Oral care knowledge, attitude and practice: Caregivers' survey and observation

To assess the knowledge, attitudes, and confidence of caregivers and administrators towards the oral health of nursing home residents in San Antonio, Texas

OBJECTIVE

The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers' ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas.

METHODS

A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver's knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator's knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content.

RESULTS

The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents' oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure.

CONCLUSIONS

The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Oral health knowledge and attitude among healthcare professionals of long-term care units: A cross-sectional survey

BACKGROUND

This study aims to evaluate the knowledge and the attitude in oral health (OH) of nurses (NUR) and auxiliary health technicians (AHT) belonging to the Long-term Care Units (LTC).

METHODS

Observational cross-sectional study. A survey was applied in five MLTC in Porto (Portugal) to 145 healthcare works (HCW). Data were collected using structured questionnaires with questions about knowledge and attitude regarding oral care. Data analysis comparison was performed using non-parametric tests (α = 0.05).

RESULTS

Out of a total of 259 HCW, 145 responses were obtained (55.98% response rate). The median number of correct answers was significantly different for NUR and AHT without oral health training (OHT) (p = .035).AHT with OHT had a significantly lower number of correct answers compared to NUR with OHT (7 vs. 9, p < .001). There was no significant difference in the number of correct answers in NUR with or without OHT (p = .391) and that the AHT without OHT have a median of correct answers significantly higher than those who they have OHT (8 vs. 7, p = .020) CONCLUSIONS: Despite the positive attitude of the HCW, the knowledge is scarce. HCW recognized the urgence to update the protocols.

PRACTICAL IMPLICATIONS

Integrating dentists in the LTC team, implementation of OH protocols and providing OH training should be considered to bridge existing gaps.

Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review

OBJECTIVE

The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures.

BACKGROUND

Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries.

METHODS

We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used.

RESULTS

Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people.

CONCLUSIONS

Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.

Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track

BACKGROUND

The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults.

MATERIALS AND METHODS

An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme.

RESULTS

Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches.

CONCLUSION

By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.

An app to support oral hygiene care: Increasing attitudes, knowledge, and confidence in identifying oral health problems among caregivers of persons living with dementia

PURPOSE

To develop and pilot test an App to help family and paid caregivers perform high quality oral hygiene care.

METHODS

A prototype of the App was refined based on stakeholder feedback (e.g., dental care professionals, direct care providers, nursing home administrator, family caregivers). The refined App was pilot tested with 16 family caregivers and 15 paid care providers of persons living with dementia (PLWD). Participants completed a pre-test, watched an App demonstration, used it for 2 weeks, and completed a post-test. Surveys included both structured and open-ended questions.

RESULTS

Phase 1 data informed the refinement of the App that led to high acceptability and usability by the Phase 2 participants. Both family and paid caregivers reported a significant increase in attitudes toward providing oral hygiene care to frail older adults (p = .05 and p = .02 for family and paid providers, respectively), knowledge about oral health and care (p = .01 and p = .02), and ability to identify oral health problems (p = .005 and p = .01). Additionally, paid caregivers reported increase in perceived support available in providing oral hygiene care (p < .001).

CONCLUSION

Stakeholder engaged approach helped increase the acceptability and usability of the App that successfully increase caregivers' attitude, knowledge, and abilities in oral hygiene care provision.

Knowledge and Practices Regarding Oral Hygiene, Cariogenic Diet Intake, and Dental Check-Ups Among Registered Nurses in Nigeria: A Pilot Study

Objectives To investigate the knowledge and practices of registered nurses in Nigeria concerning oral hygiene, cariogenic diets, and dental check-ups through a pilot study.

Methods This study was an online survey of 129 registered nurses in Nigeria. Data were collected via the WhatsApp social media using an electronic questionnaire (Google form). Data analysis was done using the SPSS version 26 software (IBM Corp, New York, USA).

Results The response and completeness rates of this pilot study were 41.7% (129/311) and 96.9% 9125/129), respectively. The majority (62.2%) of the respondents were females. The majority (89.1%) had average/above average score on basic oral health knowledge; however, there was no significant relationship between their level of basic oral health knowledge and their sociodemographic characteristics (p > 0.05). The majority (66.7%) of the respondents brushed twice daily, 86.8% used a fluoridated toothpaste, and 60.5% changed their toothbrush every 3 months. Furthermore, more than half (55.8%) consumed sugary snack/drink on daily basis, while 55.0% rinsed their mouth with water immediately after taking sugary snack, and only 55.8% did floss their teeth. Among those who flossed their teeth, only 37.5% did it once daily. It is also striking that 26.4% of the respondents had never visited a dentist for a dental check-up.

Conclusion Study findings showed a high level of basic oral health knowledge and a lower level of appropriate oral self-care practices among nurses in Nigeria. However, there is a need for a nationally representative study of nurses in Nigeria to further establish these findings.

Periodontitis and peri-implantitis in elderly people experiencing institutional and hospital confinement

An increasing number of elderly people retain their natural teeth into old age and further, the prevalence of endosseous implants for supporting oral prosthesis is ever increasing. These teeth and implants now present a considerable challenge in terms of maintenance, especially when patients become dependent on care. Periodontal and peri-implant diseases are more prevalent in elderly than in younger age cohorts. There are distinct differences related to the inflammatory response between periodontal and peri-implant tissues, both in young and old age. The age-related reasons for the increase in periodontal infections may be related to poor oral hygiene because of a loss of dexterity or vision, but also to immunosenescence. This term describes the aging of the immune system and the decline of its effectiveness with age. Low-grade infections, like chronic periodontitis, may cause low-grade inflammation and subsequently increase the likelihood of developing chronic diseases. In return, treatment of periodontitis may improve general health, as demonstrated for diabetes. A second mechanism illustrating how poor oral health translates into systemic disease is the risk of developing aspiration pneumonia. The treatment options in old age should be evaluated with regard to the issues of general health and maintenance. Systematic periodontal maintenance therapy, as performed in younger age cohorts, may be difficult to implement in elderly people experiencing institutional or hospital confinement because of logistics, barriers related to patients and caregivers, or cost. The scale of periodontal disease in old age represents a public health issue.

Informal caregivers' perceptions of oral care and their association with the use of oral health services: A cross‐sectional study among informal caregivers and their care recipients

Objective

This study aimed to describe informal caregivers' perceptions of the importance of oral care and investigate the association between these perceptions and the use of oral health services during the past year.

Background

There is limited research on informal caregivers' perceptions of oral care. These perceptions presumably influence oral self‐care along with caregivers' and care recipients' use of oral health services.

Materials and Methods

Baseline data from the multidisciplinary Lifestyle, Nutrition, and Oral health in caregivers (LENTO) intervention study were analyzed. Informal caregivers (n = 125) and care recipients (n = 120) ≥65 years of age and living in Eastern Finland participated in the study. Data were collected through semi‐structured interviews.

Results

A majority (81%) of the informal caregivers considered oral care very important. Informal caregivers who considered oral care very important had 10 or more years of education, and considered service fees reasonable were more likely to have visited oral health services during the past year than other caregivers. No association between informal caregivers' perceptions of oral care and care recipients' use of oral health services during the past year was observed.

Conclusions

The study provides insight into informal caregivers' perceptions of oral care, with most informal caregivers considering oral care to be very important. Our findings support what has been reported in previous studies in that favorable perceptions of oral care are associated with oral health service visits. This association, however, did not hold true for care recipients' use of services.

Oral health care beliefs among care personnel working with older people - follow up of oral care education provided by dental hygienists

Objectives

The proportion of older people in the population is increasing rapidly. Along with this comes an increase in the number of people requiring assistance in daily living, including oral care. Swedish law stipulates that care personnel who work with older people should be offered oral health education every year. The aim of this study was to investigate oral health care beliefs among such personnel.

Methods

A questionnaire study was conducted among 2167 personnel providing care to older people at special accommodation sites and in home care. Data were collected using the Nursing Dental Coping Beliefs Scale. Descriptive statistics were calculated and logistic regression analysis was performed.

Results

Personnel working in home care had lower odds of having an internal locus of control than those working in special accommodation, and personnel with less than 10 years of working experience had lower odds than their more experienced counterparts. Men had higher odds of having an external locus of control than women.

Conclusions

It seems important to ensure that home care personnel and less experienced personnel attend oral care educational sessions, and to encourage male staff to focus on oral care work.

Cross-sectional study of oral health care service, oral health beliefs and oral health care education of caregivers in nursing homes

OBJECTIVES

To assess oral care beliefs and oral hygiene procedures among nursing home personnel to identify strengths and weaknesses in managing oral care.

METHODS

A cross-sectional study in two nursing homes using an oral health care questionnaire including the Nursing Dental Coping Belief Scale.

RESULTS

A total of 109 health personnel participated. Oral care was seldomly achieved twice a day and dental supplies were not guaranteed. Registered nurses found the oral health of residents more acceptable than did allied health personnel with less oral care education, who mostly delivered daily care. Conversely, nursing staff with oral care education had lower dental coping beliefs, suggesting a lack of self-reliance in controlling oral health outcomes.

CONCLUSION

Dental supplies should be part of nursing care equipment. Educational programs could increase positive oral health beliefs and enhance the quality of care in these settings, particularly among those who are accountable for oral care.