Maturation of the MOUTh Intervention: From Reducing Threat to Relationship-Centered Care

Mouth care is oral infection control (Fulmer Jablonski, Mertz, George, & Russell, 2012) Consistent oral hygiene reduces the incidence of pneumonia in dependent and cognitively impaired older adults residing in nursing homes (NHs) (Maeda & Akagi, 2014; Tada & Miura, 2012; van der Maarel-Wierink, Vanobbergen, Bronkhorst, Schols, & de Baat, 2013; Van Ness, Peduzzi, & Quagliarello, 2012). Consistent mouth care also stimulates salivary production, improves appetite, and contributes to overall well-being (De Visschere, Schols, van der Putten, de Baat, & Vanobbergen, 2012; Dyck, Bertone, Knutson, & Campbell, 2012). However, older adults with dementia often resist caregiving activities associated with mouth care. Care-resistant behavior (CRB) remains one of the primary reasons for the omission of mouth care (Jablonski et al., 2009; Willumsen, Karlsen, Naess, & Bjorntvedt, 2012). As a result, NH residents with dementia who exhibit CRBs are three times more likely to have more tooth decay than those who allow mouth care (Willumsen et al., 2012; Zuluaga, Ferreira, Montoya, & Willumsen, 2012). The purpose of the current article is to describe a personalized practice originally conceived as a way to prevent and minimize CRB to provide mouth care to older adults with dementia. The intervention, Managing Oral Hygiene Using Threat Reduction Strategies (MOUTh), contains three components: (a) an evidence-based mouth care protocol for older adults with dentition or dentures; (b) recognition of CRBs; and (c) strategies designed to lower the perception of mouth care as a threatening, scary, or assaultive activity (Jablonski, 2010; Jablonski, Therrien, & Kolanowski, 2011; Jablonski, Therrien, Mahoney, et al., 2011). The current article will focus on the third component: reducing threat perception. The goal is to provide sufficient detail about threat-reduction strategies to enable nurses and other clinicians to apply these techniques to their own practice.