The effectiveness of oral hygiene interventions in preventing respiratory tract infections within elderly persons living in an institution

Abstract

Purpose of the Study: Mortality from respiratory infections, most commonly pneumonia, is a major concern in the elderly. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in knowledge to effectively manage this risk. Therefore this project aims to determine the effectiveness of oral interventions in reducing the risk and mortality of respiratory infections in the elderly population. Research Question: In elderly persons living in an institutionalized setting, do oral hygiene interventions reduce the risk and mortality of respiratory infections? Methods Used: A HyDi search using the University of Malta e-library was conducted. The search was also extended by manually checking the reference lists of the included studies and Google Scholar. Pre-determined criteria included subjects having more than 65 years of age, residing in a hospital, nursing/ residential home and studies that compared the use of chemical and/or mechanical oral hygiene interventions against no oral hygiene, routine care or placebo. Studies on mechanical ventilation, acute disease and chronic pulmonary diseases were excluded. Out of 1444 citations, four RCTs and one retrospective cohort study were retained for appraisal. The studies selected were appraised using the Critical Appraisal Skills Programme (CASP) tool, Consolidated Standards of Reporting trials (CONSORT) statement and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Overall Findings: Consistent significant results have been shown to reduce pneumonia or closely related parameters, thus further quality studies are necessary to indicate specific oral hygiene interventions ideal to reduce respiratory infections in the elderly population. Recommendations and Implications for Practice: Recommendations mainly highlights the assignment of a link nurse, continuous professional training, awareness campaigns, better quality methodological studies, development of a standard assessment tool and addressing guidelines and policies.