Protocol for the GAPA person-centred dental care at home intervention: a substudy within a cluster randomised controlled trial in Swedish home care

Abstract Background Oral health is essential to healthy ageing and closely linked to well-being, social participation, and quality of life. Frail older adults are at high risk of oral diseases, yet oral health is often insufficiently integrated into home care. Care staff frequently report limited competence and unclear routines, while older adults wish to participate actively in decisions about their oral health. GAPA Person-Centered Dental Care @ Home (Dental PCC@Home) is a co-designed model developed with older adults, significant others (informal caregivers), municipal care staff, and dental professionals. This substudy evaluates if Dental PCC@Home will promote oral health, participation, and self-determination among older adults living with complex care needs. Methods Dental PCC@Home is embedded within the parent GAPA cluster randomised controlled trial. Decisions about dental care are guided by a patient decision aid and discussion of needs expressed by the older adult or identified by care staff. Participation in the substudy is voluntary. Eligible intervention-group participants are offered a patient decision aid to support decisions about whether and how to receive dental care, followed by one of four pathways: online dental consultation, mobile home dental care, a dental clinic visit, or declining dental care. Eligible control-group participants receive standard care. Oral health and quality-of-life assessments are conducted at baseline and at six and twelve months; cognitive function is assessed at baseline only. Co-primary outcomes are changes in oral health status (ROAG) and oral health-related quality of life (GOHAI) from baseline to twelve months. General health-related quality of life (EQ-5D-5 L) is a secondary outcome. Quantitative analyses will account for clustering and repeated measurements. Semi-structured interviews with older adults, significant others, and care staff will explore experiences of care, decision-making, and implementation and will be analysed using qualitative content analysis. Discussion This project will generate evidence on a new cross-organisational model designed to improve access to oral health care for frail older adults living at home. By integrating dental care into existing care processes and offering flexible care pathways, the model has the potential to strengthen autonomy, reduce inequalities, promote health and, when indicated, address oral diseases earlier in home care. The findings may inform future practice, policy development, and person-centred approaches to oral health in ageing populations. Trial registration ClinicalTrials.gov NCT06310798. Registered on March 13, 2024.