ABSTRACT
AIMS: To examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia. BACKGROUND: Poor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries. DESIGN: A cross-sectional survey. METHODS: Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times. RESULTS: Completed questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents. CONCLUSION: Unacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes.
ABSTRACT
BACKGROUND: In many areas, new regional community-based services have been established to provide holistic care to patients with high physical, mental and social needs. Older people represent a group with multimorbidity and high healthcare needs that may benefit from holistic care, although uncertainty remains whether such an approach is effective. AIM: To review evidence for community holistic interventions in older people with multimorbidity. METHOD: The authors screened studies referenced by an earlier Cochrane Review and Academy of Medical Sciences report, both of which looked at interventions and populations more broadly, and their own searches of Medline, EMBASE, trial registration databases and hand-searching of journals since 2015. The authors included controlled community-based studies of holistic interventions with data for people aged at least 60 years. RESULTS: Studies found (five published, two ongoing) were heterogeneous. The only significant improvement relating to physical or mental outcomes occurred in self-rated health scores, seen in two studies. One consisting entirely of diabetics showed developing a self-management plan improved self-rated health (P = 0.023), and Mental Component Summary (P = 0.03). The other used a multidisciplinary-team-guided personal care plan and found self-rated overall health improved (P = 0.02). Three studies looked at service usage, only one seeing a benefit, and only in the second year. CONCLUSION: Community-based holistic interventions for people with multimorbidity tended to focus on disease management or medication modification, and resulted in few significant benefits, almost entirely in self-rated health measures. Research into interventions focused on those with the highest needs, for example, multimorbidity with frailty; high number of comorbidities may be more likely to demonstrate meaningful benefits.
