Oral health in nursing homes: resident oral health and carer knowledge

Abstract

© 2012 Mihiri Jacintha SilvaThe oral health of nursing home residents is poor, characterised by high levels of dental caries and poor oral hygiene. Affecting mostly older populations, salivary gland hypofunction and xerostomia is also likely to be common among nursing home residents. A lack of oral health care by nursing home staff is a major factor contributing to the high levels of oral disease among residents. As the Australian population ages and edentulism rates decline, the picture of oral health will change. Without appropriate strategies to improve the oral health of nursing home residents and the care they receive, the future is bleak. The impact of poor oral health extends beyond the mouth, and can affect general health of residents and impair quality of life. In order to develop programs and policies to overcome the forecast problems in oral health among nursing home residents, the current picture of oral health in nursing homes needs to be investigated fully. The aim of this study was to provide a comprehensive assessment of the state of oral health in nursing homes by examining the knowledge and attitudes of nursing home staff in addition to resident oral health outcomes. A total of 221 dentate residents and 346 nursing home staff, including Personal Care Assistants (PCAs), division one (Div 1) and two (Div 2) nurses and Directors of Nursing (DON) participated in the study. Residents’ assessments included a detailed medical history, comprehensive dental examination, and questionnaires to assess oral health related quality of life and xerostomia and saliva testing. Nursing home staff completed a questionnaire regarding their training, dental habits and oral health knowledge and attitudes. Nursing home residents were elderly and medically compromised, with high levels of functional impairment. Most residents required assistance with oral hygiene and did not regularly utilise professional dental care. There were high levels of untreated coronal and root decay, particularly among residents with functional impairment and those who had irregular professional dental care. There were no significant associations with medical conditions or the number of medications taken. The prevalence of salivary disease was high with over a half of the residents having salivary gland hypofunction and a third having xerostomia. Consistent with the current understanding, the two conditions were found to be independent. Unexpectedly, medical conditions and the number of medications taken were not associated with either of the two conditions. In regards to quality of life, the most commonly reported oral impacts were difficulty eating certain foods, feeling embarrassed or self-conscious about problems with the mouth and painful aching from the mouth. Dental caries was generally not associated with quality of life, except for a significantly higher caries rate among those who reported feeling self-conscious. Xerostomia was significantly associated with most aspects of quality if life. The findings of this study confirm the worsening oral health of nursing home residents and the wide prevalence of xerostomia and salivary gland hypofunction. It highlights the impact of these conditions on quality of life. Improving the knowledge of nursing home staff, and providing them with practical skills in oral hygiene provision, particularly of functionally impaired residents, may help improve the oral health of nursing home populations