Validation and optimization of the oral health-related section of the interRAI suite of assessment instruments
Human lifespan is increasing in all regions of the world. Ideally, these added life years are spent in good health. A healthy mouth, free of infection and with an adequate number of teeth, contributes to well-being and healthy aging. However, oral health is often poor in frail older persons who are not able to perform adequate daily oral care. Access to professional dental services is also challenging for this population which causes that oral health problems are often not detected in time. In professional care settings, oral health assessment by non-dental professional caregivers can help to detect care needs.
The interRAI suite of instruments is used internationally to assess care needs and health risks of vulnerable persons. An oral health-related section (ohr-interRAI) is included in the versions used in long-term care and in the home care setting. Ideally, this section detects persons who need assistance with daily oral care or who need to be referred to a dentist. However, the current ohr-interRAI section and related precursor versions fail to achieve this goal.
1. The first part of the PhD explored the underlying reasons for the failure of the current ohr-interRAI section to adequately detect oral care needs.
Content validity was evaluated by a group of experts who had a professional background relevant for oral health in care-dependent older individuals. The experts agreed that the ohr-interRAI section was incomplete to assess oral care needs sufficiently. It further became clear that items were lacking in relevance, clarity of wording and feasibility to be completed by non-dental caregivers.
Focus group discussions with caregivers revealed that adequate detection of oral health-related care needs was impeded by shortcomings of the ohr-interRAI section itself and by a lack of awareness and training of caregivers.
Analysis of available interRAI data from Belgium showed that the prevalence of missing oral health-related information was related to the general health status of the care client. This result confirmed that clear instructions and training are lacking on how to assess oral health.
2. In the second part of the PhD, a new optimized photograph-supported ohr-interRAI section and an associated video training were developed and tested.
A preparatory study revealed small differences between dentists and professional non-dental caregivers assessing oral health-related conditions shown on photographs. It was concluded that comments and explanations should complement the photographs to facilitate accurate interpretation by non-dental caregivers.
The optimized ohr-interRAI section was developed in consecutive phases. The nine items included self-reported oral health complaints of the client, but inspection of the mouth was also mandatory. Visualizing photographs were selected based on the assessment by a group of experts and dentists. The video training emphasized the relevance of oral health and provided instructions on how to assess oral health with the optimized ohr-interRAI section. A study with 260 nursing home residents showed that psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. However, caregiver-dentist agreement and agreement among caregivers only ranged between very low and moderate. Small positive effects of the video training were found. Based on these findings, the optimized ohr-interRAI was further modified and refined.
3. In the third part of the PhD, clear and concise practice guidelines for daily oral care were developed for the optimized ohr-interRAI. A modified Delphi study was conducted to complement the available evidence with feedback from international experts. The guidelines are now available to help to improve care when poor oral hygiene is detected with the optimized ohr-interRAI section.
In a follow-up research project, the refined version of the optimized ohr-interRAI section will be implemented and its effects will be evaluated internationally.