Oral health and nutrition in older adults in care homes: barriers and facilitators

Abstract

Background: Poor oral health is a prevalent but often overlooked issue among older adults living in care homes. High sugar intake plays a critical role, yet the relationship between nutrition and oral health in this population remains under-researched. Public health sugar-reduction efforts have largely focused on children, with limited attention to older adults, particularly those in residential care.

Aim: This thesis explores the relationship between dietary intake, nutritional status, and oral health in older adults in care homes, with a focus on the impact of sugar. It also aims to inform the design of a behaviour change intervention to reduce sugar consumption in this setting.

Methods: A multi-phase approach was used: Phase 1 (Scoping Review) examined the literature on diet, nutrition, and oral health in older care home residents. Phase 2 (Qualitative Study) involved semi-structured interviews with care home residents, family members, staff, and external healthcare professionals to explore their perspectives on oral health and dietary practices. Phase 3 (Intervention Design) used findings from the first two phases to inform the development of a sugar-reduction intervention, guided by the Behaviour Change Wheel.

Results: The review highlighted a limited but growing evidence base showing the bidirectional link between diet and oral health. The qualitative study revealed key challenges, including routine use of sugar-rich foods to address malnutrition, lack of integration between oral and nutritional care, and systemic barriers to dietary change in care homes. These findings directly informed the design of a stakeholder-informed, theory-driven intervention.

Conclusion: This thesis offers new insights into the neglected impact of sugar on oral health in care home residents. It emphasises the lived experiences of older adults and systemic gaps in care, laying the groundwork for a context-specific intervention to reduce sugar intake and improve oral health outcomes in this vulnerable group.

Date of Award	Jul 2025
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Department for Education & NIHR
Supervisor	Noleen McCorry (Supervisor), Gerry McKenna (Supervisor) & Michael Donnelly (Supervisor)