Minimising barriers to dental care in older people

Abstract

BackgroundOlder people are increasingly retaining their natural teeth but at higher risk of oral disease with resultant impact on their quality of life. Socially deprived people are more at risk of oral disease and yet less likely to take up care. Health organisations in England and Wales are exploring new ways to commission and provide dental care services in general and for vulnerable groups in particular. This study was undertaken to investigate barriers to dental care perceived by older people in socially deprived inner city area where uptake of care was low and identify methods for minimising barriers in older people in support of oral health.MethodsA qualitative dual-methodological approach, utilising both focus groups and individual interviews, was used in this research. Participants, older people and carers of older people, were recruited using purposive sampling through day centres and community groups in the inner city boroughs of Lambeth, Southwark and Lewisham in South London. A topic guide was utilised to guide qualitative data collection. Informants' views were recorded on tape and in field notes. The data were transcribed and analysed using Framework Methodology.ResultsThirty-nine older people and/or their carers participated in focus groups. Active barriers to dental care in older people fell into five main categories: cost, fear, availability, accessibility and characteristics of the dentist. Lack of perception of a need for dental care was a common 'passive barrier' amongst denture wearers in particular. The cost of dental treatment, fear of care and perceived availability of dental services emerged to influence significantly dental attendance. Minimising barriers involves three levels of action to be taken: individual actions (such as persistence in finding available care following identification of need), system changes (including reducing costs, improving information, ensuring appropriate timing and location of care, and good patient management) and societal issues (such as reducing isolation and loneliness). Older people appeared to place greater significance on system and societal change than personal action.ConclusionOlder people living within the community in an inner city area where NHS dental care is available face barriers to dental care. Improving access to care involves actions at individual, societal and system level. The latter includes appropriate management of older people by clinicians, policy change to address NHS charges; consideration of when, where and how dental care is provided; and clear information for older people and their carers on available local dental services, dental charges and care pathways.

Possible Barriers towards Seeking Dental Treatment for the Indian Elders: A Questionnaire Study

“…Lastly, similar to the study conducted by Borreani and Wright, the results of our study identified cost on transportation as the biggest indirect cost inferred by this age group [19,20]. This was especially true for individuals who did not have a family support to bring them for their dental treatment.…”

De invloed van kwetsbaarheid op mondzorggedrag en tandartsbezoek van ouderen

“…Kwetsbaarheid heeft een negatieve invloed op zowel tandartsbezoek als op mondverzorgingsgedrag (MacEntee, 2011). Onderzoek heeft aangetoond dat verminderde mobiliteit, verminderde fysieke functies, weinig energie, depressie en gebrek aan sociale steun hiermee zijn geassocieerd (Dolan et al, 1998; Kiyak en Reichmuth, 2005;Borreani et al, 2008;Stromberg et al, 2012). Niet bekend is op welke manier kwetsbaarheid en verschillende kwetsbaarheidsfactoren van invloed zijn op de mondverzorging en tandartsbezoek van ouderen.…”

“…Algemeen erkende barrières voor tandartsbezoek door ouderen, zoals 'beschikbaarheid',' bereikbaarheid', 'kosten', 'afhankelijkheid van anderen' en in sommige gevallen zelfs 'gepercipieerde orale problemen' lijken van ondergeschikt belang te zijn voor de geïnterviewde groep ouderen (Holm-Pedersen et al, 2005;Kiyak en Reichmuth, 2005;Borreani et al, 2008;Brothwell et al, 2008). Zelfs toen de interviewers meldden dat het wellicht mogelijk zou zijn om op locatie door een tandarts te worden bezocht, zeiden de meeste mensen die geen tandarts meer bezochten, dat ze niet wisten of ze van een dergelijke service wel gebruik zouden maken.…”

Modelling workforce skill-mix: how can dental professionals meet the needs and demands of older people in England?

“…Furthermore, the level of private care is shifting fast, new UK graduates are increasingly fi nding it diffi cult to get jobs in areas of their choice, and the historical fl exibility in the system has reduced with devolved budgets for dentistry. Third, many of the assumptions such as the level of care provided for older people assume that the current level of demand is appropriate to need, whereas that is patently not the case for older people: uptake is low, barriers to dental care are multiple, 43 and there is unmet need.…”