BACKGROUND: The CDC Division of Oral Health reports that 70 percent of the U.S. population over 65 has periodontal disease. The American Dental Association has found that poor oral health among the elderly in long-term care is pervasive and has been linked to aspiration pneumonia among other systemic health problems. The risk of aspiration pneumonia is associated with periodontal disease, dental caries and poor oral hygiene and complicated by swallowing disease, feeding problems and poor functional status. The cost associated with aspiration pneumonia in nursing homes alone makes the study of oral health particularly appealing to the field of long-term care.
METHODS: The research tested the extent of knowledge gain and subsequent transfer to practice in the work environment. Direct care workers attended one of six two-day trainings conducted by dental hygienists who were trained by the curriculum author. A pre-test post-test design was used to measure key content knowledge gained from the training. Standard signficance testing and instrument reliabilty and validity tests were conducted. Observation of workplace behavior before and after training, interviews and reviews of policies and procedures before and after training provided measures of the effect of the training on practice, impact on policy and procedures and understanding of the day to day practice among direct care workers related to oral health care.
RESULTS: Significant gains in knowledge about oral health among direct care workers were found on pre and post-tests at the time of the training, and at follow-up on free recall and guided assessments. Modest changes in day to day practice were found. Organizational changes occurred in some facilities supporting implementation of practices to support oral health as a priority in long term care.
CONCLUSIONS: Findings from this study for improving oral health delivery systems in long term care facilities indicate a need for opportunities among long term care agencies to enroll higher percentages of the workforce in oral health training. The effectiveness of the development of an organizational culture that prioritizes oral health care is supported by the long-term outcomes measured by the study. Further study of long-term changes in aspirational pneumonia cases and other hospital readmissions, the reasons for those readmissions and their associated costs is needed to support organizational changes necessary to further improve oral health care in long term care facilities.