Original article Oral health of institutionalised elderly: a qualitative study of health caregivers’ perceptions in Brazil Sandra Cristina Guimara ˜ es Bahia Reis 2 , Va ˆ nia Cristina Marcelo 2 , Erica Tatiane da Silva 1 and Cla ´ udio Rodrigues Leles 1 1 Department of Stomatological Sciences, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil; 2 Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil doi:10.1111/j.1741-2358.2010.00366.x Oral health of institutionalised elderly: a qualitative study of health caregivers’ perceptions in Brazil Objective: The aim of this study was to qualitatively explore caregivers’ perceptions of oral health care and factors influencing their work in a public long-term care institution for the elderly in Goiania, Brazil. Method: Data were collected from a sample of 10 caregivers using personal in-depth interviews and observation. Results: Caregivers were mainly nurses’ aides without training in oral health care. Oral health was associated with access to dental treatment, oral hygiene and use of dentures. Edentulousness, use of inappropriate dentures and appetite loss were perceived as negative images. Procedures used for oral hygiene were toothbrushing, mouth cleaning with a gauze and using a mouthwash. Conflicting priorities in routine care, lack of caregivers’ knowledge and the co-operation of the elderly were the main obstacles to satisfactory oral care. Conclusion: Oral health care of the elderly was perceived as a burden by caregivers, and did not follow a standard protocol. Caregivers’ knowledge and perceptions reinforce the need for education and training in oral health issues. Keywords: caregivers, elderly, oral health, dental care for aged. Accepted 22 October 2009 Introduction Over the past few decades, a dramatic increase in the number of elderly has been experienced by many developed and developing countries 1,2 . Chronic and degenerative conditions play an important role in the process of ageing, leading to physical and psychological limitations 3,4 . As a result, older people need help to manage daily activities from family, friends or, if required, professional caregivers in long-term care (LTC) facilities 1 . In Brazil, there are 15 million people over 60 years old, representing 8.6% of the total num- ber of individuals 5 . It is estimated that about 40% of people over 65 need some form of assistance and about 10% require extensive help to perform rou- tine tasks such as showering, getting dressed and preparing meals 6 . Brazilian social support models for the dependently living elderly comprise formal health services and informal family caregivers. The certification of the professional caregiver is rela- tively new in Brazil 7 and the recognition of factors influencing its utilisation, availability, policies and programmes relate to formal services needs improvement. With an ageing population, the health of the elderly has become a public health issue 8 , rein- forcing the need to develop strategies and policies for health promotion and disease prevention 9 . Oral health care across the world is commonly neglected by health policies aimed at the elderly and is not adequately considered in most protocols on per- sonal hygiene and general health in hospitals and Ó 2010 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2011; 28: 69–75 69