This thesis of Linet Weening-Verbree aims to contribute to improving daily oral care for older people and to enhancing knowledge and attitude of care providers regarding oral health and oral care, in nursing homes and home care nursing.
Firstly, implementation strategies to implement oral care programs in nursing homes and their effectiveness were studied. Knowledge improvement was the most frequently used strategy. Oral care programs were particularly effective in increasing knowledge and improving attitude of nursing staff. The oral hygiene of denture wearing older people showed greater improvement than those with natural teeth.
Secondly, this thesis studied the implementation of an oral care program in home care nursing teams. Our program improved the oral health and hygiene of older adults and increased the knowledge of home care nurses. A qualitative evaluation revealed that participants were positive about the program, but ongoing oral care education of home care nurses was required.
Thirdly, the quality of measurement instruments for use by non-dental healthcare providers in assessing the oral health of older people was evaluated. For most measurement instruments, the methodological quality of some measurement properties was found to be poor. The Simplified Oral Indicator developed for home care nurses was of low sensitivity and specificity, to correctly refer older people to oral health professionals.
This thesis provides insights into the effects of implementation of oral care programs in different care settings. The importance of implementations is highlighted by their positive impact on knowledge and attitude of nursing staff and the oral hygiene of older people.
