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Oral Health in the Pal iative Care Patient: Care throughout the Continuum of Il ness Rose Anne Indelicato, MSN, ANP-BC, ACHPN, OCN, Daniel Pomerantz, MD, MPH, FACP, & Dorothy Wholihan, DNP, ANP-BC, GNP-BC, ACHPN Sound Shore Medical Center of Westchester, New Rochel e, New York New York University Col ege of Nursing (NYUCON), New York, New York INTRODUCTION
OUR CASE: MRS. THOMPSON
•In 2000, the Surgeon General declared dental health as the most Pre/Post Test Results: Questions 1-5
common unmet health need. While preventative oral care has reduced tooth loss, the elderly present with more complicated dental needs and higher levels of oral disease. Diligent oral care is required to prevent systemic complications, promote adequate nutrition and maximize patient comfort and dignity. •77 year old woman with PMH of HTN, COPD, OA & Dementia •Although Palliative Care provides a “total” care focus for patients •Lives at home with her elderly sister Post Test
with serious illness, oral health issues may be forgotten or ignored, •Current Medication Regimen: HCTZ, Arthrotec, Aricept, Namenda, either due to pressing medical problems, a patient’s inability to participate in care, or lack of attention by healthcare professionals. •Wears partial dentures & uses oxygen prn •In partnership with The Oral Health Nursing Education and Topics Highlighted
Pre/Post Test Results: Questions 6-10
Practice (OHNEP) Initiative to promote inter-professional participation in oral health for all patients, an educational program •Specific Oral Care Issues for Mrs. Thompson related to:
was developed, illustrating the oral care needs and challenges for •Chronic Illnesses: COPD, osteoarthritis, dementia the elderly palliative care patient in various care settings. •Oral Health Issues Across Various Care Settings:
Post Test
•An interactive presentation: “Mrs. Thompson,” utilizing a case- •Oral Intubation & Mechanical Ventilation •Risk Profile & Prevention of Aspiration based approach was created. Content was obtained through literature searches, data from the “Smiles for Life” website and •General Medical Floor, Long Term & Hospice Care: Subjective Responses to Program:
•This presentation was incorporated into a four hour interdisciplinary conference: “Palliative Care: A Focus on Commitment to Practice Change
Forgotten Issues & Symptoms” which was held in April, 2013 in Pre/Post Test: 10 Item True/False Questions
Attendees plan to:
1.Complete tooth loss in the elderly has declined from 50% to 18% in the past •In order to have the greatest impact on the most healthcare •Invite presenters to their inpatient facilities to replicate the professionals, this free conference was offered to healthcare learning session for those staff who did not attend the conference. 2.Dietary changes in the elderly do not increase the risk of forming dental facilities and schools of nursing through professional societies •Review the current policies and procedures related to oral care at 3.The use of beta 2 agonists (such as albuterol) leads to reduction in saliva •Continuing educational credits were offered to nursing attendees who completed a course evaluation. •Incorporate new tools and reference materials related to oral care PARTICIPANTS
4.Causes for halitosis in patients at end of life include the use of oxygen and anticholinergics for secretion management. (T) 5.Implementation of oral care interventions has not reduced the incidence of •Review newly learned information with nursing assistants. Attendees included healthcare professionals and volunteers
from the Tri – State area
6.In patients with COPD, dental plaque does not impact the development of •Utilize patient case to create a unit based in-service for (New York, New Jersey & Connecticut)
professional and para-professional staff. Attendance Profile
7.Patients with early stage dementia are unable to undergo restorative dental ACKNOWLEDGEMENTS
8.The use of a spacer with an inhaler will help prevent the development of Sincere thanks to Dr. Judith
Haber at NYUCON and the Oral
9.The Mouth Care Assessment & Documentation tool involves evaluation of Health Nursing Education and
the teeth, tongue, lips and mucous membranes. (T) Practice Initiative
10.Gram + lactobacillus is often found in the oral cavity. (T)

Source: http://www.ohnep.org/sites/default/files/summit/5.%20Rose%20Anne%20Indelicato.pdf

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