Iatro-compliance: an unintended consequence of excessive autonomy in long term care facilities

Periodontal disease and caries remain the most prevalent preventable chronic diseases for seniors. Seniors transitioning into long term care facilities (LTCFs) often present with oral health challenges linked to systemic diseases, plaque control, psychomotor skills and oral health literacy. Many retain a discernible level of physical and cognitive ability, establishing considerable autonomy. This study examines the effect of autonomy on residents' ability to perform oral hygiene.

Descriptive data were developed utilizing mixed methodology on a convenience sample of 12 residents and 7 care staff of a LTCF. One-on-one interviews consisted of questions about demographics, and exploration of the influence of ageism, respect and time constraints on resident autonomy in oral care practices.

Data suggests shortcomings, such as failure of the staff to ensure oral hygiene oversight and failure of the resident to ask for assistance. Autonomy, while laudable, was used by residents to resist staff assistance, partially motivated by residents' lack of confidence in care staff oral hygiene literacy and skills. In turn, by honoring resident's independence, the staff enabled excessive autonomy to occur creating an environment of iatro-compliance.

While it is beneficial to encourage autonomy, oversight and education must remain an integral component of oral hygiene care in this population. Improved oral hygiene skills can be fostered in LTCFs by utilizing the current oral health care workforce. Registered dental hygienists (RDHs), under indirect supervision of a dentist, can fulfill the role of an oral health care director (OHCD) in LTCFs. A director's presence in a facility can decrease staff caused iatro-compliance and increase oral hygiene skills and literacy of the residents, while enhancing their autonomy through education and support.