Partners in prevention: Oral health collaboration with assisted living nursing staff
Key Highlights
- Approximately 68% of adults aged 65 and older are affected by periodontal disease, with higher risks in nursing homes due to limited access to care and health issues.
- Caregiver education on oral health significantly improves residents' oral hygiene, reducing conditions like denture stomatitis and gingivitis.
- Interprofessional collaboration between dental and health professionals is essential to address systemic health issues related to poor oral care in older adults.
- Limitations such as cognitive decline and physical disabilities hinder older adults' ability to maintain oral hygiene, necessitating caregiver support.
- More high-quality, long-term research is needed to establish effective training guidelines and explore the broader health impacts of improved oral care in aging populations.
Editor's note: This article was written by five senior dental hygiene students, with oversight from their professor, Annie Walters, as part of their community oral health project for their capstone. They attend Northern Arizona University.
People aged 65 and older are at high risk for periodontal disease, with approximately 68% affected.1 In nursing homes, the risk is even higher due to health issues, reduced dexterity, and limited access to care.2,3
Despite being a major health concern for this population, there is no federally mandated oral health training for caregivers in nursing homes.4 Here we’ll examine the effectiveness of oral health education for caregivers and emphasize the need for better training.
The value of caregiver education
Older adults, particularly those in assisted living facilities, often practice inadequate oral home care. Nursing homes rely on the nursing or caregiver staff to provide some or all of their care.5 The caregivers provide daily oral home care as well as coordinate the dental appointments.
This is where interprofessional collaboration among health professionals comes in. Without health professionals working together, public health will never prosper. Educating caretakers on dental knowledge and its systemic effects is of vital importance.
While some may think caregivers are well-versed in oral home care and its importance, studies show that the knowledge literacy of the faculty is subpar compared to the needs of the population.5 Those same studies determined that the average oral health needs of each assisted living residents are not being met by the staff.5
A study was done to compare the oral health of many older adults, one in assisted living and the other self-regulating. The population in assisted living had considerably more oral health problems, most likely due to the lack of professional dental care.5 A vast percentage of older adults has underlying dental needs that are not met due to inconsistent dental visits.6
Poor oral home care in assisted living is contributing to prominent systemic issues. An example of this is seen in a systematic review where proper oral health care is provided to older adults, which results in a reduction in pneumonia and respiratory infections by 57%, with a confidence interval of 0.25 to 0.76, although at a low certainty of evidence due to not enough studies focused primarily on this oral-systemic connection.7
The inadequate oral home care cannot be attributed solely to the staff’s lack of knowledge. Older adults often have difficulty performing their home care or getting assistance due to some limits that come with aging. Some of these limitations are cognitive decline, physical and mental disabilities, challenges with dexterity, and limited accessibility to dental treatment.6
Prevalence of periodontal disease in assisting living
Periodontal disease is prevalent in adults 65 and older due to a variety of factors. A combination of prolonged exposure to risk factors, suppressed immune function, reduced cell turnover rate, and lower levels of type I collagen are thought to contribute to the risk.8
Improving the oral health status of older adults is crucial to maintaining quality of life. It’s been found that oral health and cognitive impairment are related. One study found that 58.6% of participants with dementia had periodontal infections, compared to only 26.7% of those without.9
Education and interprofessional collaboration
Supporting residents' systemic and oral health can only be done if caregivers are equipped with the knowledge, prompting the question of how this can be achieved. A potential solution is through interprofessional collaboration with dental professionals to provide oral health and hygiene education to assisted living caregivers.
A study was conducted to evaluate 22 randomly selected nursing homes with 20 to 40 beds about caregivers' oral health education. Specifically, the researchers wanted to determine the caregivers’ knowledge of denture plaque, denture-induced stomatitis, dental plaque, and gingivitis.
The study determined that having education in place greatly benefited the oral health of residents, as the baseline for caregivers' knowledge on how to care for oral health was low at the beginning of the trial. Statistically significant results indicated that the prevalence of denture-induced stomatitis significantly decreased over six months in the treatment group compared to the control group.10
A similar study that evaluated caregiver education concluded with statistically significant results that having oral hygiene education in assisted living facilities improved caregivers' knowledge. Following oral hygiene education, caregivers demonstrated a two-point improvement in knowledge and a three-point improvement in attitude compared to the control group.11
In closing, research shows that trained caregivers can significantly improve oral health outcomes for residents. However, there are research gaps, with a lack of recent, high-quality studies on the effectiveness of caregiver education in the US. While some studies show positive results, the methods vary, and more research is needed to assess the long-term benefits. Most studies focus on oral health without exploring the impact on other health conditions, such as infections or a decline in mental function.
Future research should include long-term studies on the broad effects of caregiver education, as well as national training guidelines for staff in assisted living centers. Exploring the connection between improved oral health and overall health outcomes, such as reduced infections or better cognitive function, is essential.
References
1. Measuring oral healthcare quality in older adults. American Dental Association. 2021. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/dqa/educational-resources/measuring_oral_healthcare_quality_in_older_adults_report.pdf
2.Zimmerman S, Austin S, Cohen L, et al. Readily identifiable risk factors of nursing home residents’ oral hygiene: dementia, hospice, and length of stay. J Amer Geriatr Soc. 2017;65(11):2516-2521. doi:10.1111/jgs.15061
3. Older Americans need better access to dental care. The Pew Charitable Trusts. July 2016. https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/07/older-americans-need-better-access-to-dental-care#
4. Nurse aide training requirements by state. PHI National. July 1, 2016. https://www.phinational.org/advocacy/nurse-aide-training-requirements-state-2016/
5. Lipsky MS, Singh T, Zakeri G, Hung M. Oral health and older adults: a narrative review. Dent J. 2024;12(2):30. doi:10.3390/dj12020030
6. Albrecht M, Kupfer R, Reissmann DR, Mühlhauser I, Köpke S. Oral health educational interventions for nursing home staff and residents. Cochrane Database Systematic Revs. 2016;9(9):CD010535. doi:10.1002/14651858.CD010535.pub2
7. Cao Y, Liu C, Lin J, Ng L, Needleman I, Walsh T, Lin C. Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database Systematic Revs. 2022;11(11):CD012416. doi:10.1002/14651858.CD012416.pub3
8. López R, Smith PC, Göstemeyer G, Schwendicke F. Aging, dental caries and periodontal diseases. J Clin Perio. 2017;44(Suppl 18):S145-S152. https://doi.org/10.1111/jcpe.12683
9. Lauritano D, Moreo G, Della Vella F, Di Stasio D, Carinci F, Lucchese A, Petruzzi M. Oral health status and need for oral care in an aging population: a systematic review. Int J Environ Res Pub Health. 2019;16(22):4558. doi:10.3390/ijerph16224558
10. Frenkel H, Harvey I, Newcombe RG. Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial. Comm Dent Oral Epidem. 2001;29(4):289-297. doi:10.1034/j.1600-0528.2001.290408.x
11. Frenkel,H, Harvey I, Needs K. Oral health care education and its effect on caregivers' knowledge and attitudes: a randomised controlled trial. Comm Dent Oral Epidem. 2002;30(2):91-100. doi:10.1034/j.1600-0528.2002.300202.x
About the Author
Annie Walters, MS, RDH
Annie Walters, MSDH, RDH, has extensive experience as an oral health-care provider. She has spent time caring for individuals in Guatemala and Indian Health Service sites and is passionate about advancing access to care for individuals with specialized health care needs. She is a published author and is trained in Orofacial Myofunctional Therapy. Annie received her graduate degree from the University of New Mexico and currently serves as an assistant clinical professor at Northern Arizona University. Reach her at [email protected].