Barriers and enablers for dental care among dentate home‐based older New Zealanders who receive living support

Abstract

ObjectiveTo explore the structural, social and individual barriers to, and facilitators for, accessing dental services and remaining dentate, among a purposive sample of dentate home‐based older people who receive living support (HBOPWRLS).BackgroundStudies on the oral health of older people have largely been quantitative, while fewer studies have specifically explored the dental service utilisation patterns of dentate HBOPWRLS, especially in New Zealand.Materials and methodIn early 2019, semi‐structured interviews were conducted with a purposive sample of 40 dentate HBOPWRLS from one region of New Zealand. A parallel coding and thematic analysis of the interview data was conducted, based on the constant comparative method.ResultsBarriers to accessing dental services included the cost of dental treatment, negotiating transport issues, social isolation, traumatic childhood dental experiences, lack of role modelling for good oral health and hygiene, self‐ageing and drawing upon discourses of older people, and health conditions impacting on mobility and access to oral health care. Facilitators for accessing dental services included having a support network, parental role models, healthy diet, knowledge of the link between oral and general health, dental clearances for surgery, not wanting dentures and having a strong dislike of them, and agency to resist dentists’ advice to have a full extraction.ConclusionThe expense of dental care is a major barrier to HBOPWRLS accessing dental services at a life stage of reduced income. Strategies for boosting dental service access among socially isolated older people need further exploration.

Disentangling a web of causation: An ethnographic study of interlinked patient barriers to planned dental visiting, and strategies to overcome them

“…Barriers have been described as dental anxiety, 20,21 competing demands 22 including affordability of dental care, 18 relevance and meaning of oral health, 23‐25 embarrassment, 26 trust in dentists and dental services, 27,28 and accessibility and availability of dental care 12,29 . Some studies have described factors which help overcome barriers: patients’ persistence in care‐seeking, 12 services’ clear information provision, 12,30 providers’ communication, 12,31,32 services’ and societal support for specific needs, 12,30‐33 and financial support 30,31,33 . The few intervention studies which exist in this area have focused on counselling patients, 34,35 patient education, 34,36 provider education on social determinants, 37 tailored provision including community dental services 38,39 and macro‐level changes including public health coverage 15,40 .…”

Oral Health Profile Status and Treatment Needs in the Salvadoran Elderly Population

“…Factors associated with poor hygiene could be a lack of knowledge of proper techniques, or low or lack of income to buy basic oral hygiene kits. Furthermore, the oral health status of older adults, although in uenced by the aging process, also depends on their oral hygiene habits, the degree of physical disability, the assessment of oral health and their access to health services, among other factors [17].…”

“…In this study, the DMFT index for the missing teeth component was 16. In accordance with the high prevalence of missing teeth, in the Salvadoran population, 90.23% of older adults required prosthetic rehabilitation to improve their quality of life and masticatory function, thus reducing the risk of malnutrition in Salvadoran older adults [11,17].…”

Recommendations for improving dental care for dentate home‐based older people: A qualitative New Zealand study

“…By 2051, it is estimated that approximately 25% of all New Zealanders will be 65 years and over (it was 4% in 1901) 1 . At the same time, a number of socio‐cultural shifts and technological advancements in dentistry have meant that nowadays, older people are retaining more of their natural teeth 2‐5 . Consequently, the demand for geriatric dental care is expected to increase considerably in the near future 6,7…”

“…1 At the same time, a number of socio-cultural shifts and technological advancements in dentistry have meant that nowadays, older people are retaining more of their natural teeth. [2][3][4][5] Consequently, the demand for geriatric dental care is expected to increase considerably in the near future. 6,7 The New Zealand Ministry of Health is committed to the ageing in place strategy, whereby older people remain in their own homes with some publicly funded living support (including personal care, housework assistance and visits from health professionals).…”