The Effect of Programs to Improve Oral Hygiene Outcomes for Older Residents in Long-Term Care: A Systematic Review
Abstract
Nurses have a critical role in promoting oral health in dependent older adults residing in long-term care or having extended hospital stays. Strategies aimed at improving the quality of oral hygiene care nurses provide may contribute to better oral hygiene outcomes. The purpose of this systematic review was to examine the effect of intervention programs designed to enhance the ability of nurses or those to whom they delegate care to improve oral hygiene outcomes in frail older adults. Studies reported an educational program, either alone or augmented in some way. The study interventions consisted of: (a) single in-service education sessions; (b) single in-service education sessions supplemented by a “train-the-trainer” approach; and (c) education sessions supplemented with ongoing active involvement of a dental hygienist. None of the approaches emerged as being desirable over the others, as methodologically strong studies with good intervention integrity were lacking, and a variety of oral health outcomes were used to measure effectiveness of the interventions, making comparisons across studies difficult.
[Res Gerontol Nurs. 2014; 7(2):87–100.]
- Bassim C.W., Gibson G., Ward T., Paphides B.M., DeNucci D.J. (2008). Modification of the risk of mortality from pneumonia with oral hygiene care. Journal of the American Geriatrics Society, 56, 1601–1607
10.1111/j.1532-5415.2008.01825.x Crossref, Google Scholar - Budtz-Jørgensen E., Mojon P., Rentsch A., Deslauriers N. (2000). Effects of an oral health program on the occurrence of oral candidosis in a long-term care facility. Community Dentistry and Oral Epidemiology, 28, 141–149.
10.1034/j.1600-0528.2000.028002141.x Crossref, Google Scholar - Chalmers J., Johnson V. (2004). Evidence-based protocol: Oral hygiene care for functionally dependent and cognitively impaired older adults. Journal of Gerontological Nursing, 30(11), 5–12. Link, Google Scholar
- Chalmers J.M., Levy S.M., Buckwalter K.C., Ettinger R.L., Kambhu P.P. (1996). Factors influencing nurses’ aides’ provision of oral care for nursing facility residents. Special Care in Dentistry, 16, 71–79.
10.1111/j.1754-4505.1996.tb00837.x Crossref, Google Scholar - Chami K., Debout C., Gavazzi G., Hajjar J., Bourigault C., Lejeune B., Rothan-Tondeur M. (2012). Reluctance of caregivers to perform oral care in long-stay elderly patients: The three interlocking gears grounded theory of impediments. Journal of the American Medical Directors Association, 13, e1–e4
10.1016/j.jamda.2011.06.007 Crossref, Google Scholar - Coleman P. (2002). Improving oral health care for the frail elderly: A review of widespread problems and best practices. Geriatric Nursing, 23, 189–199.
10.1067/mgn.2002.126964 Crossref, Google Scholar - Coleman P., Watson M. (2006). Oral care provided by certified nursing assistants in nursing homes. Journal of the American Geriatrics Society, 54, 138–143.
10.1111/j.1532-5415.2005.00565.x Crossref Medline, Google Scholar - Deeks J., Dinnes J., D’Amico R., Sowden A., Sakarovitch C., Song F., Altman D. (2003). Evaluating non-randomised intervention studies. Health Technology Assessment, 7(27), iii–x, 1–173. Google Scholar
- de Lugt-Lustig K., Vanobbergen J., van der Putten G., De Visschere L., Schols J., de Baat C. (2013). Effect of oral healthcare education on knowledge, attitude and skills of care home nurses: A systematic literature review. Community Dentistry and Oral Epidemiology. Advance online publication.
10.1111/cdoe.12063 Crossref, Google Scholar - De Visschere L., Schols J., van der Putten G.J., de Baat C., Vanobbergen J. (2012). Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: A cluster randomised controlled clinical trial. Gerodontology, 29, e96–e106
10.1111/j.1741-2358.2010.00418.x Crossref Medline, Google Scholar - Dharamsi S., Jivani K., Dean C., Wyatt C. (2009). Oral care for frail elders: Knowledge, attitude, and practices of long-term care staff. Journal of Dental Education, 73, 581–588. Google Scholar
- El-Solh A.A., Pietrantoni C., Bhat A., Okada M., Zambon J., Aquilina A., Berbary E. (2004). Colonization of dental plaques: A reservoir of respiratory pathogens for hospital acquired pneumonia in institutionalized elders. Chest, 126, 1575–1582. Google Scholar
- Fiske J., Griffiths J., Jamieson R., Manger D. (2000). Guidelines for oral health care for long-stay patients and residents. Gerodontology, 17, 55–64.
10.1111/j.1741-2358.2000.00055.x Crossref, Google Scholar - Frenkel H., Harvey I., Newcombe R. (2001). Improving oral health in institutionalised elderly people by educating caregivers: A randomised controlled trial. Community Dentistry & Oral Epidemiology, 29, 289–297.
10.1034/j.1600-0528.2001.290408.x Crossref, Google Scholar - Gammack J.K., Pulisetty S. (2009). Nursing education and improvement in oral care delivery in long-term care. Journal of the American Medical Directors Association, 10, 658–61
10.1016/j.jamda.2009.09.001 Crossref, Google Scholar - Higgins J., Green S. (2011). Cochrane handbook for systematic reviews of interventions Version 5.1.0. Retrieved from http://www.cochrane-handbook.org Google Scholar
- Jablonski R.A., Munro C.L., Grap M.J., Elswick R.K. (2005). The role of biobehavioral, environmental, and social forces on oral health disparities in frail and functionally dependent nursing home elders. Biological Research for Nursing, 7, 75–82.
10.1177/1099800405275726 Crossref, Google Scholar - Jablonski R.A., Munro C.L., Grap M.J., Schubert C.M., Spigelmyer P. (2009). Mouth care in nursing homes: Knowledge, beliefs, and practices of nursing assistants. Geriatric Nursing, 30, 99–107
10.1016/j.gerinurse.2008.06.010 Crossref Medline, Google Scholar - Jablonski R.A., Swecker T., Munro C., Grap M.J., Ligon M. (2009). Measuring the oral health of nursing home elders. Clinical Nursing Research, 18, 200–217
10.1177/1054773809335306 Crossref Medline, Google Scholar - Kalisch B.J., Tschannen D., Lee H., Friese C.R. (2011). Hospital variation in missed nursing care. American Journal of Medical Quality, 26, 291–299
10.1177/1062860610395929 Crossref Medline, Google Scholar - Le P., Dempster L., Limeback H., Locker D. (2012). Improving residents’ oral health through staff education in nursing homes. Special Care in Dentistry, 32, 242–250
10.1111/j.1754-4505.2012.00279.x Crossref, Google Scholar - MacEntee M.I. (2005). Caring for elderly long-term care patients: Oral health-related concerns and issues. Dental Clinics of North America, 49, 429–443.
10.1016/j.cden.2004.10.008 Crossref, Google Scholar - MacEntee M.I., Wyatt C.C., Beattie B.L., Paterson B., Levy-Milne R., McCandless L., Kazanjian A. (2007). Provision of mouth-care in long-term care facilities: An educational trial. Community Dentistry and Oral Epidemiology, 35, 25–34.
10.1111/j.1600-0528.2007.00318.x Crossref, Google Scholar - Mojon P., Rentsch A., Budtz-Jørgensen E., Baehni P.C. (1998). Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility. European Journal of Oral Sciences, 106, 827–834.
10.1046/j.0909-8836.1998.eos106401.x Crossref, Google Scholar - Nakrem S., Vinsnes A.G., Harkless G.E., Paulsen B., Seim A. (2009). Nursing sensitive quality indicators for nursing home care: International review of literature, policy and practice. International Journal of Nursing Studies, 46, 848–857
10.1016/j.ijnurstu.2008.11.005 Crossref, Google Scholar - National Collaborating Centre for Methods and Tools. (2010). Quality assessment tool for quantitative studies. Retrieved from http://www.nccmt.ca/registry/view/eng/14.html Google Scholar
- Nicol R., Sweeney P., McHugh S., Bagg J. (2005). Effectiveness of health care worker training on the oral health of elderly residents of nursing homes. Community Dentistry & Oral Epidemiology, 33, 115–124.
10.1111/j.1600-0528.2004.00212.x Crossref, Google Scholar - O’Connor L.J. (2012). Oral health care. In (Eds.), Evidence-based geriatric nursing protocols for best practice (4th ed., pp. 409–418). New York: Springer. Google Scholar
- Pearson A., Chalmers J. (2004). Oral hygiene care for adults with dementia in residential aged care facilities. JBI Reports, 2(3), 65–113
10.1111/j.1479-6988.2004.00009.x Crossref, Google Scholar - Peltola P., Vehkalahti M., Simoila R. (2007). Effects of 11-month interventions on oral cleanliness among the long-term hospitalised elderly. Gerodontology, 24, 14–21.
10.1111/j.1741-2358.2007.00147.x Crossref Medline, Google Scholar - Philip P., Rogers C., Kruger E., Tennant M. (2012). Oral hygiene care status of elderly with dementia and in residential aged care facilities. Gerodontology, 29, e306–e311
10.1111/j.1741-2358.2011.00472.x Crossref, Google Scholar - Ploeg J., Davies B., Edwards N., Gifford W., Miller P.E. (2007). Factors influencing best-practice guideline implementation: Lessons learned from administrators, nursing staff, and project leaders. Worldviews on Evidence-Based Nursing, 4, 210–219.
10.1111/j.1741-6787.2007.00106.x Crossref Medline, Google Scholar - Pyle M.A., Massie M., Nelson S. (1998). A pilot study on improving oral care in long-term care settings. Part II: Procedures and outcomes. Journal of Gerontological Nursing, 24(10), 35–38. Google Scholar
- Registered Nurses’ Association of Ontario. (2008). Oral health: Nursing assessment and interventions. Retrieved from http://rnao.ca/bpg/guidelines/oral-health-nursing-assessment-and-intervention Google Scholar
- Simons D., Baker P., Jones B., Kidd E.A., Beighton D. (2000). An evaluation of an oral health training programme for carers of the elderly in residential homes. British Dental Journal, 188, 206–210. Google Scholar
- Sonde L., Emami A., Kiljune H., Nordenram G. (2011). Care providers’ perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia. Scandinavian Journal of Caring Sciences, 25, 92–99
10.1111/j.1471-6712.2010.00795.x Crossref, Google Scholar - Thomas B.H., Ciliska D., Dobbins M., Micucci S. (2004). A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing, 1, 176–184.
10.1111/j.1524-475X.2004.04006.x Crossref, Google Scholar - Thorne S.E., Kazanjian A., MacEntee M.I. (2001). Oral health in long term care: The implications of organizational culture. Journal of Aging Studies, 15, 271–283.
10.1016/S0890-4065(01)00023-8 Crossref, Google Scholar - van der Putten G.J., Mulder J., de Baat C., De Visschere L.M., Vanobbergen J.N., Schols J.M. (2013). Effectiveness of supervised implementation of an oral health care guideline in care homes: A single-blinded cluster randomized controlled trial. Clinical Oral Investigations, 17, 1143–1153
10.1007/s00784-012-0793-2 Crossref, Google Scholar - Wårdh I., Jonsson M., Wikström M. (2012). Attitudes to and knowledge about oral health care among nursing home personnel—An area in need of improvement. Gerodontology, 29, e787–e792
10.1111/j.1741-2358.2011.00562.x Crossref, Google Scholar - Weening-Verbree L., Huisman-de Waal G., van Dusseldorp L., van Achterberg T., Schoonhoven L. (2013). Oral health care in older people in long term care facilities: A systematic review of implementation strategies. International Journal of Nursing Studies, 50, 569–582
10.1016/j.ijnurstu.2012.12.004 Crossref, Google Scholar - Workgroup for Intervention Development and Evaluation Research. (2009). WIDER recommendations to improve reporting of the content of behaviour change interventions. Retrieved from http://interventiondesign.co.uk/wp-content/uploads/2009/02/widerrecommendations.pdf Google Scholar

