Improving the oral health of older people in care homes (TOPIC): a protocol for a feasibility study

Georgios Tsakos, Paul Brocklehurst, Sinead Watson*, Anna Verey, Nia Goulden, Alison Jenkins, Zoe Hoare, Kirstie Pye, Rebecca Wassall, Andrea Sherriff, Anja Heilmann, Ciaran O'Neill, Craig Smyth, Joe Langley, Renato Venturelli, Peter Cairn, Nat Lievesley, Richard Watt, Frank Kee, Gerry McKenna

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
Evidence for interventions promoting oral health among care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial.

Methods
This is a protocol for a pragmatic cluster randomised controlled trial with a 12 month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n=6) will receive the complex intervention based on the NG48 guideline, while care homes randomised to the control arm (n=6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a “support worker assisted” daily tooth-brushing regime with toothpaste containing 1,500ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context.

Discussion
The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes.




Original languageEnglish
Article number138
Number of pages32
JournalPilot and Feasibility Studies
Volume7
DOIs
Publication statusPublished - 02 Jul 2021

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