Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study

Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment

OBJECTIVES

To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel.

BACKGROUND

The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge.

MATERIALS AND METHODS

Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model.

RESULTS

Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: β = 0.944, Switzerland: β = 0.260, UK β = 0.791), rather than a medical doctor (Greece: β = -0.556, Switzerland: β = -0.4690, UK: β = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: β = 0.220, UK: β = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (β = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (β = 0.365) in their home (β = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: β = -0.387; UK: β = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: β = 0.454, UK: β = 0.695).

CONCLUSION

Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.

Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults

Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Dental care utilization among home care recipients, nursing home residents, and older adults not in need of long-term care: An observational study based on German insurance claims data

OBJECTIVES

To describe and compare dental care utilization (DCU) among home care recipients, nursing home residents, and older adults not in need of long-term care (LTC).

METHODS

Using nationwide claims data of 8 German statutory health and LTC insurance funds, proportions of home care recipients (n = 68,137), nursing home residents (n = 21,167), and non-LTC dependents (n = 632,205) aged 65+ years with DCU in 2017 were determined and compared. Associations between DCU and individual characteristics and setting were investigated via multivariable logistic regression. The proportions of individuals with DCU one year before and after transition to (a) home care (n = 23,590) and (b) nursing home care (n = 6,583) were compared.

RESULTS

Proportions of home care recipients and nursing home residents with DCU were lower compared to non-LTC dependents (51.9, 53.1, and 73.2%, respectively). Adjusted odds ratios for DCU for home care recipients vs. non-LTC dependents ranged from 0.55 (LTC grades 1/2; 95% confidence interval 0.54-0.56) to 0.38 (LTC grades 4/5; 0.36-0.40). For nursing home residents vs. non-LTC dependents they ranged from 0.69 (3; 0.65-0.72) to 0.67 (4/5; 0.63-0.71). Women, older individuals, those with 0-1 diseases of the Elixhauser comorbidity index, dementia, and those from West Germany were also less likely to utilize dental care than their counterparts. Utilization decreased after transition to home care (60.0 vs. 55.6%) and increased after transition to nursing homes (46.1 vs. 53.5%).

CONCLUSIONS

Nursing home residents and especially home care recipients utilized dental care less frequently than older non-LTC dependents. Organizational barriers for dental care utilization and ways to remove them should be investigated.

CLINICAL SIGNIFICANCE

Dental care utilization among LTC dependents is low and should be improved in both the home care and nursing home setting.

Association between Oral Hygiene Information Sources and Daily Dental and Denture Care Practices in Urban Community-Dwelling Older Adults

The purpose of this cross-sectional study was to explore the sources of daily oral hygiene information among urban community-dwelling older adults in Athens, Greece and associate them with their dental and denture care habits. One hundred and fifty-four older adults (aged 71.7 ± 9.2 years) participated in the study, and their dental status, denture use, daily oral care habits according to current gerodontology recommendations, and oral care information sources were investigated. Daily oral hygiene practices were poor, and a small number of individuals recalled having received oral hygiene advice from a dentist. Only 41.7% of the 139 dentate participants performed toothbrushing with fluoride-based toothpaste at least twice a day, and 35.9% completed regular interdental cleaning. Among 54 denture wearers, 68.5% removed their denture(s) at night, and 54% cleaned them at least twice a day. Oral hygiene information sources included dentists (for approximately half of the participants), media, friends/relatives, non-dental health care providers and dental technicians. Dentate participants who had received oral hygiene information from dentists had a greater probability of brushing their teeth with fluoride toothpaste at least twice a day (p = 0.049, OR = 2.15) and performing regular interdental cleaning (p < 0.001, OR = 29.26). Denture wearers who had received instructions about denture hygiene from dentists were more likely to use a brush and mild soap (p = 0.016, OR = 14.67) and remove their denture(s) at night (p = 0.003, OR = 8.75). Dentists should improve their oral health prevention and promotion strategies for their older patients.

Periodontitis and peri-implantitis in elderly people experiencing institutional and hospital confinement

An increasing number of elderly people retain their natural teeth into old age and further, the prevalence of endosseous implants for supporting oral prosthesis is ever increasing. These teeth and implants now present a considerable challenge in terms of maintenance, especially when patients become dependent on care. Periodontal and peri-implant diseases are more prevalent in elderly than in younger age cohorts. There are distinct differences related to the inflammatory response between periodontal and peri-implant tissues, both in young and old age. The age-related reasons for the increase in periodontal infections may be related to poor oral hygiene because of a loss of dexterity or vision, but also to immunosenescence. This term describes the aging of the immune system and the decline of its effectiveness with age. Low-grade infections, like chronic periodontitis, may cause low-grade inflammation and subsequently increase the likelihood of developing chronic diseases. In return, treatment of periodontitis may improve general health, as demonstrated for diabetes. A second mechanism illustrating how poor oral health translates into systemic disease is the risk of developing aspiration pneumonia. The treatment options in old age should be evaluated with regard to the issues of general health and maintenance. Systematic periodontal maintenance therapy, as performed in younger age cohorts, may be difficult to implement in elderly people experiencing institutional or hospital confinement because of logistics, barriers related to patients and caregivers, or cost. The scale of periodontal disease in old age represents a public health issue.

Policies Supporting Oral Health in Ageing Populations Are Needed Worldwide

This literature review examines the need to develop appropriate policies specific to the oral health needs of older people that are individualised, cost-effective, and sustainable. Poor oral health and impaired oral function negatively affect the health and quality of life of older adults. Developing care systems that aim to meet patients' normative needs as well as their perceived needs and expectations is one factor in successful delivery of appropriate dental care. Cost is another significant driver of utilisation, and many older adults worldwide lack adequate resources for dental care. Failure to address these issues results in poor outcomes and increased costs of dental and medical care. Disease prevention and control at early stages can preserve public and private financial resources as well as quality of life and well-being for older adults at any stage of life.

Psychometric evaluation of a short-form version of the Swedish "Attitudes to and Knowledge of Oral Health" questionnaire

BACKGROUND

Healthcare professionals' attitudes to and knowledge of oral health are fundamental to providing good oral health care to older adults. One instrument that assesses healthcare professionals' attitudes to and knowledge of oral health in a Swedish context is the "Attitudes to and Knowledge of Oral health" (AKO) questionnaire. Two of the three item-groups of the AKO have previously been validated in a Swedish context. However, it is crucial that all three item-groups are validated, and beneficial to design a shorter, easy-to-use questionnaire for healthcare professionals while maintaining adequate integrity of its reliability and validity. Therefore, the present study aims to develop a short-form version of AKO and to secure its psychometric properties.

METHODS

Psychometric evaluation with Classical Test Theory and Item Response Theory to validate and shorten AKO with 611 healthcare professionals from a population of 1159 working in a municipality in an urban area in western Sweden.

RESULTS

Of the original 16 items in the AKO, 13 were shown to warrant retention in the abbreviated/shortened form. These showed acceptable validity and reliability for assessing healthcare professionals' attitudes to and knowledge of oral health.

CONCLUSION

This validated short-form version of AKO shows acceptable validity and reliability after being reduced to 13 items, structured in a 3-part scale. The items are consistent with the total scale, indicating that the internal consistency is acceptable. Future studies should be performed to evaluate AKO in other groups of healthcare professionals, across cultures, languages, and so on, to investigate its use and strengthen its validity and reliability.