Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review

Abstract

BackgroundPoor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two major barriers to providing appropriate oral care are residents’ responsive behaviors to oral care and residents’ lack of ability or motivation to perform oral care on their own.ObjectivesTo evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents’ responsive behaviors to oral care, or enable/motivate residents to perform their own oral care.Materials and methodsWe searched the databases Medline, EMBASE, Evidence Based Reviews–Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science for intervention studies assessing the effectiveness of eligible strategies. Two reviewers independently (a) screened titles, abstracts and retrieved full-texts; (b) searched key journal contents, key author publications, and reference lists of all included studies; and (c) assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results.ResultsWe included three one-group pre-test, post-test studies, and one cross-sectional study. Methodological quality was low (n = 3) and low moderate (n = 1). Two studies assessed strategies to enable/motivate nursing home residents to perform their own oral care, and to studies assessed strategies to prevent or overcome responsive behaviors to oral care. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems.ConclusionsPotentially promising strategies are available that nursing home care providers can apply to prevent/overcome residents’ responsive behaviors to oral care or to enable/motivate residents to perform their own oral care. However, studies assessing these strategies have a high risk for bias. To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies.

Oral health and dental care of older persons—A systematic map of systematic reviews

“…Focusing on people with dementia, both Siegel et al and Rozas et al pointed out a lack of knowledge regarding effective methods to improve oral health, so no recommendations could be made concerning specific interventions. Two systematic reviews by Hoben et al and a review by Albrecht et al stressed the low quality of the available evidence and the need of rigorous studies using relevant outcome measures.…”

Oral Health and Its Associated Factors Among Older Institutionalized Residents—A Systematic Review

“…Recent studies have reported that oral hygiene and the health of the institutionalized elderly population, particularly in those with cognitive problems, are usually poor, which is attributed to a disregard for the need for oral healthcare among them and may also be due to the inadequate knowledge and skills, poor attitudes and improper practices of caregivers [96,97,99,100,101]. Oral care is usually not treated as a priority or a routine, resulting in delayed oral assessment and treatment [37,101,102]. The reasons for inadequate oral care practices among caregivers have been examined and were related to the following:time constraints and priority setting,insufficient education about oral care and skills,a lack of awareness regarding the importance of oral care in oral/dental diseases [103],an unwillingness to provide oral care due to the fear of managing uncooperative residents,the prevention of potential injuries, andavoiding an unpleasant task [104,105,106].…”

Incorporating oral health care education in undergraduate nursing curricula - a systematic review

“…Community nurses can educate and empower older people to take an active role in their oral care to prevent oral problems [37]. Nurses working in residential communities can take a leadership role in ensuring oral health care is integrated into routine nursing care [38]. Nurses can screen each resident's oral health upon admission, assess the need for an examination by a dental professional, and prepare and monitor an oral health care plan [25,39,40].…”