Co-Existence of Divergent Oral Care Approaches in Danish Aged Care: A Qualitative Study.

REVIEW QUESTION/OBJECTIVE The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia. More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. INCLUSION CRITERIA Types of participants This review will consider studies that include residents with a formal diagnosis of dementia currently residing in permanent care in Residential Aged Care Facilities. This review will exclude participants that have not received a formal diagnosis of dementia as well as those who are not living as a permanent admission in Residential Aged Care Facilities. Studies conducted on community dwelling individuals with a formal diagnosis of dementia will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the efficacy of professional oral health care performed by a dental hygienist. These studies involve professional oral health care performed by a dental hygienist using a toothbrush, interdental brushes, floss and hand scalers if necessary to remove plaque and food debris and in some instances hardened calculus or tartar. If there are studies involving the professional oral health care being performed by dentists or a combination of dentists and dental hygienists they will be included in the analysis. This review will exclude interventions involving staff training interventions and interventions performed by nurses/assistant nurses. TRUNCATED AT 250 WORDS

To identify major issues in providing and accessing oral health care in Victorian rural residential aged care services from the perspectives of dentists, aged care staff and residents. Structured interviews were conducted with five dentists, nine aged care staff and six residents. Three focus groups were conducted with aged care staff. These data were thematically analysed independently by two researchers. The challenges reported by dentists included complexity of care, infrastructure needs and need for skill development. Aged care staff reported lack of skills and confidence in providing oral hygiene care, especially in residents with natural teeth, and an increasing burden on their daily workload. Residents reported concern and shame regarding their declining oral health status and increased challenges accessing appropriate oral health care. These findings indicate the need to build and sustain aged care 'oral health teams' who are able to provide daily oral hygiene care for residents and mentor other staff. Rural dentists need access to gerodontic training, portable equipment and appropriate workspaces in aged care services. Aged care and oral health services need to establish clear referral and communication pathways.

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. Focus groups and face-to-face semi-structured interviews with aged care facility managers and staff. 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. 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 noncompliance; 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. 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.

Influencing factors that support and build aged care research capacity: Staff perspectives

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services.

ABSTRACTIntroductionRestrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence‐based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes.MethodsThis pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi‐structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation.ConclusionThis study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care.Patient or Public ContributionA person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards.Trial RegistrationACTRN12624000044527.

Objectives This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders’ opinions about the impact of COVID-19 on the mental health of aged care residents and staff. Methods A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. Results On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. Conclusions Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. Clinical Implications This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.

Gap in Dental Care Can Lead to Diabetes, Other Disease Conditions

Background: Non-dental health practitioners in Australia, including general practitioners, nurses, pharmacists, and allied health professionals, encounter patients with oral health concerns. While well-positioned to provide early intervention, their capacity is affected by knowledge gaps, confidence, and systemic limitations. Objective: To map Australian non-dental health practitioners' oral health knowledge, attitudes, and practices and identify barriers and enablers to integrating oral health into general healthcare. Methods: Following Joanna Briggs Institute methodology, five databases (MEDLINE, PubMed, CINAHL, Embase, Web of Science) were searched for original studies published between 1 January 2014 and 16 July 2024. Results: Of 3225 records, 20 studies were included: nurses (n = 8), midwives (n = 5), pharmacists (n = 5), and general practitioners (n = 2). Data were synthesised using deductive thematic analysis and descriptive counts of oral health attitudes, knowledge, and practices. Attitudes towards oral health were generally positive, but engagement varied. Midwives and pharmacists demonstrated greater involvement following structured training, whereas general practitioners, aged care staff, and cystic fibrosis clinicians reported limited engagement due to insufficient education, time constraints, and unclear roles. Additional barriers included a lack of referral pathways and clinical guidelines. Enablers included interprofessional collaboration and oral health training. Conclusions: Non-dental health practitioners are well placed to promote oral health; however, integration remains inconsistent. Addressing educational and systemic barriers through targeted training, clear referral systems, and the inclusion of oral health in general and chronic disease guidelines could strengthen oral health integration and reduce inequalities in preventive care across Australian healthcare.

P u r p o s e: Oral health and diseases are significant components of general health. However, oral health-care remains at the lowest of older patients' priorities. The inability to obtain dental care can result in progression of dental disease, leading to a diminished quality of life and overall health. Teledentistry (TD) provides an opportunity to improve the quality of oral health services. The aim of our narrative review was to analyze the usefulness of teledentistry as a part of telemedicine to improve oral health in the elderly. Materials/Methods: The PubMed database search was done for: teledentistry, oral health, oral- health related diseases, elderly, older adults. R e s u l t s: The applicability of TD has been demonstrated from children to older adults. Older adults have many obstacles in getting oral health care, including low income, lack health insurance, frailty, anxiety, depression, mobility problems or other handicaps. Available data suggests that the usefulness of TD in the provision of oral care in elderly people living in residential aged care facilities. Moreover, TD procedures were found to be as accurate as traditional face-to-face dental examinations, they was cost-effective and well accepted among patients and caregivers. C o n c l u s i o n s: TD might be a very useful tool for professional education, improving access and patient satisfaction of dental care. However, such TD modes would be difficult to widely implementation in community-dwelling older people who cannot access dental care. The ongoing "Patient centric solution for smart and sustainable healthcare (ACESO)" project will add to the intelligent oral health solutions.

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein–energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

BACKGROUND The aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in older individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard “promoting oral health in nursing” was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice. OBJECTIVE We aim to assess the acceptability of the expert standard among nursing staff providing care for older individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, care rationed or missed (CROM), and the standard’s acceptability. METHODS This quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic theoretical framework of acceptability, a questionnaire to measure the acceptability of interventions across 7 domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile and competence in mouth care using the questionnaire developed by the DNQP (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege [German network for Quality Development in Nursing]). Barriers to implementation will be evaluated according to the acute care nurses’ questionnaire on oral hygiene and CROM using the oral care–related question from the Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of first calculating the mean acceptability with a 95% CI for each recommended intervention of the expert standard. Second, repeated measures ANOVA is used to examine mean differences in acceptability between these interventions. Third, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi-square tests of independence are used to compare CROM with already published rates in German-speaking countries. RESULTS The results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. Data collection will commence in June 2025 and is expected to be completed by October 2025. CONCLUSIONS This study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in older adults. By focusing on acceptability as a prerequisite for implementation, this study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/72528

BackgroundThe aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in older individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard “promoting oral health in nursing” was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice.ObjectiveWe aim to assess the acceptability of the expert standard among nursing staff providing care for older individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, care rationed or missed (CROM), and the standard’s acceptability.MethodsThis quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic theoretical framework of acceptability, a questionnaire to measure the acceptability of interventions across 7 domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile and competence in mouth care using the questionnaire developed by the DNQP (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege [German network for Quality Development in Nursing]). Barriers to implementation will be evaluated according to the acute care nurses’ questionnaire on oral hygiene and CROM using the oral care–related question from the Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of first calculating the mean acceptability with a 95% CI for each recommended intervention of the expert standard. Second, repeated measures ANOVA is used to examine mean differences in acceptability between these interventions. Third, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi-square tests of independence are used to compare CROM with already published rates in German-speaking countries.ResultsThe results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. Data collection will commence in June 2025 and is expected to be completed by October 2025.ConclusionsThis study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in older adults. By focusing on acceptability as a prerequisite for implementation, this study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes.International Registered Report Identifier (IRRID)PRR1-10.2196/72528

Even before the COVID-19 pandemic, in many parts of the world there have been considerable, ongoing concerns about care quality provision for older people, particularly for those in residential aged care facilities. People understand that something has been fundamentally corrupted when the care of our older citizens becomes 'simply another commodity to be purchased, rather than an essential service that is their right' (Davidson, 2018: 104).

BACKGROUND AND AIM: This study investigated whether mothers’ knowledge about oral health of children during early ages influences the oral health care behavior of their children during adolescence and beyond. METHODS: This descriptive, cross-sectional, analytic study was carried out among 440 12-13-year-old students from 2 schools in Tehran, Iran, and their mothers in 2015. A self-report questionnaire consisting of 4 sections (demographic characteristics, socioeconomic information, oral health knowledge, and oral care behavior) was designed to assess the influence of mothers’ oral health care behavior in controlling early childhood caries (ECC) on their children’s oral health knowledge and behavior during their adulthood. Pearson’s correlation coefficient, chi-square test, and chi-square linear-by-linear association test were conducted to assess the effect of gender, father’s education, mother’s education, first dental care, first dental check-up, and teacher’s advice about oral health in school on oral health knowledge and behavior. RESULTS: A positive relationship was observed between first dental check-up, oral health knowledge (P = 0.05; CI = 95%) and flossing (P < 0.001; CI = 95%). Surprisingly, no differences were found between first dental check-up and tooth brushing frequency (P = 0.26; CI = 95%). CONCLUSION: The current study showed the importance of mothers’ knowledge and behavior toward their children’s oral health during early ages and its impact on the oral health care behavior of children in adulthood. This indicates that prevention behaviors starting as early as possible in childhood will cause better outcomes in adulthood.