National and international evaluation of the optimized oral health-related section of het BelRAI and its incorporation in the interRAI suite of instruments

Oral health of care-dependent older people is poor due to limited daily oral health care and difficult access to professional dental care (De Visschere et al. 2016). This poor oral health affects their general health and quality of life (Tran et al. 2018). Dental health care professionals are the most obvious health care professionals to assess the oral health of care-dependent older people. However, it is the non-dental caregiver who is responsible for their adequate daily oral care and timely referral to a dentist or other oral care professional. Therefore it is essential that these non-dental caregivers can estimate the oral health status of the care-dependent elderly. Since the eighties multi-dimensional instruments are developed to assess nursing home residents in order to identify their care needs and to allow adequate overall care planning. The internationally used interRAI Suite of Instruments (www.interrai.org) includes an oral health assessment and considers oral health as part of general health and well-being. It holds the potential to integrate oral health care into the overall care planning. As the validity of the current oral-health related interRAI section is poor (Folse et al. 2001, Nordenram & Ljunggren 2002, Krausch-Hofmann et al. 2019), our research group developed and validated an optimized version of the oral-health related section of the interRAI (funded by internal KU Leuven fund C24-15-034), referred to as the OHR-RAI. Two CAPs (Clinical Assessment Protocols) were developed. These are trigger algorithms that process the collected data from the interRAI assessment and alert the caregiver in case a care action is needed. One CAP is triggered when oral hygiene is deficient and assistance with daily oral hygiene is required. The other CAP is triggered in case oral health is deficient and referral to a dentist is required. Guidelines for daily oral health care were developed and coupled to the CAPs. With these CAPs, the collected oral health information is translated into concrete actions applicable in care when needed. The proposed project has three objectives. First, it will evaluate the effect of this newly developed oral assessment tool and associated training at the level of the care-dependent older person as well as at het level of the caregivers. At the level of the older person, the effect of the use of the OHR-RAI on oral hygiene, oral health, oral health care and general health will be evaluated over time. At the level of the caregivers, the effect on knowledge and attitude towards oral health (care) will be assessed. Besides the effect of the OHR-RAI itself, also the effect of a specifically developed training will be investigated on both the concurrent validity of the OHR-RAI and on the knowledge and attitude of the care providers. This will lead to further fine-tuning and embedding of the oral assessment in the BelRAI (the Belgian version of the interRAI, which is currently being implemented in the national health care system)(https://www.belrai.org/). Second, adaptation of the assessment to the international context, in collaboration with international partners, will allow international validation and evaluation. This project ultimately aims to incorporate and anchor the oral health assessment within the interRAI Suite of Instruments and therefore improve oral health care and oral health for care-dependent older persons internationally. Third, based on these two first objectives, adjustments will be made in order to further fine-tune the instrument and its training and to make it more reliable and effective. These results will be presented to the interRAI Instruments and Scales Committee (ISD). After agreement of interRAI ISD, the instrument will be mounted on the interRAI intraweb and spread among organizations and countries that use the interRAI assessments. The results of the research and the new instrument will also be presented at the interRAI network meetings.