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Mouth Care Needs of Elderly

Residents in Long-Term Care


Residential 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 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)
Male
Female
Residents Profile
138
109
463
432
944
1353
533
1126
<65 years 65-74 years 75-84 years 85+ years
45%
Age Distribution
Male
Female
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
Large
Print
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 centres
11 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
Only
42% of centres include a
dental/mouth check up in their
admission process
Only
14% of centres have regular
dental treatment or check-ups
of their residents
Only
How do we prioritise the oral
health care of the elderly?
1 centre (1%)
14 centres
(12%)
102 centres
(87%)
Health Board
Dental Service
Private Dental
Practitioner
Family would
arrange
If residents required routine
dental treatment
n=117
2 centres (2%)
12 centres (10%)
18 centres (15%)
87 centres (73%)
Health Board
Dental Service
Private Dental
Practitioner
Medical
Practitioner/Family
would arrange
Don't know/Not
sure
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
Ummyes
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 dont
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
reply
43%
Replied
57%
11 - YES, our residents do not
hold their own medical card
because
HB providesCustom &
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?
OPINIONS
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