Investigation of oral health assessment measures for the care planning of dependent adults

Abstract

Dependent adults (i.e. eighteen-year-old or older who need or receives assistance due to a reduction in mental capacity or physical capability) can experience oral health problems. Whilst the reasons behind these problems are complex, evidence suggests that caregivers’ limited knowledge about oral health and care may play a role. Oral health measurement instruments could provide one means by which to help caregivers establishing appropriate oral care plans for dependent adults and, thus, preventing or managing these problems. This project aimed to investigate oral health assessment measures for oral care planning of dependent adults through three separate studies. A qualitative evidence synthesis was undertaken to establish an empirical conceptual model of oral health in dependent adults. It showed that oral health in dependent adults is a dynamic and multidimensional construct that consists of four domains: the intactness and cleanliness of oral structures; oral pain and discomfort; oral functions; and noticeable oral health aspects. A systematic review was undertaken to critically appraise published oral health measurement instruments for dependent adults. It revealed many instruments have been proposed, but none of these instruments has been adequately and comprehensively tested to establish strong evidence in relation to their measurement properties, feasibility and interpretability. Finally, a qualitative interview study was undertaken to explore healthcare service providers’ perspectives on barriers and implementation issues in relation to measuring oral health in dependent adults. The consistent theme was that the implementation of oral health measurement instruments may not be easy due to multiple potential barriers. These barriers therefore need to be considered during implementation, including those related to instruments, service providers, dependent adults and implementation environment. The findings in this thesis support a recommendation that multiple perspectives need to be considered when designing and evaluating oral health measurement instruments used to guide oral care planning for dependent adults. By doing this, these instruments are more likely to meet different stakeholders’ needs and, thus, can be successfully implemented.