Dental Students’ Attitudes About Older Adults: Do Type and Amount of Contact Make a Difference?

Geriatric dentistry course effect against ageism among dental students: A cohort study

PURPOSE

The aim of this study is to investigate the effectiveness of geriatric dentistry courses as a combating strategy against ageism among dental students.

METHODS

A pre-post prospective study was conducted in three different dental schools located in the State of Sao Paulo, Brazil, that offered geriatric dentistry courses in their curricula. A questionnaire specifically developed for this research and the "Ageism Scale for Dental Students" (ASDS) were applied before and after geriatric dentistry courses in all three dental schools.

RESULTS

Among 184 dental students, 51.6% (n = 95) improved their ageism scores. Dental students who improved ASDS scores were more likely to be from a public dental school (56 .7% vs. 40.4%; p = .040), in their 8th and 10th semesters (56 .7% vs. 40.4%; p = .040), and females (55 .6% vs. 36.8%; p = .040). Other factors such as age, ethnicity, history of living with older adults, history of taking care of older adults, and knowledge of ageism were not significantly associated with ageism score improvement. Only institutional affiliation and age remained significant predictors in the final model.

CONCLUSION

In this study, the main variables correlated with reducing ageism among dental students were institutional affiliation and age.

Factors associated with predoctoral and graduate dental students' intention to care for elderly patients: A cross-sectional study

OBJECTIVES

Ageism among pre-doctoral and graduate dental students may reduce their propensity to provide dental treatment to elderly patients leading to substandard healthcare for this population. This study evaluated the impact of perceived ageism constructs and geriatric dentistry education on the intention of pre-doctoral and graduate students to provide dental care for elderly patients.

METHODS

A questionnaire was applied to collect the data for this cross-sectional study from pre-doctoral students in their clinical years and graduate students in their internship year (N = 201). A total of 183 completed responses were received, and the response rate was 91%. Hierarchical regression analysis was performed to determine the incremental effects of perceived ageism constructs and geriatric dentistry education on the intention to provide dental care for elderly patients.

RESULTS

Geriatric dental education (B = 0.328, t = 3.826, p < 0.001) and patients' low compliance (B = 0.503, t = 4.658, p < 0.001) were significantly positive predictors of pre-doctoral and graduate students' intentions to care for elderly patients. Also, negative attitudes toward the lives of elderly people have a substantial adverse effect on the intention of care for this population (B = -0.225, t = -2.206, p = 0.029). Cronbach's alpha for the scale constructs ranged from 0.738 to 0.886.

CONCLUSIONS

Advanced geriatric training may cultivate pre-doctoral and graduate students' deeper understanding and recognition of the intellectual and practical benefits that might arise from offering dental care to elderly people.

Perception and Attitude of Dental Students Towards Geriatric Care: A Questionnaire-Based Survey

Introduction Geriatric dentistry concerns the influence of aging and systemic disorders on oral health. Every dental practitioner must comprehensively understand the oral health conditions affecting geriatric patients and the physiological, psychological, and social aspects of aging to deliver holistic care. Methods A cross-sectional survey was undertaken among postgraduate students, interns, and undergraduates in dental colleges across the Delhi National Capital Region (NCR), India. This survey employed a self-administered questionnaire to gauge the attitude of undergraduate and postgraduate students towards elderly patients. Results The study included 312 participants with a mean age of 24.95 years (±2.95 years). The distribution of participants by educational level: Intern: 25.3% (n=79), postgraduate (PG)-1 Year: 16.7% (n=52), PG-2 Year: 9.0% (n=28), PG-3 Year: 9.9% (n=31), undergraduate (UG)-3 Year: 19.2% (n=60), UG-4 Year: 19.9% (n=62). Most respondents strongly agreed on the necessity of being more empathetic and attentive when treating geriatric patients. Similarly, the majority strongly concurred on the differences in treatment and communication required for geriatric patients, underscoring the need for specialized training. Significant differences were observed between undergraduate (UG) and postgraduate (PG) students regarding their confidence in treating geriatric patients, their understanding of geriatric patients' expectations, and their willingness to treat geriatric patients in their future practice, with PG students agreeing on all these aspects. Conclusion Overall, most participants showed a favorable attitude towards elderly patients. However, postgraduates demonstrated a deeper comprehension of the needs of geriatric patients and exhibited greater confidence in their ability to treat them both presently and in future practices. Despite this, there was a recognized need for specialized training. Consequently, there is a call for increased workshops and training sessions focused on geriatric patients.

Breaking the links between ageism and health: An integrated perspective

Ageism refers to prejudice, stereotypes or discrimination based on a person's actual or perceived chronological age. While ageism can affect people at all stages of the human lifespan, ageism against older adults has emerged as the most pervasive and potentially harmful. Much is now understood about how ageism can impact older people's health and wellbeing via structural, organisational, and provider level biases that threaten the provision of equitable and ethical healthcare. Negative attitudes about age and ageing also contribute to workforce shortages in aged care sectors, such as residential aged care and nursing. However, often underappreciated is how self-directed ageism, which refers to ageism turned against oneself, can also be an important determinant of health and wellbeing. Relative to external sources of ageism, negative internalised ageist beliefs are not only experienced more frequently in older adults' everyday lives, but are also more strongly linked to their health and wellbeing. Here we highlight how this understanding means that eliminating ageism requires a multifaceted approach that targets not only health care systems and aged care professionals, but older people themselves. Because normal age-related cognitive changes in how we think, perceive and reason increase the risk of older people viewing themselves through a negative and ageist lens, we provide a novel discussion of how broader insights from cognitive ageing literature must play a central role in any agenda focused on breaking the links between ageism and health.

Impact of an interdisciplinary curriculum for dental students (GeriDent-Cologne) on attitudes and awareness towards older people and geriatric conditions

INTRODUCTION

Training of dental students in the treatment of older patients must also consider the multiple chronic medical conditions that may be present. We developed an interdisciplinary gerodontology training curriculum for dental students (GeriDent-Cologne) to investigate its influence on the attitudes and expectancies of dental students towards the treatment of older patients.

MATERIALS AND METHODS

The curriculum (given to fourth-year students) comprised five clinical examination stations that simulated different medical conditions affecting older people. Students were able to experience related issues first hand, express their fears and problems concerning dental treatment in older people and, through discussion with the supervisor, develop strategies to overcome these difficulties and enhance treatment. An extended version of the Los Angeles Geriatric Attitudes Scale was given to fourth- and fifth-year students (who acted as controls) over one semester.

RESULTS

Dental students had a positive attitude towards older people, and their attitude did not change after attending the curriculum. However, participating in GeriDent-Cologne had a significant beneficial impact on the feeling of being prepared to treat older people, led to a significantly greater understanding of the impact of medical issues and resulted in a considerably higher level of geriatric clinical knowledge over time.

CONCLUSIONS

GeriDent-Cologne led to positive and semester-long changes in awareness and knowledge of specific geriatric problems that influence dental treatment. We recommend the curriculum as a blueprint for the module of senior dentistry implemented in the new German dental licencing regulations.

Perception of Old Age in German Undergraduate Dental Students-A Comparison of Two Cohorts 10 Years Apart

Previous studies revealed that students’ willingness to provide dental services for older patients is mainly influenced by their individual perception of elders rather than their knowledge about old age. The aim of this study was to estimate students’ perception of old and young age as well as their hopes and fears associated with old age and to compare two cohorts that participated in the study 10 years apart. Data were obtained from a questionnaire completed by two cohorts of undergraduate dental students from 2006 to 2008 (T1, n = 207) and 2016 to 2018 (T2, n = 135). Participants were asked to define the ages that they consider a man or woman to be old and young. Moreover, they had to specify their fears and hopes associated with old age. Reported thresholds for old age differed significantly between T1 and T2. In contrast to T1 students, T2 students defined a person to be old at a higher age and barely differentiated between the old ages of men and women. Furthermore, T2 students presented more fears related to aging than T1 students, e.g., psychological problems or loss of independence. The perception of age appears to be a multifactorial process and significantly changed between students of T1 and T2. Fears of dental students regarding old age should be addressed in, e.g., gerodontological curricula, to foster positive experiences in interaction with older people and highlight the important and rewarding aspects of gerodontology.

Survey on the attitudes of dental hygiene students towards treating elderly patients

OBJECTIVE

This questionnaire-based survey assessed the attitudes of dental hygiene students towards treating elderly patients.

METHODS

The 14-item UCLA 14-item Geriatrics Attitudes Scale (GAS-14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS-14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p < 0.05).

RESULTS

Three hundred eighty-five students (Switzerland: n = 157, mean age = 25.38 ± 4.6 years; Belgium: n = 82, mean age = 27.58 ± 12.8 years; Canada: n = 146, mean age = 25.95 ± 12.3 years) completed the survey for a response rate of 86.3%. The overall GAS-14 scores for Switzerland, Belgium and Canada were 3.61 ± 0.42, 3.24 ± 0.37 and 3.32 ± 0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p < 0.0001). Overall scores revealed a significant effect of progressive training (p = 0.010). The GAS-14 score was influenced by the nationality of the participants (p < 0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders.

CONCLUSIONS

The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes.

Diet and Oral Health Coaching Methods and Models for the Independent Elderly

Health-related behavior based on diet is an important determinant of oral health in independent elderly. Aging impairs senses, mastication, oral status, and function, causing nutritional needs and diet insufficiencies that contribute to a vicious circle of impairment. But the present needs of independent older adults suggest that health research and oral health care should shift from disease management and therapy to integral customized and personal treatment plans, including lifestyle, psychological, nutritional, and oral health coaching approaches. In this paper health coaching approaches in medical and dental settings are valued as to their effectiveness for older adults. Furthermore, coaching approaches for seniors are discussed and coaching models for better senior patient-dentist cooperation on the diet issue are suggested. Diet and oral health coaching is proven to be a modern senior patient-centered approach that needs to be incorporated at all relevant settings. It should aim to empower older adults in co-management of their oral diseases or bad diet habits affecting their oral health. This can be carried out through an incorporated educational plan for dentists either at the postgraduate or professional level since advantages seem to enhance the quality of life of the independent elderly.

Determinants of Ageism against Older Adults: A Systematic Review

Ageism is a widespread phenomenon and constitutes a significant threat to older people's well-being. Identifying the factors contributing to ageism is critical to inform policies that minimise its societal impact. In this systematic review, we gathered and summarised empirical studies exploring the key determinants of ageism against older people for a period of over forty years (1970-2017). A comprehensive search using fourteen databases identified all published records related to the umbrella concept of "ageism". Reviewers independently screened the final pool to identify all papers focusing on determinants, according to a predefined list of inclusion and exclusion criteria. All relevant information was extracted and summarised following a narrative synthesis approach. A total of 199 papers were included in this review. We identified a total of 14 determinants as robustly associated with ageism. Of these, 13 have an effect on other-directed ageism, and one on self-directed ageism. The quality of contact with older people and the positive or negative presentation of older people to others emerged as the most robust determinants of other-directed ageism; self-directed ageism is mostly determined by older adults' health status. Given the correlational nature of most studies included in this review, inferences on causality should be made cautiously.

Students report more positive attitudes toward older adults following an interprofessional service-learning course

The aim of this study was to assess undergraduate students' perceptions of older adults over the semester in an interprofessional service-learning course that implemented a health promotion program called Bingocize® at community facilities for older adults. Students were surveyed at the beginning of the semester, at midterm, and at the conclusion of the course. Quantitative and qualitative data were collected to assess the students' perceptions and experiences. Results suggest that a course on aging that includes interprofessional service-learning in geriatric settings is associated with a significant increase in positive perceptions of the older adult population. Further research, however, is warranted to validate the findings.

A call to greater inclusion of gerodontology in the dental curriculum: A narrative review

AIM

This literature review explores the need for greater prominence of gerodontology in the undergraduate dental curriculum, focusing on the significance of gerodontology for dental students on clinical placements.

BACKGROUND

As Australia's population ages the number of dentate older people is increasing. An assessment of the dental profession's preparedness, including that of future providers, is needed to ensure that this public health issue is addressed.

METHODS

A database search was performed in MEDLINE (Ovid), CINAHL and JCU OneSearch. Of the 41 articles identified, 31 were selected for review using a narrative approach.

DISCUSSION

Of the 31 articles reviewed, 12 were Australian, 9 North American and 5 European. Five overarching themes were identified, including preparedness for residential aged care facilities; barriers to oral health services provision; attitudes to aged care; gerodontology as part of a dental school curriculum and service-based learning.

CONCLUSION

There are differences in the gerodontology curricula of dental schools, with a wide variation of clinical exposure to older patients. There is evidence that exposure to gerodontology curriculum prior to treating older people may help dental students feel more prepared for managing patients in aged care. The current marginal status of gerodontology in dental school curricula is in need of review.

"You Get Beautiful Teeth Down There": Racial/Ethnic Minority Older Adults' Perspectives on Care at Dental School Clinics

To help eliminate reported racial/ethnic and socioeconomic inequities in oral health care, listening to the perspectives of racial/ethnic minority older adults on their experiences with dental school clinics is needed. The aim of this study was to examine the experiences of African American, Puerto Rican, and Dominican older adults who attend senior centers in upper Manhattan, New York City, regarding the care received at dental school clinics. Focus groups were conducted from 2013 to 2015 with 194 racial/ethnic minority men and women aged 50 years and older living in upper Manhattan. All of the 24 focus group sessions were digitally audiorecorded and transcribed for analysis. Groups conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Seven subthemes were manifest in the data related to these adults' positive experiences with dental school clinics: excellent outcomes and dentists, painless and safe treatment, affordable care, honest and reputable, benefits of student training, accepting and helpful, and recommended by family and friends. Negative experiences centered around four subthemes: multiple visits required for treatment, loss of interpersonal communication due to use of technology, inconvenient location, and perceived stigma with Medicaid. This study provided novel evidence of the largely positive experiences with dental schools of racial/ethnic minority senior center attendees. Interventions targeted at the organization and provider level, including organizational motivation, resources, staff attributes, climate, and teamwork plus payment programs and services, insurance and affordability, and provider- and system-level supports, may improve health care processes and patient experiences of care.

Can Caring Create Prejudice? An Investigation of Positive and Negative Intergenerational Contact in Care Settings and the Generalisation of Blatant and Subtle Age Prejudice to Other Older People

Caring is a positive social act, but can it result in negative attitudes towards those cared for, and towards others from their wider social group? Based on intergroup contact theory, we tested whether care workers' (CWs) positive and negative contact with old‐age care home residents (CHRs) predicts prejudiced attitudes towards that group, and whether this generalises to other older people. Fifty‐six CWs were surveyed about their positive and negative contact with CHRs and their blatant and subtle attitudes (humanness attributions) towards CHRs and older adults. We tested indirect paths from contact with CHRs to attitudes towards older adults via attitudes towards CHRs. Results showed that neither positive nor negative contact generalised blatant ageism. However, the effect of negative, but not positive, contact on the denial of humanness to CHRs generalised to subtle ageism towards older adults. This evidence has practical implications for management of CWs' work experiences and theoretical implications, suggesting that negative contact with a subgroup generalises the attribution of humanness to superordinate groups. Because it is difficult to identify and challenge subtle prejudices such as dehumanisation, it may be especially important to reduce negative contact. © 2016 The Authors. Journal of Community & Applied Social Psychology Published by John Wiley & Sons Ltd.

Engaging dental professionals in residential aged-care facilities: staff perspectives regarding access to oral care

The limited access to oral care for older people living in residential aged care facilities (RACFs) has been noted repeatedly in the literature. The aim of this study was to explore RACF staff perspectives on how to engage dental professionals in the provision of oral care for RACF residents. Semi-structured interviews were conducted with 30 staff from six purposively selected RACFs located in high socioeconomic areas to gain understanding of the multidimensional issues that influenced the engagement of dental professionals from a carer perspective. Analysis revealed that staff perceived tensions regarding affordability, availability, accessibility and flexibility of dental professionals as significant barriers to better oral care for their residents. Participants raised a series of options for how to better engage dental professionals and reduce these barriers. Their ideas included: the engagement of RACF staff in collaborative discussions with representatives of public and private dental services, dental associations, corporate partners and academics; the use of hygienists/oral health therapists to educate and motivate RACF staff; the promotion of oral health information for troubleshooting and advice on how to deal with residents’ dental pain while waiting for support; the encouragement of onsite training for dental professionals; and the importance of gerodontology (geriatric dentistry). Findings highlighted the need to explore alternative approaches to delivering oral care that transcend the model of private clinical practice to focus instead on the needs of RACFs and take into account quality of end-of-life oral care.