highlighting the need for tailored, patient-centred approaches. The findings emphasize the role of effective communication, non-verbal cues, and timing in reducing CRBs, offering practical guidance for nurses and nursing students. Implementing these strategies can lead to better health outcomes for patients while also reducing the physical and psychological strain on caregivers.