Does residential aged care need dental professionals? A qualitative study on dental professionals' perceptions in Australia

Singapore dentists' attitudes toward dental care provision for older adults with disabilities

OBJECTIVES

This study aimed to assess dentists' attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care.

BACKGROUND

Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists' attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons.

METHODS

A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses.

RESULTS

There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual's severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care.

CONCLUSIONS

The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists' willingness to provide care; however, additional specific targeted interventions are also needed.

Perspectives of oral health therapists on the barriers to oral care provision in nursing homes in Singapore: A qualitative analysis

INTRODUCTION

Oral health therapists (OHTs) are a valuable resource for increasing access to dental care for the frail elderly in nursing homes (NHs). However, OHTs face several barriers and their skill-set continues to be under-utilized.

AIMS

To evaluate the perceptions of OHTs regarding the barriers towards oral care provision for the elderly residents in NHs.

METHODOLOGY

Semi-structured interviews were conducted with 11 OHTs to discuss the factors that may hinder them from providing oral health services in NHs. An inductive thematic analysis directed by the grounded theory approach was performed.

RESULTS

Four major themes emerged: (i) lack of opportunity, (ii) lack of adequate education and training, (iii) limited work scope and registration status, and (iv) lack of adequate financial remuneration and adequate equipment. OHTs also raised the lack of awareness among OHTs and the various stakeholders, of how the skill-set of OHTs may be relevant for oral care provision in NHs.

CONCLUSION

Findings revealed underlying educational and regulatory barriers which need to be addressed in tandem. Addressing these barriers can be impactful in informing future strategies for the greater utilization of the skill-set of OHTs in Singapore.

Distribution of Australian dental practices in relation to the ageing population

OBJECTIVE

The purpose of this study was to analyse and map the distribution of the ageing population, by sociodemographic profiling, in private and public dental practices in Australia.

BACKGROUND

The rapid increase in the aged population in Australia requires a comprehensive approach to ensure accessibility to geriatric dental services. However, the availability of dental services for the older people requires further investigation of the demographic distribution of need.

MATERIALS AND METHODS

Dental practices were located and mapped against the ageing population data. The address for each dental practice in Australia was compiled from online access sources. Australian socioeconomic data were integrated with dental practices, clinic locations and older populations using Geographic Information System (GIS) technology.

RESULTS

There was an uneven distribution of dental practices across Australia's States and Territories (NT and ACT). Tasmania had the highest ratio of private practices to the older population (1:1000) and the highest percentages of this ageing cohort (32%, 61%) that lived more than 5 km from private and public dental practices respectively. Higher percentages of dental practices were located in areas of lower socioeconomic status in Tasmania, Queensland and South Australia (47%, 42% and 38%) respectively, however, these areas were associated with higher ageing population densities.

CONCLUSION

There is a geographic maldistribution of dental practices in relation to the spatial distribution of Australia's older population, with the inequity most pronounced in the most disadvantaged areas. This inequality requires a National approach to match dental services to the population that they serve.

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.

An integrated oral health program for rural residential aged care facilities: a mixed methods comparative study

BACKGROUND

People in residential aged care facilities (RACF) are at very high risk of developing complex oral diseases and dental problems. A multidisciplinary approach incorporating oral health professionals and RACF staff is important for improving and sustaining oral health in RACFs. However, difficulties exist with access to oral health services for RACFs, particularly those in regional and rural areas. This study investigated the impact and experience of an integrated oral health program utilising tele-dentistry and Oral Health Therapists (OHT) in RACFs in a rural setting within Australia.

METHODS

A mixed method comparison study was undertaken. Two hundred fifty-two clinical audits were completed across nine facilities with and without access to the integrated oral health program. Twenty-seven oral health quality of life surveys were completed with eligible residents. One focus group discussions (FGD) and eight interviews were completed with RACF staff. Thematic analysis was conducted on the transcribed FGDs and IDIs. Quantitative data were analysed using descriptive statistics.

RESULTS

Audits showed an improved compliance to Australian Aged Care Quality Accreditation Standards for oral health in the facilities with access to the integrated program compared to those without the program. Thematic analysis revealed that facilities with the integrated program reported improvements in importance placed on OH, better access to OH services and training, and decreased disruption of residents, particularly those with high care needs.

CONCLUSIONS

The integrated oral health program incorporating OHTs and tele-dentistry shows potential to improve the oral health outcomes of residents of RACFs. Improvements for managing oral health of residents with high care needs were observed. RACFs without easy access to an oral health service will also likely benefit from the increased support and training opportunities that the program enables.

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland

PROBLEM

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas.

DESIGN

A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used.

SETTING

One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland.

KEY MEASURES FOR IMPROVEMENT

Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service.

STRATEGIES FOR CHANGE

The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required.

EFFECTS OF CHANGE

Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted.

LESSONS LEARNT

Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities.