Good Oral Health Practices Reduce Pneumonia Cases in Nursing Home

Nursing homes that implemented staff training in oral health saw a 31% decrease in pneumonia cases compared to nursing homes that have not used the program, according to an article published in The Journal of the American Medical Association Network Open. The paper emphasizes the importance of oral hygiene on overall health, as findings suggest if nursing assistants brush residents’ teeth, clean between their teeth, and perform gum care, they can reduce pneumonia in older adults. 

The paper, “Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence,” published by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill (UNC), evaluates the effectiveness of the center’s Mouth Care Without a Battle staff training program. This cluster-randomized trial evaluated the program’s effectiveness over a 2-year period.

Nursing homes that participated in the program for two years (2152 residents from 14 paired nursing homes) saw a significant 26% to 31% reduction in pneumonia incidence limited to the first year. However, these interventions were not significant in reducing pneumonia incidence at two years, underscoring the importance of sustained efforts. 

“The link between providing oral care and pneumonia is that oral hygiene is improved. We studied the amount of care provided and oral hygiene through two years, and saw more mouth care and better oral hygiene in year one than in year two,” says Sheryl Zimmerman, PhD, distinguished professor and codirector of the Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research. “So it is logical to assume there wasn’t an effect on pneumonia in year two because less mouth care was being done. The real ‘nut to crack’ here is to not only have staff do mouth care, but to sustain doing so.”

These findings add to the mounting evidence that maintaining oral health in older adults in assisted living facilities is vital to patients’ general health. 

It also shows that by using techniques taught in Mouth Care Without a Battle nursing assistants can successfully provide oral care to people with Alzheimer’s disease and related dementia. Zimmerman explains, “That’s a big deal because those people are most at risk for poor oral hygiene, and, by extension, pneumonia—and it’s not always easy to provide oral care.”

Developed by an interdisciplinary team at the Sheps Center Program on Aging, Disability and Long-Term Care, the program teaches nursing home staff and caregivers about products and techniques that overcome dental challenges, and the staff learns about individualized care. Under the program’s guidance, one nursing assistant should be assigned to the role of oral health aide, and all nursing assistants should provide oral care, as well. 

“The oral health aide would provide care for the people who require extra time; also, s/he would serve as a resource to the other staff,” Zimmerman says. “On a societal level, we found that the time needed to provide proper care (and the related supplies) saved money in comparison to the cost of hospitalization.”

The link between oral health and cognitive function has been studied, with evidence showing poor dental hygiene may affect cognitive decline. Older adults also face transportation and mobility issues, and cognitive diseases, such as dementia and Alzheimers, that impact their ability to care for themselves. But nursing home staff can help residents maintain their oral health and positively impact their overall quality of life. 

Looking to the future, Zimmerman hopes to receive funds from the centers for Medicare and Medicaid services to work with more than 100 nursing homes in North Carolina to help them adopt better oral care practices. Directors interested in Mouth Care Without a Battle can access the training program at mouthcarewithoutabattle.org.