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Objective This qualitative study explored barriers and enabling factors to the implementation of an oral hygiene protocol in nursing homes. Background Oral health care in nursing homes in Flanders ( Belgium) is inadequate. Materials and methods Qualitative data were obtained from nurses employed in 13 nursing homes involved in two randomised controlled trials in Flanders- Belgium. Data were collected by focus group and face-to-face interviews during April 2005 and December 2009. All transcripts were analysed with support of NVivo 8 ( Version 2008). Transcripts were intuitively analysed in a two-step method. Results Most revealed barriers were consistent with previous findings in the literature. Newly reported barriers were respect for residents' self-determination, experience based oral health care by nurses, residents' oral health status and nurses' inability to notice residents' oral health status. Demand-driven oral health care was found to be a strong enabling factor. Conclusion The integration of oral health care into day-to-day care seems to be a major problem due to a multitude of barriers. In future implementation innovations in oral health care an a priori assessment of influencing factors is recommended. [ABSTRACT FROM AUTHOR]

This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome. [ABSTRACT FROM AUTHOR]