Residents Who Have Suffered from Strokes

Cerebrovascular accident (CVA), or stroke, is one of the most common severe medical events among the population. The greatest risk factor for CVA is hypertension, which is prevalent in the United States, particularly among older adults. 76% of older adults >65 years of age have hypertension, compared to 47% of the general adult population in the United States.¹⁶ The prevalence of CVA increases with age and is higher among nursing home residents and care-dependent adults than among the general population.¹⁷

The effects of a stroke are well-documented and recognizable, but they also vary from patient to patient. These include hemiplegia (paralysis from the midline on either the right or left side of the body), aphasia (difficulty speaking or understanding language), memory and cognition problems, ataxia (trouble with movement or coordination) and mobility limitations, dysphagia (difficulty with swallowing), and aspiration.¹⁸

It is necessary for caregivers in nursing homes and other settings to plan and perform care that will mitigate the results of strokes, including oral health risks.

First, patients should always be allowed the autonomy and respect that is due to everyone. This means that with whatever level of independence the patient can perform their own oral care, they should be given the supplies and instruction to do so. And for patients who have the disabilities or limitations described above, caregivers should help supplement their care to the degree required in each case. This requires a balance of ensuring independence but also providing the level of assistance that is adequate to ensure optimal oral care. Many residents have the capability to continue their own oral care routine provided they are given the proper oral aids. These could include floss holders, electric toothbrushes, and devices for fixing a toothbrush to a surface to brush removable appliances.¹⁹ All of these are helpful aids for those who have suffered hemiplegia, leaving them with limited dexterity, the use of only one hand, or the use of their non-dominant hand. All of these approaches are designed to help achieve thorough oral hygiene, which must also be at the proper frequency—at least twice per day as well as after each meal and before bedtime.

Important Reminders for Caregivers:

• Prevent resident from choking on saliva and toothpaste by keeping them upright and helping them lean forward, as stroke patients often have difficulty with swallowing.

• Ensure thorough cleaning of all teeth and entire vestibule, as stroke patients may have impaired control of tongue or one side of face.

• Promote as much resident independence as possible, offering only the amount of assistance necessary for optimal oral care.