Collaboration and person-centered care for better oral health in older adults

Jessica Persson Kylén highlights how the lack of coordination between healthcare units can affect the oral health of older adults receiving home care. Photo: Nicklas Jendeby

Many older adults require both dental care and medical care, but today there are often no routines for how oral health should be integrated into the general care plan for older individuals receiving home-based care.

Doctoral researcher Jessica Persson Kylén, a registered dental hygienist, has seen the issue up close. With her dissertation "Oral Health Care Planning: A conceptual model based on collaboration and person-centered care," she contributes to bridging a research gap and hopes to inspire to the creation of new methods with a higher degree of collaboration, focusing on each older individual.

"Dental care has its own system with its recordkeeping systems and organization, and healthcare has another. Both sides possess vital knowledge about the older person’s care needs, but they lack insight into each other's perspectives, even though it concerns the same person", says Jessica.

Older adults fall through the cracks

The research is based on four studies within municipal settings, and includes older adults, nurses in home healthcare, nursing assistants, and dental hygienists. The results show that older adults want to participate in decisions regarding their oral health and can contribute valuable knowledge concerning life history, preferences, and wishes.

"As people age, they often lose regular dental visits, either because they can't manage to go or because the right support is lacking. In a fragile period of life, there is a risk of losing contact with dental care just when it’s most needed", Jessica says.

She describes that a high percentage of older adults suffer from dental caries, which cannot be addressed with fillings and isolated interventions. It needs to be prevented, and the underlying causes need to be mapped. Poor oral health can cause significant discomfort and difficulties in eating, which in turn can weaken the older individual. Additionally, there is a connection between oral diseases and cardiovascular diseases and diabetes.

New and more organized methods

Since 2008, Swedish law has regulated that everyone with a significant and permanent care need in daily life has the right to an oral health assessment at home. Part of Jessica Persson Kylén’s research has been to examine how these assessments are performed. Typically, both a dental hygienist and a nursing assistant are present, and advice is given on how to manage oral health. However, Jessica identified that there are no well-defined role descriptions, and it is unclear who is responsible for taking further actions based on the patient's needs.

"This is actually a great opportunity for workplace-integrated learning, but there are no structured frameworks, and little knowledge transfer is taking place."

Jessica’s dissertation proposes a new model where action plans and documentation are entered into a digital platform that both the older adult, municipal care, and dental care can access, potentially also including the older adult’s relatives. The new model also focuses on giving nursing assistants in home healthcare more knowledge to assess oral health in older individuals independently.

"We have included a tool that is already validated for use by non-dental-trained personnel. It helps nursing assistants to inspect the mouth and assess whether interventions are needed."

Putting the person first

Another important takeaway from Jessica’s work is the significant need to see older adults as unique persons, with their own knowledge about their health and needs. At home, where the context is a crucial part of care, it is essential that the model is adapted to the individual’s preferences and lifestyle.

"You can come up with lots of processes, but the most important thing is that it works in everyday life for people, which can look very different from person to person", Jessica says.

During her work, she visited Canada and met researchers who are leading experts in person-centered care and shared decision-making. What inspired her the most was the importance of involving the person for whom the research is truly meant – the person whose health and everyday life are at stake.

"It’s impossible to design something without asking the person how they feel and what suits them. For example, many older adults we’ve talked to don’t want assistance with daily oral care, because it feels like an intrusion on their privacy. But they may be open to help in other ways. We need to find ways to accommodate that."

Large-scale testing ahead

Once the doctoral defense is concluded, an extensive test of the model will take place next year. This will be conducted together with municipalities in the Västra Götaland Region, Public Dental Service, Karlstad University, and the University of Gothenburg. Sixteen teams, each working with 15 older individuals, will use Jessica’s model. Another group will work according to the current practice, and the project will then be evaluated. The aim is that the cross-organizational collaboration will be seen as educational and encourage more interdisciplinary teamwork.

"And that it will lead to better oral healthcare in home-based care, with more collaboration and the person at the center. The main goal of the research is to create benefits and health for the elderly population, so that more people experience an improved quality of life", Jessica concludes.

Jessica Persson Kylén is a recent PhD in Work-Integrated Learning at University West. Here you can find her dissertation, "Oral Health Care Planning: A conceptual model based on collaboration and person-centred care."

Contact: Jessica Persson Kylén, University West

At University West, we conduct research in collaboration with the surrounding world to create a better future.