Response to: Integrating Oral Care Into Nurse‐Led Models: A Critical Step to Reduce Pneumonia in Older Adults

We thank Yang and Bai [1] for their interest in INTERCARE as a nurse-led care model [2] and we welcome the opportunity to address the point raised. We believe that constructive discussions about the role of oral health in preventing pneumonia both in-hospital and as a reason for hospitalizations amongst nursing home residents are essential for advancing our understanding of this key area of geriatric care. INTERCARE is a complex intervention with six evidence-based components, with the main aim to reduce unplanned hospital transfers of residents in residential long-term care (RLTC) [2]. A central component to INTERCARE is the INTERCARE nurse, an in-house registered nurse in an expanded geriatric role, who was one of the key mechanisms for the significant effect of INTERCARE on reducing unplanned hospital transfers [3]. Our intervention focused on reducing unplanned hospital transfers for ambulatory care sensitive conditions (ACSC). These include pneumonia, which accounts for about 15% of all ACSC leading to hospitalizations from RLTC in Switzerland [4]. While we did not report specifically on transfers due to pneumonia in the INTERCARE study, around 10% of all unplanned transfers we observed were due to infection and/or respiratory disorders [3]. Although INTERCARE addressed pneumonia as a possible reason for hospitalizations, it did not specifically test oral care interventions or other pneumonia-specific preventive strategies. Our findings therefore do not provide direct evidence in support of oral health recommendations. Rather, they highlight the burden of pneumonia as a cause of potentially avoidable hospital transfers in RLTC. In this context, evidence from prior research as highlighted by Yang and Bai, although largely focused on hospital-based care, may offer complementary insights for improving residents' outcomes and quality of care by fostering oral health. Nurses in expanded roles like the INTERCARE nurses play a pivotal role in identifying and addressing the specific health needs, empowering care staff, and supporting the delivery of qualitative care for residents. In INTERCARE, we specifically developed a curriculum with in-depth geriatric training, which in the meantime became an accredited course of advanced studies [5]. The comprehensive training offers a blend of classroom teaching, e-learning, and self-study, emphasizing practical application, reflection on workplace experiences, and ongoing individual and group coaching. It focuses on comprehensive geriatric assessment—including oral health as an important aspect of older adult health but not introducing a standardized, evidence-based protocol—, advance care planning, geriatric syndromes, key clinical symptoms, pharmacology, data-driven quality development and supports trainees in taking up a clinical leadership role. We see the need to integrate a more standardized approach to oral health in the training of nurses in expanded roles to raise their awareness, knowledge, and skills so that they can empower care teams to tackle the challenges linked to oral care, especially with residents with dementia. Collaboration with oral health professionals seems key to foster such training. A focused learning unit on oral health care for RLTC residents is currently in the planning stage and will be integrated into the intended expansion of the INTERCARE curriculum. We are convinced that the same work needs to be done for staff providing hospital care, although such learning units and practical trainings need to consider the specific contexts (e.g., short-stay vs. long-term care), staff's grade mix and competences, as well as resident/patient characteristics. F.Z. and F.S. contributed equally to the conception, drafting, critical revision, and final approval of this reply letter and agree to be accountable for all aspects of the work. The authors have nothing to report. The INTERCARE study has received funding from the Swiss National Foundation (SNF) as part of the National Research Program (NRP) 74, Project Nr. 407440_167458, Stiftung Pflegewissenschaft, grant number 2165–2017, and Ebnet Stiftung, Switzerland. For this reply, no financial support was received, and the INTERCARE sponsors had no role in its conduct or reporting. The authors declare no conflicts of interest. This publication is linked to a related article by Yang and Bai. To view this article, visit https://doi.org/10.1111/jgs.70308.