Barriers, challenges, and facilitators in oral health care for older adults in home-based care: stakeholder perspectives from germany

Abstract Background With the growing number of people requiring long-term care in Germany, not only is the prevalence of chronic diseases increasing, but oral health is also deteriorating. Many older adults with functional impairments who live at home can no longer maintain their oral hygiene independently and therefore rely on caregivers. Consequently, the quality of oral care often depends these caregivers. However, as oral health care in the outpatient setting involves multiple stakeholders — including dentists, dental assistants, general practitioners, professional and family caregivers- the fragmented German healthcare system, characterised by distinct responsibilities and reimbursement models, often results in poor coordination among those stakeholders. We aimed to explore the perspectives of key stakeholders, including family caregivers, professional caregivers, dentists, dental assistants, and general practitioners, to identify barriers, challenges, and facilitators related to both the delivery and utilisation of oral health care for older adults in need of home-based care. Methods As part of the ‘ Interaction of Systemic Morbidity and Oral Health in Ambulatory Patients in Need of Home Care (InSEMaP) ’ study, we conducted a descriptive qualitative study incorporating both homogeneous and heterogeneous stakeholder focus groups, complemented by individual interviews with professionals involved in oral health care for home-based care recipients in Hamburg, Germany. All interviews were digitally recorded, transcribed verbatim, and analysed using deductive-inductive qualitative content analysis following Kuckartz’s framework. Results A total of 55 stakeholders participated in six homogeneous focus groups (n = 29), two heterogeneous focus groups (n = 9), and 17 individual interviews. Three main themes emerged: (1) Facilitators and Challenges in Oral health care , (2) Utilisation of Dental Care , and (3) Interprofessional Collaboration . Conclusions Improving oral health care for older adults in need of home-based care requires greater awareness of its relevance to overall health and well-being. Our findings highlight the need for structured interprofessional collaboration, alongside reforms in reimbursement models, caregiver training, digitalisation, and coordination of care. Addressing these factors may contribute to improving oral health care services for older adults with reduced functional capabilities. Trial registration DRKS00027020. Date of Registration: 04/01/2022; https://drks.de/search/de/trial/DRKS00027020 .