Provision of dental care in aged care facilities,NSW, Australia – Part 1 as perceived by the Directors of Nursing (care providers)

doi: 10.1111/j.1741‐2358.2012.00670.x Provision of dental care in aged care facilities, NSW, Australia – Part 1 as perceived by the Directors of Nursing (care providers) Objective: To ascertain the Directors of Nursing (DONs) perception of the provision of dental care and the difficulties in oral health maintenance for residents in New South Wales (NSW) aged care facilities (ACFs). Background: There were no specific figures relating to DONs’ perceptions of oral health needs and dental care nor obstructions to dental care of residents. Materials and methods: A total of 414 questionnaires, encoded for confidentiality, were posted to all DONs of ACFs in NSW and the data analysed. Results: Questionnaires were returned from 255 ACFs (response rate 61.6%) representing 16 861 residents with a male‐to‐female ratio of 1:3.45. Of these residents, 48% had a dental assessment on admission by qualified dental staff. In 74.2% of facilities, no regular visits by dental staff took place, and 58.6% considered the perceived unwillingness of dental professionals to visit residents a barrier to good oral health. DONs reported that 53.6% of residents had dentures only, while 18.3% had natural teeth only. The most frequent difficulties reported by staff were residents’ use of abusive language (78.2%) and residents refusing to open mouth (60.9%). Conclusion: Lack of involvement of dental professionals in admission assessment and in ongoing programmes was of concern to DONs in ACFs.     

Aged care staff perspectives on oral care for residents: Western Australia

Objective: To determine manager and staff perceptions of oral health and dental service issues for residents in aged care facilities in the Perth Metropolitan Area, Western Australia. Design: Focus groups and face‐to‐face semi‐structured interviews with aged care facility managers and staff. Setting and subjects: Personnel at 12 facilities (high‐level and low‐level care) located in the Perth Metropolitan Area participated in the study. Interviews were conducted with 14 facility managers. Focus groups and face‐to‐face interviews were conducted with 40 facility staff. Results: Managers and staff had similar views regarding most issues. While resident oral health was considered important, regular oral care programmes were limited or lacking. In general, high care facility residents did not have regular dental checkups, while those in low‐level care facilities usually visited their own dentist for checkups or treatment. Barriers to maintaining regular oral care included: resident non‐compliance; financial concerns; lack of co‐operation from family; mobility issues; and lack of interest from dental professionals. Suggested improvements to current services included regular on‐site visits, staff education and specialised dental professionals. Conclusion: Residents face many barriers to maintenance of adequate oral health care, particularly those who are functionally dependent and cognitively impaired. There is an urgent need for appropriate oral care programmes for aged care residents, which include dentists with aged care experience and continuing education for facility staff. Any major programmes should be evaluated carefully.     

Oral health care issues in aged care facilities in Western Australia: resident and family caregiver views

Objective: To investigate resident and family perceptions and attitudes towards oral health care and access to dental services for aged care facility residents. Method: Focus groups and individual interviews with residents and family caregivers were conducted at aged care facilities in the Perth Metropolitan Area, Western Australia. Results: There were 30 participants from twelve aged care facilities (21 residents and nine family caregivers). Five focus groups comprising both residents and family caregivers were conducted in addition to three face‐to‐face interviews with residents. Both groups considered oral health very important to overall health and quality of life. Family caregivers noted a lack of dental check‐ups and specialised professional oral care, particularly in high‐care facilities. Low care residents were more likely to have regular dental check‐ups or dental treatment and off‐site dental visits were straightforward due to their mobility and family member assistance. Family caregivers noted time limitations and lack of expertise in oral health care amongst staff in high‐care facilities, and the challenges of maintaining oral care for residents with poor mobility or cognitive impairment. It was considered important that staff and management liaise with family caregivers and family members in provision of oral care. Conclusion: Regular oral care, assessment and treatment were considered limited, particularly for residents in high care. There is a need for comprehensive, ongoing oral health programmes involving appropriately trained and empathetic dental health professionals and staff to improve oral health care in Perth’s aged care facilities.     

Oral health in nursing home residents with different cognitive statuses

Objective: To compare oral health in nursing home (NH) residents with different cognitive statuses. Background: Oral health is a significant issue for NH residents because of its relationships to quality of life, systemic health and well‐being. It is known that oral health is poor in NH residents. However, how oral health differs in NH residents with different cognitive statuses remains unclear. Materials and methods: Nine hundred and two NH residents were retrospectively recruited from a community‐based geriatric dental clinic in Minnesota, USA. Comprehensive medical, dental, cognitive and functional assessments were completed for the participants. On the basis of medical history and cognitive status, participants were categorized into three groups: without cognitive impairment (non‐impaired group), with cognitive impairment but no dementia (impaired group) and with dementia (demented group). ANOVA, Chi‐square and Fisher’s exact tests were used to compare medical, dental and functional statuses between groups. Results: Oral hygiene was poor in NH residents. Forty per cent of participants in the impaired group were edentulous, significantly higher than the edentulism rate in the demented group (29%, p = 0.01). More than 60% of the participants lost 16 or more teeth prior to examination. Depending on their cognitive status, 82–92% of the participants arrived with one or more caries or retained root. Dentate participants in the impaired and demented groups averaged about six caries or retained roots, significantly more than 4.7 caries or retained roots in the non‐impaired group (p = 0.01). Conclusion: Oral health was poor but slightly different in NH residents with different cognitive and functional statuses.     

Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death

Objective: The aim of the study was to reveal barriers to providing dental care for residents in long‐term care (LTC) facilities. Design: Participants were selected randomly from the dentist register in Berlin and Saxony, Germany. The sample consisted of 60 self‐employed and 60 employed dentists, a further 60 dentists worked in their own dental practice but also part‐time in an LTC facility. In semi‐structured interviews a questionnaire with 36 statements concerning working conditions, administration and cost, insecurity concerning treatment decisions as well as confrontation with ageing and death was employed. Subsequently, the study participants were asked to rank the four dimensions concerning their impact on the decision against providing dental care in an LTC facility. Results: The random sample was representative in age and gender for the dental register in Berlin and Saxony. Fifty‐six per cent of the participants (63% of the men and 51% of the women; 52% of the self‐employed, 60% of the employed and 56% of the consultant dentists) indicated unfavourable working conditions as biggest obstacle in providing dental care in an LTC‐facility. Thirty‐two per cent of participants rated administration and cost, 7% the insecurity in treatment decisions as major hindrance. Only 5% of the participants rated the confrontation with age and death as substantial barrier. There were no age and gender differences. Dentists in Berlin seemed more concerned about administration and cost of a consultancy activity and less secure in their therapy decisions than the colleagues from Saxony (p < 0.001). Dentists who work partly in LTC facilities were the least concerned about the confrontation with ageing and death (not significant), employed dentist showed the least secure in their treatment decisions (p > 0.001). Conclusion: It can be concluded that the awareness of infra‐structural and financial aspects in providing dental care in LTC facilities should be raised with health politicians and that these aspects should be considered when inaugurating or re‐structuring the consultancy services to LTC facilities. Further it would be desirable to establish more postgraduate training programmes to increase clinical and ethical competence in the area of gerodontology.     

Attitudes to and knowledge about oral health care among nursing home personnel--an area in need of improvement

doi: 10.1111/j.1741‐2358.2011.00562.x
Attitudes to and knowledge about oral health care among nursing home personnel – an area in need of improvement Background: In 1999, a dental reform became law in Sweden that regulated both dental care to dependent individuals and training in oral health care for nursing home personnel. Substantial resources have been channelled into these efforts, but the outcome of these efforts has not been evaluated. The aim of this study was to explore attitudes to and knowledge about oral health care among nursing home personnel more than 5 years after the law was adopted, that being 2005. Methods: A total of 454 individuals employed at nursing homes answered a questionnaire of 16 multiple‐choice items concerning attitudes to and knowledge about oral health care. Results: Eighty‐nine per cent considered oral health care to be an important part of good nursing. The answers indicated problems, however, when it came to its implementation and knowledge, and 35% stated that they had had no formal education in oral health care. Conclusions: Despite generally positive oral health care attitudes, it is important that oral health care education is available to and made of interest for all nursing home personnel, especially in light of the increase in number of natural teeth and frequency of crowns and bridges among dependent elderly.     

Oral health promotion among older persons and their care providers in a nursing home facility

Objectives: To assess oral health status and oral health‐related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers’ oral health attitudes and knowledge. Methods: Participants included 137 residents (58.1% female, age range 32–94 years, 91% African–American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP‐14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on‐site geriatric oral health education and training programme. Results: Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP‐14, the mean severity was 9.2 (SD = 12.0), extent (number of items rated as ‘fairly often’ or ‘often’) was 1.2 (SD = 2.6) and prevalence (participants rating at least one item at least ‘fairly often’) was 37.8%. Most prevalent negative impact items were about ‘oral pain’, ‘appearance’ and ‘self‐consciousness’. Regarding OHK, caregivers’ knowledge improved following instruction from 65% correct on the pre‐test to 90% correct on the post‐test (p < 0.05). Subsequent to the eight in‐service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents. Conclusion: Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers’ OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.     

Oral health and dental care facilities in Maltese residential homes

Objectives: To establish oral health care practices, including the use of dental services, in the residential homes of Malta and Gozo by assessing the knowledge of home managers and assistance of care staff regarding residents’ oral health and hygiene; and evaluating the residents’ demand for dental treatment and residential home managers response to this demand. Subjects: A total population sample of licensed residential homes (38) in Malta and Gozo was used comprising all home managers in government (seven), church (20), and privately run (11) residential homes. Method: A 19‐question questionnaire was designed, piloted and sent to the home managers requesting them to report on the dental care provision for their elderly residents. The questionnaire was distributed by post, along with a reply‐paid envelope and an explanatory letter. A response deadline of 1 month was included. Results: An 87% response rate was achieved. Whilst the majority of home managers (64%) were aware of domiciliary dental services, there was no code of care practice for oral health. Routine dental check‐ups were not organised for residents of most homes. Although home staffs were generally given information about residents’ oral health and hygiene, the majority did not assist residents with oral hygiene. Home managers identified the following barriers to the use of dental services by residents: cost, communication problems with dental staff, journey to place of treatment, waiting time at the dental clinic, access to premises/clinic, lack of information on oral health and dental service availability, no one to accompany the person to the clinic, and health problems such as mobility, poor eyesight, hearing impairment and mental health status. Conclusion: Although most home managers appreciate the importance of oral health care for their residents, the residents still face many barriers to maintaining adequate oral health care and accessing dental services.     

Oral health‐related quality of life in patients receiving home‐care nursing: associations with aspects of dental status and xerostomia

doi:10.1111/j.1741‐2358.2009.00344.x
Oral health‐related quality of life in patients receiving home‐care nursing: associations with aspects of dental status and xerostomia Objective: To explore the differences in oral status, dental attendance and dry mouth problems between patients with long‐term disease with high and low scores on Oral Health Impact Profile 14 (OHIP 14) and how patients cope with oral problems such as xerostomia and a reduced ability to brush their teeth. Background: There has been a lack of studies of oral health and oral health‐related quality of life in the frail elderly within the community services. Materials and methods: A cross‐sectional questionnaire study was conducted with 137 patients receiving home‐care nursing. Structured interviews were conducted by student nurses using OHIP‐14, items from the Xerostomia Inventory and questions concerning dental visit habits, brushing of teeth and data from medical records. Results: Eighty‐three per cent of patients had natural teeth and 60% had only natural teeth. ‘Natural teeth only’ indicated a low score on OHIP‐14. Problems with brushing and items concerning xerostomia indicated a high score on OHIP‐14. Contrasts in the assessments concerning brushing of teeth and xerostomia indicated low priority from the patients themselves and the nursing staff. Conclusion: Community health services should focus upon oral health. Both patients and nurses should assess the need for regular brushing of teeth carried out by home‐care nurses. Assessment and treatment of dry mouth problems should have higher priority.     

The dental awareness of nursing home staff in Singapore - a pilot study

Objective: The aim of this pilot study was to assess the oral health knowledge among staff working in a local nursing home managed by a voluntary welfare organisation. Method: A self‐administered questionnaire was completed by 53 nursing staff working in a home with 270 residents. The questionnaire was structured to assess the staff's knowledge of dental caries, periodontal disease and the care and use of dentures. Results: 99.6% of the respondents felt that oral health care of the elderly was very important. However, only 45.3% of them attributed the cause of dental caries to the frequent intake of sugar. Bacteria in dental plaque was identified by 88.7% of them as the main cause of periodontal disease while 96.2% of them indicated that dentures should be cleaned at least once a day and rinsed after every meal. Conclusion: The staff of this nursing home demonstrated positive knowledge of periodontal disease and denture care. However, their knowledge of dental caries revealed substantial room for improvement. This could signal an area for future staff training and development. Such efforts would help establish a team of caregivers who can improve the oral health and quality of life for residents in the nursing home.     

A 5‐year follow‐up of older adults residing in long‐term care facilities: utilisation of a comprehensive dental programme

Objective: This study will compare the clinical outcomes of 139 elders residing in long‐term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. Background: Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. Material and methods: A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. Results: Eighty‐three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70–73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56–72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, χ² = 7.9, df = 2). Conclusion: Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.     

Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech-language pathologists and dental hygienists

doi: 10.1111/j.1741‐2358.2011.00513.x Health care professionals’ perspectives on oral care for long‐term care residents: Nursing staff, speech–language pathologists and dental hygienists Background: Oral health has been identified as a key factor in general health and systemic disease in long‐term care populations. To optimise oral health of this population, it is important to understand the oral care perspectives held by health care professionals involved in oral care provision. Objectives: To explore perspectives regarding oral care held by nursing staff, speech–language pathologists (SLPs) and dental hygienists (DHs) in long‐term care institutions and to understand how their perspectives impact activities and processes involved in the delivery of oral care. Methods: A focus group methodology was utilised. Separate focus groups for each targeted profession were held. Transcribed data were analysed using constant comparative analysis. Results: Daily oral health maintenance and monitoring was considered a role of nursing staff. SLPs and DHs have roles focusing on advocacy, education and supplemental care. Social factors motivate nursing staff to provide oral care, whereas factors related to the general health consequences of poor oral health underlined the motivations of SLPs and DHs. Conclusions: Education and training initiatives incorporating social aspects of oral health may be more effective for motivating nursing staff than approaches emphasising physical risk factors. Organisations can foster environments that support collaboration and communication amongst the members of multidisciplinary teams in order to promote oral health as a priority.     

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.     

Oral hygiene of elderly people in long-term care institutions--a cross-sectional study

Objective: The aim of this cross‐sectional study was to assess the level of oral hygiene in elderly people living in long‐term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long‐term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.     

Oral health care in private and small long-term care facilities: a qualitative study

Objective: Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long‐term care facilities (LTC) in Porto Alegre/RS city. Methods: Twelve private and small‐size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. Results: The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co‐operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. Conclusions: Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.