BEHAVIORAL INTERVENTIONS FOR ORAL CARE IN COGNITIVELY IMPAIRED OLDER ADULTS

Cognitive impairment, including dementia and Alzheimer's disease, compromises older adults' ability to maintain oral hygiene, leading to increased dental plaque, periodontal disease, and tooth loss. Care-resistant behaviors during oral care present significant barriers to effective hygiene maintenance. This narrative review evaluates behavioral interventions designed to improve oral care practices amon cognitively impaired older adults. A comprehensive search of electronic databases including PubMed, Embase, CINAHL, and Cochrane Library was conducted to identify studies examining nonpharmacological behavioral interventions for oral care in dementia. The Threat Perception Theory provides a neurobiological framework for understanding care-resistant behaviors as defensive fear responses rather than intentional aggression.The Managing Oral Hygiene Using Threat Reduction (MOUTh) intervention has demonstrated efficacy in improving mouth care completion in nursing home residents. Major behavioral strategies encompass adaptive communication, individualized behavioral support using frameworks such as DICE,environmental modification,attention-shifting techniques, and structured caregiver-supported protocols. Implementation is hindered by progressive cognitive decline, staffing shortages, high caregiver turnover, and inadequate reimbursement for behavioral oral care. Person-centered behavioral interventions show promise for improving oral care in cognitively impaired older adults.