Integrating oral health assessment in the care for older people by means of the interRAI oral health section: an implementation and evaluation study. 

Abstract

Background: Oral health of care-dependent older people is generally poor which can affect their general health and well-being. In nursing homes, caregivers such as nurses and nurse aids are important actors for delivering oral care and detecting oral health problems. Performing regular oral health assessments is a key element to improve oral health in older people. The interRAI instrument used in the long-term care facilities (LTCF) includes an oral health section (OHS) and holds the potential to integrate oral care in the general care planning. Since the standard OHS fails to adequately detect oral health problems, an optimized section was developed. The study evaluates the optimized OHS of the interRAI suite of instruments in order to integrate oral health assessment in the daily practice. 
 Setting and participants: Care-dependent older people living in 11 nursing homes in Flanders, Belgium, who are 65 years or older. Their professional caregivers are also included in the study.
 Methods: This 2-year longitudinal cluster randomized controlled trial is set up in three parallel groups (2 test groups and 1 control group) to evaluate the effectiveness and the usability of the optimized and validated OHS for use in the interRAI-LTCF. In the intervention groups T1 and T2, trained caregivers use the interRAI-LTCF with the optimized OHS. Additionally, caregivers in T2 receive support to use new guidelines for oral care. In the control group, caregivers assess oral health using the standard OHS. The study has a longitudinal design with a mixed methods approach.
 The data collected about oral health and general health will be coupled with a national registry database on dental care consumption to analyze the outcome of the OHS regarding dental referral and actual dental care utilization. At the caregiver level, changes in knowledge and attitude regarding oral health will be evaluated using questionnaires. Interviews with older people and focus group discussions with caregivers will help to understand the usability of the optimized OHS and associated training.
 Results: The quantitative results will show whether the use of the optimized OHS enables improved oral health in care-dependent older people in residential care and improves the knowledge, attitude and perception of caregivers towards oral health and oral care. The qualitative data will show how older people and their caregivers experience the use of this OHS and to what extent daily and professional oral health care changes for the older people, being more intensively integrated in general care planning.
 Discussion: In residential care settings, prioritizing care tasks often brings neglect regarding oral care for care-dependent older people. Professional dental care is also difficult to deliver, due to mobility or lack of resources. This study evaluates whether regular oral health assessments performed by caregivers in residential care improve oral health in older people and to what extent these oral health assessments lead to better integration of oral care in general care. The results will shed light on the ongoing situation and will provide evidence to support the use of the optimized OHS and accompanying oral care guidelines in daily practice.