Person-centred Co-ordinated Care for Older People. How is Dentistry Involved?

Objectives: It remains unclear how dentistry fits within person-centred care for vulnerable older people. This is important because poor oral health negatively impacts on dignity, quality of life and wellbeing. The objective was therefore to perform a qualitative evidence synthesis to explore staff, family and residents’ views of barriers to and facilitators of the provision of person-centred dental care for older people living in care homes.

Methods: A “best fit” framework synthesis of primary research exploring stakeholders' views in order to understand how and why current interventions (dentistry and oral care) might or might not be person-centred, and to identify relevant areas for further primary qualitative research in this field. Data from primary research studies were coded against a priori framework and data not captured by this framework were then analysed using secondary thematic analysis to generate new themes.
Results: An existing conceptual framework for person-centred care was used as the basis for the a priori framework. A comprehensive literature search, including interrogation of four key databases, retrieved 336 unique citations for review and synthesis. Sixteen qualitative primary research studies were found to satisfy the inclusion criteria. The majority of studies explored the views of care home staff. Evidence was found to support all of the key concepts in the a priori framework. The new themes produced by the synthesis, related to the contextual specifics of the setting (the care home) and the interventions (dentistry and oral care). A new framework and conceptual model was then created using all themes, both pre-existing and newly specified, found by reviewers within the data.
Conclusions: The synthesis and conceptual model offers a strong starting-point to guide the delivery of improved dental and oral care for older people in care homes. However, more research on the views of dentists, care home residents and family members is needed.