09 May In 500 words, briefly, present your project with the preliminary results obtained during implementation. Please include at least 2 references. This is for a discussion bo

Oral Health Promotion to Improve the Quality of Life in

Older Adults Living Independently

Jorge Trapaga

UAGM

Scholarly Project

Running Head: ORAL HEALTH PROMOTION 2

2

Oral health promotion to improve the quality of life in older adults living independently

Oral health diseases are the most neglected in healthcare organizations, affecting almost 3.5 billion people worldwide. They are not highly discussed for all age groups, but when it comes to older people, they need more care. Most of the problems are related to dentistry, but older adults, especially those who live independently, are highly prone to the disorders. Older adults do not have the strong immunity to face the different diseases. Oral diseases are common because of the decayed tooth and dental carriers. The project will discuss the problem in detail (Allin, 2020).

Older adults need the care of their families to face the different issues. The research and practice problem focuses on the oral health problems of older adults who lack family care and live independently. They have different experiences in self-care and dental issues. Sometimes, the older adults are neglected because they do not have enough money to go to a dentist or physician to treat their diseases or suffer from other diseases, so they ignore the oral health disorders. The topic of oral health will have huge scope in the future (Li, 2021).

The state of being physically, mentally, and socially well is referred to as health. Such definition has been widely accepted and is used as a guiding principle by healthcare practitioners. The process of empowering people to exert more control over and improve their health is known as health promotion. It shifts away from an emphasis on personal conduct and toward the various societal and environmental interventions. Broad research has been studied to determine the importance of oral health and increase awareness of its significance to the general population. Poor oral health can lead to pain, eating and speaking difficulties, and poor self-esteem (Li & Yao, 2021). It can also have a negative effect on general health, contributing to heart disease, stroke, pneumonia, and other health complications.

Oral health promotion involves the various activities, including education, policy development, and community-based initiatives. Current statistics demonstrates that over 78% of the elderly population experience issues with oral health (Janto et al., 2022). It shows that oral health is among the highly overlooked conditions in healthcare. It is not highly discussed for all age groups, but when it comes to older people, they need more care. Most of the issues are related to dentistry, but older adults, especially those who live independently, are highly prone to the disorders (Drachev et al., 2022). The elderly do not have the strong immunity to face the different diseases.

Oral diseases are common because of the decayed tooth and dental caries (Li & Yao, 2021). A number of factors contributes to the oral health problems experienced by older adults, and they include age-related changes in the mouth, such as a decrease in saliva production and increase in a number of teeth with fillings or crowns, gingivitis and periodontal disease, tooth decay and loss, abscessed tooth; chronic illnesses, such as diabetes; and medications, such as those used to treat high blood pressure and depression. Apart from that, older adults are more likely to have a poorer diet and be less physically active, which can affect oral health (Allin et al., 2020).

Older adults have experienced the health problems like caries, periodontal, and plaque. All of these will be focused on in the research project. After the identification of the problem, the intervention will be implemented. There are three components of the intervention. The first is to give awareness and educational sessions to the older people who will be the participants. They will be informed of the predicted issues of oral disorders. Moving on, the assessments will be conducted before and after the program, and in the end, the health belief model will be implemented throughout the research project. The project's purpose is to explore the effect of a four-week oral health education project on elderly persons living independently at an adult community within Miami, Florida.

Significance of the Practice Problem

Today, a great majority of countries have faced the issue of the aging population. At the same time, an increase in the proportion of the elderly implies the increase in the prevalence of poor health outcomes (Thomson et al., 2021). Typically, older people are associated with high medicine use, various chronic and acute illnesses, and multiple physiological alterations in aging body systems (Schensul et al., 2020). Oral health at an advanced age is considered a highly significant determinant of life satisfaction and quality of life (Reisine et al., 2020). Usually, the elderly is at higher risk of numerous health problems and social isolation because of life crises, hence implying greater alteration in their informal relationships (Karkada et al., 2021(b)). Apart from the fact that older people endure discomfort and pain related to poor health, they exhibit poor psychosocial and physical functioning, thus affecting the ability to perform daily activities and maintain social connections (Karkada et al., 2021(a)). In addition, they suffer from poor oral health, which becomes a substantial problem at an advanced age.

Oral health is an integral part of people’s lives and has an impact on physical, social, and emotional health. Firstly, poor oral health has several clinical outcomes (Montanha-Andrade et al., 2019). Frequently, it is associated with plaque buildup, edentulism, tooth loss, as well as root and coronal caries (Bianco et al., 2021). Apart from this, Ortíz-Barrios et al. (2019) mention that older adults often experience oral mucosal lesions, chewing problems, and the use of non-functional dentures (complete or partial), among other conditions. Apparently, preventing deterioration in swallowing and chewing function can assist in prolonging a healthy lifespan (Saito et al., 2020). Although the elderly generally retains their teeth longer, they experience poor oral health due to accumulated oral deficiency (Roma et al., 2021). Apart from various clinical outcomes, the effect of poor oral health on quality-of-life parameters is highly pronounced among the elderly (Rosli et al., 2019). For instance, often, damaged dentition results in functional limitations, such as problems with biting and chewing, psychological effects including reluctance to eat in front of other people, behavioral effects, such as restriction on the amounts or types of foods, and discomfort or pain while eating (Rosli et al., 2019). However, age is not the main reason why older people have oral problems. Thus, poor oral hygiene and ignored chronic diseases are the major reasons for poor oral health (Teufer et al., 2019). The situation is exacerbated by the fact that the elderly seeks dental care less often compared to other age groups. In turn, poor oral health can threaten normal speech and food intake, which can result in adverse psychological and social outcomes (Roma et al., 2021). Moreover, treatment of oral diseases can be difficult in this age group due to low motivation and chronic diseases (Roma et al., 2021). In such a way, oral health is highly important to the elderly, which is why oral health promotion is necessary to improve their quality of life.

When examining oral health in the elderly, oral health-related quality of life (OHRQoL) should be considered. Often, older people living independently, who have different oral problems, exhibit poor psychosocial and physical function, as well as discomfort and pain. In turn, these conditions have significant implications on their ability to carry out daily activities and imply problems in their social communication and oral functioning (Ortíz-Barrios et al., 2019). Czwikla et al. (2021) indicate that, generally, older adults who live independently are less able to visit the dental office, brush teeth, and take care of dentures. This can result in toothache, systemic disease, poor oral health, poor nutritional status, and an increased risk of tooth loss (Czwikla et al., 2021). Apart from this, the outcomes of insufficient oral health can contribute to reduced quality of life and increased healthcare costs (Czwikla et al., 2021). Tooth loss is considered one of the major elements that have an impact on the biopsychosocial state of the elderly (Ortíz-Barrios et al., 2019). Tooth loss is not only a result of untreated periodontal disease or caries since it can indicate extraction of teeth during the orthodontic intervention, trauma, and a complex of other factors not associated with dental illnesses, for example, inability or unwillingness to pay, the lack of access to dental services, and adverse attitudes towards healthcare (Ortíz-Barrios et al., 2019). In the elderly, there are signs of healthy habits obtained early in life, hence meaning that the aging process produces a series of alterations in sensory perception, social status, as well as motor and cognitive functions. On a large scale, social origin has a close association with the risk of illnesses, including periodontitis and caries (Ortíz-Barrios et al., 2019). Social context has a strong effect on individual behavior, with oral hygiene becoming the most significant behavioral factor. Therefore, many older adults face problems with social communication and oral functioning when it comes to oral health, and, therefore, it is necessary to implement effective oral health promotion programs. Older people should follow an oral hygiene regimen that can be performed with the help of various devices, for instance, mobile phones that provide an opportunity to introduce behavioral programs into real-life contexts.

Research Problems, PICOT Question, and Hypotheses

Older adults need the support from their families to face the different issues. The research and practice problem focuses on the oral health issues of older adults that lack family care and live independently. Oral health is disregarded mainly by many people, especially older adults, which is why this topic was chosen. Caries, periodontal disease, and plaque are among the oral health issues that are more prevalent among the elderly. They have different experiences in self-care and dental problems. Sometimes, the older adults are neglected since they do not have enough money to go to a dentist or physician to treat their diseases or suffer from other conditions, so they ignore the oral health disorders. The topic of health would have immense scope in the future.

The research question is: “What is the effect on oral health(O), before and after, (C) of a four-week (T) oral health education program (I) among older adults living independently in an adult living facility in Miami, Florida (P)?” The elderly persons at an independent adult living in Florida are the demographic being studied. The study's intervention is an oral health education program, as contrasted to the failure to perform the education. The desired outcome is an improvement of oral health to be achieved in four weeks. Older adults have experienced the health problems of caries, periodontal, and plaque. The research would concentrate on each of these. Oral health is the dependent variable in this inquiry. A four-week oral health education program for elderly individuals living independently in a Miami, Florida, adult living facility, is the independent variable. The study hypothesizes that the four-week oral well-being education scheme would encourage the oral health amongst the elderly population.

There are three components of the intervention. The first is to give awareness and educational sessions to the older people, the participants. They would be informed of the predicted issues of oral disorders. Moving on, the assessments would be conducted before and after the program, and in the end, the health belief model would be implemented throughout the research project.

Theoretical Framework: The Health Belief Model (HBM)

It is logic that older adults face many health issues, however, this project is devoted to one of the aspects of their health that is often neglected, namely oral health. The purpose is to check how proper education in this area will help this group to be more attentive to oral health. The health belief model (HBM) is a handy tool to reach this purpose. Using the HBM, older adults will have some properly shaped perceived constructs, like susceptibility, severity and benefits, will not see any barriers to applying to health providers and will correctly accept the offered action clues in the form of the educational materials. The results of a four-week educational session in the HBM framework will be favorable for the considered age group.

A Brief History of the HBM

It is worth noting that the HBM is not a product of nurses. It is a non-nursing approach, developed by y social scientists of the U.S. Public Health Service in the early 1950s (The health, 2019). The material, named Main Constructs (n.d.), gives a more detailed information and reveals that the theory was developed by social psychologists Hochbaum, Rosenstock and others. So, the HBM is a group work. The initial aim of the HBM was “to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease.” (The health, 2019, para.1). Though the HBM was not developed by nursing providers, some scientific scholarly base for its development is present: “chest x-rays for tuberculosis (TB) screening that were underused because many people with TB did not recognize their symptoms and did not seek medical care for what they deemed a mere cough (Green et al., 2020). Thus, the HBM development is properly grounded.

Social psychologists saw that they could help healthcare providers to solve the problem of people’s disbelief that they may have something wrong with their health and that conventional medical approaches can significantly help them to improve their quality of life. At the initial stages of its development the HBM was rooted in the process of information giving about different preventive healthcare services and immunization. Later some educational sessions were added. The HBM had to address some people’s concerns about whether some physical and moral efforts, implemented into the healthcare process are truly worth the received results (Green et al., 2019). Thus, the main goal of the HBM is to convince people in the necessity to be treated.

It is possible to state that both psychologists and the obtained test results of the patients played a crucial role in the HBM development. The information helped to prepare a scientific base for the approach. Psychologists shared their experience in this aspect and stated that people were truly afraid of developing some serious illness and this perceived fear could be managed. Different messages on TV and social media could encourage people to apply to preventive services or to pass some additional tests (Green et al., 2019). Thus, the HBM does both: explains why people lose belief in medical services and determines how it is possible to help such possible patients from a psychological point of view.

Constructs of the HBM

As it is clear from the previous paragraphs, the HBM proved to be very useful, as it answers many questions about people’s behavior in terms of healthcare. The model has a number of properly developed constructs. They are perceived benefits, severity, susceptibility and barriers and acute cues and self-efficacy (Main construct, n.d.). Perceived susceptibility is often named as the first construct. The scholars define it as: “belief about getting a disease or condition” (Main constructs, n.d.). It is a starting term, because, if a psychologist learns that a person fears to develop some illness, it can be a starting point for applying the HBM.

It is interesting to note that the HBM can be applied to any perceived parameter and that if a person has one, this fact does not mean that he/she has others or all the others. A person may have a strong belief in the severity of his/her state and the benefits of applying to some medical services. However, he/she may have such a strong belief into the existing barriers to a healthcare process that he/she will not do anything. It is the time to give a person some cues to action in the form of the educational materials. In such a way he/she may have a feeling of self-efficacy, the construct, which was added later to the list (Green et al., 2019). Thus, the HBM logically distributes the activities.

Besides the enumerated constructs, the developers of the HBM theory state that there are some individual factors that influence people’s desire to apply to healthcare providers. They are age, gender, ethnicity and other (Main constructs, n.d.). It is easy to understand these personal characteristics. For example, if a person is too young, he/she may treat his/her health carelessly, simply because he/she mostly feels good. People of male gender do not tend to apply to providers, because they are mostly overloaded with work or think that their wives will assume a responsibility for everything. In order for the HBM to properly influence an individual, he/she should be ready to change his/her health behaviors. The approach is effective for people, who continuously repeat the same harmful actions like do not fasten their seat belt or consume fast food. The HBM works for people, who do not believe that they can quit their unhealthy habit like smoking or regular alcohol consumption (Green et al., 2019). Thus, there are numerous circumstances, when the HBM is effective.

Components of the HBM and the Practice Change Model

The project of the practice change model is devoted to evaluating the results of a 4-week educational session about the importance of oral health for older adults, living in Miami, Fl. Different reasons for such a careless attitude of older adults to their oral health are possible. One factor is that they live independently. Other factors are the enumerated perceived constructs. The discussed HBM is the most suitable to encourage the older adults to care for their oral health.

It is a well-known fact that oral health is very important for the overall state of health of an individual. Caries and periodontitis are the most common dental health problems in the world (Ashoori, et al., 2020). Older adults can suffer from plaque too. Ashoori et al. (2020) write that their research of students’ oral health issues showed “the necessity to emphasize the perceived benefits, self-efficacy and cues to action.” (p.26). With the purpose to solve the existing dental health issues of the students. Older adults, as another age-group, may perceive these actions well too. It is possible to additionally add the concept of perceived severity, as older adults definitely want to prevent the development of any complications. Thus, it is obvious that my research proposal should be devoted to the HBM.

The discussed findings can be complemented by some research results of other scholars. Sulat et al. (2018) indicate that researching more than 450 articles, devoted to the HBM “perceived benefits were the strongest predictor, while perceived severity was the weakest.” (p.500). However, for the investigated age group the construct of perceived severity will encourage the patients to apply to the oral health care. The planned educational sessions will have a preparatory part and a part that will show, which perceived constructs are revealed or shaped. First, it is required to learn, what facts older adults already know about dental health, including plaque reduction. Then possible patients will receive all educational materials and explanations. The last stage will be to learn how the views of older adults changed after the sessions, and if the materials or actions triggered this change and their oral health improved. Itis possible to change the views of the older patients on their oral health with the help of the HBM and give them such actions cues that they will include regular oral health examinations into their regular checks.

It is worth noting that the HBM is very practical and valuable for older adults with dental health problems. It is important to shape all perceived constructs for them. They should understand that their general state of health includes the condition of their oral health. The action cues in the form of educational sessions and written materials will demonstrate the older adults that there are not any barriers to applying to dental healthcare providers and they should be encouraged to do it with the help of the offered action cues. The HBM will definitely shape some constant oral health habits with the considered group of the older adults.

Synthesis of the Literature

Oral Health

A lot of literature is dedicated to the study of oral health problems and promotion to improve the quality of life in older adults who live independently. Such close attention to this topic is associated with the fact that the population is aging, which is a real problem in many countries. According to Bianco et al. (2021), aging is considered one of the most severe problems of the 21st century for many countries. In 2000, the number of people aged 60 and older was around 605 million while, by 2050, it is estimated to increase to almost 2 billion (Mittal et al., 2019). Moreover, Shokouhi et al. (2019) state that the increase in the elderly population requires close attention to various needs of this age group affecting their quality of life, which is a measure of social development. Old age has a connection with certain physiological alterations, eating problems, and dental and oral issues, for instance, difficulty swallowing and chewing food and tooth loss, which is followed by various diseases (Shokouhi et al., 2019). The authors indicate that chronic diseases tend to increase with age (Shokouhi et al., 2019). The presence of chronic illnesses is exacerbated by the decline in the normal functioning of the aging body, isolation, dependency on others, disability, and the decline in the quality of life (Shokouhi et al., 2019). The aging population increases the burden of different chronic diseases including oral problems.

The elderly experiences a high prevalence of different dental diseases and conditions. They include tooth loss, periodontal disease, plaque buildup, caries, unmet oral care needs, and worsening quality of life (Schensul et al., 2019). Apart from this, Dhama et al. (2021) state that dry mouth, dental caries, and precancerous/cancerous lesions are the most common oral and dental conditions observed in the elderly. Oral health is related to chronic disease and systemic health problems in older age (Malekpour et al., 2022). For instance, cognitive decline, dementia related to serum Porphyromonas gingivalis, high levels of immunoglobulin G, and xerostomia from multiple medications, as well as diabetes and cancer treatments relate to high levels of decay, insufficient oral hygiene, edentulism, and loss of teeth (Schensul et al., 2019). Periodontal disease is related to stroke and heart attack while periodontal treatment can have a positive impact on diabetes control (Schensul et al., 2019). Furthermore, insufficient oral health has an adverse effect on the oral health quality of life (Schensul et al., 2019). Therefore, many older adults experience oral health problems, which is why oral health promotion is of paramount importance to improve the quality of life of this group of people.

Further, a lot of literature is dedicated to the study of various indexes and scales to measure oral health-related quality of life. Nowadays, the Geriatric/General Oral Health Assessment Index (GOHAI) is commonly applied in order to assess oral health-related quality of life. It is grounded on three assumptions, namely, a) an individual can measure oral health through self-assessment; b) levels of oral health and hygiene vary from person to person, which can be demonstrated by applying measures grounded on an individual’s self-perception; c) self-perception has been determined as a predictor of oral health (Ortíz-Barrios et al., 2019). These indexes determine and measure problems associated with oral health in respondents with the 12-item questionnaire that assesses oral health problems in the last three months (Ortíz-Barrios et al., 2019). GOHAI is extremely useful since it assesses the severity of psychosocial consequences related to different oral diseases. GOHAI serves as a valuable tool for the evaluation of the outcomes of oral care services and programs (Ortíz-Barrios et al., 2019). The data provide the basis for efficient policies for an individual segment of the population, for instance, the elderly.

Moreover, Bianco et al. (2021) describe a positive side of using GOHAI. The authors mention that Atchison and Dolan elaborated the Geriatric/General Oral Health Assessment Index in 1990 (Bianco et al., 2021). The index explores the psychological, physical, and physiological needs of the elderly, therefore complementing clinical care. It evaluates three measures of quality of life-related to oral health, which include physical functions involving swallowing, speaking, and chewing; psychosocial functions, such as attitudes towards dental health, irritation from impressions, self-limitation of social contacts because of dental problems, and insecurity about oral health; discomfort or pain, including the mouth discomfort or use of medications (Bianco et al., 2021). Bianco et al. (2021) indicate that GOHAI attaches great importance to the functional state and discomfort. Moreover, Zhi et al. (2021) state that the index places more emphasis on subjective oral health with less clinical alteration and direct clinical aspects. In turn, Bianco et al. (2021) describe one more index related to oral health — OIDP, which was developed by Adulyanon in 1996. OIDP represents one of the characteristics of oral health-related quality of life scales (Wong et al., 2021). These instruments evaluate psychometric features admissible to the elderly (Wong et al., 2021). It consists of nine items that assess the severity and prevalence of problems with dentures or teeth found in the last six months and what effect they have had on older people’s daily activities as per Zhi et al. (2021). In such a way, the source examines GOHAI and OIDP as well as studies how these scales evaluate the impact of oral hygiene and health on quality of life.

Oral Health and Quality of Life

Oral health is essential to good overall health and well-being. The Surgeon General of the United States and the World Health Organization (WHO) have urged preventive public health practices and improved access to oral care (Schensul et al., 2021). The elderly experience great disparities in both mainly because of the limited access to quality dental care and insufficient opportunities to get preventive education that would assist in addressing such diseases as edentulism, periodontal disease, and caries (Schensul et al., 2021). Mittal et al. (2019) try to identify causes resulting in poor oral health among older adults. According to the authors, the use of dental services among the elderly is low due to multiple barriers (Mittal et al., 2019). At the same time, there is no single factor that serves as the biggest barrier to accessing dental services among the elderly. The location of the facilities, the cost of dental care, limited income, the lack of specialists, and the lack of awareness of the services provided are the most common barriers to the use of dental services by older adults (Mittal et al., 2019). In addition, the lack of perceived need for care, oral hygiene literacy, and disability are significant factors that have a substantial impact on dental visits by the elderly (Gunpinar & Meraci, 2022). Apart from this, Lee et al. (2022) claim that oral health literacy is influenced by various demographic factors, such as the level of education, age, diet, monthly income, and activities of daily living. Moreover, Assari and Bazargan (2019) pay attention to socioeconomic status, especially a high level of education. According to the authors, this status promotes access to dental services and protects against insufficient oral health (Assari & Bazargan, 2019). Nonetheless, all people should be as knowledgeable about their healthcare needs as their physicians (Denis et al., 2021). All the barriers mentioned above affect oral health-related quality of life.

Many sources focus on such a phenomenon as oral health-related quality of life (OHRQoL). For instance, Top et al. (2019) state that OHRQoL is applied as an important metric to evaluate and measure health outcomes and treatment management. Mouth and teeth diseases are considered an important public health problem today and OHRQoL can help to evaluate outcomes of oral services and care. Reisine et al. (2021(b)) state that much attention to the quality of life can be associated with the definition of health proposed by the WHO. According to the WHO, health can be defined as “a complete state of physical, mental, and social well-being and not just the absence of disease” (Reisine et al., 2021(a), p 2). Therefore, quality of life has been included in the professional framework for oral health, hence supporting the notion that, in order to assess oral health in people or the results of clinical trials, clinical indicators are not enough (Reisine et al., 2021(a)). The authors affirm that OHRQoL serves as a highly significant construct for determining oral health and is applied as an outcome measure in adult dental clinical trials (Reisine et al., 2021 (a). Zheng et al. (2021) indicate that OHRQoL can be applied for measuring and assessing the effect of oral hygiene and health on a people’s quality of life. It implies a subjective perception of the state of the oral cavity and a subjective assessment of the psychological function, physical function, and aspects of the social activity of oral health (Sermsuti-Anuwat & Pongpanich, 2021). In addition, OHRQoL has the potential to evaluate the association between overall health and oral health from experience and subjective perspectives (Zheng et al., 2021).

In contrast to Reisine et al. (2021(a)), Zheng et al. (2021) pay attention to college students and not the elderly. According to Zheng et al. (2021), college students should have a good quality of OHRQoL since they become future agents of social progress and play a highly important role in the future development of the country. If compare them with people of the middle age, college students are in a period of dynamic growth and their health, behavior, lifestyle, and social psychology are more likely to alter. In turn, poor OHRQoL can have an adverse impact on the stat