Evidence-Based Construction Of Non-Intubated Elderly Patients With Oral Management Program

Objective:The questionnaire survey method was used to understand the oral cleansing status and influencing factors of non-intubated elderly patients in tertiary general hospitals in Shanxi Province.The oral health behaviors of non-intubated elderly patients after hospitalization were analyzed.The demand for oral management was clarified.On this basis,the system retrieves clinical practice guidelines and systematic evaluations on oral management of non-intubated elderly patients at home and abroad,constructs a best practice information book for oral management of non-intubated elderly patients,and constructs the oral cavity of non-intubated elderly patients through expert meeting method.The management program provides a reference for the oral management of non-intubated elderly patients in hospitals.Methods:(1)Questionnaire method: Based on the WHO Oral Health Survey.5th version survey program,search for relevant literature at home and abroad,and make self-made questionnaires based on the clinical characteristics of non-intubated elderly patients,and adopt convenient sampling method to select 6 cities in Shanxi Province.284non-intubated elderly patients in neurology and neurosurgery in 6 tertiary general hospitals conducted face-to-face questionnaires on oral health-related quality of life,oral health attitudes,and behaviors;(2)Semi-structured interview: In-depth interview with 20 non-intubated elderly patients to understand their needs for oral management;(3)Comprehensive evidence method: systematically search for clinical practice guidelines and systematic evaluation of oral management of non-intubated elderly patients,and integrate and analyze the contents of the literature;(4)Evidence evaluation: According to the “ JBI 2010 version of evidence classification and evidence recommendation level system”,the above evidence iscomprehensively and refined,and the best practice information booklet and preliminary draft for non-intubated elderly patients’ oral management are drawn up;(5)Expert meeting method: Organize experts in the field of aged care and oral care to hold an expert meeting to revise and improve the first draft of the oral management plan for non-intubated elderly patients,and form the final version of the oral management program for non-intubated elderly patients.Results:(1)Questionnaire survey results: A total of 302 questionnaires were distributed and284 valid questionnaires were returned,with an effective recovery rate of 94.04%;1)Oral health-related quality of life and influencing factors in non-intubated elderly patients: oral health-related quality of life scores for non-intubated elderly patients were(3.52±1.64)points,number of teeth,and Barthel self-care ability scores(activities)Of daily living;ADL),the role of patients after admission was the influencing factor of oral health quality in elderly patients(P<0.05),predicting 13.3% of the variation;2)Comparative analysis of oral health behaviors of non-intubated elderly patients before and after admission: Only 26.5% of elderly patients brushed their teeth ≥ 2times a day before admission,and decreased to 16.0% after admission.49.2% of elderly patients did not use fluoride toothpaste before and after admission.The frequency of use of toothbrushes,mouthwashes,wooden toothpicks,plastic toothpicks and dental floss was statistically significant(2=221.741,554.928,329.044,333.995,713.991,P<0.01).The frequency of brushing after admission was ≥2 times.The number of people once a day has decreased,the number of people who have never brushed their teeth has increased,and the number of people who have ≥2 times has increased;3)Ordered logistic regression analysis of oral cleansing status and influencing factors in elderly patients with severe non-intubation: culture level,economic level and ADL had significant effects on the frequency of brushing in non-intubated elderly patients after admission(P<0.05).(2)Qualitative findings: The oral management needs of non-intubated elderly patients are mainly in four aspects: physiological needs,oral health knowledge and management skills needs,balance of general health and oral health needs,economic and social support needs;(3)Evidence synthesis and evidence evaluation: Through the domestic andinternational database evidence search,a total of 8 clinical practice guidelines and15 systematic reviews were included,which were combined and extracted,and a preliminary evidence of 8 aspects was established: oral health care Concepts,assessments,objectives,records,risk factor management,clustering measures,hierarchical management programs and health education;(4)The formation of the best practice information book for oral management of non-intubated elderly patients: combined with the current status of the survey results,evidence retrieval and evaluation results,preliminary formation of non-intubated elderly patients oral management program best practice information book,mainly covering The best evidence of eight aspects;(5)Construction of oral management program for non-intubated elderly patients:Organized 6 experts from the geriatrics,stomatology,neurology,and neurosurgery,held expert meetings,and revised the structure and contents of the first draft of the program.Content item,supplementary content 2,including 8 aspects of advice.Conclusion:(1)The oral health status of elderly patients is not ideal,and has not improved after hospitalization.On the contrary,other behaviors other than sputum are significantly weakened;it is necessary to improve the oral health behavior of patients and observe whether they will improve the clinical outcome of patients;(2)Older patients with different ADL,oral health-related quality of life and oral health behavior after admission are different,guiding us to develop a graded oral management program for elderly patients under different ADL;(3)Based on the current situation survey,evidence synthesis and expert meeting method,an oral management program for non-intubated elderly patients suitable for clinical practice and meeting the needs of patients was constructed.The program consists of 8 aspects,for future managers to caregivers in elderly patients.Training in oral health management provides programs to promote the scientific and standardized development of oral management for non-intubated elderly patients.