Group home caregivers' comfort levels regarding physical resistance during oral hygiene care

Perceptions on Oral Care Needs, Barriers, and Practices Among Managers and Staff in Long-Term Care Settings for Older People in Flanders, Belgium: A Cross-sectional Survey

Background and Objectives

This study aimed to explore oral health perception and oral care needs, barriers, and current practices as perceived by managers and staff in long-term care organizations for older people in Flanders.

Research Design and Methods

This is a cross-sectional study where 2 questionnaires were developed, one for managers and one for caregivers, and were validated in Flemish long-term care organizations. Descriptive analyses and multivariable generalized linear models evaluated the main outcomes and their associations with determinants such as the size of the organization, the presence of an oral health policy, collaboration with a dentist, among others.

Results

A total of 145 managers and 197 caregivers completed the questionnaire. More than 50% of caregivers and managers perceived their residents’ oral health as mediocre to good. Collaboration with a dentist (B = 0.84) and oral health care involvement (B = 0.08) within the organization showed a strong association with a positive perception of oral health. Lack of time (57%) and care resistance (70%) were the most important barriers perceived by caregivers. Guidelines concerning oral care were not available or were unknown to 52% of the caregivers. Having an oral health policy within the organization was strongly associated with the correct use of guidelines for daily care of natural teeth (B = 1.25) and of dental prosthesis (B = 1.15).

Discussion and Implications

The results emphasize that collaborating with a dentist and the presence of an oral health policy in care organizations are important for a positive perception of the oral health of the residents and for the adoption of guidelines by caregivers and managers. In addition, training on handling care refusal should be included in the overall training. These results are crucial input for the development of a methodology for implementing a structured oral care policy in long-term care facilities.

Family Caregiver Experience of Resistance to Care: Occurrence Patterns, Context, and Impact on Caregiver

Although the extant literature identifies resistance to care (RTC) as one of the most frequently reported and impactful caregiver (CG) stressors, typical studies that rely on quantitative measures of RTC do not fully explain how and why RTC negatively influences CGs' well-being. As such, it is difficult to develop specific intervention strategies to support CGs in dealing with RTC. Informed by existing literature and tenets from Stress Theory, the current study includes semi-structured interviews with 19 family CGs of community-dependent (non-institutionalized) elders, regarding their RTC experiences. Through a directed qualitative content analysis, we explored occurrence patterns, contextual factors of when and how RTC occurs, how CGs respond to RTC, and its potential impact on CGs' subjective stress. The results revealed distinguishable characteristics of four types of RTC: Frequent-Pervasive, Frequent-Delimited, Transition-Activated, and Shock-to-Unfamiliar/Unexpected. We discuss how recognition of those types of RTC can be integrated into CG support intervention strategies.

What is it about carer-led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

OBJECTIVES

To undertake a realist review of carer-led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review.

METHODS

Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context-mechanism-outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom.

RESULTS

Of the 697 potential sources, 112 studies progressed to full-text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer-led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer-led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system-level approach; involving carers in design and implementation; tailoring of training to suit carers' needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well-being of carers; and repeating training.

CONCLUSIONS

The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how.

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium

OBJECTIVES

To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders.

MATERIALS AND METHODS

Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018.

RESULTS

Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients' needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers' questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively.

CONCLUSIONS

Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders.

CLINICAL RELEVANCE

The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities.