Providing ambulatory healthcare for people aged 80 and over: Views and perspectives of physicians and dentists from a qualitative survey

Abstract

Background People aged 80 and over frequently face complex chronic conditions and health limitations, including oral health problems, which are primarily addressed by ambulatory (i.e., outpatient) healthcare. This demographic development is expected to affect the provision of care. However, few studies have investigated physicians’ and dentists’ views across the various medical disciplines in non-institutional settings. This study investigated how healthcare providers perceive caring for very old people, and how they feel healthcare should be designed for this patient group. Methods A qualitative online survey comprising nine open-ended items was conducted among physicians and dentists practicing in the ambulatory healthcare sector in North Rhine-Westphalia, Germany. Apart from child and adolescent healthcare, no medical specialties were excluded. The results were analysed using Kuckartz’ approach of structuring qualitative content analysis. A descriptive codebook was developed first. After coding all the material, recurring patterns between the topics were investigated and compared between two groups of participants, physicians and dentists. Results N = 77 cases were included in the analysis, from which n = 21 originated from the field of ambulatory general practice care and internal medicine, n = 19 from specialties (e.g., neurology, urology), and n = 37 from dentistry. Caring for patients aged 80 and over was perceived as challenging because of complex health conditions and treatments such as multimorbidity and polypharmacy, and patients’ cognitive and physical limitations. In characterizing good care in older age, both groups found individual care important, as well as empathetic interactions and good collaboration in networks of healthcare providers. Inadequate reimbursement and limited resources and time were the most important barriers to providing good care, while one of the most important facilitators was healthcare providers’ attitude and motivation. Conclusions Physicians’ and dentists’ conceptions of good healthcare are in line with the conceptualization of patient-centred care. However, the transfer in everyday care delivery is hampered by the current design of healthcare structures. Healthcare providers feel overstrained by the increasing demands placed on them. Adaptations for improvement should focus on building strong networks of cooperating health professions, especially including dental care, and local social support structures.

Dental care for older adults in home health care services - practices, perceived knowledge and challenges among Norwegian dentists and dental hygienists

“…Poor oral hygiene, a sugar-rich diet, and dry mouth are common risk factors for oral diseases [ 5 ]. Earlier studies have pointed to a lack of awareness regarding oral health and hygiene among healthcare providers, patients, and relatives – resulting in poor oral health [ 26 ]. Substantial treatment needs as well as inadequate daily oral hygiene have been revealed among older adults in HHCS [ 10 ].…”

“…Limited resources and time have been described as barriers against providing the necessary dental care. In addition, physical limitations, multimorbidity and polypharmacy may lead to medical complexity and an unstable overall health, which may hamper the treatments [ 26 ]. The challenges experienced by dentists and dental hygienists in the present study were consolidated into three domains: time, practical organization, and communication.…”

Outreach dental care programme for older adults using long‐term care services in Hong Kong: A qualitative study

“…16 A network of cooperating healthcare providers, including dental professionals, and social support structures should be built to design patient-centred care for older adults. 21 The older adults' emotional and social needs should be taken into account while providing outreach dental care. 22 This study also revealed that different outreach dental teams uate training in various specialities, on the treatment decisions for complex endodontic cases reported that procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most important factors affecting clinical decisionmaking.…”

“…Obtaining the medical history of the older adults prior to the service and proper identification information for the outreach dental team members and the older adults on the day of service could be considered as important as obtaining consent from the older adults and their family members 16 . A network of cooperating healthcare providers, including dental professionals, and social support structures should be built to design patient‐centred care for older adults 21 . The older adults' emotional and social needs should be taken into account while providing outreach dental care 22 …”