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Lack of training leaves gaps in oral healthcare

Care and health professionals need practice guidelines and education to improve the oral healthcare of aged care residents, according to new analysis.

There has been a lot done for the oral health of Australian aged care residents including the rollout of a national education program and screening tools, yet research shows problems still persist, said Amy Villarosa, a research support officer at the Centre for Oral Health Outcomes, Research Translation & Evaluation (COHORTE).

COHORTE, an interdisciplinary research centre based at Western Sydney University, undertook a small qualitative study in aged care that highlighted an unclear scope of practice regarding resident oral health, inadequate training for care workers, and a lack of dental referral pathways.

Amy Villarosa

Ms Villarosa told Australian Ageing Agenda aged care nurses were bearing responsibility for the oral healthcare of aged care residents despite it requiring a multidisciplinary solution.

In addition to aged care workers, nurses and dentists, dietitians, occupational therapists, physiotherapists and speech pathologists have a role to play in the oral healthcare of residents, she said.

While practice guidelines for oral care are in place for nurses, a clear scope of practice is lacking across the board despite many of the allied health professional organisations citing they should be involved in resident oral health in their position statements, Ms Villarosa said.

For example, the 2015 joint position statement by the Dietitians Association of Australia and Dental Health Services Victoria, said it was the dietitians’ role to perform oral health screening, promotion and education. However, there is little evidence to suggest this is being implemented, she said.

Joel Feren

Dietitians Association of Australia spokesperson and an accredited practising dietitian Joel Feren said he supported guidelines on oral healthcare for dietitians working in residential aged care to guide their practice.

Mr Feren told AAA regular dentist visits and making sure all residential staff were aware of the importance of oral healthcare could also improve the situation.

Inadequate training, referral pathways

The gaps in training for care workers in particular was raised in the COHORTE study.

The qualitative study, which involved 25 care workers, nurses and managers working in two aged care facilities in Sydney, aimed to understand participants’ perceptions of oral health care for residents.

Ms Villarosa said all staff acknowledged the importance of oral health care in aged care and reported they readily engaged in oral care tasks.

However, in addition to a lack of clarity about roles and scope of practice, staff reported a lack of time and inadequate oral health training among challenges to providing oral health care to residents, she said.

“Care staff who are providing the day-to-day oral hygiene aren’t always involved in these larger national training programs, but their training requirements also need to be addressed,” she said

The findings also indicated that no clear referral pathways to send aged care residents to a dentist was limiting residents’ abilities to access aged care services, she said.

Ms Villarosa’s wrote a discussion article on this topic, which was published in the Australian Nursing and Midwifery Journal this month, in response to the research.

Dentists call for aged care funding

It its pre-budget submission, the Australian Dental Association, the peak professional body representing dentists and dentist students, has called for increased funding to support better access to oral and dental health care for aged care residents.

Many aged care residents are not receiving the assistance they require from aged care facility staff to maintain oral health, the ADA wrote.

The ADA is recommending the 2018–19 federal budget include capital funding to support on-site dental treatment facilities and equipment in larger residential aged care facilities and scholarship funding to upskill nurses, doctors, and dental practitioners through education focused on oral and dental care for geriatric and dementia patients.

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One Response to Lack of training leaves gaps in oral healthcare

  1. Cristina G February 28, 2018 at 4:40 pm #

    My experience is that aged care staff delivering care to my Mother who is living with dementia are not providing adequate oral hygiene services to her.
    I am also aware of other carers and advocates with the same experience.
    A common excuse is that it is difficult to attend to oral hygiene of a person living with dementia as they can become agitated and non compliant.
    My mother is a very compliant woman. A a result of poor oral hygiene, she has had to undergo teeth extraction by a mobile dental service which attends monthly at her facility.

    We need comprehensive training in oral health for aged care staff and supported in full by care managers and boards of management. Training in managing changes in behaviour also need to be addressed. It is not good enough to simply place the responsibility back on the person with dementia.
    For family who are not living in close proximity to the facility, it is imperative that care staff look after this daily health requirement as family are unable to assist.

    I understand the pressures on care staff and in reality my issue is not with them but with the organisational lack of understanding of the needs for increases in staffing ratios, particularly in facilities where the clients are vulnerable and frail and in need of extra support. Boards of Management need to realise what the staff at the coal face are tasked to do and the importance of their roles…caring and supporting our wonderful older generation.

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