การพัฒนาระบบการดูแลสุขภาพช่องปากสำหรับผู้สูงอายุติดบ้านหรือติดเตียงในชุมชนบ้านดอนแสลบ จังหวัดกาญจนบุรี

Abstract

Objective: To develop an oral health care system for homebound or bedridden elderly at Ban Don Salab, Kanchanaburi Province. Methods: The stakeholders in this research consist of homebound or bedridden elderlies and/or elderly caretakers from 32 families, 7 individuals from the Ban Don Salab Sub-District Health Promotion Hospital multidisciplinary team, 12 elderly caregiver volunteers, and 1 village headman. The research was carried out between November 2018 and October 2019 which was divided into 3 stages: 1) The preparation stage, which consists of studying the current oral health care system for homebound or bedridden elderlies at Ban Don Salab and carrying out a multidisciplinary team group discussion to examine data and analyse the strong and weak points of the current system; 2) The development stage, which consists of planning, testing, observation, and reflection on the developed system; and 3) The evaluation stage which consists of evaluating the oral health care behaviour, level of plaque index and tongue coating of homebound or bedridden elderlies, and the stakeholders' satisfaction. The researcher collected data quantitatively and qualitatively. The quantitative data was analysed using descriptive statistics while the qualitative data, after examination, was organized and analysed. Results: 1) In the preparation stage, 20 homebound elderlies and 12 bedridden elderlies had an average age of 77.1 years, of which 68.8 percent were female. Most of them were lived with a caregiver, only 1 lived alone. The average number of natural teeth were 11.09+10.60 teeth per person. The average number of functional occluded teeth were 1.65+2.86 pairs per person. The average number of decayed teeth were 4.44+6.33 teeth per person. There were no fillings found. The average number of tooth loss was 20.91+10.60 teeth per person. The average age of 31 elderly caregivers were 52.6 years. Originally, Ban Don Salab Community has a long- term health care centre for elderlies requiring Long-Term Care (LTC), but the system does not include oral health care. Therefore, the stakeholders require a new system which cares for oral health according to the Primary Care Cluster policies. 2) The development stage, consisted of 7 activities including, 1. Training team members about the Primary Care Cluster policies to give staff understanding in order to operate accordingly, 2. Creating a team polo shirt with the symbol "PCC DENT DON" for wearing while working to show team unity, 3. Exploring for new elderlies who have not yet joined the Long Term Public Health Service for Elderly Requiring Long-Term Care (LTC) Project, 4. Developing a plan for oral health care integrated with bodily health within the LTC Project, 5. Creating a communication channel through the LINE application for exchanging opinions, 6. Providing training workshops on elderly oral health examination and oral care for elderly caregiver volunteers by requesting support funds from the Don Salab Sub-district Administration Organization, and 7. Inspecting the oral health of homebound or bedridden elderlies by elderly caregiver volunteers. The following activities have formed a new system for oral health care for homebound or bedridden elderlies at Ban Don Salab: 1. Searching for homebound or bedridden elderlies, 2. Incorporating the elderlies into the LTC Project, 3. Examining the elderlies oral health, 4. Generating a plan for individual's general health care and oral health care, 5. Gaining participation from local offices, 6. Developing skills and knowledge on oral health advisory for elderly caregiver volunteers, 7. Following up individual's general health care and oral health care, and & Using technology for communication. 3) In the evaluation stage, homebound or bedridden elderlies were found to carry out oral cleansing more frequently compared to previously, which was nil or at least once a day. Homebound elderlies carried out oral cleansing themselves while bedridden elderlies had caregivers to carry out oral cleansing for them. The average level of plaque index reduced with statistical significance from 2.57±0.60 to 1.50+0.69 (p<0.01) while tongue coating reduced from 1.59±0.57 to 1.31=0.60. All data participants were satisfied with the developed oral health care system. Suggestions: The development of an oral health care system for homebound or bedridden elderlies requires: a team of staff that trusts one another, defining clear roles and understanding about Primary Care Cluster policies; integration of oral health care guidelines with the LTC Project; increasing the elderly caregiver volunteers' proficiency in oral health caregiving and advisory; creating long term plans by requesting supporting funds from the Sub-district Administration Organizations; and using technology for communication and follow up.