Oral care and stroke units.

OBJECTIVE: To investigate oral care provision reported by senior nurses in stroke care settings in Scotland. BACKGROUND: Stroke can have adverse effects on oral care and health. Little is known about current oral care practices in stroke care settings. MATERIALS AND METHODS: We designed a postal survey to be completed by ward managers or senior nurses. After piloting, the survey was distributed to all 71 units in Scotland, identified as providing specialist care for patients in the acute or rehabilitation stages following stroke. Pre-notification and reminder letters were circulated. Responses were anonymous. RESULTS: All but one survey was completed and returned. Help from dental professionals was available to most units (64/70) mostly on request. Only a third of units received oral care training in the last year (23/ 70). The majority of this training was ward based (20/23). The use of oral care assessment tools and protocols was limited (16/70 and 15/70 units respectively). Not all units had access to toothbrushes, toothpaste or chlorhexidine. For patients unable to perform oral care independently, senior nurses expected the patients' teeth or dentures to be cleaned at least twice a day in 59 of 70 and 49 of 70 units respectively. CONCLUSION: The response rate was excellent and has provided a national overview of oral care provision for patients in stroke care settings. Access to staff training, assessments, protocols and oral hygiene material varied considerably. This information provides a valuable baseline from which to develop and evaluate the effectiveness of ward-based oral care interventions for stroke patients.

Driving cessation in patients attending a memory clinic.

BACKGROUND: Driving is an increasingly important form of transport for older people. Dementia is common in later life and will eventually lead to driving cessation, which reduces the public health risk of impaired driving but also impairs access to services. The factors associated with driving cessation in dementia are uncertain. OBJECTIVE: To examine the demographic, psychometric and personal factors associated with driving cessation in patients attending a memory clinic in a European setting. DESIGN, SUBJECTS AND SETTING: A retrospective study of 430 consecutive patients referred over a 21 month period to the memory clinic at a university teaching hospital. METHODS: The data collected included a questionnaire administered to their carers regarding demographic and personal factors as well as driving practices. All subjects had standardised neuropsychological and functional assessments. Dementia diagnosis was recorded using DSM IV criteria. RESULTS: Driving cessation in this population was associated with poorer cognitive and functional status, older age, and living in the city. Of those studied, 22% continued to drive: 63% of these were driving daily, 71% were driving unaccompanied and 31% reported an accident. There was no difference in the neuropsychological testing between those who reported an accident and those who did not report an accident. CONCLUSIONS: Driving cessation was affected not only by psychometric performance but also by demographic and personal factors.