The innovative pilot programme out to improve oral healthcareby Ruth Nichol
Ensuring older people get better oral healthcare is the aim of an innovative Dunedin pilot programme.
But improvements in dental care in the past 50 years, combined with a growth in the older population – of whom half will eventually end up in residential care – mean that oral health is becoming an increasingly important issue for the aged-care sector.
“More and more people are keeping their own teeth and this has happened quite quickly,” says Moira Smith, a public health researcher and dentist at the University of Otago. “We’ve never had to face this before and we’re not prepared for it.”
Few rest-home residents have all their own teeth, and the teeth they do have are not usually in great shape. A combination of factors puts their remaining teeth at greater risk of decay. These include receding gums, which expose the roots of the teeth, mouth dryness caused by the drugs they take, and a loss of manual dexterity, which makes it hard to use a toothbrush properly.
“We know that when you enter a rest home, your risk of dental caries doubles compared with the rest of the adult population, and if you’re in a dementia unit, it doubles again.”
Smith is co-author of Our Older People’s Oral Health, based on a survey of 2218 New Zealanders aged 65 or more who were living in aged-care facilities or receiving home-based assistance in 2012. The survey found that just under half had at least some of their own teeth, but they had concerning levels of untreated decay, and many had high levels of plaque and calculus deposits.
Maori, Pasifika and others with low socio-economic status had even poorer oral health.
Smith says New Zealand is not alone in having this problem and we’re now trying to work out how to tackle it. One of the actions recommended in the Ministry of Health’s recently published Healthy Ageing Strategy, for example, is to “identify and promote innovative care arrangements for the oral healthcare of older people receiving home and community support services and living in aged residential care”.
But there are no easy solutions to the problem, which Smith says is one of a number of complex health issues facing the aged-care sector.
“We’re trying to keep people living independently for as long as possible, so they’re entering rest homes at a later stage, when they’re much more likely to need hospital or psycho-geriatric care.”
The 2012 survey found that cost is one reason people in rest homes don’t seek dental treatment. But physical access is also a problem; even if they can afford the treatment, getting to a dental surgery can be a huge obstacle.
“The research consistently shows that a domiciliary service is the best for rest homes,” says Smith. “Leaving the site can be time-consuming and difficult.”
She says many simple dental procedures, such as cleaning, examinations and even easy extractions, could be done at a rest home.
And although some facilities are doing a great job of caring for their residents’ oral health, others have less understanding of what’s required to keep a person’s mouth clean.
A voluntary programme set up by University of Otago dental students may help rectify that. We Care aims to promote geriatric oral health by running educational sessions for caregivers at aged-care facilities.
A pilot programme at Dunedin’s Ross Home has just finished. Using material developed by the New Zealand Dental Association, 20 student volunteers ran sessions with staff on good toothbrushing technique and the importance of using soft toothbrushes and fluoride toothpaste. They also talked to them about how to care for people with dentures.
They reinforced their messages by giving the home a range of oral healthcare products bought with a US$1000 grant from the Wrigley Company Foundation, which works with the NZDA to fund dentalprojects for at-risk communities.
We Care co-ordinator James Choo says they hope the programme will become permanent, but that depends on the results of an assessment being done by post-graduate dental students.
“We’re taking baby steps until we find out how it goes at the first rest home.”
This article was first published in the October 14, 2017 issue of the New Zealand Listener.
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