Matthias Hoben1, Alix Clarke2, Kha Tu Huynh3, Nadia Kobagi4, Angelle Kent5, Huimin Hu6, Raissa A C Pereira7, Tianyuan Xiong8, Kexin Yu9, Hongjin Xiang10, Minn N Yoon11. 1. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Electronic address: mhoben@ualberta.ca. 2. School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: alix1@ualberta.ca. 3. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Electronic address: khatu@ualberta.ca. 4. School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: nkobagi@ualberta.ca. 5. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Electronic address: angelle@ualberta.ca. 6. State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China. Electronic address: huhmchn@outlook.com. 7. Faculty of Dentistry, University of São Paulo, São Paulo, Brazil. Electronic address: raissa.andujas.pereira@usp.br. 8. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: xiongtianyuan@qq.com. 9. Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: kexin@usc.edu. 10. Ultrasound Department, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China. Electronic address: hilary.shannon@foxmail.com. 11. School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: Minn.yoon@ualberta.ca.
Abstract
BACKGROUND: Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. METHODS: We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. RESULTS: We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%). CONCLUSIONS: We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.
BACKGROUND: Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. METHODS: We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. RESULTS: We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%). CONCLUSIONS: We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.
Authors: Cathleen S Colón-Emeric; Kirsten N Corazzini; Eleanor S McConnell; Wei Pan; Mark P Toles; Rasheeda Hall; Melissa Batchelor-Murphy; Tracey L Yap; Amber L Anderson; Andrew Burd; Sathya Amarasekara; Ruth A Anderson Journal: J Am Med Dir Assoc Date: 2017-11-22 Impact factor: 4.669
Authors: Amanda Kenny; Virginia Dickson-Swift; Carina Ka Yee Chan; Mohd Masood; Mark Gussy; Bradley Christian; Brad Hodge; Susan Furness; Lisa C Hanson; Samantha Clune; Emma Zadow; Ron J Knevel Journal: BMJ Open Date: 2021-05-05 Impact factor: 2.692
Authors: Sheryl Zimmerman; Philip D Sloane; Kimberly Ward; Christopher J Wretman; Sally C Stearns; Patricia Poole; John S Preisser Journal: JAMA Netw Open Date: 2020-06-01
Authors: Georgios Tsakos; Paul R Brocklehurst; Sinead Watson; Anna Verey; Nia Goulden; Alison Jenkins; Zoe Hoare; Kirstie Pye; Rebecca R Wassall; Andrea Sherriff; Anja Heilmann; Ciaran O'Neill; Craig J Smith; Joe Langley; Renato Venturelli; Peter Cairns; Nat Lievesley; Richard G Watt; Frank Kee; Gerald McKenna Journal: Pilot Feasibility Stud Date: 2021-07-02