Helping Older Adults with Their Oral Health . . . from Miles Away

For the past four years, Tirzah Weiskotten has been trying to help her 75-year-old father from more than 500 miles away. 

“I face a lot of challenges,” Weiskotten says. “Caregiving from far away is very different from living with him at home and seeing him day to day.” 

Her father was diagnosed with dementia in 2021 and lives in Maine. Weiskotten lives in Washington, DC, with her husband and three young children. Even though she and her siblings try to visit their father as much as they can, she realized she needed help. 

“I was looking for a way to connect with resources that were especially helping Mainers,” she says. 

That’s when she discovered the MOTIVATE at Home program, a free oral health education program for care partners of older adults created by Lunder-Dineen Health Education Alliance of Maine, a CareQuest Institute for Oral Health grantee. (The program was also the focus of a recent CareQuest Institute webinar.) Lunder-Dineen is a program of the Peter L. Slavin, MD Academy for Applied Learning in Health Care at Massachusetts General Hospital. 

Weiskotten was so pleased with MOTIVATE at Home’s mission to provide resources for caregivers and care partners that she joined its caregiver advisory committee. The role of the advisory committee was to shape the program’s development. 

“I really wanted to be a voice for remote caregivers by sharing my experience,” she says. “I felt it was important to contribute to this project to codesign content that truly reflected what we need.” 

Since she joined the committee, unfortunately, she’s noticed that her father has been struggling to stick with his daily routines. And when she visited him a few months ago, she also noticed another routine might be declining. 

“His whole bathroom counter was cleared off,” she says. “I’m not sure where he keeps his toothbrush anymore.” 

The MOTIVATE at Home Program

Weiskotten grew up in Maine, and her parents made sure dental health was a priority. 

“I loved going to the dentist so much that I dressed as a tube of toothpaste for Halloween a few years in a row,” she says. “I loved my dentist. He was so funny.” 

Because she knows the importance of oral health, she wanted to make sure her father continues to take good care of his mouth and teeth. Using the MOTIVATE at Home tools and tips and becoming part of the committee where other caregivers shared their experiences helped her become aware of what was missing in her father’s bathroom and the steps to take before his dental health suffers. 

“Because I was on the panel, I have conversations about his dental health with my dad, his doctor, and his dentist,” she says. “I don’t know if I would have had I not been a part of this.” 

Lunder-Dineen Associate Director Denise O’Connell, MSW, LCSW, CCM, says the organization created the MOTIVATE at Home program two years ago. The first year was dedicated to getting input from caregivers like Weiskotten about what the program should look like while also using the latest older adult oral health evidence and applying best practices for creating engaging adult learning. 

“We learned that they really wanted easy access 24/7 on demand, so that’s why it’s a website,” she says.

 O’Connell says typically most people, including health care professionals, are not well informed about the importance of oral health care for older adults. They often make other health aspects a priority when managing the day-to-day lives of their loved ones and overlook oral health care. 

Weiskotten noticed when she was touring long-term care facilities that dental care didn’t come up unless she asked about it. 

“I asked a lot of questions like ‘Is there a dentist who comes in, or do we have to take him to the dentist?’” she says. “Those were things that were not mentioned on the tour unless you asked.” 

Now in its second year, Lunder-Dineen has been reaching out to organizations, like Maine’s Area Agencies on Aging, the Senior Companion Program, and Age Friendly Windham to ask them to adopt the program to reach even more people. 

Driving Home That Oral Health Is Health 

A recent CareQuest Institute report shows people with Alzheimer’s disease and related dementias — including those living in long-term care facilities — are at increased risk of poor oral health, due to challenges with maintaining oral hygiene and accessing professional oral health care. 

“Oral health is more than having a mouth full of white teeth,” O’Connell says. “Most are unaware of the elevated risks to older adults when oral health care is overlooked. If you do not brush and floss well and routinely, bacteria will grow. And if you’re an older adult and your mouth environment is already at higher risk because it’s dry — and if you can’t brush yourself — that bacteria is going to grow and cause decay, which can lead to other systemic problems. The MOTIVATE at Home program explains this well and what a person can do each day to minimize those risks.” 

The program’s tools and tips can be passed along to anyone who is caring for older adults facing different challenges across the country. Weiskotten has shared them with her siblings and her husband. 

“My husband has been asking me for help in caring for his uncle, and the MOTIVATE at Home tools are useful to him as well,” she says. “We’re trying to figure out how to support him and what community resources are available to him. My husband isn’t as ingrained in the community where his uncle lives as I am in the community in Maine, and the resources created by Lunder-Dineen can be accessed anywhere by anyone. I’m grateful for that. In a way, Lunder-Dineen is helping Mainers spread helpful tips across the country, which is pretty cool.” 

Now, Weiskotten and her siblings are thinking about finding ways to make sure their father can continue living at home as long as possible. Because of MOTIVATE at Home, Weiskotten says her family now feels well equipped to know what to look out for when it comes to his oral health. 

“I have a lot of tools in my toolbox that I think are going to help when we do find those in-home supports,” she says. “We’ll be able to provide more information for the people who are helping him on a day-to-day basis.”