Persons with Alzheimer’s disease and related disorders (ADRD) have significantly poorer oral health (e.g., more oral plaque, more severe periodontitis, more caries, and fewer teeth) than cognitively intact older adults. Even individuals with mild dementia (IMD) are at higher risk of poor oral health and evidence is strong to suggest that inadequate oral hygiene practices are a major contributing factor. Maintaining good oral hygiene is a critical step in preventing deterioration of oral health and general overall health for persons with ADRD. A few studies conducted in nursing homes have shown that with routine oral hygiene care, the oral health of persons with ADRD improves notably in a short period of time. However, family members who provide care (i.e. care partners) to individuals living at home with mild dementia, provide supervision or assistance with other daily activities, but often neglect oral hygiene. Because care partners play an essential role in supervising and caring for IMD at home, an intervention with both IMD and their care partners to improve oral self-care may have long term oral health benefits for the IMD. Yet, few interventions have addressed oral health problems among older adults in general and among IMD in particular, and to our knowledge, no oral health interventions have been conducted among community-dwelling IMD. To address this gap in knowledge, we propose a novel intervention to help care partners learn how to adapt methods for guiding the IMD in carrying out oral hygiene. Mild dementia is an ideal time to intervene because IMD still retain sufficient cognitive ability to perform oral hygiene tasks successfully with minimal assistance. Using the results from a pilot study we conducted, we developed and finalized the intervention protocol and established our multidisciplinary research team (NIDCR 1R34DE023881). The results from our pilot study provide strong indication that our care partner-assisted intervention will generate positive oral health outcomes. Our team is ready to implement a U01 randomized control trial (RCT) in New York City and North Carolina. The intervention includes both a tailored oral care plan and a behavioral component using the Adaptive Leadership Framework for Chronic Disease that our team introduced to manage symptoms associated with chronic conditions, such as dementia. The specific aims are to: Aim 1: Evaluate the effectiveness of a care partner-assisted intervention to improve oral hygiene and oral hygiene behaviors in individuals with mild dementia. Aim 2: Assess changes in mediating factors/process outcomes, including communication between the dyads, oral health knowledge, and self-efficacy for both participants and care partners to understand mechanisms of the intervention. This innovative care partner-assisted oral care behavior intervention will assist IMD and care partners in implementing a cooperative oral hygiene care plan to prevent deterioration of oral health, which in turn, will help our targeted population of those with ADRD to maintain independence in completing daily activities and quality of life for an extended period of time.

Public Health Relevance Dementia is a common chronic disease in older adults. Individuals with dementia have significantly poorer oral health than cognitively intact older adults. This innovative care partner-assisted oral care behavior intervention will help individuals with mild dementia to maintain independence in completing daily activities and quality of life for an extended period of time.