University of Otago researchers surveyed the oral health of 987 people living in aged residential care and found those with dementia, and older men in general, have dirtier and more decayed teeth.
Lead researcher, Professor Murray Thomson says poor oral health in older people is a “major clinical and public health problem which is going to get worse”.
Older people have higher rates of cognitive and physical impairments that can adversely affect their oral self-care and complicate the provision of oral care, he says.
“Neither the aged care sector nor the dental profession, in most countries, is prepared. Not only do we have more and more older people every year, but more and more people are entering old age with their own teeth, rather than full dentures, as was the situation just a couple of decades ago.
“In some ways, dentistry has been a victim of its success – we have long emphasised the idea of ‘teeth for life’ without much thought to what happens towards the end of life.
Dental problems can lead to health problems
Professor Thomson says greater rates of tooth decay can result in dental and facial infections, poorer quality of life, malnutrition and difficulties in communication.
The Otago study, published in Gerodontology, backs up a growing body of research that shows that dental problems can be the source of general health issues.
There is international evidence of the links between periodontal disease and cardiovascular disease, diabetes and other chronic illnesses.
The 1997 report Preventive Dental Strategies for Older Populations, commissioned by the National Health Committee, showed that the most common dental conditions affecting older people, including tooth decay, gum disease and saliva problems, can cause severe limitations in day-to-day activities.
A 2004 report in the New Zealand Medical Journal published the results of a survey of dependent elderly people in Christchurch and the researchers’ recommendation that “oral health should be considered part of overall health when the Ministry of Health writes service specifications and minimum requirements for rest homes and residential care facilities”.
Since then there have been calls for a change in the policy and monitoring environment around oral care policies in aged care facilities.
In 2015, INsite spoke to Dr Clive Ross, previously the clinical director for the Oral Health unit at Auckland District Health Board, who said that despite letters to various Ministers, oral health in older people is still not being taken seriously enough.
Our Older People’s Oral Health, published in December 2015, urged critical policy development around older people’s oral health
Professor Thomson agrees that “slow progress” is being made in the area.
“It’s a very complex situation involving a lot of players – the aged care sector, the Ministry of Health, the dental profession, and the public. An encouraging sign is the inclusion of oral health in New Zealand’s Healthy Ageing Strategy. That’s a starting point, but there is a lot of work to be done,” he says.
The Healthy Ageing Strategy sets out plans to improve oral health in all community and service settings, through collaboration between the Ministry, DHBs, PHOs, oral health service providers and aged care providers. These plans include developing clinical pathways for optimal dental care throughout ageing and into the end of life; identifying and promoting innovative care arrangements for the oral health care of older people in both residential care and the community; and providing information and advice on dental care to aged care providers and older people’s families and carers.
No requirement for providers to prioritise oral health
As things stand at the moment, dental care is excluded from the Age-Related Residential Care (ARRC) Agreement between district health boards and aged care providers, leaving rest homes to manage the oral health care of their residents and families to fund it themselves.
And as the Health and Disability Service Standards don’t specify that aged care providers have to provide an oral health care programme, oral health has a tendency to slip down the priority list.
This is reflected in the poor uptake of funded programmes aimed at training caregivers in looking after the oral health of their residents.
The Ministry of Health helps fund the New Zealand Dental Association’s Healthy Mouth, Healthy Ageing regional workshops, however due to limited funding only 20 workshops are offered each year, so not all aged care workers have access.
This year the NZDA is also trialling a number of in-house training sessions.
“About 3500 care workers have attended these sessions overall,” says NZDA Oral Health Promotion Manager Deepa Hughes. “However, given that the aged care sector has around 30,000 care staff we need to do something more substantial.”
“We have highlighted this to the Ministry and requested for further funding to expand these oral care training workshops. With the inclusion of oral health in New Zealand’s Health Ageing strategy we are hoping for further funding in this area.”
However, Hughes says limited funding is not the only problem. She says that despite excellent feedback from those who have attended the sessions, the uptake by residential care facility staff is very limited.
“This is due to the lack of national protocols and policies for the provision of oral care assessments and hygiene care in New Zealand residential facilities. Without the contractual obligations it is simply not a requirement for them. Currently, it is up to the carers and their managers to decide if they want to attend these training sessions or not.”
“The NZDA recommends further funding from the Ministry of Health to extend our current training programme to offer uniform oral health care training and standards for all caregivers across New Zealand.”
Professor Thomson’s oral health advice:
- Brush twice daily with fluoride toothpaste
- Clean carefully between the teeth at least two to three times per week
- Avoid having sweet drinks or snacks between meals (and that includes sugar in tea or coffee – it takes only a couple of days to get used to not having it);
- Avoid smoking.
Research paper: ‘Oral status, cognitive function and dependency among New Zealand nursing home residents’ by W. Murray Thomson, Moira B. Smith, C. Anna Ferguson, Ngaire M. Kerse, Kathryn Peri, Barry Gribben. Gerodontology. DOI: 10.1111/ger.12337