Assessment of the Impact of Oral Health Training for Caregivers on the Oral Health-related Quality of Life of Residents in Nursing Homes

Throughout life, the oral cavity plays a vital role in many essential functions such as chewing and social interactions (communication, smiling, etc.). Its ageing is accompanied by disturbances that affect the overall health and quality of life of elderly people, particularly when they are dependent and/or institutionalised.

In these frail patients, local changes (reduced salivary flow, presence of removable dentures, etc.) as well as general pathologies (diabetes, hypertension, etc.) and their treatments, combined with neglect of daily hygiene and a decline in immune defences, lead to an imbalance in the oral microbiome. This imbalance manifests itself in the accumulation of biofilm (dental plaque), weakening of oral tissues and a worsening of the overall clinical condition. This dysbiosis has consequences both at the somatic level (imbalance of diabetes, development of cardiovascular diseases, etc.) and in terms of patients' quality of life (eating disorders, pain, discomfort, communication difficulties).

To ensure a good quality of life in relation to oral health, daily care is therefore necessary to remove bacterial plaque and food debris from the teeth, mucous membranes and dentures.

With an ageing population, the number of seniors losing their independence is increasing and could reach nearly 4 million people by 2050. Faced with this demographic change, the increase in care needs in residential care homes for the elderly (EHPAD) is accompanied by a shift in patient profiles. Patients are increasingly older and increasingly dependent. They therefore require specific care that is both compassionate and respectful of residents.

Before entering nursing homes, elderly people face barriers to accessing conventional dental care (financial barriers, accessibility to practitioners). In addition, they generally have functional limitations such as physical mobility difficulties and cognitive impairments. As a result, the oral health of elderly people is often impaired by the time they are admitted to a care facility. Once these dependent individuals have entered care homes, communication difficulties between the care team and the dentist constitute an additional barrier to access to care. Thus, the fact that an elderly person is in an institution reduces their use of dental services by 25% compared to a population of elderly people living independently at home. Given these multiple constraints that can limit the monitoring and management of the consequences of ageing in the oral cavity, it is understandable that the oral health of institutionalised people in France is poor.