A study of oral care provision to functionally dependent long-term care

Background: Over the past three decades oral health has improved in Canada yet, oral health disparities still exist. This is especially true for elderly populations living in long-term care (LTC) facilities. Functionally-dependent residents of LTC facilities are vulnerable, at risk of poor physical, psychological and social health. As a result, this population is also at high risk for oral diseases and associated systemic problems. Research shows that dependent seniors living in LTC facilities have poor and deteriorating oral health and their access to oral health care is limited. The lack of proper oral care provided in these facilities is one of the primary reasons for widespread oral disease amongst residents. With the demographic trend in Canada towards an increasingly large elderly populations, new guidelines and practices to focus on their oral health is urgent. Purpose and Objectives: The purpose of this study was to describe the oral care provided during the morning care activities by allied nursing staff (ANS) in two LTC facilities in Quebec. Our objectives were to describe the occurrence and duration of oral care, the time spent on other key aspects of morning care (e.g., grooming, bathing, toileting), the type of morning oral care practices provided to LTC residents (e.g., type and amount of oral care supplies used for natural teeth/dentures, the amount of time required to prepare the resident and materials used), and the location where oral care was provided.Methods: This study followed a descriptive research design using a validated observational tool. This tool was used to collect real-time observations of morning care practices delivered by the staff. Observations were recorded for specific oral care-related practices (e.g., tooth brushing, denture cleaning), factors that influenced the provision of oral care (e.g., resident resistance), naturally occurring interventions used to accomplish this care (e.g., behavioral / communication strategies) and resistance to oral care.Results: Oral care was provided for 28/54 (51.8%) of the residents and for the remaining 26/54 (48.1%) residents, no oral care was given. The average time spent on oral care was 24.9 + 30.6 seconds. Flossing was not offered to any resident. None of the 11 edentulous residents had their oral cavity brushed. In five of the 28 cases, ANS washed their hands prior to giving oral care. In 19 of 28 cases new gloves were worn before giving oral care. For the other 9, hand washing was not done nor were new gloves donned. ANS removed the dirty gloves after cleaning other parts of body and put on clean gloves however without washing their hands in most cases. Mostly the oral care was performed either immediately after the ANS had washed the resident’s body (e.g., face, perineum area) and changed incontinence products (diapers) or dressed the resident. In six cases, oral care supplies were placed next to the contaminated body wash supplies (i.e., used towels and water bowls) and were not then decontaminated prior to using on the resident. Environmental factors (e.g., noisy room, other people present or interfering during care provision, interruptions due to any reason such as pain, incontinence, and residents’ resistive behavior) were responsible for influencing and interrupting the oral care in nine cases. 2 out of these nine residents did not receive care and for remaining seven oral care was first interrupted and then rushed.Conclusion: This study identified that standards for oral care in LTC facilities in Quebec are not consistent with recommended practices for dependent seniors. Gaps exist between oral care policy and the translation of policy into action. The association between good oral health and the provision of good oral care is complex. This trend needs an urgent change; oral care must become a priority. A knowledge translation effort is needed to prioritize oral care as a key component of general health.

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