The Oral Health Needs of the Elderly Resident in the Community - Term Paper Example

Running Head: Health and Social Care Health and Social Care Name Institute Date The Oral Health Needs of the Elderly Resident in the Community Introduction It is normally agreed that the elderly population consists of individual aged 65 and above. The elderly population is increasing at am alarming rate in Australia and it is expected to reach between 24-26 per cent by 2051 (Australian Institute of Health and Welfare 2008). There is a trend towards having natural teeth and it is estimated that by 2019, 80 per cent of the Australian elderly population will be having natural teeth (Australian Institute of Health and Welfare 2004). This elderly population with more natural teeth has led to growth in the pool of teeth, which require treatment. The most common oral health problems of the elderly include dry mouth, dental caries, periodontal disease, tooth wear and oral cancer. The most common dental caries include recurrent caries around failing restorations, root caries and cervical caries. Elderly people who smoke and drink are more likely to develop soft tissues lesion and hence are prone to oral cancer (Antoun et. al 2008). The oral health status of the elderly is a complex issue as revealed in knowledge of oral disease trends. Elderly people are at high risk of contracting oral diseases. There are various activities that determine the oral health status of the elderly people; their general health, oral hygiene, dental experiences, communication abilities and social support. Oral disease and conditions can have social effects on the quality of life of the elderly. In a survey conducted in South Australia about the effect of oral conditions on the comfort levels and functional abilities of the elderly people, 5 per cent of people with natural teeth and 10 per cent of those without natural teeth experienced difficulty when chewing, avoided talking in public and smiling, worried during eating and avoided eating food most of the time. Five percent reported that their oral health had considerable effect on their interpersonal relationship. Therefore, the key to promoting and improving better oral health among the elderly is by employing oral health promotion approaches that focus on dental characteristics and on their quality of life matters (Slade 2007). Research studies have shown that elderly people rarely use professional dental health services. Most elderly people, especially the socio-economically disadvantage, have poor access to oral health care. Barriers to oral health care among the elderly people include disability, financial hardship after retirement, high cost of treatment and dental manpower shortage, and negative attitudes towards oral health (Antoun et. al 2008). What to learn The aim of this paper is to find out how the oral health needs of the elderly people are catered for. It set to examine the various models that have been developed to deliver oral health care services by looking at their strengths and weakness and thereby find out the best model for delivery oral health care services to the elderly living in the community. Oral Health Care Models Australia is a multicultural society and hence, the oral health needs of the elderly population are diverse. It is paramount to build upon current oral health care policy to promote the development of more effective oral health care models that caters for the culturally diverse elderly population. There are several models which have been developed to deliver health care to the elderly people in the community. They include; ethno-specific, partnership, community-based, outreach and Geriatric oral health care models (Sweeney et. al 2007). Ethno-specific oral health care Model: This model was developed to deliver oral health care services to elderly people with different cultural needs. This model is associated with high rate of service utilization and satisfaction. However, providing service based on cultural background can be challenging since it may obscure other factors that determine an individual’s choice and care needs. Due to the heterogeneity within cultural diverse groups and ethnicity identity, a service delivery model that only focuses on ethno-specific needs of the elderly people is idealistic and impractical (Ellerhaw et.al 2005). Partnership oral health care model: This model was developed to provide comprehensive oral health care to residents in the community. The dental hygienist is given the role of coordinator so as to utilize his dental hygienists’ knowledge and expertise to promote an interdisciplinary approach that is cost-effective. The role of the dental hygienist is to conduct resident oral assessment, develops individualized oral hygiene care oral hygiene care plan, monitor oral status and consults with and educates residents and family about oral health needs (Sweeney et. al 2007). Community-based model: This model is mostly used to deliver oral health care to elderly people with special needs. It involves oral health assessment, alliance building, improvement and networking of local resources, training of dental professionals and utilization of preventive dentistry training resources. The strength of community-based model is that it matches the person in need of dental care with the right resource for providing that care. This model utilizes the services of a dental care coordinator to carry out periodic dental screening tests, and make referrals to suitable local dental professionals. The weakness with this model is that funding and reimbursement issues were not taken into consideration (Ellerhaw et.al 2005). Oral health outreach model: This model provides ways for delivering coordinated care services to the elderly people. It provides easier access to information and referral about oral health services. The dental hygienist and a community educator play significant role in the development and supervision of the program. The dental hygienist evaluates the current needs of the elderly people and makes sure that coordination of appropriate services to meet those needs. The role of the community educator is to make sure that the elderly, oral health professionals and caregivers are conscious of oral health needs of the elderly people. The strength of this model is that it ensures the elderly people are given oral health care that match their needs. However, this model is expensive as it requires continuous education of the elderly, professional and caregivers during every phase of this model (MacEntee 2005). Geriatric oral health model acts as a better model for taking care of the oral health needs of the elderly. It promotes collaboration between local health authorities and dental associations. It also supports positive actions to help the elderly people keep 20 or more teeth by the time there are 80 years. These actions includes better nutrition, taking rest, good exercise, control of alcohol use and restriction of smoking, prevention of cancer and circulatory diseases and mobile dental services for the frail elderly (Slade 2007). Strategies towards improving Elderly Oral Health Health promotion programs: It is important to encourage oral hygiene as part of general health by promoting and creating awareness among the older people to maintain good general health and individual hygiene starting with good oral hygiene. The dental hygienist can use of talks, posters, exhibitions and pamphlets to promote oral health at the community. He/she should also involve the community in promoting oral hygiene aids, for example toothbrushes and toothpastes (Antoun et. al 2008). Prevention programs: The dental hygienist should screen new cases of oral health problems and demonstrate and provide advice as regards oral health and methods of self-examination in identifying oral disease. He/she should also develop and improve the local people skills on self-care, counsel the elderly and caregivers on diet and food preparation and counsel the older people on maintenance of denture hygiene Slade 2007). Treatment programs: The dentist should treat the elderly people on-site at the centre. There are different types of treatment; restoration, scaling, prophylaxis and minor oral operation. The dentist should give appointments as per the elderly patients’ schedules and refer complex cases for specialist treatment (MacEntee 2005). Training and education programs: Oral health staff and other identified health personnel should be given basic training on handling elderly patients, while dental officers should be trained on management of the elderly patient and geriatric dentistry. Dental technologists should be given post-basic training, especially on copy-denture technique. Those taking care of the elderly patients at home should be trained identifying the common oral signs, oral diseases and disorders that have an effect on the older people and making suitable referral. They should also be trained on health balance diet, good oral hygiene practice and oral health care for the bedridden elderly (Ellerhaw et.al 2005). Domiciliary dental care programs: As people grow old, their mobility and ability for self-care is reduced by physical or mental disability and terminal diseases. They are unable to access mainstream dental services and they can only depend on domiciliary care services for their oral health care. There are various methods that can be used to deliver oral heath care into homes; using fully-equipped dental vehicles used as walk-in dental surgeries for delivery of care and mobile dental equipment (Sweeney et. al 2007). The Way Forward There is no single oral health care model that can meet the needs of all elderly people from cultural diverse backgrounds. The different models of oral health care should work independently and in partnership to deliver effective oral health care to the elderly people. Some models of care may be more appropriate to certain communities than others, depending on many factors, for example, culture, geographical characteristics. However, there is need for greater elasticity of service models to promote option for clients, to decrease division and confusion and improve access to the system. The four key elements to effective provision of oral health care services to the elderly people with diverse cultural needs are mainstreaming, targeting, engagement and benchmarking. Hence, a multidisciplinary and holistic approach to health care of the older people is the best way to provide oral care to elderly based on a clinical situation. This is because the government cannot be able to provide all the oral health services and care needed by the elderly people through welfare commitments. Therefore, there is urgent need to move from welfare-oriented policies and programs to a more contributory and participatory approach. It is important to develop self-help programs which incorporate oral health care for the older people. Antimicrobial Therapy Antimicrobial therapy is the use of chemicals to kill or slow down the growth of bacteria that causes periodontal disease. Antiseptic and antibiotics are the most common form of therapy that is used. Antiseptics are found in mouth rinses and are commonly used to help prevent periodontal disease. Antibiotics are sued to kill specific bacteria and are usually placed under the gums or given as pills to treat gum disease. There are various methods that can be used to determine the efficacy of antimicrobial therapy in relation to the elderly. Evaluation: The dentist should evaluate the brushing and flossing habits of elderly patients under antiseptic therapy. He should also give advice on how the patient can improve on his/her brushing and flossing habits. The patient should brush at least twice a day and for about two minutes each time and floss one time in a day. The dentist should also make sure that the patient is taking the medicine as prescribed. Periodontal examination: The dentist should carry out a periodontal examination two or three months after administering antibiotic therapy, which measures the height of bone around each tooth. X-rays: The dentist should carry out X-rays every few years to determine the efficacy of antimicrobial therapy. The dentist may prescribe a different antibiotic if the first one did not work or even recommend a gum surgery (Australian Health Ministers’ Conference 2004). Research Questions and Proposals There is shortage of published research papers reporting results of oral health approach programs. Therefore, there is urgent need to conduct evidence-based research that focus on the delivery of community aged care services to people from different cultural backgrounds. Few research studies have been carried out as regards oral health promotion and community-directed oral disease prevention for the elderly people. Though there is sufficient knowledge to develop and assesses oral health intervention programs for the elderly, there is no research that has been carried out on community-based oral health promotion programs. Only a few intervention studies have been conducted. Therefore, demonstration projects are urgently needed with more emphasis given on monitoring designs, execution analysis and process and outcome assessment. It is important to carry out research about socio-dental indicators and measurements as this may help in analyzing the effects of oral diseases and disorders on individuals and society at large. Operational research on effectiveness of oral health intervention programs are urgently needed for policy development. Basic research and health system research should be considered. Lesson Learnt Understanding the complexities of delivering services to elderly people from the different cultural groups is challenging as shown by the different models that have been developed in the past 30 years and need a stronger empirical base. The response to this challenge lies in developing an interdisciplinary and comprehensive oral care model that incorporate the community, patient and their families in the provision of oral health care services to the elderly. What Still to Learn How evidence-base for partnership models can be can be extended and translated to improve the design and delivery of oral health care services to the elderly people in the community. References Australian Health Ministers’ Conference 2004. Healthy Mouths Healthy Lives: Australia’s National Oral Health Plan 2004-2013. National Advisory Committee on Oral Health. South Australian Department of Health. Adelaide Australian Institute of Health and Welfare 2008. Australia’s health 2008. Cat. No. AUS 99. Canberra: AIHW. Antoun JS, Adsett LA, Goldsmith SM, and Thomson WM. 2008. The oral health of older people: general dental practitioners’ beliefs and treatment experience. Spec Care Dentist; 28: 2-7. Eller haw A, Spencer A J & Slade G D, 2005, Oral Health in South Australia 2004, Population oral health seriesno; 4, AIHW cat. No. POH 4, AIHW, Canberra. MacEntee MI. 2005, Caring for elderly long term care patients: oral health related concerns and issues. Dental Clin N Am; 49: 429-443. Slade G D, 2007, Oral health for older people. Evaluation of the South Australian Dental Service project, Population oral health series no. 6, AIHW cat. No. POH 6, AIHW, Canberra. Sweeney MP, Williams C, Kennedy C, MacPherson LM, Turner S, Bagg J. 2007, Oral health care and status of elderly care home residents in Glasgow. Community Dent Health; 24: 37-42. Read More