Improving the oral health of frail and functionally dependent elderly

Abstract

The Australian Government endorsed a national evidence based oral health model when it introduced the first Nursing Home Oral and Dental Health Plan in 2010. Called Better Oral Health in Residential Care, it promotes a multidisciplinary approach with doctors, nurses, care workers and dental professionals sharing responsibility for the four key processes of oral health screening, oral health care planning, daily oral hygiene and access to dental treatment. Frail and dependent residents are most conveniently treated on‐site, hence an aged care/dental partnership is encouraged to facilitate the use of portable dental equipment in the delivery of dental care. Currently, few dentists provide services to residential aged care facilities (RACFs), with loss of clinical time in practice, difficulty in providing clinical care in a non‐dental environment and lack of referral pathways from the RACFs to the dentists contributing to the problem. The need to establish a model of care involving dental hygienists/oral health therapists in RACFs has merit. Minimal intervention treatment using glass ionomer cement (GIC) and silver fluoride is ideal in aged care. However, GIC has limitation in dry mouths with low pH caused by polypharmacy or disease. Palliative and definitive treatment techniques need to be individualized with consideration of a patient's ability to maintain their own mouths as well as their mental and physical competence. The range of products available to address the oral diseases common to the frail elderly is growing. The oral health care provider is required to establish a preventive regime that is tailored to the patient's needs, is realistic and under revision as the patient's needs change.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff

“…Many initiatives have been implemented in an attempt to improve the oral health care of aged care residents, including the “Better oral health in residential care” model of care . Endorsed by the Australian government, this programme promoted a multidisciplinary approach to oral care in RACFs, involving a shared responsibility between doctors, nurses, care workers and dental professionals.…”

Oral health in residential aged care: Perceptions of nurses and management staff

“…This study has highlighted that although staff were aware of existing training resources and acknowledged evidence‐based training programmes (Better Oral Health in Residential Care) (Lewis et al, ), evidence from this was not being translated into practice due to a fragmented oral care system in their RACF. Along with our previous findings (Villarosa et al, ), this study suggests a consensus among RACF staff that there is a need for awareness raising, mandatory training, interdisciplinary practice guidelines and clear referral pathways to ensure adequate oral health care in RACFs.…”

Oral Hygiene Routine of Functionally Dependent Elderly Individuals Performed by Home Caregivers

“…Moreover, it is a cause of tooth decay and coated tongue and is associated with increases in hospitalization rates and healthcare costs, thereby compromising quality of life [9]. Thus, the oral hygiene routine for functionally dependent elderly individuals requires certain skills on the part of the caregiver [13].…”

“…Due to a lack of knowledge and skills, caregivers do not understand the harmful consequences of poor oral hygiene to the health of elderly individuals [22]. Thus, in addition to adequate training, a continuing education program in oral health for caregivers is very important to meeting the specific demands of the geriatric public [13,14,22,23]. Challenges regarding the oral hygiene rou-tine are related to the health conditions of the elderly, the caregivers themselves and the underlying socio-cultural context.…”