A gaping hole: Oral health care for dependent older people
Following decades of improved oral health care, many people in New Zealand now reach older age with their own teeth. However, dependent New Zealanders (those who require regular care support through home-based care or aged residential care facilities) have poor oral health, suggesting that they are not receiving adequate oral health care. This affects their overall health and quality of life in ways that may be painful, debilitating or fatal. These problems are exacerbated by shortfalls in oral health services, which are frequently unaffordable and/or inaccessible. This thesis explores the feasibility and acceptability of publicly-funded oral health care provision for dependent older people in New Zealand among key informants from the oral health and aged care sectors. The New Zealand oral health and aged care systems are compared and contrasted with those from Canada, Australia, the United Kingdom and Ireland. These comparable countries face similar issues in cost and access barriers for dependent older people, and have various approaches that could be applied in the New Zealand setting. The research was framed by Guay’s (2005) three-point model of addressing demand, expanded by Smith (2010) to include awareness. Semi-structured interviews were conducted with eight key informants, comprising experts in dentistry, aged care, health policy and older people’s advocacy. This research confirmed that dependent older New Zealanders’ oral health is in a state of crisis. Oral health policy has not been sufficiently developed or implemented to guide oral health care for older people. Preventive oral health care is insufficient for purpose, while cost and access barriers frequently prohibit clinical treatment. The oral health and aged care workforces both require improved conditions, regulation, training and interdisciplinary alliances to meet dependent older people’s oral health needs. While the workforce is interested in making these changes, centralised public funding is necessary for their implementation, and to reduce cost barriers for patients. Accessibility can be helped through a combination of in-house, mobile and domiciliary care provision, and more widespread training in special care dentistry. Any oral health care programme must foreground the human rights of older people, disabled people, and other socioeconomic minorities such as Māori and Pasifika people. This thesis concludes that publicly-funded oral health care for dependent older people is not only acceptable but urgently necessary, and highly feasible if effective political strategies are developed for its implementation. It therefore recommends a call to action by oral health and aged care professionals, older people’s advocates, disability rights organisations, and others concerned about dependent older people’s health and wellbeing.
Advisor: Smith, Moira; Leung, William
Degree Name: Master of Public Health
Degree Discipline: Wellington Department of Public Health
Publisher: University of Otago
Keywords: dentistry; dentist; dental; oral; dental health; oral health; aged care; residential care; seniors; older people; elderly; teeth; oral health funding; New Zealand; Aotearoa; qualitative; oral health system; dental health system; dental health funding; dental care; dental care inequality; ageism; rest homes; rest home; free dental care; oral health policy; dental care policy; geriatric; dental care advocacy; dental care activism; Albert Guay
Research Type: Thesis