Poor routines mean poor oral health for care home patients

Anisha Hall Hoppe, Dental Tribune International

Wed. 4. December 2024

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GOTHENBURG, Sweden: Maintaining oral health in the ageing population is vital for quality of life, and challenges in oral care in nursing homes demand effective prevention strategies. In Sweden, the Senior Alert quality register employs a systematic preventive care approach, but studies suggest that nursing staff may not fully utilise it for oral healthcare, leading researchers at the University of Gothenburg to explore their experiences with its use in nursing homes. The findings revealed significant challenges in maintaining oral hygiene for residents, particularly those with disabilities or cognitive impairments like dementia, and highlighted how unclear routines in nursing homes can jeopardise the oral health of older adults. Emphasising the need for enhanced collaboration and leadership in oral care, this study has major implications for dental clinicians.

Conducted at the Sahlgrenska Academy, the study involved focus group interviews with 14 nurses and 14 assistant nurses from nursing homes in western Sweden. While assessment using the Senior Alert healthcare tool was considered essential by the healthcare workers, they reported that unclear responsibilities among staff often hindered its effectiveness. This lack of clarity frequently led to oral care being overlooked in favour of other duties, ultimately compromising residents’ oral and overall health.

The findings underline that oral health is interconnected with broader health risks. For instance, poor oral hygiene can exacerbate issues like difficulty chewing or swallowing, leading to weight loss and reduced quality of life. Despite the nursing staff recognising this, their ability to perform thorough risk assessments and interventions was undermined by inconsistent training and knowledge gaps.

Lead author Dr Lisa Bellander, a dentist and doctoral student, noted in a press release the potential of structured approaches to oral care monitoring and maintenance to improve outcomes. “We noted that a structured approach enables healthcare workers to detect problems in the oral cavity earlier on, and thereby take action before these problems result in unnecessary suffering. However, one of the biggest challenges is getting older adults to want to participate in self-care, especially when they have cognitive impairments.”

Prof. Helle Wijk, co-author and expert in nursing, emphasised the need for nursing home management to prioritise oral care. “Managers needs to be committed to creating clear oral care routines and provide the right conditions for all staff to receive necessary training. Our study shows that when roles and responsibilities are unclear, there is a risk that older adults’ oral health will deteriorate, and this can have serious consequences for general health. Clear leadership is required if the work with oral care is to improve.”

For dental clinicians, this study reinforces the importance of engaging with nursing home staff to provide guidance, education and support for implementing structured oral care practices. Clinicians can play a pivotal role in bridging knowledge gaps and advocating for systematic approaches that prioritise oral health as an integral component of general well-being for older adults.

The study, titled “A preventive care approach for oral health in nursing homes: A qualitative study of healthcare workers’ experiences”, was published online on 1 October 2024 in BMC Geriatrics.