Nurse‐ and Caregiver‐Led Oral Health Interventions in Older Adults Living in LongTerm Care Facilities: A Systematic Review and Meta‐Analysis

Introduction Oral diseases are a significant health problem commonly observed among older adults living in long‐term care facilities. Maintaining adequate oral hygiene in this population is often challenging due to physical dependency, cognitive decline, and limited access to dental services. Poor oral hygiene has been associated with adverse outcomes such as chewing difficulties, nutritional problems, swallowing difficulties, and an increased risk of aspiration pneumonia. In long‐term care settings, initiatives aimed at improving oral health are generally based on staff training and structured care protocols. However, the effectiveness of these interventions may vary depending on institutional care conditions, staff competence, and the continuity of implementation. Objective The aim of this systematic review and meta‐analysis is to evaluate the effectiveness of nurse‐ or caregiver‐led oral health interventions in improving oral hygiene outcomes among older adults living in institutional care settings. Methods A systematic literature search was conducted in PubMed, Scopus, CINAHL and Web of Science to identify randomized controlled trials evaluating oral health interventions delivered by nurses or caregivers among individuals aged 60 years and older living in long‐term care facilities. Data extraction and risk of bias assessment were performed independently by two researchers. The meta‐analysis was conducted using a random‐effects model with standardized mean differences (Hedges’ g). Results Six randomized or cluster randomized controlled trials including more than 900 participants were included in the analysis. The interventions consisted of caregiver training programs, professional toothbrushing practices, implementation of oral hygiene protocols, and structured oral care programs. The meta‐analysis showed a moderate improvement in plaque outcomes in favor of the intervention groups (Hedges’ g ≈ −0.62). Improvements were also observed in denture plaque outcomes (Hedges’ g ≈ −1.13); however, heterogeneity among the studies was very high. Despite this heterogeneity, the overall direction of the effect favored the intervention groups. However, because of the high between‐study heterogeneity and methodological variability, the magnitude of the pooled effects should be interpreted with caution and should not be considered a precise or definitive estimate of intervention effectiveness. Conclusion Nurse‐ or caregiver‐led oral health interventions may have the potential to improve oral hygiene outcomes among older adults living in long‐term care facilities. However, the certainty and precision of the estimated effects are limited by the small number of studies, methodological diversity, and substantial heterogeneity. Therefore, the findings should be interpreted cautiously, and further high‐quality trials with standardized outcome measures are needed.