Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians

Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized In 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 care-givers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority     

Conflicting priorities: oral health in long-term care

Open-ended interviews were conducted with 109 individuals. These included: administrators, staff, dental personnel, residents, and family members, associated with 12 long-term-care (LTC) facilities to contrast different human resource and organizational strategies for managing the delivery of oral health care to the elderly residents. A multiple case-study analysis revealed that no particular organizational strategy was ideal, although three important components—oral hygiene, diagnostic assessments, and dental treatment—were common to all. The dental personnel everywhere believed that oral health in the midst of other conflicting priorities received inadequate attention, while the administrators and staff acknowledged that they were weak at recognizing oral disorders and assisting with oral hygiene. In all, the interviews offered a portrait of the conflicting priorities associated with LTC, and they provide practical insights to successful strategies of care in this population .     

Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments

Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group.     

Dental auscultation for nursing personnel as a model of oral health care education: development,baseline, and 6-month follow-up assessments

Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group.     

Nursing personnel's views on oral health from a health promotion perspective: a grounded theory analysis

The aim of this study was to develop a model for how nursing personnel view oral health in general and the oral health of the care receivers in particular, applying a health promotion perspective and using grounded theory analysis. Data were collected through interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the transcribed interviews showed that there were four strategies, related to staff education, hospital resources, and leadership motivation. The strategies were grounded in data and emerged from the interaction between the two main categories: 'the valuation of the importance of oral health' and 'the behavior towards oral health maintenance'. They were characterized as the routine, theoretical, practical, and flexible strategies, with the latter considered ideal. As increased knowledge is one important part in enhancing the nursing personnel's ability to perform oral hygiene procedures, there is a need for education among nursing personnel, primarily among those using a routine strategy.     

Nursing personnel's views on oral health from a health promotion perspective: a grounded theory analysis

The aim of this study was to develop a model for how nursing personnel view oral health in general and the oral health of the care receivers in particular, applying a health promotion perspective and using grounded theory analysis. Data were collected through interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the transcribed interviews showed that there were four strategies, related to staff education, hospital resources, and leadership motivation. The strategies were grounded in data and emerged from the interaction between the two main categories: 'the valuation of the importance of oral health' and 'the behavior towards oral health maintenance'. They were characterized as the routine, theoretical, practical, and flexible strategies, with the latter considered ideal. As increased knowledge is one important part in enhancing the nursing personnel's ability to perform oral hygiene procedures, there is a need for education among nursing personnel, primarily among those using a routine strategy.     

Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population

Oral hygiene and oral health are a major concern for long-term-care facility residents who are unable to care for themselves. In this six-week study, the efficacy of a sonic toothbrush (Sonicare®) was compared with traditional manual brushing in a setting where hygiene care was provided by caregivers. Evaluations of plaque levels were made at baseline and at 2, 4, and 6 weeks according to the Silness and Löe index. The sonic brush was found to be significantly superior to the manual brush over the trial period (MANCOVA; p = 0.026). Plaque reduction at 6 weeks was found to be 38% with the sonic brush and 6% with the manual brush. The results indicate that the sonic brush may be an effective way to provide improved oral health to nursing home subjects when oral care is caregiver-provided.     

Oral health status of older adults in Arizona: results from the Arizona Elder Study

This study was undertaken to compare oral health status of independent community-dwelling elders with those using long-term-care services. Clinical examinations and self-reported socio-demographlc data were collected for 2927 older adults living Independently, using home-care services, or living In nursing facilities. Mean age of dentate participants (n = 2021) was 72.2 years (range, 50–103 years); mean number of teeth, 18.16; mean DFS, 28.86; and mean RCI, 15.23. In multi-variate analyses, receiving home-care services or living in a nursing facility was significantly predictive of poorer oral health status with respect to both coronal and root carles. This was also true for ethnic groups other than non-Hispanic-white. We concluded that, In a large, multi-ethnic sample, direct comparisons highlight significant unmet treatment need among users of long-term-care services, compared with independent older adults living in the same communities.     

Factors contributing to the variation in oral hygiene practices and facilities in long-term care institutions for the elderly

OBJECTIVE: This study was designed to explore variations in oral hygiene practices and facilities in long-term care institutions for elders. Reported level of caregivers' knowledge related to oral health, reported work-climate, management, size of the institution and the mean age and degree of dependency of residents were evaluated. METHODS: Sixteen nursing homes were selected, using stratified random sampling, in the region of Gent (Flanders). Nine different strata were used based on size and management. Factors thought to be associated with the variation in oral hygiene practices and facilities were collected from 225 caregivers (75%) through a structured 45-item questionnaire. The questionnaire was validated and tested for reliability during a test-retest prior to the start of the study. The relation between rates of oral hygiene practices and facilities and explanatory variables was investigated using correlation analysis and subsequently by multiple regression analysis. RESULTS: The best fitted regression model explained 30% of oral hygiene practice variation. The most predictive variable was the knowledge of caregivers, which explained 17% of the variation, while mean age explained 7% and managerial behaviour 6.3%. There was a trend towards a negative relationship with mean age, degree of dependency and size of the institution. CONCLUSION: Most of the variance in oral health practices and facilities in long-term care institutions for elders in Gent remains unexplained. Knowledge, mean age and managerial behaviour were the most likely explanatory variables.     

Oral health profile in an institutionalized population of Italian adults with mental retardation

The oral health of 219 residents with mental retardation living in a long-term-care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty-five subjects had calculus and/or shallow pockets (4–5 mm); 61 had deep pockets (≥ 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.     

Oral health assessment by nursing staff of Alzheimer's patients in a long-term-care facility

Dental care and oral hygiene are often neglected in nursing homes. This study examines the effect of an education program on the ability of nursing staff to conduct an oral health assessment for a population of persons with Alzheimer's disease and related disorders. The findings of this study showed that the CNA 's are as capable as the Licensed Nurses in assessing oral health status. In future training of nursing staff, increased emphasis on identification of problems in specific areas may improve the overall assessments by nurses and nursing assistants .     

Preferences for and influences on oral health prevention: perceptions of directors of nursing

Directors of Nursing (DONs) from 196 of 206 Nebraska long-term-care (LTC) facilities were sent a pre-tested questionnaire. The aim was to assess available on-site dental services, existing oral health education and prevention programs as well as future needs/preferences, and the influence of 10 factors in assessing and maintaining residents' oral health. Of the 196 DONs contacted, 126 (64%) participated. Only 36% of DON responded reported having on-site dental services. DONs Indicated a preference for nursing staff (NS) oral health in-service training over other educational and/or programmatic proposals. When asked to select the five most influential factors in assessing and maintaining residents' oral health in their respective facilities, DONs selected resident factors (mean, 2.8) more often than NS factors (mean, 2.2). DONs most often identified residents' (R) ability to perform oral hygiene (n = 99), R' cooperation with OH assistance (n = 98), R' interest in their oral health (n = 83), NS interest in R' dental health (n = 70), and NS time constraints (n = 69) .     

Oral health coordinators in long‐term care—a pilot study

This pilot project tested a curricular and systems approach to improving the oral health care of nursing home residents in three facilities in New Hampshire. An oral health coordinator (OHC) was appointed in each facility to act as a liaison between nursing and dental staff, provide resources for nursing assistants, and ensure staff delivery of residents’ daily oral care. During the study, residents’ oral health status was assessed at four intervals and ongoing training was provided to nursing staff. At the conclusion of the pilot study, an evaluation of the results indicated an improvement in oral hygiene in all facilities. The role of the OHC showed promise when that person was active in holding nursing staff accountable for daily oral care of the residents.     

A self-reported survey of Alzheimer's centers in Southwestern Pennsylvania

Directors of nursing at 23 nursing homes with Alzheimer's units in Southwestern Pennsylvania completed a self‐reported survey of 12 questions. Responses from the self‐administered questionnaires (100% response rate) revealed a wide variation in the staff categories assessing the oral health status of newly admitted residents with AD. The respondents described oral examinations that were incomplete when compared to the oral indicators listed in the Minimum Data Set. All nursing homes reported that oral hygiene was provided each day. The number of residents in a facility had a significant effect on the frequency of oral hygiene provided. Only 52% of the facilities reported yearly oral examinations for this population. According to the respondents, dental treatment was typically performed on‐site. The oral health care costs were paid by Medicare, Medicaid, the residents/family members, or by other undescribed resources. Insufficient time, staff, and training, as well as uncooperative behavior, were identified as barriers to optimum oral health care for residents with AD. Additional staff, specialized training, and increased government reimbursement were suggested to improve the oral health care for this group of older adults. For future studies, review of medical records and on‐site evaluation of the oral health care at these facilities should be required to verify the reported practices.     

The opinions and attitudes of dental school academic staff towards oral healthcare education for older adults

The term ‘oral health care for older adults’ has various interpretations, and its meaning is not clear among dental school academic staff. Additionally, there are no theoretical or practical stand‐alone courses on oral health care for older adults in Japanese dental schools. To improve oral health care education, we investigated the opinions and attitudes toward oral health care education for older adults among academic staff in dental schools. Data were collected in seven dental schools from May to September 2013 via an online questionnaire survey. Five‐hundred‐fifty‐eight academics (428 male, 130 female) participated (response rate 57%). The average number of years since they had completed a university degree was 20.2 (SD 10.2) years. The majority (Over 90%) of participants perceived that oral health care should be provided in nursing facilities, hospitals, and at home. Its treatments and instructions should include, not only methods of keeping good oral hygiene, but also improvement of oral function such as swallowing training and salivary glands massage. The majority (84.2%) suggested oral health care education should be combined as a one‐credit, stand‐alone course. Findings indicate that dental academics have an understanding the need for a course in oral health care for older adults. Participants supported the need for further development of education in oral health care for older adults’ in Japan, as a separate course on its own right. However there were some different views about content by teaching field. The need for a national core program for teaching oral health care education was suggested.     

An Interprofessional Approach to Oral Hygiene for Elderly Inpatients and the Perception of Caregivers Towards Oral Health Care

ObjectiveThe objective of this study was to investigate the effect of an interprofessional oral hygiene support program for elderly inpatients and the perception of caregivers of the elderly towards oral health care.Materials and methodsParticipants comprised 37 elderly inpatients requiring nursing care (17 males, 20 females; mean age, 83.3 ± 4.9 years) and 29 registered nurses who participated in the interprofessional oral health care support program as a caregiver (4 males, 25 females; mean age, 45.2 ± 10.3 years). In this program, inpatients received daily oral cleaning by registered nurses based on each patient's oral health care plan. The number of microbes on the tongue surface of the inpatients was measured once a week for 12 weeks. Additionally, as an investigation of the perception of the caregivers towards oral health care, a questionnaire about the required frequency and duration for oral cleaning was conducted with registered nurses before and after the program to investigate the perception of the caregivers towards oral health care.ResultsSignificant differences were observed in the number of microbes on the tongue surface between baseline and at every measurement after the beginning of this program, except for the first week. The mean required frequency and duration for oral cleaning by registered nurses at baseline were 1.5 ± 0.8 times and 3.8 ± 2.2 minutes, whereas those after the program were 2.7 ± 0.7 times and 5.8 ± 2.9 minutes, respectively.ConclusionImplementation of the program decreased the number of microbes on the tongue surface of the elderly inpatients and improved the perception of their caregivers towards oral health care.     

Oral treatment need and oral treatment intention in a population enrolled in long-term care in nursing homes and home care

The aim of the study was to evaluate the realistic oral treatment need in a population in southern Sweden enrolled in long-term care (LTC), in nursing homes (NH), or home care (HC), taking into consideration treatment intention. Every third individual enrolled in LTC was selected after proportionally stratifying a total of 866 subjects according to gender. Of these, 732 (85%) were available for a simple clinical oral health evaluation in their own homes. Dental status, oral mucosal status, oral hygiene status, oral mucosal inflammation, and oral mucosal friction were assessed by observational examinations; suspected malignancies were also noted. Oral treatment need was expressed in accordance with the Treatment Need Index (TNI) as no, minor, major, or urgent, while treatment intention was expressed in accordance with the Treatment Intention Index (TII) as the aim to relieve, delay, maintain, or improve. The rationale for using the TII is to offer subjects in this generally frail population oral treatment at an appropriate level, taking their medical condition into consideration. It was found that 61% of the sample had a need not just for an oral health evaluation but also for additional dental treatment, 31% to be accomplished by prophylactic and 30% by reparative or emergency measures; only 1% were estimated to be in urgent need. Furthermore, one manifest and one suspected oral malignancy were found. The results indicate that realistic oral treatment need, guided by the examiner's estimation of the appropriate treatment intention, is modest in this population, but that regular oral screening is mandatory.