A Qualitative Evaluation of the Implementation of an Oral Care Program in Home Care Nursing.

An Oral Care Program (OCP) was implemented in home care nursing teams in a northern province of the Netherlands to improve the oral health and hygiene of older people who make use of formal home care in 2018-2019. The aim of the current study was to evaluate the experiences of the stakeholders involved (older people, home-care nurses and dental hygienists) and to report the experienced impact of OCP, with a qualitative approach. Three dental hygienists, nine home care nurses, and eight older people were interviewed with semi-structured interviews, which were audio recorded, transcribed and analyzed using thematic analysis. The codes derived were grouped into nine main themes. OCP was experienced as mostly positive by all stakeholders involved. The educational part lead to more awareness towards oral care, but should be repeated regularly. Personalized oral care plans for older people were experienced positively, however, obtaining oral care behavior changes appeared to be difficult. Collaboration between dental hygienists and home care nurses lead to a positive experience from both sides The method and intensity of collaboration varied between the teams. To provide better access to oral health care for older people in the community, a long term collaboration between home care nursing teams and dental care professionals in their working area should be established.

Oral Health and Frailty in Community-Dwelling Older Adults in the Northern Netherlands: A Cross-Sectional Study.

The aim of this study was to explore the association between oral health and frailty in community-dwelling Dutch adults aged 55 years and older. Included were 170 participants (n = 95 female [56%]; median age 64 years [IQR: 59−69 years]). Frailty was assessed by the Groningen Frailty Indicator. Oral health was assessed by the Oral Health Impact Profile-14-NL (OHIP-NL14). OHIP-NL14 item scores were analyzed for differences between frail and non-frail participants. Univariate and multivariate logistic regression analyses were performed to assess the association between oral health and presence of frailty. The multivariate analysis included age, gender, and depressive symptoms as co-variables. After adjustment, 1 point increase on the OHIP-NL14 scale was associated with 21% higher odds of being frail (p = 0.000). In addition, significantly more frail participants reported presence of problems on each OHIP-NL14 item, compared to non-frail participants (p < 0.003). Contrast in prevalence of different oral health problems between frail and non-frail was most prominent in 'younger' older adults aged 55−64 years. In conclusion: decreased oral health was associated with frailty in older adults aged ≥55 years. Since oral health problems are not included in most frailty assessments, tackling oral health problems may not be sufficiently emphasized in frailty policies.

Evaluation of an Oral Care Program to Improve the Oral Health of Home-Dwelling Older People.

The aim of this study was to evaluate the impact of the implementation of an Oral Care Program on home care nurses' attitudes and knowledge about oral health (care) and the impact on older people's oral health. A pre-post study, without a control group, was conducted. A preventive Oral Care Program (OCP) was designed, focusing on home care nurses and older people, in collaboration with dental hygienists. Implementation was measured with questionnaires at baseline and after 6 months for home care nurses; for older people, implementation was measured at baseline and after 3 months with the Oral Health Assessment Tool and a questionnaire about oral (self) care between January 2018 and September 2019. Although the study design has limitations, the oral health of older people improved significantly after 3 months and the OCP was most beneficial for people with full dentures. The OCP improved knowledge and attitude of home care nurses. The program fitted well with the daily work routines of home care nurses. Individual-centered care plans for older people, education of home care nurses and the expertise of the dental hygienists have added value in home care nursing. Future implementations should focus on older people with natural teeth.