Research focus

Oral health for older people

Summaries of three studies into issues of concern for older people's nurses

Summaries of three studies into issues of concern for older people's nurses

Toothbrush
Picture: SPL

Compared with previous generations, more older people have retained some or all of their teeth, but more than 40% of community-dwelling older people aged 75 and over have unmet oral health needs. Poor oral health is associated with physical ill health, admission to long-term care, reduced quality of life and increased infection risk (National Institute for Health and Care Excellence 2016).

However, the importance of oral health can be undervalued by healthcare professionals and older people. Three studies relating to oral health for older people are summarised. 

Minimising barriers to dental care in older people

Uptake of dental care is low among older people, and declines with age and deprivation. In this UK-based study researchers aimed to identify barriers to dental service use and suggest strategies to minimise these barriers.

Qualitative data were collected through focus groups and single interviews with people aged 65 and older and, when appropriate, carers (n=39). Purposive sampling was used to reflect the demographics of an urban inner city population.

A framework method involving a matrix-based iterative approach to analysis transformed raw data into key dimensions and classifications, and further analysis developed ‘explanatory accounts’ of the data generated.

Five themes emerged as barriers to oral health seeking behaviour. Most participants identified cost or fear of cost, including NHS treatment, particularly with pension-based incomes. Anxiety linked to previous bad experiences, perceptions of availability and difficult accessibility of NHS services, including the physical environment, and the characteristics of the dental professional were highlighted.

Minimising barriers to accessing and using dental services included the provision of more age-related public information about local accessibility, charges and care, reducing NHS charges and improving professional education specific to older people.

Borreani E, Wright D, Scrambler S et al (2008) BioMed Central Oral Health. 8:7. www.biomedcentral.com/1472-6831/8/7 (Last accessed: 10 August 2016.)

 

Oral health of older people admitted to hospital for needs assessment

In this New Zealand-based study researchers assessed the dental health of community-dwelling older people admitted to specialist care with deteriorating physical health.

A mixed-methods approach involving 200 consenting patients aged 65 and older was adopted. This comprised a medical records review, clinical oral examination and results from a self-reported Oral Health Impact Profile-20 quality of life (QOL) questionnaire. Those with cognitive impairment were excluded from the questionnaire. Participants’ mean age was 82.6 years (SD 6.6).

Of the 200 participants, 50% were dentulous, retaining 2 to 30 teeth, with men and those from lower socioeconomic groups retaining fewer. One third (n=33) were functionally dentate requiring no intra-oral prosthetics. Caries-associated treatment needs were found in 71% of the dentulous participants and more than 25% required at least one extraction. Of the edentulous participants (n=100), 75% required dental intervention to refit or renew prosthetics.

Fifty nine participants (30%) had visited a dentist in the previous year: only 7% of edentulous participants had done so. Reasons for non-attendance included fear, access problems, feeling too ill and self-perception of good oral health.

Data analysis was descriptive and no tests for significance were reported. Self-reported QOL measures (n=167) found that QOL was better in dentulous participants, but people aged 80 and older reported fewer effects on QOL than younger participants.

The study highlights the need to improve service access through health promotion strategies and incorporating dental services into medical centres. Oral health assessment, including effect on QOL, should be incorporated into physical health assessments.

Ling G, Love R, MacFadyen E et al (2014) New Zealand Dental Journal. 110, 4, 131-137.

Oral health-related quality of life in an aging Canadian population

Measuring oral health-related quality of life (QOL) reflects that dentistry interventions aim to improve life rather than merely prolong life.

This Canadian cross-sectional study involved participants (n=1,461) grouped by age into pre-seniors (45–64) and seniors (65+), and by residential status (long-term care facility (LTC) or community-dwelling). QOL was measured using the 14-item Oral Health Impact Profile questionnaire with additional demographic questions.  

Participants were selected by a random telephone survey for community dwellers and interview for purposely selected LTC residents who also had an intra-oral examination.

Statistical analysis involved two-tailed tests interpreted at the 5% significance level. Chi-square analysis for categorical variables and logistic regression were used to identify factors related to prevalence of oral impacts in the measure.

Findings show that participants in LTC were older and reported less pain, but increased difficulty and embarrassment when eating and speaking. They were less likely to access dental services and rated their health and QOL as poorer than community-dwelling participants.

Rural-dwelling participants also accessed services less frequently than those in urban areas. Those aged under 65 in the community reported greater prevalence, extent and severity of oral impacts than those aged over 65 irrespective of residential status.

Findings suggest that, as people age, they may not perceive oral health problems to be as important as other physical health issues. Difficult access to services, including in LTC, and poor health literacy and public health information are all barriers to maintaining oral health and related QOL.

Kotzer R, Lawrence H, Clovis J et al (2012) Health and Quality of Life Outcomes. 10:50. www.hqlo.com/content/10/1/50 (Last accessed: 10 August 2016.)

 

Reference

  • National Institute for Health and Care Excellence (2016) Oral Health for Adults in Care Homes. nice.org.uk/guidance/ng48 (Last accessed: 10 August 2016.

Lindsay Dingwall is a clinical academic nurse consultant (older people) at School of Nursing & Health Sciences, University of Dundee/NHS Tayside

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