Informing The Debate On Oral Health Care For Older People: A Qualitative Study Of Older People’s Views On Oral Health And Oral Health Care

Original article

Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care
E. Borreani, K. Jones, S. Scambler and J. E. Gallagher
King’s College London Dental Institute, Department of Oral Health Services Research & Dental Public Health, Denmark Hill Campus, London, UK

doi: 10.1111/j.1741-2358.2009.00274.xInforming the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care Background: Older people represent a growing and diverse section of the population. As age increases, people are more likely to experience health and mobility problems and be at higher risk of developing oral disease. Nevertheless, few older people utiliseprimary oral healthcare services. It is therefore important to understand the value older people place on oral health and dental services to inform providers and planners of oral health care. This research was conducted as part of a study to identify potential ways of minimising barriers to oral health care in older people. Objectives: To explore perceptions of oral health and oral healthcare servicesamongst older people living in a socially deprived inner city area and how these are related to service utilisation. Methods: A qualitative approach was utilised to explore the range of issues related to older people’s perceptions of oral health and their views on health care. This involved a combination of focus groups and semi-structured individual interviews with older people and their carers.Data analysis was conducted using the Framework approach. Results: • Response: Thirty-nine older people and/or their carers participated in focus groups. • Oral health perception: Oral health was associated with the presence of natural teeth, the absence of pain, practical/social functioning, preferably supported by positive assessment by a dentist. • Oral health life-course: Older people have along and complex dental history. Past negative experiences with oral health care, especially in childhood, strongly influenced present attitudes towards dentistry and dental personnel. • Citizenship and right to health care: There was a strong perception that, as ‘British citizens’, older people should have a right to free health care and that the National Health Service (NHS) should support them inthis phase of their life. Conclusions: The oral health life-course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of importance and place great emphasis on their citizenship and rights of access to state funded oral health care. This raises important issues for the funding and delivery of NHS oral health care for olderpeople. Keywords: older people, access, barriers, oral health, life-course. Accepted 1 September 2008

Background
The number and proportion of older people in the population is increasing, particularly in the developed world where there has been a reduction in communicable diseases and an increase in the number of people dying from non-communi-

cable diseases and chronic conditions1–3.Increasing life expectancy and falling birth rates have exacerbated this trend, leading to an ageing population and new challenges for the medical and dental professions4–7. By 2050, the proportion of older people in the UK is projected to increase to almost a quarter of the population, making
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Ó 2009 The Authors Journal compilation Ó 2009 The Gerodontology Association and Blackwell MunksgaardLtd, Gerodontology 2010; 27: 11–18

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them a key group for health care and resource allocation8,9. The oral health needs of the population are changing with an ageing population that is retaining their teeth. This has resulted in a reduction in the need for complete dentures and an increased risk of tooth-related oral diseases10–12. The prevalence of both oral and...