November 13, 2013 -- INTELIHEALTH -- Interviews with frail older people show that some common barriers to dental care may be more complicated than they seem.
Researchers from the Netherlands interviewed 51 older people between 2009 and 2012. All were in assisted-living facilities. Some lived there full-time. Others went there during the day only.
The researchers found that most older people see oral self-care as something that helps to maintain their sense of self-worth. Taking care of their teeth and gums helps them feel normal and independent.
But they didn't look at visiting the dentist in the same way. Of the people interviewed, only two felt that visiting the dentist contributed to their sense of self-worth and dignity. Those who were more frail and less independent were much more likely to abandon regular dental visits. But they did continue their oral hygiene routines.
Many of the people with full or partial dentures did not visit a dentist anymore. However, about half of the people who had stopped going to the dentist also complained about oral problems. These included poorly fitting dentures, loose teeth or painful spots in their mouths.
There were three main themes behind why people no longer visited the dentist:
- They didn't believe that going to the dentist would do anything. Those with dentures tended to assume that dentures were supposed to be uncomfortable. They didn't think visiting the dentist would help.
- They thought their oral health was less important now, because they were old and frail and possibly near death. In the face of other health problems, oral health seemed less crucial.
- They had a limited amount of energy, and were choosing not to use some of it for a dental visit.
Some people also mentioned other barriers to visiting the dentist or continuing their oral hygiene routine. These included: frailty, problems with holding a toothbrush or using floss, problems with walking, confusion, lack of social support.
Cost is a commonly recognized barrier to dental care. However, the people in this study said they would not visit a free dental clinic, even though most had some form of dental discomfort. To them, the benefits did not exceed the effort needed to visit the dentist: It simply wasn't worth it.
The authors suggest focusing on interactions between nursing-home staff and elderly people. Compassionate listening, paying attention to what's important to each resident, and more careful observation could help staff understand the priorities of each person and support oral care.
The study appears in the November issue of the journal BMC Oral Health.
-- Nancy Volkers, InteliHealth News Service
