Cuidados bucais em instituições de longa permanência para idosos

Abstract

This dissertation presents three articles on the topic of oral health of institutionalized elderly people that seek to evaluate the oral care provided by professionals of Long-Term Care Facilities (LTCF) for the elderly people and qualify instruments that propose such an assessment regarding their measurement properties. In order to map the instruments for assessing the oral health of elderly people living in LTCF by non-dentist professionals and to assess their measurement properties, a systematic review protocol and a systematic review were developed. Studies describing the development of instruments to assess the oral health of institutionalized old people by non-dentist professionals were included. Studies evaluating at least one measurement property (validity, reliability or responsiveness) were considered. Electronic surveys were performed and properties were assessed using the parameters for risk of bias assessment according to the Consensus-based Standards for the selection of health Measurement INnstruments (COSMIN). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rank the quality of evidence and recommend the most appropriate instrument. 15 studies reported measurement properties of seven instruments, with the ohr-interRAI being the instrument with the greatest potential to be recommended. In addition to it, OHAT, DHI, OAS, OHSTNP has potential for use. Considering the level of evidence available, the use of the ohr-interRAI for evaluative purposes is recommended until new high-quality evidence demonstrates superior measurement properties for other instruments with potential for use. Thus, there is a need to improve the methodological aspects of the studies and carry out more consistent studies to assess the measurement properties of existing instruments that have the potential to be indicated for use. The third study sought to describe the oral hygiene practices of institutionalized elderly people dependent on care in the context of the COVID-19 pandemic and to analyze the factors associated with the performance of these procedures by professionals working in LTCF. This is a cross-sectional, exploratory study with a non-probabilistic sample of LTCF professionals. Data on oral hygiene practices, sociodemographic profile, professional performance and training, structure of the LTCF, work process and perception of professionals were collected through an online questionnaire, previously validated by the Expert Committee, between June and December 2020. Associations were investigated using simple and multiple logistic regression. Of the 179 professionals who answered the original survey questionnaire, 76.0% performed oral hygiene for dependent elderly people and 42.5% reported difficulties, including barriers such as the elderly's lack of cooperation (93.20%), lack of knowledge (35.60%), lack of time (29.30%) and lack of necessary materials (27.6%). Having a training course for elderly caregivers (OR = 3.27, CI 1.53 - 6.98) and for oral hygiene (OR = 2.19, CI 1.01 - 4.79) were associated with a higher frequency of performing oral hygiene. Oral hygiene practices are carried out in LTCF in Brazil during the context of the COVID-19 pandemic and training for caregivers of the elderly and for oral care can favor the provision of such care.