Oral care in older adults with care needs: Assessing interventions and exploring experiences and perceptions in municipal old age care

Abstract

Oral health is significant for overall health and quality of life. Older adults live longer and keep their natural teeth to a greater extent. Oral health and oral hygiene among older adults residing in nursing homes is generally poor, and municipal old age care face challenges in meeting older adults’ oral health and oral care needs. This thesis aimed to test interventions, and explore experiences and perceptions related to oral care among older adults, professionals and staff within municipal old age care across multiple organisational levels. Study I evaluated the feasibility of an intervention where dental hygienists on a weekly basis for three months coached staff at nursing homes in providing oral care. The results showed limited improvements in staff attitudes and beliefs about oral health. Older adults’ oral health was good at baseline and remained stable throughout the study, indicating that the intervention had limited effect. Study II explored the experiences of professionals within municipal old age care and dental care services regarding the use of oral care cards, which are multiprofessional tools intended to document oral health status and guide care for older adults with extensive needs. Ten group and individual interviews were conducted and analysed through qualitative content analysis. The results indicated that the oral care cards were not anchored in the nursing care context and that there were unclarities concerning responsibilities. Informants highlighted challenges in accessibility, coordination and ethical considerations, revealing that oral care cards were underutilised and poorly integrated into existing care frameworks. Study III assessed the impact of integrating dental hygienists as consultants in municipal old age care across four intervention and two control municipalities. The intervention was conducted between 2018 and 2021. A quasi-experimental design with pre- and post-intervention surveys showed increased knowledge of the dental care subsidy, and higher participation in oral health education in intervention municipalities. Study IV investigated older adults’ perceptions of future needs of assisted oral care in the event of care dependency. Interviews with community-dwelling older adults receiving home help services showed differences between older adults’ ideal and practical realities concerning assisted oral care, particularly when declining health limits communication. Respectful interaction was valued, and uncertainty about future needs underscored the importance of early planning. In conclusion, the studies showed that interventions aimed at strengthening oral care competence among professionals and care staff increased knowledge in specific areas and participation in education, although their impact on attitudes, beliefs and routines was limited. Perceptions of oral care cards revealed both possibilities and challenges in supporting older adults’ oral health across individual and organisational levels. Older adults express a strong wish to manage oral care independently but will accept assisted oral care when essential.