Evidence summary: why is access to dental care for frail elderly people worse than for other groups?

Care home managers' perspectives on domiciliary dental care: a qualitative study

BACKGROUND

Domiciliary dental care (DDC) is an established, safe and cost-effective alternative to standard care which can increase accessibility to professional dental care for care-dependent individuals. Qualitative research with care home managers has explored current practices and specific barriers to accessing dental care services: this has highlighted problems with dentist availability, accessibility and financial concerns. No research has explored reported experiences of DCC implementation in care home settings.

PURPOSE

This study aimed to explore care home manager's perspectives and preferences on DDC following its wider implementation.

METHODS

The study used a qualitative approach in a constructivist paradigm. Six semi-structured face-to-face interviews were conducted with ten care home managers from a purposive sample of care homes participating in DDC. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.

RESULTS

Five major themes were defined. Care home managers preferred DDC to avoid logistical challenges and stress for residents, highlighting the need for on-site dental services. While they wished for reliable partnerships with locally based oral health professionals, this was seen as unrealistic due to their limited willingness to treat care home residents. DDC was valued for its accessibility and support, yet financial concerns were raised due to increasing costs associated with DDC. Managers also emphasized the importance of stable oral care teams within the care home; they noted, however, that this was difficult to achieve due to high staff turnover in long-term care.

CONCLUSION

Domiciliary dental care was widely accepted and appreciated by the care home managers in this study, but increasing costs presented a significant threat to its sustainability.

Caregivers' perceptions towards oral healthcare services for elders living in Malaysian nursing homes-A qualitative study

OBJECTIVE

To assess the perceptions of caregivers towards oral healthcare services received by elders in Malaysian nursing homes and to identify challenges and suggestions for improvement.

BACKGROUND

Caregivers play an important role in the oral health care of elders in nursing homes.

METHODS

This study employed a qualitative approach using the nominal group technique (NGT) to obtain caregivers' feedback in nursing homes in Malaysia. Data were manually transcribed, summarised into keywords/key phrases, and ranked using weighted scores.

RESULTS

In total, 36 caregivers (21 from government and 15 from private nursing homes) participated in the NGT sessions. Overall, caregivers were satisfied with the low treatment cost, the quality of treatment, and the availability of dental visits to nursing homes. Caregivers were dissatisfied with the frequency of dental visits, long waiting times at government dental clinics, and inadequate denture hygiene education for elders in nursing homes. The challenges faced by caregivers were elders' poor oral health knowledge and attitude and lack of elders' trust of caregivers to look after their oral health. Suggestions for improvement were to increase the frequency of dental visits to nursing homes, provide oral health education to elders and caregivers, and give treatment priority to elders at dental clinics.

CONCLUSION

Despite being satisfied with the basic oral healthcare services received by elders in Malaysian nursing homes, caregivers raised some issues that required further attention. Suggestions for improvement include policy changes in nursing home dental visits and treatment priority for elders at government dental clinics.

Oral care practices of long-term care home residents and caregivers: Secondary analysis of observational video recordings

AIMS AND OBJECTIVES

To describe the proportion of toothbrushing task steps, long-term care residents had an opportunity to complete; the duration and quality of toothbrushing by both residents and caregivers; and the feedback caregivers provided.

BACKGROUND

Poor oral health is widespread among older adults in long-term care homes; however, little is known about their actual oral health practices.

DESIGN

Secondary analysis of video recordings.

METHODS

A total of 58 video-recorded sessions were analysed from two long-term care homes in Canada. Eligible residents had at least one natural tooth, required oral care assistance, had Alzheimer's disease and understood English. Eligible caregivers spoke English and had worked for at least 1 year with people with dementia. Toothbrushing success was identified by the resident's participation in, and completion of, nine toothbrushing steps. Total time spent brushing teeth was calculated by summing the duration of time spent brushing teeth. Quality was described by time spent brushing the facial versus the lingual or occlusal surfaces. Caregiver verbal feedback was pulled from transcripts and analysed using content analysis. STROBE guidelines were used in reporting this study.

RESULTS

The two step residents most frequently completed or attempted were brushing their teeth (77% complete, 7% attempt) and rinsing their mouth (86% complete, 2% attempt). The average time spent brushing teeth was 60.33 s (SD = 35.15). In 66% of observed videos, toothbrushing occurred only on the facial tooth surfaces, with no time spent brushing the lingual or occlusal surfaces.

CONCLUSION

Caregivers are supporting residents to independently complete toothbrushing; however, the duration and quality of toothbrushing are not sufficient to ensure optimal oral health.

RELEVANCE TO CLINICAL PRACTICE

Clear, detailed guidelines are required to ensure adequate oral care for long-term care residents. Staff need to be aware that all surfaces should be brushed to ensure proper oral health.

Self-perception and popular practices of oral health among black slave descendants elderly women in Brazil

Objective: To investigate the perception and oral health practices among older quilombola women (black population group, descendants of slaves in Brazil). Methods: Qualitative research with elderly women living in a rural community formed by descendants of slaves in Brazil. The study was performed through a semi-structured interview with nine of the rural community residents and following content analysis of the narratives. Results: All elderly women are edentulous (partially or totally) and dental problems that led them to use natural means of pain relief were identified. With the analysis of the transcripts, three main categories emerged: the elderly of Quilombola Rural Community Julia Mulata and edentulism; self-perceived oral health of older women of the Quilombola Rural Community Julia Mulata; Popular practices used in the presence of health problems. Conclusion: Quilombola elderly consider the loss of teeth as natural aging; they present life stories linked to dental problems; seek to solve their dental problems with the use of traditional folk therapies.

An investigation into denture loss in hospitals in Kent, Surrey and Sussex

Background The loss of dentures for inpatients can have a detrimental effect on their well-being. Self-respect and dignity become compromised along with their ability to eat meals and communicate clearly, and long-term recovery.Aim This investigation aimed to identify the reported number of dentures lost in hospitals and the financial reimbursements given by trusts to replace them.Method Information on reported denture loss and reimbursement was collected in 12 trusts throughout Kent, Surrey and Sussex.Results Eleven out of 12 trusts returned data about how many dentures were lost in their hospitals, between them 695 dentures were reported lost over five years (2011-16). Seven trusts reported financial reimbursements for dentures losses; results showed £357,672 was reimbursed over six years (2010-16), the highest amount reimbursed for a single denture was £2,200.Conclusion The results indicate that denture loss is a problem in hospitals that contributes to the financial burden for the NHS. Consideration needs to be given by hospitals to find ways to reduce the number of dentures lost every year.

NHS dental service utilisation and social deprivation in older adults in North West England

Objective To explore NHS dental service utilisation (attendance and treatment activity) of older adults.Design Retrospective analysis of dental treatment claim forms (FP17s) over a 15 month period.Population A total of 690,433 older adults in North West England.Results NHS dental care attendance decreased with increasing age; 49% in 65-74 years, 39% in 75-84 years and 23% in the over 85 years age group. Across all older age stratifications, the more deprived patients had a higher rate of examinations, extractions, dentures and preventative advice compared to the least deprived patients. However, the relationship was opposite for the rate of fillings and complex restorative treatment; the rate was higher for the least deprived older adult patients.Conclusions Despite 95% of older adults living in the community, the number of older adults accessing NHS dental care in this data set is thought-provoking. Additionally, there is a complex relationship between the type of treatment provided and the patient's IMD level. The authors acknowledge the major limitations of this dataset; affluent people are more likely to access private dental care and the availability of NHS dental services is likely to vary across different regions. However, the use of 'big data' is necessary to provide a pragmatic approach for future research in the management of older adults in general dental services.

Oral health care in older people in long term care facilities: a systematic review of implementation strategies

OBJECTIVES

Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the importance of a clear evidence-based implementation strategy to improve oral health care. The aim of this study is to review implementation strategies used to promote or improve oral health care for older people in long term care facilities from the perspective of behaviour change, to code strategy content at the level of determinants, and to explore their effectiveness.

DESIGN

Systematic review of literature.

DATA SOURCES

The digital databases of the Cochrane Library, PubMed and Cinahl have been searched up to September 2011 for relevant articles.

REVIEW METHODS

After a systematic selection process, included studies were quality assessed by three researchers. We extracted the study characteristics using the EPOC Data Collection Checklist and Data Abstraction Form. Strategy content was extracted and coded by using the Coding Manual for Behavioural Change Techniques. This manual groups the behaviour change techniques under relevant behavioural determinants.

RESULTS

Twenty studies were included in this review. Implementation strategies were delivered by dental hygienists or dentists. Oral health care was performed by nurses and nurse assistants in all studies. All studies addressed knowledge, mostly operationalized as one educational session. Knowledge was most often combined with interventions addressing self efficacy. Implementation strategies aimed at knowledge (providing general information), self-efficacy (modelling) or facilitation of behaviour (providing materials to facilitate behaviour) were most often identified as successful in improving oral health.

CONCLUSIONS

Knowledge, self-efficacy and facilitation of behaviour are determinants that are often addressed in implementation strategies for successful improvement of oral health care in older patients. Strategies addressing increasing memory, feedback of clinical outcomes, and mobilizing social norm are promising and should be studied in the future. However, as the quality and heterogeneity of studies is a reason for concern, it is not possible to unequivocally recommend strategies or combinations of strategies for improving oral health care in the older population. When choosing strategies to improve oral health care, care professionals should thoroughly examine the setting and target group, identify barriers to change and tailor their implementation strategies to these barriers for oral health care.