Cuidados bucais de pessoas idosas: barreiras percebidas por profissionais de instituições de longa permanência filantrópicas e privadas

Abstract

Population ageing is a global reality and all efforts are directed towards ensuring that older people live longer and better, including those who are frail and in need of care. In an institutional environment, caregivers and nursing staff are essential to provide adequate oral care and collaborate directly for the health and quality of life of residents. This study aimed to investigate the practices and barriers perceived in oral health care for elderly people by professionals working in Long-Term Care Institutions (LTCFs), comparing philanthropic (FL) and private (PV) institutions. A cross-sectional study was conducted from January 2023 to April 2024, among professionals from all 29 philanthropic LTCFs (census) and a sample of 27 private LTCFs in Belo Horizonte, selected randomly and proportionally. A self-completed questionnaire containing 24 closed questions (sociodemographic profile, professional, practice, barriers and perceived needs in oral health) and an open question about the challenges for performing oral hygiene in the elderly was applied. The associations between the type of LTCF and the variables analyzed were evaluated using Pearson's X² test/Fisher's exact test and the Mann-Whitney test. A total of 427 professionals responded, 341 and 86 of whom were philanthropic and private LTCFs, respectively. Most were women (91.1%), with a mean age of 41.0 (SD=11.4), with complete high school (68.8%), and as caregivers for the elderly (79.1%). The majority reported cleaning their mouth/teeth/prostheses of dependent elderly people (91.0%), having clarity in the provision of care (93.4%). Many considered it difficult/very difficult to perform oral hygiene in dependent elderly (27.7%). Caregivers of private LTCFs reported more frequent support (82.4% vs. 71.2%, p=0.037) and easier to motivate oral hygiene among independent older adults (60.5% vs. 47.8%, p=0.039). Caregivers of philanthropic institutions more frequently identified oral health needs among the elderly (43.5% vs. 25.0%, p=0.000). There was no difference in the frequency of perceived barriers between private and philanthropic LTCF caregivers. In both types of LTCFs, most professionals reported feeling comfortable or neutral to clean the natural teeth of the elderly, interdental and dental prosthesis cleaning. Most of them expressed comfort to motivate an independent elderly person to perform oral hygiene and perform it in those who do not show resistance. Discomfort was more frequently manifested to perform oral hygiene in those who showed physical (FL: 45.5%; PV: 34.9%) or verbal resistance (FL: 32%; PV: 26.7%), who had poor oral health (FL: 24.9%; PV: 20.9%) and halitosis (FL: 24.5%; PV: 17.4%). Professionals reported comfort in performing oral care for the elderly, but they face barriers in the presence of clinical-functional impairment, resistant behaviors or poor oral health conditions. There were differences in the support and motivation of caregivers in relation to oral care and in the frequency with which they identify dental needs in the elderly according to the type of LTCF.