Oral care for frail elders: knowledge, attitudes, and practices of long-term care staff.

The University of British Columbia Geriatric Dentistry Program (GDP) offers dental services and provides a comprehensive in-service education program for nursing and residential care-aide (RCA) staff in the provision of daily mouth care for elders in various long-term care (LTC) facilities in Vancouver. This study examined the general impact of the education initiative at one LTC site. A survey (N=90), semi-structured open-ended interviews (N=26), and product audits were conducted to 1) examine the impact of the GDP education initiative on the level of knowledge, attitudes, and practices of RCAs and nursing staff regarding the provision of daily mouth care; 2) identify the enablers and barriers that influenced the provision of daily mouth care practices, policies, and protocols using the PRECEDE-PROCEED model of health promotion research; and 3) assess the self-perceptions of RCAs and nursing staff members regarding their oral health. A knowledge gap was evident in some key areas pertaining to prevention of dental diseases. Twenty-five percent of residents were missing toothbrushes and toothpaste for daily mouth care. Residents who exhibit resistance to mouth care tended not to receive regular care, while issues such as time, increased workload, limited staff, and the lack of an accountability structure are disenabling factors for provision of daily mouth care. Results suggest that the impact of educational interventions is affected by the quality of in-service education, an absence of identified predisposing, reinforcing, and enabling factors, and a strong commitment among LTC staff to the provision of daily mouth care for frail elders.