Mouth Care Needs of Elderly Residents in Long-Term Care

Mouth Care Needs of Elderly Mouth Care Needs of Elderly Residents in Long-Term CareResidents in Long-Term Care

Residential Unit QuestionnaireResidential Unit Questionnaire

National Programme for Dental Epidemiology - Lot 1

study designed in consultation with the Lot 1 Health Board User Group

Background

Pilot Study

2 pilot studies in Dundrum and Kerry highlighted problem areas for clinical examination of elderly residents

difficult to obtain informed consent difficult to validate medical history sample biased towards very active

residents or residents with dental problems

Postal Survey : No Clinical Exam

To assess at residential unit level the

mouth care needs of elderly residents in long-term care in Ireland

current oral health care practices

current level of service provision

barriers to care

Aims

To communicate findings to decision makers

All residential centres for the elderly under the direct care of the Health Boards

Excluding psycho-geriatric units

Coverage

Sample = 177 units

A survey questionnaire was posted to all residential units on the validated database and completed by a senior staff member.

Method

Response Rate = 73%

Questionnaire returned

129 units

Questionnaire not returned

48 units

Sample = 177 units

Under Direct Care of HBs

124 centres

5692 residents

Questionnaire ResultsQuestionnaire Results

Size of Units

Unit size

11-20 15 12.1% 249 4.4%

21-50 87 70.2% 2892 50.8%

51-100 11 8.8% 819 14.4%

101-200 11 8.8% 1732 30.4%

Total 124 100% 5692 100%

Centres Residents

Residents Profile

40.0%

60.0%

43.4%

56.6%

In Residential Care General Population (CSO 2002)

Gender Balance(aged 65 and over)

MaleFemale

Residents Profile

138 109

463 432

944

1353

533

1126

<65 years 65-74 years 75-84 years 85+ years

45%45%

Age DistributionMaleFemale

elderly in residential care of HBs as percentage of general population :

0.4%

1.5%

4.0%

65-74 years

75-84 years

85+ years

4% of the population aged 85 years and over are in residential care

of the HBs!

Residents Profile

42% of residents are able to read

LargeLargePrintPrint

Residents Profile

14% of residents are able-bodied (i.e. able to climb stairs)

Residents Profile

60% fully dependent

22% semi-independent

18% independent

Staff Training

82 centres

42 centres

Yes = 66% No = 34%

Staff Training

If YES:

when was training provided?

No. Centres % Centres No. Centres % Centres

During basic training 74 90% 12 15%

Special post graduate course 5 6% 2 2%

Course provided since starting to work with elderly

10 12% 13 16%

Other 7 9% 8 10%

Nurse Care Assistant

Staff Training

Do you see a need for training in this area?

Staff Training

3 centres11 centres

110 centres

Yes = 89% No = 9% No Answer

How do oral health/dental problems/denture problems

come to light generally?

77% nursing/care staff observation

15% resident/family member reported problem to staff

8% no answer

Do you know the entitlements of older people in relation to dental care?

59% Yes

13% No

26% Not sure

2% No answer

15% of centres have ever had an oral health needs assessment

carried out in their unit

15% of centres have ever had an oral health needs assessment

carried out in their unit

Only…Only…

42% of centres include a dental/mouth check up in their

admission process

42% of centres include a dental/mouth check up in their

admission process

Only…Only…

14% of centres have regular dental treatment or check-ups

of their residents

14% of centres have regular dental treatment or check-ups

of their residents

Only…Only…

How do we prioritise the oral health care of the elderly?

How do we prioritise the oral health care of the elderly?

1 centre (1%)

14 centres (12%)

102 centres (87%)

Health BoardDental Service

Private DentalPractitioner

Family wouldarrange

If residents required routine dental treatment…

n=117

2 centres (2%)

12 centres (10%)

18 centres (15%)

87 centres (73%)Health BoardDental Service

Private DentalPractitioner

MedicalPractitioner/Family

would arrange

Don't know/Notsure

If residents required emergency dental treatment…

n=119

…dentist?

…oral health promoter, hygienist or dental nurse?

44%

6%

Domicillary Care

Has your unit ever been visited by a…

Umm…yes

Is it difficult to get a dentist to visit the unit ?

52% Yes

43% No

6% No reply

When a dentist does visit who does he/she see…?

55% replied dentist only see residents in pain/problem

6% replied dentist sees all residents at least every 2 years

36% replied dentist never visits

4% did not reply

How far to the nearest accessible dentist ?

33% no reply

37% within 1 mile

52% with 3 miles

58% within 5 miles

64% within 10 miles

How are residents transported to the dentist?

41% taxi

29% ambulance

28% family

23% unit minibus

13% walk to dental surgery

35% residents are treated in unit

3% residents don’t ever go to dentist

Medical Card

Is there a policy in your CCA/Health Authority for eligible elderly clients in residential care under the direct care of the Health Boards not to hold their own medical cards?

All persons aged 70 years and over are entitled to a Medical Card.

Did not reply43%

Replied57%

11 - YES, our residents do not hold their own medical card

because HB provides…Custom &

practice…

5 - NO, our residents can hold their own

medical card…

1 - Policy is under review…

How many of your residents hold their own medical card?

On average, 43% of the elderly in long-term residential care hold

their own medical cards…

Medical Card

All persons aged 70 years and over are entitled to a Medical Card.

57% of elderly in care do not hold their own medical cards…

Medical Card

All persons aged 70 years and over are entitled to a Medical Card.

Can they avail of the DTSS?

OPINIONSOPINIONS

Oral health services required:

80% provision of dentures/extractions

80% denture repairs

59% oral hygiene instruction

58% scaling & cleaning

49% emergency treatment

44% treatment for mouth ulceration

21% fillings

#1 need

Barriers staff encounter in providing daily mouth care:

40% patient cooperation

31% inadequate training / awareness of importance of daily mouth care

29% staff shortages/time pressure of normal routines

Difficulties in providing access to dental treatment:

41% availability/access to services (particularly for routine care)

24% arranging transport/escorts

13% mobility/cooperation of patients

Issues

Responsiblitity for oral health care of residents in units under the direct care of the HSEs

Oral health care training for nurses and care assistants, with emphasis on care of the elderly with high dependency

Availability and accessibility of dental services, particularly for routine treatment

Domicillary Care for elderly with disabilities