Outreach dental care programme for older adults using long-term care services in Hong Kong: A qualitative study.

OBJECTIVES: To explore the effects and improvement needs of an outreach dental care programme (ODCP) for older adults using residential care or daycare services from the perspectives of the caregivers, the dentists and administrative staff involved in the implementation of the ODCP. METHODS: A qualitative study was conducted through semi-structured interviews with three stakeholders, long-term care (LTC) facility caregivers, administrative staff and dentists working for the ODCP. Combined maximum variation and snowball sampling strategies were adopted, and 22, 9 and 7 participants were interviewed from each stakeholder, respectively. The interviews were conducted via telephone, which were audio-recorded and transcribed verbatim for analysis. NVivo software was used for storing and analysing the data. Data analysis was conducted continuously during the study. RESULTS: Most participants opined that the ODCP benefited older adults by raising their oral health conditions and awareness. However, they complained of the complicated administrative procedures, unmet dental treatment needs, inefficient coordination, unclear work guidelines and shortage of dental manpower. More advanced dental treatment options, better coordination among different parties, simpler administrative processes and better incentives for dentists were proposed to further improve the programme. CONCLUSIONS: According to the stakeholders, ODCP seems beneficial to older adults using LTC services. Further improvements in the scope of dental treatments, cooperation between the outreach dental teams and caregivers, and streamlining of the administrative process are needed for the provision of effective outreach dental care to satisfy the unmet treatment needs of older adults who use LTC services. Better incentives are needed to attract and retain dentists.

Outreach dental care program for older adults using residential care or day care services in Hong Kong: A cohort study.

AIM: To evaluate the effects of an outreach dental care program (ODCP) on the oral health status and oral health-related quality of life (OHRQoL) of older adults who used residential or day care services in Hong Kong. METHODS: Older adults who had received dental treatments provided in the ODCP were recruited. Clinical examinations were performed by one calibrated examiner (SXY) at baseline and 1-year follow-up in the residential homes or day care centres. Face-to-face interviews were conducted using the transition scale of the Oral Health Impacts on Daily Living (OHIDL) questionnaire to investigate the perceived change in OHRQoL at baseline, 2-month and 1-year follow-ups. The Wilcoxon matched-pair signed-rank test or McNemar/McNemar-Bowker test was used to explore the change in oral health status after dental treatments. Factors associated with the perceived change in OHRQoL were explored with binary logistic regression. RESULTS: Four hundred and thirteen older adults (mean age = 83.8 years) participated in the study at baseline, and 377 (91.3%) and 359 (86.9%) were successfully followed 2 months and 1 year after receiving the outreach dental service, respectively. At the 1-year follow-up, the number of decayed teeth and functional tooth units, and the prevalence of poor denture hygiene decreased while there was more dental plaque deposition and a higher proportion of participants with gingival bleeding upon probing. More than 50% of the participants perceived no change or an improvement in OHRQoL in all domains at both follow-ups. Older adults who perceived their oral health status as 'healthy or fair' and those who suffered from toothache at baseline had a higher chance to perceive having a better or at least the same OHRQoL at the 2-month and 1-year follow-ups, respectively. CONCLUSIONS: The ODCP in Hong Kong can solve some of the dental problems of older adults using long-term care services and keep most of them from deterioration in OHRQoL, especially those suffering from toothache.

Global Perspectives of Oral Health Policies and Oral Healthcare Schemes for Older Adult Populations.

The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.