Oral health and institutionalised elderly

Aim: The main aim of this thesis was to generate initiatives promoting good oral health for institutionalised elderly. It was therefore essential to investigate how their oral health status has changed over time, whether care professionals have adequate oral care knowledge and if the oral hygiene of the institutionalised elderly can be improved in the long-term by a new quality assurance system. Methods: Several different methods were used, with both descriptive and analytical study designs. Factors relating to both residents and caregivers were investigated. Clinical examinations of long-term care (LTC) residents from five LTC institutions were performed in 2004. Dental status, caries, periodontal disease, stomatitis and presence of prosthodontic restorations were registered and the results were compared with a similar study from 1988. In 2005, a questionnaire-study was carried out among all Norwegian colleges educating care professionals working with basic care in LTC institutions. Quantity and quality of oral care training provided were assessed. A new quality system aimed at improving and maintaining oral hygiene standards of the elderly in long-term care was implemented in a nursing home. This oral hygiene programme included 1) motivation and oral care training of the nursing staff, 2) production of picture-based oral care procedure cards, 3) distribution of adequate oral care equipment, 4) practical implementation of new routines and 5) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months and eventually after 6 years. During this time care staff’s opinion about the use of electric toothbrushes on the care-dependent resident was investigated by a questionnaire-study. Results: Several significant changes in the oral health status among the institutionalised elderly have occurred since 1988, the most important being a decrease in the frequency of edentulism and an increase in the prevalence of oral diseases. Regarding the oral care training in the basic education of caregivers, variations between the different types of colleges were found. However, the majority of schools seem to provide information and training to cover basic requirements regarding oral care. Sustained improvements of LTC residents’ oral hygiene were found 6 years after implementing the oral hygiene programme. Most of the caregivers preferred electric toothbrushes rather than manual ones. Many reported it made oral hygiene provision easier and less time-consuming, especially for residents without severe dementia. Conclusion: The change in oral health of the institutionalised elderly constitutes a twosided challenge, affecting both dental personnel and caregivers. The public dental service should be strengthened to handle the increased dental treatment need in this group. Lack of oral care training in the basic education of care professionals can not account for the inadequate oral hygiene in Norwegian LTC institutions. Putting resources into the implementation of a preventive oral hygiene programme is therefore more likely to lower the incidence of oral infections among LTC residents. For such a programme to be effective, training, mandatory routines, adequate equipment and support from dental personnel must be present. On-site staff training is important if unskilled as well as the professional caregivers are to attain adequate oral care knowledge and skills. The programme should also place responsibility at the individual level and reflect an institution-based philosophy with high oral hygiene priorities