Oral Health Falls Between Cracks In Swedish Elder Care

Despite existing guidelines and public dental care subsidies for older adults, oral health problems remain common among older people receiving home help services or living in residential care facilities. Unclear responsibility and a lack of routines mean that oral care often receives low priority, according to a doctoral thesis from the University of Gothenburg.

An increasing number of older adults retain their natural teeth well into old age. At the same time, the risk of dental caries, periodontal disease, dry mouth, and pain increases as health declines and care needs grow. Oral health affects the ability to eat and speak and is closely linked to nutrition, general health, and quality of life. Previous research has shown that older adults who receive formal care services, on average, have poorer oral health than peers who manage without assistance.

In her doctoral thesis, dental hygienist and PhD candidate Isabelle Johansson examined how oral health can be supported within municipal elder care in Sweden. The thesis is based on four studies that evaluate interventions aimed at improving oral care and explore how older adults, as well as staff in elder care services and dental services, perceive responsibility for oral health.

Limited impact

Several interventions currently used to strengthen oral care in elder care settings were found to have limited impact. Repeated coaching sessions led by a dental hygienist for care staff in residential care facilities resulted in neither measurable improvements in the oral health of older adults nor lasting changes in everyday care practices. Oral health was relatively good at baseline and remained stable over time, but did not improve.

Another tool commonly used in the Swedish elder care context, oral care cards, was often poorly integrated into everyday care. Responsibility, follow-up, and handover procedures were unclear, which meant that the cards did not function as intended in daily practice.

When dental hygienists instead worked strategically at the organizational and management level, awareness of available dental care subsidies increased mainly among managers and other key personnel. However, the results indicate that knowledge and intentions did not consistently reach everyday care practice.

Oral care overlooked in home help services

Interviews show that older adults receiving home help services want to manage their oral health independently for as long as possible. At the same time, there are no clear routines for who should identify declining ability and take the initiative for oral care when older adults can no longer manage on their own, for example in cases of dementia or severe illness. As a result, necessary support is often introduced too late or not at all.

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"Most older people want to brush their own teeth for as long as possible, and that is understandable, because it is about both independence and well-being. But oral care did not seem to receive attention within home help services, despite the potentially serious consequences of poor oral health," says Isabelle Johansson, PhD candidate at Sahlgrenska Academy, University of Gothenburg.

She notes that responsibility for oral care in older adults is often unclear between dental services and elder care services. When structures and routines are lacking, oral care easily becomes an issue that is not discussed.

"We need to develop approaches together with elder care services to initiate early conversations with older adults about oral care and future needs, so that the right support can be provided in time," says Isabelle Johansson.

Overall, the thesis shows that improving oral health in elder care is not primarily a matter of additional training, but of establishing structures that are sustainable over time. Clearer allocation of responsibility, effective collaboration between dental services and elder care services, and early conversations with older adults about future needs are crucial to ensuring that oral health does not become a neglected part of care.

Doctoral thesis: Oral care in older adults with care needs. Assessing interventions and exploring experiences and perceptions in municipal old age care; Oral care in older adults with care needs: Assessing interventions and exploring experiences and perceptions in municipal old age care