Oral health care for frail older adults in nursing homes from a management perspective: a survey-based study

Journal article, 2025

Background: Oral diseases and poor oral hygiene are prevalent among frail older adults in nursing homes. Despite well-known organizational barriers such as low prioritization, time and staff shortages, and lack of routines and training, research on the perspective of nursing home management remains limited in this area.
Purpose: To investigate the views and experiences of professionals in leadership roles regarding oral health needs and routines as well as barriers and facilitators in providing effective oral care for frail older adults in nursing homes.
Methods: A web-based survey was sent to 1,526 nursing home professionals (managers, coordinators and registered nurses) in Sweden. The survey comprised a 52-item questionnaire covering oral health needs, oral care barriers and facilitators, routines, education, collaboration with dental care services, and the use of the quality register Senior Alert, designed to support a preventive approach in nursing care and the Revised Oral Assessment Guide-Jönköping (ROAG-J).
Results: Responses were received from 166 managers, 55 coordinators and 243 nurses, yielding a 32% response rate. About half of the respondents perceived residents’ oral health as poor, and 83% reported that most residents required assistance with oral care. The main barriers were difficulties for nursing staff to perform oral care and residents’ unwillingness to participate, often due to dementia. Increased and regular training in oral care for nursing staff was viewed as the most important facilitator; however, only 41% of respondents reported that their staff had received training regularly. The Senior Alert register and the ROAG-J were widely used and generally perceived as effective. Oral health was also frequently discussed during regular Senior Alert team meetings, with a high level of management involvement.
Conclusions: The significant and complex oral care needs of older adults in nursing homes, coupled with the fact that nursing staff often lack adequate training, stress the importance of management allocating resources, ensuring regular staff training and strengthening collaboration with dental care services. Senior Alert’s structured approach seems to have the potential to enhance the engagement of nursing home professionals in managing residents’ oral health.