Oral Assessment and Preventive Actions within the Swedish Quality Register Senior Alert: Impact on Frail Older Adults’ Oral Health in a Longitudinal Perspective

Abstract

Poor oral health is common among older people in nursing homes. To identify and prevent oral health problems among the residents, ROAG-J (Revised Oral Assessment Guide–Jönköping), a risk-assessment instrument, is used by nursing staff routinely, and the outcome is registered in the web-based Swedish quality register Senior Alert. This study aims to investigate the preventive actions registered when oral health problems are identified and the effect of these actions longitudinally. ROAG-J data registered at nursing homes in Sweden during 2011–2016 were obtained from the Senior Alert database. Out of 52,740 residents (≥65 years), 41% had oral health problems, of whom 62% had preventive actions registered. The most common action was “Assistance with cleaning teeth”. Longitudinally, during the five-year observation period, a slight increase in oral health problems assessed with ROAG-J was found. Registered preventive actions, however, led to significant improvement in the subsequent assessment for the ROAG items lips, tongue, and dentures. Standardised risk assessments like ROAG-J provide an opportunity to detect problems early and establish preventive actions. The study, however, indicates a further need for structured education and a continuous follow-up in ROAG-J. Moreover, increased collaboration between nursing and dental care to improve oral health for older residents at nursing homes is needed.

A registry study of oral health problems and preventive interventions among older persons receiving municipal healthcare – PROSENIOR

“…To the best of our knowledge, our study is the first to investigate the correspondence between specific oral health problems and associated planned preventive interventions according to ROAG‐J. While our study focused on correspondence between specific problems and associated interventions, a recent study by Bellander, Andersson, Wijk, et al (2021) investigated longitudinal effect of preventive interventions according to ROAG‐J and found some improvements in oral health. Our results demonstrate inconsistency between risk and preventive interventions for oral health problems.…”

Cross-cultural translation and modification of the revised oral assessment guide for oral health assessment by non-dentists

“…The utilization of ndROAG is suggested as a screening tool for patients and non-dentists to facilitate early detection of oral problems, fostering self-awareness, and encouraging oral self-care, ultimately promoting improved oral health outcomes for patients. Although the original ROAG had been used only in older people [ 7 , 10 – 13 ], the ndROAG can be used with adult and older patients. Using the ndROAG strengthens the capability of the primary healthcare setting by enabling community-dwelling people, community health worker, as well as non-dental personnel to detect and manage the initial stage of oral diseases.…”

“…The ROAG has been translated into several languages, such as Portuguese, German, and Swedish, and been used by nurses, CHVs, physicians, and caregivers to assess the oral health of older people [ 10 – 13 ]. Furthermore, modifications have been made to the ROAG to tailor its use for specific populations, including intensive care patients [ 14 ] and individuals undergoing chemotherapy [ 15 , 16 ].…”

Oral health assessment in institutionalized elderly: a scoping review

“…This resulted in 12 studies being clustered into 5 studies (i.e. exclusion of 7 studies) [25][26][27][28][29][30][31][32][33][34][35][36]. Altogether, 86 studies were included for analysis.…”

“…All categories were scored as healthy, changed or unhealthy. The Revised Oral Assessment Guide -Jonköping (ROAG(J)) is somewhat similar, as oral health is evaluated by assessing the condition of voice, lips, oral mucosa, tongue, gums teeth, saliva, swallowing, protheses/implants (grades 0-3) [25,80,81,115,116], however, this method is unvalidated. The OHAT and ROAG(J) are instruments developed for trained nursing staff, as is the Brief Oral Health Examination Status [122].…”