Perceptions of care-dependent older people in nursing homes about their oral health and oral care

Abstract

Background: Oral health is associated with general health but often remains neglected in residential care settings. Integration of oral care into general care is necessary, but literature shows that appropriate oral care is hampered by multiple barriers. Among older people, attitudes towards oral health and oral care are poor, as they are often unaware of the importance of oral health. The lack of ability to perform their own oral care, due to ageing, is also a perceived barrier. This study is part of research on the implementation of the new Oral Health Section (OHS) in the interRAI assessment of general care needs of nursing home residents. The aim of the study is to identify older people’s experiences with their own oral health, with the oral care performed, their perception of the importance of oral care, as well as their meaning about the assessment of their oral health using. 
 Setting and participants: Care-dependent older people living in 3 Flemish nursing homes. 
 Methods: In-depth interviews were performed and the Oral Health-Related Quality of Life 14 (OHIP-14) instrument was completed. This validated instrument measures the degree of self-rated oral health and satisfaction with the oral health status. The OHS was also filled out, which assesses whether they need assistance with daily oral hygiene care (Oral Hygiene CAP) and whether they need to be referred to a dentist (Dentist CAP). Interviews were coded, validated and discussed by 2 researchers and analysed in the software Nvivo1.7.
 Results: A total of 22 care-dependent older people were interviewed. The mean age of the sample was 84.5 (± 8.2 SD) and 63.6% were female. A total of 11 participants (50%) had no teeth but wore dentures; the others still had their natural teeth. The mean score of the OHIP-14 was 3.9 (range 0-56), indicating good scores for oral health-related quality of life. All older people who still had their natural teeth found it important to keep them in the future. Most older people were satisfied with their own oral health (81.8%), although, according to the results of the CAPs, 86.4% of them scored poorly on the assessment of oral hygiene and 68.2% needed immediate referral to a dentist. This shows that older people tend to overestimate their own oral health and are often satisfied, despite having several oral health problems.
 Conclusions/implications: The study provided information about the perceptions and experiences of older people regarding their oral health and oral care. Learning about their experiences and perceptions can help to identify their wishes and needs, making it possible to improve daily oral care and proactively develop strategies to provide effective dental care for the future older population. Policy makers can use these results to foster the integration of oral care guidelines into care protocols within nursing homes, as well as support collaboration with dentists and dental hygienists within care facilities.