1. 1782 Quality Of Oral-Care by Caregivers
In Government-Assisted Long-Term-Care-Institutions-For-Elderly-People
in Trinidad
1782
A. Paryag1, D. Lewis2, R. N. Rafeek3
A. Paryag, Conservative Dentistry - Prosthodontics, University Of The West Indies Schoo Of Dentistry, Mt.Hope, TRINIDAD AND TOBAGO D. Lewis, Dorset Health Care University NHS Foundation Trust, Poole, UNITED KINGDOM R.N. Rafeek, Conservative Dentistry, University Of The West Indies School Of Dentistry, Mt. Hope, TRINIDAD AND TOBAGO
Introduction
Increasing longevity and declining fertility rates have been shifting the age distribution of populations in all industrialized countries toward older age groups.
The rate of growth of older persons is more rapid in the less developed regions. As a consequence, the United Nations projects the older population will be increasingly concentrated in these regions1
Rawlins (2004)2 noted that Caribbean populations have aged as a result of the demographic transition.. The population over age 60 years as a percentage of the total population projected for 2025 is 20.0% for Trinidad,2.
Previous investigations in the United-Kingdom reveal that the attitudes or reasons why oral-hygiene skills may not be practiced by caregivers in long term care institutions for the elderly range from fear and psychological concerns to distaste when dealing with oral-hygiene.3-5
At the present time there is not in existence a detailed and integrated written policy on ageing for Trinidad and Tobago6. The challenges faced by elderly people here however are not very different from elderly people around the world.
Aim
To investigate: The Knowledge, Attitudes, Beliefs and Training of Caregivers / Nursing Staff in relation to Oral-Care in long-term-care- institutions for elderly people, in Trinidad.
Objectives
Investigate the Knowledge of Caregivers / Nursing Staff
Examine the Attitudes of Caregivers / Nursing Staff
Determine the Beliefs of Caregivers / Nursing Staff
Ascertain the level of Training of Caregivers / Nursing Staff
in Government-Assisted long-term-care-institutions, in relation to Oral
Care for elderly people in Trinidad.
Method
42 questionnaires were couriered to the respective homes with prepaid return packages being enclosed. Completed questionnaires were returned via courier and the data entered into an excel spread sheet for analysis.
TABLE 1: KNOWLEDGE OF CAREGIVERS WITH RESPECT TO ORAL CARE OF THE ELDERLY
Questions
Correct Response
TRUE
FALSE 1
Care home staff have a responsibility to look after residents oral health
True
89.7
10.3 2
An oral health risk assessment should be completed within 48 hours of admission
82.8 3
A care plan should be completed after the oral health risk assessment is carried out
72.4
13.8 4
Dental referral is the responsibility of all staff
69.0
20.7 5
It is the responsibility of staff to help brush residents teeth and help clean residents dentures if necessary
79.3 6
If the residents gums bleed when you are brushing their teeth, you should stop brushing
False
31.0 7
After brushing natural teeth with fluoride toothpaste, the mouth should be rinsed with water
86.2
6.9 8
If a resident refuses oral care, it may be because they have dental pain
51.7
44.8 9
Lack of saliva does not cause a problem for older people
17.2 10
Teeth should be cleaned twice a day with a fluoride toothpaste 11
A healthy mouth is important for general health
96.6
0.0 12
Dentures should be taken out at night, cleaned and soaked.
3.4 13
Disposable gloves should be worn when cleaning residents teeth 14
Sugar does not affect the teeth of older people
75.9
Results
Response Rate - 69%.
27.6% completed nursing-training.
69.0% responded in the affirmative to having received basic-training in oral-care.
72.4% of respondents stated that they would like to receive training in oral-care.
69.0% responded that the statement “If the residents gums bleed when you are brushing their teeth, you should stop brushing”, was true. (TABLE 1; FIG. 1)
89.7% believed that brushing and flossing daily prevent gum disease. (TABLE 2; FIG. 2)
79.3% agreed that dentures should be removed at night. (TABLE 2; FIG. 2)
TABLE 2: ATTITUDES AND BELIEFS OF CAREGIVERS WITH RESPECT TO ORAL CARE OF THE ELDERLY
Strongly
Agree
Disagree
Strongly Disagree 1
Oral care / cleaning the mouth is important
86.2
13.8
0.0 2
Brushing and flossing daily prevent gum disease
55.2
34.5
10.3 3
Health of the mouth is related to health of the body,
62.1
31.0
6.9 4
As people age, they naturally lose their teeth
27.6
24.1
44.8
3.4 5
Dentures should be removed at night. 6
Dentures should be removed and cleaned after every meal
51.7
37.9 7
People with teeth or dentures should try and clean them themselves.
17.2 8
The resident / patient is responsible for asking for assistance with dental care.
48.3 9
I am not responsible for oral care of the resident / patient 10
Cleaning the mouth is difficult because patients don’t co-operate 11
Cleaning the mouth is difficult because of my lack of training in oral care 12
Cleaning the mouth is more difficult than personal hygiene 13
Cleaning the mouth is more unpleasant than personal hygiene e.g. changing diapers
41.4
Fig. 1: Knowledge Of Caregivers With Respect To Oral Care Of The Elderly
Fig. 2: Attitudes And Beliefs Of Caregivers With Respect To Oral Care Of The Elderly
Conclusions 
Training is inadequate and appears to be impacting upon knowledge, attitudes and beliefs negatively in certain key areas of oral-care. While attitude toward oral-care and improving knowledge is positive, erroneous beliefs need addressing. Although the knowledge of caregivers is adequate in many aspects, there is still room for improving their awareness of appropriate practices for oral-care of residents in long-term-care-institutions.
References
Weeks JC, Fiske J. Oral care of people with disability: a qualitative exploration of the views of nursing staff. Gerodontology 1994; 11:
Lewis M. The Caribbean Health Situation. Port-of –Spain Trinidad: Caribbean Epidemiology Centre (CAREC) (Unpublished paper).
Frenkel H, Harvey I, Needs K. Oral health care education and its effect on caregivers’ knowledge and attitudes: a randomised controlled trial. Community Dent Oral Epidemiol 2002;30:
Rawlins J. M. Ageing and The Family: Confronting the challenges. The University Of The West Indies, Mount Hope, Trinidad, 2004
Williams D. Policy on ageing in Trinidad and Tobago. From Ageing: Discussing the issues in Trinidad. School of Continuing Studies. The University of The West Indies, St. Augustine Trinidad 2004.
Wardh I, Andersson L, Sorensen S. Staff attitudes to oral health care. A comparative study of registered nurses, nursing assistants and home care aides. Gerodontology 1997;14:28-32

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