Is dental education meeting the oral health needs of older adults?

Dental teachers' perceptions about the status of geriatric dentistry in the dental curriculum: A qualitative exploration in the Indian context

BACKGROUND

The increasing geriatric population in India needs special attention from the oral health workforce. This study explores dental teachers' perceptions of the status of geriatric dentistry in the dental curriculum and the challenges of implementing geriatric dentistry curriculum in the present dental training sector in India from the trainers' (teachers) perspective.

METHODS

We utilised a qualitative approach, and four focus group discussions were conducted with/among various levels of academic teachers-Heads of Departments (n = 8), Board of Study members (n = 7), Deans (n = 5), Lecturers and Associate professors (n = 8). All discussions were audio-taped and transcribed. Data was analysed thematically, and coding was done using an inductive approach. Consensus on themes was achieved through deliberations.

RESULTS

Three themes were identified-Unique challenges in managing geriatric patients (bordering on Dental care, Attitude, Awareness, Social issues and dependency on family); Current issues with provision of geriatric care (Curricular concerns-Teachers' training, Students' training, Instructional content, timing of delivery; Students' and trainers' attitudes; Infrastructural issues) and Strategies for advancement (Sensitisation of policymakers, Collaboration with other agencies, Modification in course design, Improved educational strategies and Shift in patient care delivery).

CONCLUSION

Trainers perceived a strong need to develop geriatric competencies among dental students. A geriatric dentistry curriculum based on local needs could ensure the success and sustenance of change. Introducing specialisation in geriatric dentistry would ensure quality oral care for the rising geriatric population. Innovative teaching strategies, interdisciplinary training and the use of newer technologies could aid in improved teaching of geriatric dentistry.

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.

Dental Care to Reduce Aspiration Pneumonia Recurrence: A Prospective Cohort Study

BACKGROUND

Aspiration pneumonia has a high recurrence rate, and oral care by dentists has been found effective in preventing its onset; however, this has not been evaluated using prospective studies. Therefore, we conducted a prospective study to evaluate the effectiveness of professional oral care by dentists in reducing aspiration pneumonia recurrence in older adult patients.

METHODS

In this prospective cohort study, we evaluated a dental oral care intervention, using a historical control group (control group). It was conducted at a single-centre regional core hospital in Japan that serves a large number of patients aged older than 80 years. Patients who were hospitalised for aspiration pneumonia were included in this study. During the study period (1 April 2021 to 31 March 2022), the clinical group received weekly professional cleaning by a dentist and the control group received standard oral care by a nurse as usual from 1 April 2020 to 31 March 2021. The dentist oral care group received weekly professional oral care from a dentist and was followed prospectively for 1 year. A Kaplan-Meier analysis was used to evaluate the timing of recurrent aspiration pneumonia or death. A Cox proportional hazards model was used to obtain a hazard ratio and determine the 95% confidence intervals.

RESULTS

There were 91 participants in the clinical group and 94 in the control group. The mean age of participants was 85 years, and 75 (40.5%) were female. The recurrence rate was 27.5% in the clinical group and 44.7% in the control group (P = .005). Professional cleaning by a dentist reduced the risk of recurrence of aspiration pneumonia by approximately 50% (adjusted hazard ratio, 0.465; 95% confidence interval, 0.278-0.78).

CONCLUSIONS

Professional cleaning by a dentist was associated with a lower rate of aspiration pneumonia recurrence than nurse-provided conventional oral care.

Dental students' reflective learning from a geriatric interview assignment

OBJECTIVES

As part of geriatric education at the University of British Columbia's Faculty of Dentistry, undergraduate students are required to interview an older adult over 65 years old and critically reflect in writing on the meaning of this interview to themselves and their professional lives in not more than 2000 words. They are also encouraged to use a life grid. This study explored the impact of this assignment on the students as learners and on their views about their profession.

METHODS

Interview assignments were collected from the entire cohort of 54 third-year students in 2021 and analyzed in 5 stages, using an exploratory thematic analysis, including an interactive coding process to identify patterns (themes) within the assignments using NVivo R1 software. Two researchers coded assignments individually and met to reach a consensus about the codes, to mitigate potential biases.

RESULTS

Five main themes were identified, including communication, life course journey, person-centered care, social determinants of health, and access to care. A wide range of ideas emerged under each theme, including several practical suggestions to improve future practice as an oral health professional. A little over 40% of the students used the life grid in their interviews. Modifications on the interview assignment are suggested.

CONCLUSION

Students' reflections highlighted their observations on a wide range of ideas within each theme, many pertaining to their future profession. They also discussed how this knowledge would inform their future practice in terms of their interactions with, and providing care to, patients with similar situations.

Ageism scale for dental students (ASDS): A focus group review of content validity

PURPOSE/AIM

Improve content validity of the Ageism Scale for Dental Students (ASDS) and identify barriers to using the scale.

METHODS

Thematic analysis of transcripts of three purposively sampled focus groups of 1) geriatric dentistry specialists, 2) older adult dental patients, and 3) dental students.

RESULTS

Twenty-five participants engaged in focus groups. No new concepts to define ageism were identified. Experts found the scale acceptable and appropriate, yet they raised specific potential revisions to scale questions. Commonly reported themes already addressed by ASDS included the importance of tailoring decision-making to patient preference and not making assumptions about older adults' capacity or preferences for dental care. Barriers to identifying ageism or using the scale included experiential differences in interpreting scale items, cultural differences in attitudes towards older adults, and potential overlap with social determinants of health. Secondary findings include recommendations for older-adult focused training for dental students to provide positive, concrete guidance on caring for older adults.

CONCLUSION

There are opportunities to refine the Ageism Scale for Dental Students and to allow tailoring of the scale for specific national or cultural contexts.

Lack of Physician-Dentist Collaboration in Aspiration Pneumonia Prevention

This opinion paper addresses the challenges and future directions for preventing aspiration pneumonia in Japan's rapidly aging population. It highlights the increasing proportion of elderly individuals and the associated rise in health issues like decreased swallowing function, a risk factor for aspiration pneumonia. The paper emphasizes the effectiveness of dentist-provided oral care in preventing this condition but notes the lack of collaboration between dentists and physicians in Japan's clinical practice. Key challenges identified include the scarcity of full-time hospital dentists, insufficient communication between physicians and dentists, limited patient understanding and motivation regarding oral care, and a lack of training in geriatric dentistry. The paper advocates for enhanced awareness among healthcare professionals and patients, increased hospital dentists, and improved collaboration mechanisms, particularly in light of recent positive changes in insurance reimbursement policies for elderly oral care.

Postgraduate dental resident education: A pilot in age-friendly "mentation" training

OBJECTIVE

Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health.

BACKGROUND

Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias.

MATERIALS AND METHODS

We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice.

RESULTS

The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 ± $ \pm \ $ 0.97) and knowledge acquisition (4.36 ± $ \pm \ $ 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care.

CONCLUSION

Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.

Linking current dental education to gerontological education to meet the oral health needs of growing aging populations

Objective

This study aimed to recognize the gaps in dental education by studying the current level of geriatric oral health training of recent graduated dentists who have been admitted into an Advanced Education in General Dentistry (AEGD) program.

Methods

The AEGD program was developed along with the Age-Friendly 4Ms model to enhance current dental education. We adopted the Rapid Cycle Quality Improvement model to test the effectiveness of the training for AEGD residents from 2019 to 2022. A total of 18 residents participated (6 residents each year). A 5-question survey was administered before and after the rotation and Wilcoxon signed-rank with Fisher Exact tests were conducted to compare pre- and post- rotation results.

Results

All 18 residents have completed pre- and post-program surveys. They self-reported minimal to no training in preparation to provide care to older adults with multiple chronic conditions. After the rotation, residents' confidence in treating older adults was significantly increased (p = 0.011). Meanwhile, residents gained knowledge to apply the 4Ms framework (what matters, medication, mentation, and mobility) to their practices (p = 0.015) and provide age-friendly care for older adults.

Conclusion

The study identified and addressed the missing link in dental education to gerontological and geriatrics education. More clinical rotations and didactic training to equip residents with competences of providing geriatric oral health are strongly recommended.

Evaluation of a concept to classify anamnesis-related risk of complications and oral diseases in patients attending the clinical course in dental education

BACKGROUND

Aim of the current study was the assessment of risk classes according to a previously established system to classify the anamnesis-related risk of complications and of oral diseases in a cohort of patients attending the dental student course for dental preventive measures.

METHODS

Patients attending the student course between April 2020 and December 2021 were included. To assess the medical history, a specific anamnesis tool was used, which included the classification of different potential anamneis-related risks originating from general diseases, medications or lifestyle factors into a low, moderate or high risk of complications and/or risk of oral diseases. Thereby, the risk of complications was defined as the increaeed probability of harm during dental measures (professional tooth cleaning, invasive dental treatment or any kind of manipulation, which may cause a bacteremia), e.g. infectious endocarditis. On the other hand, the risk of oral diseases was an increaeed probability of development and/or progression of oral diseases like caries, periodontitis or mucosal diseases. Those risk classes were subsequently analyzed under consideration of age and gender.

RESULTS

858 patients, with a mean age of 50.48 ± 20.72 [median: 52.0] years, and a nearly balanced gender distribution (50.8% female and 49.2% male) were included. In the overall cohort, the risk of complications related with dental measures was low in 38.3%, moderate in 42.4% and high in 19.3% of participants. The risk of oral diseases was low in 33.1%, moderate in 37.2% and high in 29.7% of participants. Both, the risk of complications and the risk of oral diseases increased with patients' age (p < 0.01). Thereby, the risk of complications as well as the risk of oral diseases related to general diseases and medication significantly increased with age (p < 0.01).

CONCLUSION

Nearly one fifth of patients in dental student couse show a high risk of complications related with dental measures. Morever, nearly one third of those individuals have a high anamnesis-related risk of oral diseases. With increasing age, the amount of patients in high risk classes becomes higher. Future dental education and research should address the high relevance of anamnesis-related risk factors.

Educating dental students to provide compassionate age friendly care for older adults

As the world population ages, the need for age friendly care increases. In dentistry, age friendly care requires an appropriate comprehension of multiple factors that can be categorized in socio-economic circumstances, systemic health problems, and oral health conditions. In addition to the understanding of these factors and its relationships among each other, the future dental workforce should also be aware of unconscious and pervasive societal stereotypical perception of older persons, aging, and being old, which results in ageism and ageist attitudes. Dental schools can play an important role on raising ageism awareness and combating ageism in healthcare, thus preparing the future of the dental workforce to provide compassionate age friendly care. This paper will discuss ageism in dental schools and learning strategies used to combat it and increase compassionate care delivery for older adults.