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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