Oral care perspectives of professionals in nursing homes for the elderly

Identification and assessment of factors that impact the demand for and supply of dental hygienists amidst an evolving workforce context: a scoping review

BACKGROUND

This study involved a scoping review to explore factors influencing dental hygienist demand and supply in high-income countries.

METHODS

A six-stage scoping review was conducted with separate search strategies tailored to four databases (MEDLINE, CINAHL, Google Scholar, and Google) plus a targeted scan of dental hygienist organization websites. This yielded 2,117 unique citations, leading to 148 articles included in the review.

RESULTS

Nearly half of the articles (47%) focused on the United States, with 11% on Canada. Most articles (91%) were in English, alongside 13 in Korean and one in French. Journal articles comprised 62% of the publications, followed by reports/working papers (11%) and websites (11%). Other types included conference abstracts, policy briefs, and presentation slides. Content-wise, 47% were original research, with analysis articles (14%), commentaries (11%), and reviews (8%) also present. The articles were coded into three main categories: workforce characteristics/projections, factor-specific analyses, and workforce opportunities. The articles on workforce characteristics covered demographic, geographic, and employment aspects of dental hygienists, along with projections for supply and demand using simulation modelling and geospatial analyses. Factor-specific articles investigated the (1) working environment, (2) policy/regulatory/training environment, (3) job/career satisfaction and related human resource issues, and (4) scope of practice. The third key category of articles highlighted opportunities for expanding the workforce through alternative models in different sectors/settings (e.g., public health, primary care, long-term care, hospitals, mobile outreach, and non-clinical roles including research, education and leadership) and for a range of vulnerable or underserved populations (e.g., geriatric and pediatric populations, persons with disabilities, those living in rural/remote areas, Indigenous peoples, and incarcerated people).

CONCLUSIONS

This review provides a comprehensive documentation of the current state of the dental hygienist workforce, compiling factors affecting demand and supply, and highlighting opportunities for the dental hygienist workforce in Canada and other high-income countries. The findings offer a foundation for future research, highlighting the need for more focused and rigorous reviews and underscoring the necessity of high-quality studies to verify the effectiveness of various interventions and policies. This is crucial to address dental hygienist workforce challenges and ensure the sustainability and effectiveness of oral health care delivery.

Homebound oral care for older adults: A qualitative study of professional carers' perspectives in Perth, Western Australia

OBJECTIVE

To examine professional support workers and case managers' (professional carers) perspectives of what promoted or compromised oral health care in homebound adults aged over 65 years in Perth, Western Australia and identify professional carers' need for support in this context.

BACKGROUND

Accessing dental services can be difficult to navigate and unaffordable for homebound older adults. Paid carers often play a substantial role in facilitating access to services yet there is limited qualitative evidence of the perspectives of these stakeholders.

METHODS

Given limited evidence in this area, this simple qualitative study was informed by constructivist grounded theory. Participants comprised 15 professional carers of homebound older adults. Transcripts were analysed to identify participant perceptions of key barriers and enablers to providing oral health care.

RESULTS

Barriers to clients accessing dental care included participants' uncertainty around navigating the dental system, low priority of oral health care, affordability and confusion around who was responsible to provide oral care. Enablers included participants supporting clients' autonomy around oral care, better integration of oral care into primary health care and education and opportunity for training for professional carers.

CONCLUSION

Ensuring oral health is part of primary health plans, clarifying roles and responsibilities around delivering oral health care to homebound older adults and training carers were key findings. Inter-sectoral collaboration between the dental and aged care sectors can benefit dental practitioners and professional carers in shared learning and has likely flow-on effects for homebound older adults.

What about the fundamentals of nursing-its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

AIM

This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care.

METHODS

This scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023.

RESULTS

Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care.

CONCLUSION

Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798.

Establishing an empirical conceptual model of oral health in dependent adults: Systematic review

AIM

This qualitative evidence synthesis was performed to establish a conceptual model of oral health in dependent adults that defines the construct of oral health and describes its interrelationships based on dependent adults' and their caregivers' experiences and views.

METHODS

Six bibliographic databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, OATD, and OpenGrey. Citations and reference lists were manually searched. A quality assessment of included studies was conducted independently by two reviewers using the Critical Appraisal Skills Programme (CASP) checklist. The 'best fit' framework synthesis method was applied. Data were coded against an a priori framework and data not captured by this framework were thematically analyzed. To assess the confidence of the findings from this review, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used.

RESULTS

Twenty-seven eligible studies were included from 6126 retrieved studies. Four themes were generated to further understand oral health in dependent adults: oral health status, oral health impact, oral care, and oral health value.

CONCLUSION

This synthesis and conceptual model offer a better understanding of oral health in dependent adults and subsequently provide a starting point to guide establishment of person-centred oral care interventions.

Should oral care be about more than a gut feeling? A qualitative study investigating patients' and healthcare professionals' experiences

AIM

To explore patients' and healthcare professionals' (HCPs) experiences of oral care during hospitalisation to identify needs and challenges.

BACKGROUND

Daily oral care is important to patients' health and well-being, to prevent diseases in the oral cavity, systemic infections and increased morbidity, which subsequently can lead to prolonged hospitalisation and, at worst, increased mortality. Despite this knowledge, oral care is a neglected part of nursing practice. Studies do not clearly identify barriers regarding oral care, as the existing knowledge is inadequate.

DESIGN

A qualitative study exploring participants' experiences to gain new in-depth knowledge of oral care among hospitalised patients.

METHODS

A phenomenological-hermeneutic approach was applied. Participant observations were conducted on five hospital wards, combined with individual semi-structured interviews with 16 patients and 15 HCP. Data analysis was based on Ricoeur's theory of narrative and interpretation.

RESULTS

Four themes describing the challenges regarding oral care emerged: Oral care as a gut feeling; oral care fades into the background; even self-reliant patients need help with oral care; and the mouth reflects the life lived.

CONCLUSIONS

The identified challenges show there is a need for improvement in the health professional approach to oral care in nursing practice. Focus on increasing HCPs' knowledge, skills and competences can increase their nursing agency and support patients' self-care capacity.

IMPACT

Investigation of oral care during hospitalisation revealed four main challenges concerning both patients' and HCPs' lack of knowledge and awareness of oral care. Thus, patients and HCPs should be included in developing solutions to improve oral care in nursing practice.

REPORTING METHODS

The COREQ criteria for reporting qualitative research were adhered to.

PATIENT CONTRIBUTION

A patient representative was involved in the discussion of the proposal, conduct and results of the study.

Revealing a gap in the clinical competence of nursing staff in nursing homes: a cross-sectional study with the Ms. Olsen test

BACKGROUND

Nursing staff, caring for frail older people in long-term care, needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care. In Finland, nursing care is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff's clinical competence and adequate and continuous education.

AIM

This study aimed to explore nursing staff, i.e. the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses' clinical competence and fundamental background factors.

METHODS

We conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland, between December 2020 and January 2021. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence.

RESULTS

This study with the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the clinical competence test. In the self-evaluation, almost all participants evaluated themselves with good clinical competence. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. Significant correlation was found between Swedish as a working language and mother tongue and the score for clinical competence.

CONCLUSION

The clinical competence test, the Ms. Olsen test, was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. We found gaps in the clinical competence in Finnish nursing homes, both for PNs and RNs. The result differed remarkably from their self-assessments and the staff did not use the national nursing guidelines as required to develop their nursing skills and knowledge. Gaps in the clinical competence have been identified and can be used to develop targeted continuous education.

Promoting oral and dental healthcare among the elderly in a residential care home in Isfahan: a best practice implementation project

INTRODUCTION

Oral health is an important aspect of general health, which affects the wellbeing and quality of life of older adults. Residents in aged care facilities often suffer from overall dental neglect and insufficient oral healthcare, leading to moderate-to-high levels of oral diseases. Furthermore, physical or mental health concerns may result in difficulties in maintaining good oral health.

OBJECTIVES

This implementation project aims to audit and improve the oral healthcare status of the elderly living in a residential care home in Isfahan, Iran using the JBI evidence summary.

METHODS

The methods are preimplementation and postimplementation design using audit and feedback with a situational analysis to guide implementation planning. Seven evidence-based quality indicators were used to measure preintervention compliance with the best practice. Situational analysis was used to identify and target barriers through locally developed practice change strategies following which a repeat audit was conducted at 4 months. Four nursing staff, 11 caregivers, and 38 residents were interviewed for both the baseline and the follow-up audit.

RESULTS

Compliance rates improved for all seven criteria except the use of a soft-bristled toothbrush (criterion 6). All eight categories of criterion 2 measuring assessment of oral health improved by at least 10%, with the largest improvements in saliva assessment and gingiva assessment. Criterion 1 (oral health training for caregivers) reached the greatest compliance rate (100%).

CONCLUSION

The implemented strategies included improving knowledge and changing the attitudes of the caregivers through organizing educational sessions. These strategies were developed to address process and structural barriers to best practice and were helpful for staff uptake of evidence.

Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study

Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.

Image diagnosis models for the oral assessment of older people using convolutional neural networks: A retrospective observational study

AIMS

The purpose of this study was to construct a model for oral assessment using deep learning image recognition technology and to verify its accuracy.

BACKGROUND

The effects of oral care on older people are significant, and the Oral Assessment Guide has been used internationally as an effective oral assessment tool in clinical practice. However, additional training, education, development of user manuals and continuous support from a dental hygienist are needed to improve the inter-rater reliability of the Oral Assessment Guide.

DESIGN

A retrospective observational study.

METHODS

A total of 3,201 oral images of 114 older people aged >65 years were collected from five dental-related facilities. These images were divided into six categories (lips, tongue, saliva, mucosa, gingiva, and teeth or dentures) that were evaluated by images, out of the total eight items that comprise components of the Oral Assessment Guide. Each item was classified into a rating of 1, 2 or 3. A convolutional neural network, which is a deep learning method used for image recognition, was used to construct the image recognition model. The study methods comply with the STROBE checklist.

RESULTS

We constructed models with a classification accuracy of 98.8% for lips, 94.3% for tongue, 92.8% for saliva, 78.6% for mucous membranes, 93.0% for gingiva and 93.6% for teeth or dentures.

CONCLUSIONS

Highly accurate diagnostic imaging models using convolutional neural networks were constructed for six items of the Oral Assessment Guide and validated. In particular, for the five items of lips, tongue, saliva, gingiva, and teeth or dentures, models with a high accuracy of over 90% were obtained.

RELEVANCE TO CLINICAL PRACTICE

The model built in this study has the potential to contribute to obtain reproducibility and reliability of the ratings, to shorten the time for assessment, to collaborate with dental professionals and to be used as an educational tool.

Oral Care Cards as a Support in Daily Oral Care of Frail Older Adults: Experiences and Perceptions of Professionals in Nursing and Dental Care—A Qualitative Study

Frail older adults often have poor oral health. In Sweden, oral care cards are designed to be used as an interprofessional tool for documenting the oral health status of older adults with extensive care needs and to describe oral care recommendations. The aim of this study was to explore nursing and dental professionals’ experiences and perceptions of oral care cards. Nursing and dental care staff were interviewed in groups or individually. The recorded data were transcribed verbatim and analyzed using qualitative content analysis. A theme emerged: Navigating an oral care responsibility that is not anchored in the nursing and dental care context. The theme was elucidated in three categories: “Accessibility and usefulness”, “Coordination between nursing and dental care”, and “Ethical approach”. The participants perceived a lack of surrounding frameworks and collaboration concerning oral care and the use of oral care cards. An oral care card could ideally facilitate interprofessional and person-centered oral care. However, oral health does not seem to have found its place in the nursing care context. Further research is needed to investigate how oral care cards ought to be developed and designed to support oral health care work.

Health policy analysis on barriers and facilitators for better oral health in German care homes: a qualitative study

OBJECTIVES

To assess possible health policy interventions derived from the theoretical domains framework (TDF) by studying barriers and facilitators on the delivery of oral healthcare and oral hygiene in German care homes using a behavioural change framework.

DESIGN

Qualitative correlational study to evaluate a national intervention programme.

SETTING

Primary healthcare in two care homes in rural Germany.

PARTICIPANTS

Eleven stakeholders participating in the delivery of oral healthcare (hygiene, treatment) to older people, including two care home managers, four section managers, two nurses/carers and three dentists.

INTERVENTIONS

Semistructured interviews conducted in person in the care homes or by phone. A questionnaire developed along the domains of the TDF and the Capabilities, Opportunities and Motivations influencing Behaviours model was used to guide the interviews. Interviews were transcribed and systematised using Mayring's content analysis along the TDF.

RESULTS

860 statements were collected. We identified 19 barriers, facilitators and conflicting themes related to capabilities, 34 to opportunities and 24 to motivation. The lack of access to professional dental care was confirmed by all stakeholders as a major limitation hampering better oral health.

PRIMARY OUTCOME

A range of interventions can be discussed with the methodology we utilised. In our interviews, lack of dentists willing to treat patients at these facilities was the most discussed barrier for improving oral health of nursing home residents.

SECONDARY OUTCOMES

Dentists highlighted the need for better incentives and facilities to deliver oral healthcare in these institutions. Differences with urban settings regarding access to healthcare were frequently discussed by our study participants.

CONCLUSIONS

Within our sample, greater capacitation of care home staff, better financial incentives for dentists and increased cooperation between the two stakeholders should be considered when designing interventions to tackle oral health of care home residents in Germany.

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.

Oral Assessment and Preventive Actions within the Swedish Quality Register Senior Alert: Impact on Frail Older Adults' Oral Health in a Longitudinal Perspective

Poor oral health is common among older people in nursing homes. To identify and prevent oral health problems among the residents, ROAG-J (Revised Oral Assessment Guide–Jönköping), a risk-assessment instrument, is used by nursing staff routinely, and the outcome is registered in the web-based Swedish quality register Senior Alert. This study aims to investigate the preventive actions registered when oral health problems are identified and the effect of these actions longitudinally. ROAG-J data registered at nursing homes in Sweden during 2011–2016 were obtained from the Senior Alert database. Out of 52,740 residents (≥65 years), 41% had oral health problems, of whom 62% had preventive actions registered. The most common action was “Assistance with cleaning teeth”. Longitudinally, during the five-year observation period, a slight increase in oral health problems assessed with ROAG-J was found. Registered preventive actions, however, led to significant improvement in the subsequent assessment for the ROAG items lips, tongue, and dentures. Standardised risk assessments like ROAG-J provide an opportunity to detect problems early and establish preventive actions. The study, however, indicates a further need for structured education and a continuous follow-up in ROAG-J. Moreover, increased collaboration between nursing and dental care to improve oral health for older residents at nursing homes is needed.

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.

Oral hygiene and health-related quality of life in institutionalized older people

Aim

We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities.

Findings

Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL.

Message

Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.

Purpose

We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored.

Methods

This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants’ background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden.

Results

Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender.

Conclusions

Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents’ oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups.

Older people's experiences of oral health and assisted daily oral care in short-term facilities

Background

Older people’s oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

Method

A descriptive, qualitative study was performed through interviews with 14 older people (74–95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

Results

The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff’s knowledge.

Conclusions

The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff’s attention towards older peoples’ oral health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02281-z.

Daily Tasks and Willingness to Work of Dental Hygienists in Nursing Facilities Using Japanese Dental Hygienists' Survey 2019

Oral health care by dental hygienists contributes to the maintenance of nutritional and general health for older people in nursing facilities. This study aimed to investigate daily tasks and willingness to work among dental hygienists working in nursing facilities in Japan. In 2019, using a self-administered questionnaire, a postal cross-sectional survey was conducted among members of the Japanese Dental Hygienists' Association. Questionnaires were distributed to all 16,722 Association members (responses, n = 8932; return rate, 53.4%). We analysed data from 368 dental hygienists currently working in nursing facilities. Item response theory and correspondence analyses were performed. In total, >90% of dental hygienists undertook oral examinations and provided oral hygiene instructions to residents and facility staff. In contrast, the implementation rate of tasks related to interprofessional collaboration was relatively low (approximately 50%), and 72.6% of dental hygienists indicated that they wanted to continue working in nursing facilities. Their willingness to work was closely associated with work involving interprofessional collaboration. Our study findings showed that dental hygienists' work content in nursing facilities was diverse, but that there was variation in implemented tasks. Willingness to continue working in nursing facilities was associated with interprofessional collaboration among dental hygienists.

Oral health among older adults in nursing homes: A survey in a national quality register, the Senior Alert

Aim

To investigate the extent to which the Revised Oral Assessment Guide–Jönköping (ROAG‐J) is used by nursing staff routinely in nursing homes in Sweden and to describe oral health status of the residents.

Design

An observational, retrospective register‐based study.

Methods

Data from different validated health assessments instruments, including ROAG‐J, for the period 2011–2016 were obtained from the Web‐based national quality register Senior Alert. The basis for the analyses was 190,016 assessments.

Results

About half of all residents had underwent at least one annual ROAG‐J assessment (2014–2016). During the period 2011–2016, 42% of the residents (n = 92,827) were registered to have oral health problems. Significantly more oral health problems were found for men and for those with younger age, poorer physical condition, neurophysiological problems, underweight, impaired mobility and many medications. In conclusion, poorer oral health was found for more care‐dependent individuals, which shows a need of preventive actions.

Relying on nursing staff for oral hygiene care: A qualitative interpretive description study

Nurses may not prompt or offer assistance with oral hygiene care activities to patients who do not ask for help because they appear independent in their ability to perform their oral hygiene care. That is, nurses may be inclined to preserve patient autonomy over ensuring adequate oral hygiene outcomes. The purpose of this qualitative Interpretive Description study was to explore, with older patients in post-acute settings, their perspectives and experiences with being autonomous or relying on nursing staff for oral hygiene care. Bedside interviews with 21 patients revealed that: (a) their oral hygiene had deteriorated since hospitalization; (b) nurses may not be aware of patients' oral health values or offer help unless asked; and (c) patients are generally open to being asked if they need help with oral care, being prompted to complete oral care, being asked if they have completed oral care, and having nurses ensure adequate oral care.

The oral health quality of life for seniors in residential facilities who have direct access to care as compared to those without access

INTRODUCTION

This pilot study tests whether there is a perceived difference in oral health when residents in long-term care facilities receive direct access to the scaling of teeth/debridement using dental hygiene instruments compared to facilities who provide only minimal oral hygiene care.

METHODS

The study was a quasi-experimental pretest/post-test control group design and took place at two long-term care senior residential facilities in Sheridan, Wyoming. Fifteen residents from each facility comprised the study sample (n = 30). The treatment group received a debridement and oral hygiene education and the control group received brushing, flossing, and oral hygiene education.

RESULTS

Results revealed a significant difference in pre/post OHIP-5 scores in the treatment group (p = 0.0222). The control group had improved scores, but it was not significant.

CONCLUSIONS

This study demonstrated a significant difference in the perception of oral health quality of life when seniors received a dental cleaning where they reside.

Oral health in residential aged care: Perceptions of nurses and management staff

Aim

This study aimed to explore the perceptions of residential aged care nursing and management staff regarding oral care, to develop strategies to improve the oral health of aged care residents.

Design

A qualitative approach was used.

Methods

Two focus groups were conducted with nursing and management staff at two residential aged care facilities and transcripts were thematically analysed.

Results

All staff had an awareness of the importance of oral health; however, they highlighted the significant challenges in the current system that affect implementation of oral health training and practice guidelines in the residential aged care facility. High staff turnover, time constraints, difficulties in accessing dental services and working together with residents, their families and external staff were barriers to providing oral health care. Staff highlighted the need for formalized clinical guidelines and processes and efficient dental referral pathways to create a more cohesive system of care.

Is an oral health coaching programme a way to sustain oral health for elderly people in nursing homes? A feasibility study

OBJECTIVES

This study examines the feasibility of an oral health coaching programme involving practical support on individual level to staff in a nursing home in Sweden, aiming to improve oral health care-related beliefs of nursing staff and the oral health of residents.

METHODS

This intervention study consisted of three wards from one nursing home, and both staff (n = 48) and residents (n = 58) were invited. In the control ward, 9 staff and 16 residents participated; in test ward 1, 10 staff and 13 residents participated; and at test ward 2, 14 staff and 17 residents participated. An oral health coaching programme was performed 4 h/wk for 3 months. The staff completed the nursing Dental Coping Beliefs Scale at baseline and after 9 months. Oral health of the residents was assessed using the Revised Oral Assessment Guide and mucosal-plaque score at baseline and after 3, 6 and 9 months.

RESULTS

At baseline, 33 staff participated and 22 at 9 months follow-up. For the residents, the figures were 48 and 32, respectively. After the intervention, the nursing DCBS revealed changes related to usage of fluoride, oral health support, gum disease and approximal cleaning. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents' relatively high level of oral health was stable during the study period.

CONCLUSIONS

Despite limitations in the programme, an oral health coaching programme can support nursing staff in maintaining a high level of oral health in residents. The programme was shown feasible, although design improvements are needed.

Oral health and oral care in short-term care: prevalence, related factors and coherence between older peoples' and professionals' assessments

Background

Oral health is important for well‐being and overall health. Older peoples′ oral health is well described in the residential care context, but remains understudied in short‐term care.

Objective

The aim of this study was to describe oral health, daily oral care and related factors among older people in short‐term care and to compare self‐perceived oral health with professional assessment.

Materials and methods

This cross‐sectional study included 391 older people in 36 short‐term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self‐perceived oral health. Self‐care ability was assessed with Katz Index of Activities of Daily Living (Katz‐ADL).

Results

Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self‐care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self‐perceived oral health.

Conclusion

Professionals’ assessments of oral health differed considerably from the older peoples′ own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self‐care (ADL). This study indicates that in order to improve older peoples′ oral health and oral care we need to provide person‐centred oral care and to develop a close collaboration between nursing and dental staff.

Barriers and facilitators for provision of oral health care in dependent older people: a systematic review

OBJECTIVES

Provision of oral health care (OHC), including oral hygiene (OH) or oral/dental treatment, to dependent older people (DOP) is frequently insufficient. We aimed to assess barriers and facilitators perceived by different healthcare professionals towards providing OHC to DOP.

MATERIALS AND METHODS

A systematic review was performed. Studies reporting on knowledge, attitudes, and beliefs acting as barriers and facilitators for provision of OHC were included. One database (PubMed) was searched and data extraction independently performed by two reviewers. Thematic analysis was used and identified themes translated to the domains and constructs of the theoretical domains framework (TDF) and aligned with the domains of the behavior change wheel (BCW). Analyses were stratified for the two target behaviors (providing oral hygiene and providing oral/dental treatment) and according to different stakeholders' perspective. For quantitative analysis, frequency effect sizes (FES) were calculated.

RESULTS

In total, 1621 articles were identified and 41 (32 quantitative, 7 qualitative, 2 mixed method) studies included. Within these 41 studies, there were 7333 participants (4367 formal caregivers, 67 informal caregivers, 1100 managers of care, 1322 dentists, 340 DOP). Main barriers for providing OH were "lack of knowledge" (FES 65%, COM-B domain: capability, TDF domain: knowledge) and "patients refusing care" (62%, opportunity, environmental context and resources). Main facilitators were "OHC training/education" (41%, capability, skills) and "presence of a dental professional" (21%, opportunity, environmental context and resources). Main barriers for provision of dental treatment were "lack of suitable facilities for treatment/transportation of patients" (76%) and "patients refusing care" (53%) (both: opportunity, environmental context and resources). Main facilitators were "regular visiting dentist" (35%) and "routine assessment/increased awareness by staff" (35%) (both: opportunity, environmental context and resources).

CONCLUSIONS

A number of barriers and facilitators for providing different aspects of OHC were identified for different stakeholders.

CLINICAL RELEVANCE

Our findings help provide the evidence to develop implementation strategies for providing high-quality systematic OHC to DOP.

REGISTRATION

This review was registered at Prospero (CRD42017056078).

Occurrence of oral health problems and planned measures in dependent older people in nursing care

AIMS AND OBJECTIVE

To describe oral health problems and planned measures in older people receiving nursing care.

BACKGROUND

Poor oral health conditions have a negative impact on the quality of life of older people. Therefore, oral care is an important task in daily nursing activities.

METHODS

Data were obtained from the web-based Swedish national quality register Senior Alert. Data regarding oral health status and planned measures in individuals ≥65 years from one county in Sweden between July 2014-June 2015 were included. The Revised Oral Assessment Guide-the Jönköping (ROAG-J) was used routinely by nursing staff in nursing care facilities to measure oral health status.

RESULTS

Oral assessments were made on 2,567 individuals (65.7% women). The most common oral health problem was related to "Teeth" (43.0%), which indicates deficient oral hygiene and/or broken teeth. At least one measure was planned in all the participants. The most common planned measures were "Moistening of the mouth" (16.6%), followed by "Brushing - assistance or complete help" (13.5%).

CONCLUSION

Oral health problems were common, and planned measures did not seem to be sufficient to address the identified problems. The results indicate that greater priority should be given to the oral health care of older people in nursing care.

RELEVANCE TO CLINICAL PRACTICE

The study highlights the importance of not only identifying oral health problems but also having knowledge and strategies for oral health care. Collaboration is needed to support nurses in caring for the oral health care of older people in nursing homes.

[Interprofessional collaboration in geriatric primary oral healthcare in Québec – Implementation landmarks]

Accelerated ageing of the population results in an ever-increasing number of functionally dependent elderly persons. Even healthy older people experience self-care deficits due to decreased mobility, endurance and sensory loss. Residents in long-term care centres depend on caregivers for the majority of their activities of daily living.Dental services for functionally dependent seniors generally remain inadequate. Several factors may explain this situation, including the absence of government guidelines and the lack of initial and continuing training of both dental and non-dental personnel.Based on a review of the scientific literature published between 1970-2016, four strategies were identified to improve this problem:Promoting, supporting and formalizing interprofessional collaboration.Building a common vision for oral health.Developing complementary and shared professional and relational skills.Redefining the roles and responsibilities of primary care practitioners.These strategies could be considered in the process of implementing a dental service adapted to the needs of this population group.

Knowledge, perceived skills and activities of nursing staff to support oral home care among older domiciliary care clients

BACKGROUND

Increasing number of older adults lives in their own homes, but needs help in many daily routines. Domiciliary care nursing staff (DCNS) is often needed to support oral home care. However, information of nursing staff's knowledge, skills and activity in this task is sparse.

OBJECTIVES

The study aimed to assess DCNS knowledge, perceived skills and activities to support oral home care of older domiciliary care clients.

MATERIAL AND METHODS

The study was conducted among DCNS in one of the largest cities in Finland. All DCNS members (n = 465) received a questionnaire with 14 multiple choice and open questions regarding the perceived skills, knowledge and activities of oral health guidance of older domiciliary care clients. In total, 115 (25%) DCNS members returned the questionnaires. Frequencies, percentages, means and standard deviations were used to describe the samples and study variables. DCNS was categorised according to age and working years for group comparisons, which were assessed with chi-squared test.

RESULTS

Knowledge concerning oral health was mostly on a high level. Around 50% of DCNS considered their knowledge regarding dental prosthesis hygiene as sufficient. Of the DCNS, 67% informed that they had received education on oral health care. However, over 50% of the DCNS had a need for further education in issues related to oral home care. DCNS were active in supporting most oral and prosthesis hygiene means, yet less in guidance concerning toothbrushing. Activity to support cleaning the interdental spaces was the weakest, in which only 12% of the respondents considered having average or excellent skills. Younger DCNS had better knowledge on oral home care due to recent education, but older staff members were more skilful in performing oral hygiene measures.

CONCLUSIONS

There is a need for structured instructions and training on oral home care for DCNS. Oral home care should be taken into account more often and regularly.

Healthcare providers' experiences of assessing and performing oral care in older adults

AIMS AND OBJECTIVES

The purpose of this study was to describe healthcare providers' experiences, knowledge and attitudes in relation to the assessment of oral health in older adults.

BACKGROUND

Oral health is an important element in the care of older adults. An increasing proportion of older people need the help and support of community-based healthcare services, which are responsible for providing oral health assessment for this group. Although oral care is an important part of nursing care, studies show that it is often an overlooked area in the care of older people.

DESIGN

An inductive qualitative description design was used.

METHODS

The participating healthcare providers were selected from a municipality in western Sweden. Purposeful sampling was employed and data were collected through focus-group interviews and were analysed with content analysis.

RESULTS

The analysis resulted in four categories: healthcare providers' knowledge and attitudes to oral health; routines affect flexibility; challenges in assessing and performing oral care and ethical dilemmas. The results showed that oral health was neglected because of several factors. Lack of knowledge, inadequate procedures and time constraints were most prominent. The healthcare providers' own attitudes affected the performing of oral health assessments. Ethical dilemmas related to the attitudes of those people in receipt of care and their relatives, and their integrity and autonomy, could be seen as complicating factors.

CONCLUSIONS

The healthcare providers expressed that they did not have the necessary knowledge of oral health that was required in their area of responsibility. In addition, they described their own attitudes as being important when attending to the patients' oral health.

IMPLICATIONS FOR PRACTICE

The healthcare providers themselves identified lack of knowledge and their own attitudes as being especially important factors in the oral care of older adults, and further research in this area is needed.

Developing an integrated resource to promote oral health in nursing homes

Public health is the responsibility of every nurse and nursing practice should adopt a life course approach to the promotion of health and well-being. This approach requires a renewed focus on health promotion interventions aimed at older people, including those resident in nursing homes. The oral health status of older people in nursing homes has been reported as suboptimal, predisposing them to poorer health-related quality of life. Interventions focusing on knowledge and behaviours related to oral health management for nurses, other caregivers and older people have the potential to improve the provision of oral care. This article discusses a project undertaken by a team of preregistration nursing students to plan and develop an integrated oral health promotion resource for older people in nursing homes. Healthy Smile, Healthy Me comprises a poster called five steps for oral hygiene and an oral health box. Initial feedback from a pilot of the resource in a nursing home is encouraging and research is planned to explore the feasibility, acceptability and efficacy of the resource.

Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia.More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth.

BACKGROUND

Dementia poses a significant challenge for health and social policy in Australia. The quality of life of individuals, their families and friends is impacted by dementia. Older people with dementia often have other health comorbidities resulting in the need for a higher level of care. From 2009 to 2010, 53% of permanent residents in Residential Aged Care Facilities (RACFs) had dementia on admission. Older Australians are retaining more of their natural teeth, therefore residents entering RACFs will have more of their natural teeth and require complex dental work than they did in previous generations. Data from the Australian Institute of Health and Welfare showed that more than half the residents in RACFs are now partially dentate with an average of 12 teeth each. Furthermore, coronal and root caries are significant problems, especially in older Australians who are cognitively impaired.Residents in aged care facilities frequently have poor oral health and hygiene with moderate to high levels of oral disease and overall dental neglect. This is reinforced by aged care staff who acknowledge that the demands of feeding, toileting and behavioral issues amongst residents often take precedence over oral health care regimens. Current literature shows that there is a general reluctance on the part of aged care staff to prioritize oral care due to limited knowledge as well as existing psychological barriers to working on another person's mouth. Although staff routinely deal with residents' urinary and faecal incontinence, deep psychological barriers exist when working on someone's mouth due to their own personal values of oral health or their views that residents should be looking after their own teeth or dentures. Furthermore, residents with behavioral issues associated with dementia frequently have their oral hygiene neglected as they may be resistant and violent towards receiving oral care from aged care staff. Studies have shown that residents with dementia will often refuse to open their mouth or partake in oral hygiene care by aged care staff. The aged care staff in return often do not pursue an oral care regimen for these "difficult" residents, perpetuating the cycle of oral neglect and resultant disease.Dental hygienists are qualified oral health professionals who are specifically trained to develop individualized oral health care plans and preventative programs to reduce oral health disease in the community. Residents with dementia in aged care facilities have the right to live their lives comfortably and free of oral discomfort or pain. A Victorian study conducted by Hopcraft et al. investigated the ability of a dental hygienist to undertake a dental examination/screening for residents in aged care facilities, to develop a preventative and periodontal treatment plan and to refer patients appropriately to a dentist. Results from this study demonstrated that there was an excellent agreement between the dentist and dental hygienist regarding the decision to refer residents to a dentist for treatment, demonstrating high sensitivity (99.6%) and high specificity (82.9%). Residents from 31 Victorian RACFs (n=510) were examined by a single experienced dental epidemiologist and one of four dental hygienists using a simple mouth mirror and probe. Hopcraft et al. concluded that hygienists should be utilized more widely in providing holistic oral health care to residents in aged care facilities.Recently, Lewis et al. discussed the need to develop models of care to improve access to dental care for frail and functionally dependent elderly people in aged care facilities, with the model of care involving dental hygienists/oral health therapists having merit.The concept of professional oral care involves an oral health professional such as a dental hygienist or oral health therapist supervising or assisting residents with their oral care. Oral care involves the mechanical removal of plaque and food debris using a toothbrush, interproximal brush and floss.In 2014, Morino et al. explored the efficacy of short term professional oral care from dental hygienists once a week after breakfast for one month. In this study, the dental hygienists did not perform dental scaling but brushed subjects' teeth using a toothbrush and interdental brush. Dental plaque scores decreased significantly (Fisher's two-tailed tests, p<0.05) in the professional oral health intervention group. Interestingly, the positive effects of this short term intervention were sustained for the following three months (Wilcoxon test, p<0.05).A pilot study in Arkansas was conducted by Amerine et al. and utilized the dental hygienist as the "oral health champion" in the residential aged care facility using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI) scores to measure oral health. The results from this study showed improvements in three measured areas (tongue health, denture status and oral cleanliness) in the dental hygiene champion group. These findings suggest that the presence of a dental hygiene champion in long term care facilities may positively impact the oral health of residents requiring assistance with their oral care. However, the authors noted further research in this concept is required.Van Der Putten GJ et al. explored the effectiveness of a supervised implementation of an oral health care guideline in care homes. In each ward of the care homes, a nurse who acted as the ward oral health care organiser (WOO) was appointed. The dental hygienist and an investigator would attend the RACFs every six weeks to support them. The dental hygienist would train the WOO, and the WOO would train the ward nurses and nurse assistants. Participants were allocated into an intervention or a control group. The intervention group received supervised oral care. Statistically significant differences in mean dental and denture plaque scores at six months in both groups occurred (student t-test, p < 0.0001). This research study implemented an intervention using the train-the-trainer approach and although improvements in dental and denture plaque scores were seen in the six-month period, the long-term effects of this intervention are unknown. Further studies exploring the long-term effects of staff training on oral health education are needed as well as ongoing staff training in aged care facilities.A systematic review on oral health and aspiration pneumonia conducted by Vander Maarel-Wierink et al. has suggested that, in the frail elderly, the best intervention to reduce the incidence of aspiration pneumonia is brushing of teeth after each meal, cleaning dentures once a day, and receiving professional oral health care once a week.The need to advocate for a new model of geriatric dentistry is critical. A holistic multi-disciplinary approach to health care for residents entering aged care homes is imperative to achieve better oral health and comfort for residents, especially with Australia's ageing dentate population. A dental examination and assessment on admission to a RACF should be conducted by a Registered Nurse (RN), followed by an oral health professional such as a dentist, dental hygienist or oral health therapist. Current practice in the majority of Australian government funded nursing homes is that the RN or the Assistant in Nursing (AIN) conduct the oral health assessment as part of the aged care funding instrument (ACFI). Ongoing oral health care supported by an oral health professional is important throughout the individual's residency and eventual palliation whilst in an aged care facility.No systematic reviews conducted on the impact of professional oral care on the oral health of elderly people living in residential aged care facilities could be located, despite extensive searching of Medline, CINAHL, EMBASE, Web of Science, Cochrane Central Register of Trials and Dentistry & Oral Sciences Source (DOSS) databases. A JBI systematic review was conducted in 2004, titled, "Oral hygiene care for adults with dementia in residential aged care facilities"; however, this review examined the prevalence, incidence and increments of oral diseases; the use of assessment tools to evaluate oral health; preventative oral hygiene care strategies; and the provision of dental treatment and so had a different clinical focus. Twenty studies were included for analysis in the review conducted by Weening-Verbree et al, The studies in this review addressed oral health knowledge of aged care staff and mostly were conducted as an educational session delivered by dental hygienists or dentists.Overall, the current evidence available on interventions to improve oral health for residents living in aged care facilities is inadequate and should be explored further.

The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study

BACKGROUND

Dysphagia and potential respiratory pathogens in the oral biofilm are risk factors for aspiration pneumonia in nursing home residents. The aim of the study was to examine if the daily application of 0.05% chlorhexidine oral rinse solution is effective in reducing the incidence of aspiration pneumonia in nursing home residents with dysphagia. Associations between background variables (age, gender, dysphagia severity, care dependency, medication use, number of medical diagnoses, teeth and dental implants, and wearing removable dentures) and the incidence of aspiration pneumonia were also examined.

METHODS

This study is a multicenter study in which for 1 year participants with dysphagia in the intervention group received the usual oral hygiene care with the addition of a 0.05% chlorhexidine oral rinse solution, whereas participants in the control group received only oral hygiene care.

RESULTS

Data of 103 participants in 17 nursing homes were analyzed. Survival analysis showed no significant difference in the incidence of pneumonia between both groups (Cox regression, HR = 0.800; 95% CI [0.368-1.737], p = 0.572). Cox regression analysis for Functional Oral Intake Scale (FOIS)-level showed a significant risk of the incidence of pneumonia (HR = 0.804; 95% CI [0.656-0.986], p = 0.036). After adjustment for Group and FOIS-level, Cox multivariate proportional hazard regression analysis showed that the variables age, gender, Care-dependency Scale-score (CDS) number of diseases, medication use, number of teeth, and the presence of dental implants or removable dentures were not significantly associated with the incidence of pneumonia.

CONCLUSIONS

Chlorhexidine oral rinse solution 0.05% as an adjunctive intervention in daily oral hygiene care was not found to reduce incidence of aspiration pneumonia. The requested number of participants to achieve sufficient power was not established and high drop-out rate and non-structural compliance was present. The power was considered to be sufficient to analyze the associations between the background variables and the incidence of pneumonia in the included nursing home residents with dysphagia. Dysphagia was found to be a risk factor for aspiration pneumonia.

TRIAL REGISTRATION

Registration in The Netherlands National Trial Register: TC = 3515. Approval for the study was obtained from the Medical Ethical Committee of the Radboud University Medical Center (NL. nr:41,990.091.12).

Oral Health Status of Older Adults in Sweden Receiving Elder Care: Findings From Nursing Assessments

BACKGROUND

Frail elderly people often have poor oral hygiene, contributing to oral health problems that can detract significantly from quality of life.

OBJECTIVE

The aim of this study was to describe oral health status of frail elderly individuals using the Revised Oral Assessment Guide-Jönköping (ROAG-J), a mouth assessment instrument that can be used in daily nursing care.

METHODS

Data were obtained from the Swedish Senior Alert quality registry in one Swedish municipality. ROAG-J assessments on admission to elder care and one subsequent occasion were used. ROAG-J measurements documented oral health in nine areas: voice, lips, oral mucosa, tongue, gums, teeth, saliva, swallowing, and presence of any prostheses or implants. Assessments were made by nursing staff during the course of daily nursing care.

RESULTS

Individuals 65 years of age or older and receiving elder care services (N = 667) were involved; 1,904 assessments made between November 2011 and March 2014 were used for the analysis. On the basis of both assessments, less than one third of participants had oral health problems. No significant difference in any of the oral health variables was found between first and subsequent assessments. At first assessment, men and women differed in tongue health (p < .01); at the subsequent assessment, gender differences in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006) were observed.

DISCUSSION

Most participants had good oral health. Assessments made by nursing staff using the ROAG-J demonstrate that this tool can be used in daily nursing care, where different, important oral conditions may be encountered. However, knowledge about oral health conditions and the ROAG-J instrument is important to ensure high validity. The ROAG-J enables nursing staff to detect problems in the mouth and to guide decisions related to oral health interventions.

Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis

BACKGROUND

Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.

METHODS

We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence.

RESULTS

We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%).

CONCLUSIONS

We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.

Role of information and communication technology in promoting oral health at residential aged care facilities

Information and communication technology (ICT) can provide knowledge and clinical support to those working in residential aged care facilities (RACFs). This paper aims to: (1) review literature on ICT targeted at residents, staff and external providers in RACFs including general practitioners, dental and allied health professionals on improving residents’ oral health; (2) identify barriers and enablers to using ICT in promoting oral health at RACFs; and (3) investigate evidence of effectiveness of these approaches in promoting oral health. Findings from this narrative literature review indicate that ICT is not widely used in RACFs, with barriers to usage identified as limited training for staff, difficulties accessing the Internet, limited computer literacy particularly in older staff, cost and competing work demands. Residents also faced barriers including impaired cognitive and psychosocial functioning, limited computer literacy and Internet use. Findings suggest that more education and training in ICT to upskill staff and residents is needed to effectively promote oral health through this medium.

Mini dental assessment: a simple screening test for non-dental staff

OBJECTIVE

The objective of this study was to develop a simple tool for the assessment of possible dental treatment needs (DTN) for non-dental professionals (Mini Dental Assessment, MDA). To keep the assessment universal, we aimed to base it on the patient's history and a simple chewing efficiency test (CET) as the dental status is a known determinant for chewing efficiency.

MATERIALS & METHODS

The assessment was developed using data from 169 patients from two sites (University Hospital Giessen, St. Bonifatius Hospital Lingen, both Germany). In all patients, a dental examination was performed, the denture status was evaluated (based on the California Dental Association criteria; CDA criteria), and the DTN was determined. In addition, the time since the patient's last visit to a dentist (TLVD) and denture age (DA) were assessed. Furthermore, a CET was carried out and the comminution score was determined (CETS).

RESULTS

In total, 108 patients required dental treatment. The mean value (±SD) was 2.9 ± 0.9 score points for the DTN, 2.5 ± 3.8 years for the TLVD, and 10.8 ± 8.9 years for the DA. There was a significant correlation (Spearman, P < .05) between the DTN and degree of comminution (3.4 ± 1.8). Based on the results of the statistical analysis, the intended assessment tool was developed using the variables CETS, TLVD, and DA weighed by their respective regression coefficients (10:3:1). Subsequently, the resulting MDA score (51.32 ± 28.14) was calculated. A sensitivity/specificity analysis was conducted and a receiver operating characteristic curve was calculated (SPSS 17.0, area under curve 0.805; 95 % CI 0.738-0.873).

CONCLUSION

It can be concluded that the dental status of elderly patients is reflected in the outcome of the MDA. However, ongoing validation is needed.

TRIAL REGISTRATION

DRKS00003219.

Does enhancing personal care assistants' own oral health influence their attitudes and practices towards oral care for residents - a pilot study

OBJECTIVES

To investigate whether, within a residential care facility, increasing personal care assistants' (PCAs) awareness of their own oral health status and self-care skills would alter existing attitudes and behavioural intentions related to the oral health care of residents.

METHODS

PCAs (n = 15) in the dementia care unit of a residential care facility in Melbourne, Australia, were invited to participate in a small research project that appeared to test the effectiveness of a work-place oral health educational programme in enhancing their own oral health whilst masking the actual outcome of interest, namely its effect on PCAs oral healthcare attitudes and practices towards the residents.

RESULTS

Post-intervention, the self-reported confidence of the PCAs to identify their personal risk for oral health problems, identifying common oral health conditions and determining the factors contributing to their personal oral health was increased significantly (P < 0.05). Post-intervention, the self-reported confidence of the PCAs to feeling confident to identify factors that could contribute to poor oral health of residents, identify resident's higher risk for poor oral health and feeling confident in identifying common oral health conditions in residents was also increased significantly (P < 0.05).

CONCLUSION

The results of this pilot study show that the educational intervention to increase the personal care assistants' (PCAs) awareness of their own oral health status and self-care skills increased the confidence of the carers to identify oral health risks in the residents, as well as increasing their self-reported confidence in providing oral care to residents.

Correlates of attitudes and perceived behavioural control towards oral care provision among trained and untrained nursing home caregivers in Singapore

AIMS AND OBJECTIVES

To investigate the perspectives of nursing home caregivers towards oral care and the determinants of their attitudes and perceived behavioural control.

BACKGROUND

There are few studies analysing nursing home caregivers' perspectives on the provision of oral care and factors correlated with these perspectives.

DESIGN

Cross-sectional study.

METHODS

Interviewer-administered survey questionnaires were completed by caregivers from five nursing homes in Singapore (n = 94). The rating-scale questionnaire items explored caregivers' attitudes, subjective norms and perceived behavioural control, as guided by the theory of planned behaviour. Demographic characteristics, oral care training received, years of work experience, oral hygiene behaviour and dental visit frequency of the caregivers, as well as organisational characteristics such as a requirement for oral care and the number of patients under their care, were obtained.

RESULTS

Caregivers had very positive attitudes towards the provision of oral care. Half of the caregivers lacked confidence in providing oral care without harming the patients and this was not different by oral care training received. Multivariable linear regression analysis found that receiving oral care training and having a requirement by the nursing home to provide oral care were related to higher attitude scores but not perceived behaviour control. Having more residents under their care and on-the-job caregiver training were associated with lower perceived behavioural control.

CONCLUSIONS

This study found that nursing home caregivers had positive attitudes towards providing oral care, but more modest perspectives about their ability to perform that behaviour.

RELEVANCE TO CLINICAL PRACTICE

These findings have useful implications for the oral care training of nursing home caregivers. While attitudes towards the importance of oral care may be positive among nursing home caregivers, our study suggests that future interventions should include practical skills training for oral care management and consider organisational strategies for encouraging oral care provision.

Culturally and linguistically diverse (CALD) carers' perceptions of oral care in residential aged care settings in Perth, Western Australia

OBJECTIVE

The aims of the study were twofold: to explore African migrant carers' perceptions of oral health who worked in residential aged care and to investigate their perspectives of oral care for aged care residents.

BACKGROUND

Culturally and linguistically diverse (CALD) carers are strongly represented in Australian residential aged care facilities.

METHODS

Exploratory qualitative research targeted carers from African backgrounds working in residential aged care facilities in Perth, Western Australia. Fifteen African carers were recruited through community networks and participated in semistructured interviews. Data were analysed for key themes related to the study's aims noting similarities and differences between participants.

RESULTS

All participants considered oral health important to individual well-being and quality of life. Most had limited knowledge of prevention and early detection of oral disease resulting from regular dental check-ups with the majority visiting dental professionals only for dental pain. Yet participants considered oral health care for residents needed improvement. Suggestions included dental professionals on staff and training and professional development for all staff not just in oral health care but also in working respectfully and sensitively with residents and staff from CALD backgrounds.

CONCLUSION

Our findings suggest that, to ensure residents receive high quality oral health care, ongoing professional development is required, not only for CALD carers in oral health but also for non-CALD staff in care that is respectful of cultural differences.

Does residential aged care need dental professionals? A qualitative study on dental professionals' perceptions in Australia

OBJECTIVE

Adults in residential aged care often retain their own teeth following restorative dental procedures during their lives. They may also have physical and psychological comorbidities impacting on oral health including side effects from medications. residents' poor oral hygiene, dental caries and periodontal disease raise questions about the quality of oral health care in aged care facilities. This paper presents findings from a study investigating dental professionals' perceptions of barriers and enablers to providing oral care to residents in such settings.

MATERIAL AND METHODS

Following university ethics approval, semi-structured interviews were conducted with 17 dental professionals [five dentists, three oral health therapists (OHTs) and nine dental hygienists] across Australia to address the issue. Interviews were transcribed and analysed for key themes, noting similarities and differences within and between groups that were compared to existing evidence.

RESULTS

Key themes emerging from interviews included individual and organisational difficulties dental professionals experience when meeting residents' oral health needs; poor access to dental resources; limited oral health education for aged care staff; and lack of interprofessional collaboration. Suggested enablers to oral health included interprofessional education and practice, reflecting broader trends in health care that positively impact on health outcomes.

CONCLUSION

Improving residents' oral health requires appropriate organisational commitment to support dental and non-dental health providers deliver high-quality oral care. This study highlights the need to critically review barriers and enablers to providing such care, particularly as Australia's ageing population increases and longer periods are spent in residential aged care.