Abstract
Introduction and objectives
The population of older people in New Zealand is increasing. With advancing age, older people are more likely to develop some form of disability. More and more older people are retaining their teeth, but epidemiological evidence indicates that oral disease continues older people are considered a caries-active group. There are marked differences in the oral health status of community dwelling and nursing home residents, with treatment needs higher in the latter. To date, little is known about clinical presentations of older people (community dwelling and nursing home residents) to hospital dental departments in New Zealand. There are currently no data describing the demographic characteristics, sources of referral and the nature of dental treatment provided to older people presenting to hospital dental departments in New Zealand. Keeping this theme in mind, I undertook this study to answer the following research questions:
1. What is the status of oral health among older people living in New Zealand; and
2. What are the barriers to dental care among older people living in New Zealand?
This study was conducted in two parts.
The first part of this study was an 8-month clinical audit at Waikato Hospital Dental Department to determine:
1. The demographic characteristics, source and reasons for referral, dentition status of the older people (>65 years of age) presenting to the Dental Department of Waikato Hospital; and
2. The nature of their dental problems, the treatment received and the follow-up care.
The second part of this study was a secondary analysis of the 2012 older peoples’ national oral health survey data. The second part of this study was conducted to:
1. Describe older New Zealanders’ use of dental services; and
2. Determine any difference in the nature of dental problems, and barriers to dental care among older adults in community-dwelling and Residential care facilities.
Method
For the first part of the study, information on patients aged 65 or more who presented to the dental department from 1st February to 31st October 2018 was abstracted from the Waikato DHB clinical database. Data analysed included demographic characteristics, dentition status, source of referral, medical history, treating clinician, treatment delivered and whether there was follow-up care. This information was then entered a data capture form and numerically coded. The IBM SPSS (Statistical Package for the Social Sciences) for Windows program was used for the analysis of the data.
The data for the second part of this study were obtained from the 2012 New Zealand Older People’s Oral Health Survey (OPOHS) data dictionary. The 2012 OPOHS was part of the Study into Older People’s Oral Health Issues; an umbrella project funded by the Ministry of Health. The 2012 OPOHS was the first nationwide survey to collect information on the oral health status of older adults in New Zealand, residing in community-dwelling and residential aged-care facilities. In addition to ascertaining the clinical and self-reported oral health status of vulnerable older adults, the 2012 OPOHS also reported on the oral health services accessed by them. The Stata statistical software package (Stata Corp for Windows) was used to analyse the older people’s use of oral health services from the 2012 OPOHS data-set .
Results
Part 1 – Clinical audit
Among the 203 identified patients (in the 8-month clinical audit), there was a male-to-female ratio of almost 3:2, and 90% were of European origin. Overall, 80% of the patients were living in their own homes; 80% were dentate. Some 30% presented with at least two medical conditions, and those living in a rest home had a higher mean number of medical conditions. General dental practitioners had referred more than 40% of patients in the 85+ age group whereas general medical practitioners (GP) had referred 33% in that age group. More than 50% of rest home patient referrals to the dental department were from their GP. Some 33% were oncology referrals (internal), while 33% were acute referrals and 60% had presented for elective dental treatment. Swollen face, odontogenic infection and irreversible pulpitis were the most likely reasons for acute referrals. Around 10% of patients had teeth extracted. Two-thirds of patients were referred to their general dental practitioner for follow-up.
Part 2- Secondary analysis of 2012 NZOPOHS data
More than half of the overall study population were edentulous. The proportion of edentulous participants was higher in the RC population than the HB group. Overall, twice as many residents living in their own homes than those in the RC population had visited a dentist in private practice, with dental check-up being the main reason for visit. Likewise, 30% of the participants received a dental clean and similar proportion also had their teeth filled. Around 20% of the participants had a dental extraction. A higher proportion of residents from HB category than those in the RC population also visited a DHB dental clinic and a dental technician. On the other hand, at least three in four residents from the residential care population (dentate and edentulous) had not visited a dentist in the previous 12 months. Lack of perceived need and cost were reported as the two main reasons not visiting a dental professional in the past 12 months. Almost one in three participants from both the HB and RC facility reported “Moderate” or “A lot of difficulty” in paying a $150.00 dental bill. On the other hand, 25% of the Residential-care participants reported travel distance as the main reason for not seeking dental care in the past 12 months.
Conclusion
Around 25 older patients per month are referred to the waikato hospital dental department, for care from diverse referral sources, and the proportion of acute referrals is relatively high, suggesting that poor oral health among older adults is an important problem. Those living in residential care are unable to access professional dental care as easily as those in their own homes. Lack of perceived need, costs of the dental treatment and travel distance are reported as the major reasons for not visiting a dental professional. These findings show that older people presenting at hospital dental clinics have oral health needs and dental treatment needs that require urgent attention. Their inability to access dental care raises serious concerns about their oral health.