HOPE program addresses oral health in hospitalized seniors

08/01/2023

While dental health may not immediately be associated with a stay in the hospital, inadequate oral hygiene can lead to devastating disease and a significant loss of quality of life, particularly in the elderly, who represent the largest proportion of hospitalized patients. Bacteria from the oral cavity can travel to the lungs and cause older patients to contract hospital-acquired pneumonia, a serious and potentially fatal infection..

In less than a year since the HOPE program began at Banner – University Medical Center Phoenix, 1,731 patients aged 65+ have received enhanced oral care.

To address this challenge, Banner – University Medical Center Phoenix created the Hospital Oral Care and Proactive Education: HOPE Dental Program, with generous funding from Delta Dental Foundation of Arizona. The partnership established Susan Dimpfel as oral health nurse navigator and dental hygienist Nicole Petit as consistent educators and resources for nurses and patients. They support patients across hospital units and departments and collaborate with nursing staff and therapists to identify barriers to care and facilitate access to dental services and oral health care for the highest-risk patients. The partnership also includes development and delivery of patient oral health care training for nurses and patient care assistants.

Many older Americans do not have dental insurance and the federal Medicare program does not cover routine dental care. According to the Centers for Disease Control and Prevention, older Americans with the poorest oral health tend to be those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or living in a group facility such as a nursing home also increases the risk of poor oral health.

Board members of Delta Dental of Arizona Foundation participated in a tour of the Geriatric unit at Banner – University Medical Center Phoenix lead by Dr. Nimit Agarwal, MD (at right). He is joined by (from left to right) Nicole Petit, RDH; Sandra Badzak, PCA; Michael Jones, President & CEO, Delta Dental of Arizona; Josefa Pucti, PCA; and Susan Dimpfel, RN.

In less than a year since the HOPE program began at Banner – University Medical Center Phoenix, 1,731 patients aged 65+ have received enhanced oral care and Susan and Nicole have seen 200 specific patients, evaluated them and provided care and recommendations. The program has been such a success, the protocol developed is now being shared across the Banner Health system for potential implementation with adult patients. As online oral health education rolls out, all adult/non-ventilated patients in Banner will potentially benefit from more thorough and appropriate oral care.

“For patients admitted to the hospital, oral care is often the last thing on the mind of their physicians and nursing staff, because there are so many pressing clinical issues to sort out,” explains Dr. Nimit Agarwal, a geriatrics and internal medicine physician leading the Division of Geriatric Medicine at Banner – University Medical Center Phoenix and the University of Arizona College of Medicine – Phoenix. He leads the Center for Healthy Aging at Banner – University and is the program director of the Geriatric Medicine Fellowship. “However, oral care is one intervention that brings the joy of taste, the joy of having a smile, and the joy of being able to feel a bit more human while hospitalized. Good quality care includes performing interventions like oral health; but, given the reality of how health systems are currently functioning, this simple care remains a challenge to achieve.”

Almost all patients seen by Nicole and Susan are age 65 or older, often confused or showing signs of dementia, with a history of poor dental care, and dependent on nursing staff for oral care due to inability to care for themselves. The most common reason they are in the hospital is for an orthopedic injury caused by a fall or infection like pneumonia, sepsis, or urinary tract infection.

“A recent patient was referred to us from a Progressive Care Unit,” Nicole says. “The patient was confused and not fully awake. Without many teeth, and with one of the lower ones very loose, the nurse was afraid it could come out and the patient would either choke, aspirate, or both. As the patient had already suffered from aspiration pneumonia, the nurse was justifiably concerned. Susan visited the patient and was able to provide care. She showed the patient care assistant how to clean the mouth and then had a consult by our oral maxillofacial surgery providers, who saw the patient the same day and were able to remove the loose tooth at the bedside to prevent aspiration and, hopefully, speed recovery as the patient was just beginning to eat again.”

“The HOPE Dental Program sponsored by the Delta Dental of Arizona Foundation is really a blessing for our patients and for our nursing staff,” says Dr. Agarwal. “Our vision is that every patient receives high quality, evidence-based care, which will make their life better. We are so grateful to the Delta Dental of Arizona Foundation for allowing us the chance to bring this vision to life through their generous support.”

To make a gift in support of oral health for the most vulnerable, visit the link below.

Support the HOPE Dental program