The impact of oral health education taken by personal support workers caring for a geriatric population in a long-term care facility: A mixed-methods study

Policy Options to Complement the New Canadian Dental Program Enabling High Quality Care for People With Disabilities and Older Adults

BACKGROUND

The newly announced Canadian Dental Care Plan (CDCP) particularly aims to reduce financial barriers to dental care for individuals living below a family income threshold. The Canadian government has also launched an "Oral Health Access Fund" to support projects aiming to address financial barriers to dental care for older adults, those with disabilities and other groups. Evidence from programs implemented elsewhere in the world could inform policy decisions and address such non-financial barriers for older Canadians and those with disabilities.

AIM

To identify dental programs and policies in OECD countries focusing on people with disabilities and older people, and to outline how they might be applied to the Canadian context.

METHODS

The strategy for this narrative literature review comprised a combination of Medical Subject Headings (MeSh) or their equivalent, title/abstract keywords, truncations, and Boolean operators. Medline (Ovid), Embase (Ovid), CINAHL and Scopus were used. The searches were limited to English language publications involving programs and policies in all OECD countries. All searches ran from inception to January 25, 2023, with no restrictions on publication time.

RESULTS

The search identified 129 articles eligible for review. Findings were categorized as (1) interventions at the institutional-level (subdivided into patient-, professional- and community-focused programs) and (2) interventions at the governmental-level (subdivided into universal, population-specific, and community-based programs). Evidence suggests that targeted, integrated coaching or education programs for oral health care are beneficial, especially when programs are constantly evaluated and improved. Programs with a unified network system that integrates various relevant organizational and health domains have demonstrated to be most effective in the improvement of oral health care and overall health. Dental and medical healthcare workers play a crucial role in improving oral health outcomes and need motivation and fair compensation when caring for older people.

CONCLUSIONS

There is limited quality evidence supporting approaches to improving oral health care and oral health for older people and those with disabilities. It is important for policymakers and stakeholders to consider programmes from other countries when expanding the CDCP.

Integration of a dental hygienist into the interprofessional long-term care team

BACKGROUND

To address poor oral health of residents in long-term care homes (LTCH), this study explored the process of integrating an educational resource and a dental hygienist on the interprofessional care team.

METHODS

This convergent mixed-methods study took place at a 472-bed LTCH in Toronto, Canada from February to August 2018. Nurses employed at the LTCH participated in the study. During the study period, a dental hygienist was integrated into an interprofessional LTCH team. Nurses completed an online eLearning module about using the Oral Health Assessment Tool (OHAT) when referring residents' oral health concerns to a. Pre/post knowledge quizzes, module feedback and satisfaction surveys were administered. A retrospective chart review examined OHAT use and compared nurse and dental hygienist oral health assessments. Two cycles of semi-structured interviews with five nurses explored experiences with the eLearning module, OHAT and integration of the dental hygienist into the team.

RESULTS

Nurses scored well on the knowledge quizzes and reported comfort in using the OHAT to refer oral concerns to a dental hygienist; however, actual use was minimal. oral health issues were under-reported by nurses on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS); the dental hygienist reported significantly more debris, teeth lost and carious teeth (all P < 0.0001). Qualitative analysis indicated that the nurses valued dental hygienist integration into the team. Using knowledge mobilisation practices, a new oral health referral tool was developed.

CONCLUSIONS

This study highlights the feasibility and desirability of an oral health eLearning module, practical assessment tools and participation of a dental hygienist on the LTCH interprofessional care team.

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.