Development of practice guidelines for daily oral care in care-dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach.
Stefanie Krausch-Hofmann, Ellen Palmers, Dominique Declerck and 1 others
PMID 33074589WHAT IT FOUND
Experts agreed on practical oral-care items for nursing assistants to use with care-dependent older adults, covering brushing, dentures, tongue cleaning, assistance and resistant behaviour.
The guidelines were not tested in patients.
Key findings
01The final guidelines contain 54 items across 8 domains.
0251 items reached high or very high agreement in survey 2, and 3 more reached agreement in survey 3.
03Three proposed items were not adopted: chlorhexidine use, soaking dentures in cleanser, and using a mirror during care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study reached expert consensus on guideline wording, but it did not test whether the guidelines improve oral health or reduce pneumonia. Most experts were dentists, so the consensus may not represent all professions that provide daily oral care. Experts came from 14 countries, and Western Europe and North America were overrepresented among interRAI countries. Experts were asked to assume enough staffing, time and materials, which may not match real care settings. The paper states that scientific evidence is scarce for many oral-care devices and approaches in care-dependent older adults. The guidelines are not mandatory and may not overcome time constraints, training gaps or unclear responsibilities.
Declared interests
KU Leuven is named as the funder.
The easy way to misread this
Do not read the consensus as proof that the guidelines improve oral health or reduce aspiration pneumonia. The study did not test the guidelines in patients or measure oral-health outcomes.