Southern Nevada assisted living residents’ perception of their oral health status and access to dental care

Inequality in dental services: a scoping review on the role of access toward achieving universal health coverage in oral health

BACKGROUND

Improving access to health services is a way towards achieving universal health coverage (UHC) in oral health. The purpose of this review was to map the determinants of access to dental services within a UHC framework.

METHOD

Scoping review methods were adopted for the review. PUBMED, Scopus, ISI Web of Science and ProQuest were searched for academic literature on determinants of access to dental services in OCED countries. Articles published in the last 20 years were included. No restriction was placed on study methods; only articles in English language were included. Qualitative synthesis was conducted, along with a trend analysis and mapping exercise.

RESULT

A total of 4320 articles were identified in the initial search; 57 articles were included in the qualitative synthesis. The results indicate 7 main themes as the determinants of access to dental services: family condition, cultural factors, health demands, affordability of services, availability of services, socio-environmental factors, geographical distance. Defined determinants of access to dental services, family condition, cultural factors and geographical access to dental services can fill the population axis of the UHC cube. Health demands and affordability of services fill the gap of financial protection as another axis of the UHC cube and finally, availability of dental services and socio-environmental factors are aligned with the appropriateness of services, the third axis of the UHC cube.

CONCLUSION

According to the results, family condition and cultural, health demands, affordability and availability of services, social environment, and geographic factors can affect dental health access and equality. Socio-cultural determinations also need to be considered in applied planning. Addressing these factors to improve access to dental services can pave the way for achieving universal health coverage in oral health and should be considered in different levels of policymaking.

How accurate is the assessment of certified nursing assistants on resident's oral self-care function in three North Carolina assisted-living facilities?

AIMS

To examine the association between the assessments of certified nursing assistants (CNAs) on resident's oral self-care function and resident's oral hygiene outcomes in three North Carolina assisted-living (AL) facilities.

METHODS AND RESULTS

Sixty-five dentate AL residents were included in this secondary analysis. CNAs were asked to rate the AL residents' overall oral self-care function using a 6-point Likert scale. Their assessments were then compared with the objective, performance-based Dental Activities Test and the oral hygiene and gingival health measures. The analysis showed that nearly 90% of the participants presented with at least one untreated decayed or broken tooth. On average, nearly two-thirds of the surfaces were covered by soft deposits (Debris Index = 1.83, SD = 0.60). Generalized mild to moderate inflammation (Gingival Index = 1.51, SD = 0.53) commonly presented on residents' gingiva. CNAs were able to accurately identify the residents with substantial impairment in oral self-care function, yet they tended to overestimate the oral self-care function of residents with mild to moderate impairment. CNAs assessments were also not significantly correlated with residents' oral hygiene measures.

CONCLUSION

CNAs failed to identify and provide assistance to AL residents with impaired oral self-care function, contributing to poor oral oral hygiene in these vulnerable individuals.

Developing and Testing A Model of the Assisted Living Environment

The assisted living (AL) environment plays an important role in supporting residents' satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD=26.2) beds and the majority were for profit facilities (n=41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ2/df=1.861, p<.05; CFI=.858, RMSEA=.126). Having a comprehensive AL environment measurement model will advance future research that explores the impact of the environment on resident outcomes. Findings from this study will inform interventions and programs designed to modify AL environments to optimize residents' satisfaction with AL.

Use of care and the oral health status of people aged 60 years and older in France: results from the National Health and Disability Survey

Objective

We aimed to analyze, from the data in a national survey, the use of oral care and the oral health status of patients living at home or in an institution.

Background

Patients aged 60 years and older have important oral health needs, but their oral management may differ according to their immediate environment. The fact of living at home or in an institution can influence the use of care and alter the patients’ perception of their oral health status.

Methods

The data analyzed were taken from a survey on disability and health carried out in 2008–2009, which is representative of the population living in France. It consists of two sections, one centered on disability and health among home-dwellers and the other on patients living in an institution. In each of these two populations, we carried out descriptive analysis of three themes: use of care, forgoing of care, and oral health.

Results

Although visits to physicians and specialists were frequent, visits to dentists were lower in both populations. While a minority of patients forwent care, it was dental care that was mainly forgone by both home-dwellers and institutionalized patients. The cost factor remained the principal reason, but other factors such as fear or accessibility problems were cited. Use of a dental appliance was considerably more frequent among institutionalized patients than among home-dwellers, with just over half the institutionalized population wearing a dental appliance. Perceived state of oral health remained difficult to interpret.

Conclusion

To improve access to oral care for the elderly, the patients, their entourage and health providers need increased awareness and information on the importance of good oral health. Better information must be associated with regular clinical examination.