27
Volume1 Issue2
|
I
ssues and
P
eople
inoffering services toelderlypatients.
36
Muchmoreempathy for frail and
dependent elderlypatientswas evident
from the88%of dentists inScotland
whoattended to residents incare
facilities,
37
presumablybecausedentists
received support from thepublichealth
system toprovide services topatients
indomiciliarycare.
The impactsof poor oral healthon the
qualityof lifeof elderlypeople isnot
always recognizedbydental profes-
sionals,
38,39
whomay focusmoreon
“quickfixes”for acutedental problems
thanoneffectivemanagement of the
chronicconditions that sooften lead
todeteriorationof thedentition inold
age.
40,41
Management of frail elderly
patientswithmultiplecomorbidities
typically requires collaborationwith
other healthcareprofessionals (e.g.,
physicians, nurses, careaides, speech
languagepathologists, dieticians,
facilitymanagers and socialworkers).
Yet formal interprofessional educational
programs aremissing from thecur-
riculaofmost healthcareprofessions
becauseof constraintsof time, logistics
and resources, aswell as a lowpercep-
tionof the significanceof this aspect of
career development.
42
Consequently,
other professional groupsoftenover-
look the roleof dentistry in integrated
care for older people.
43
Access todental care for elderly
residents in long-termcare facilities
depends stronglyon thecultureand
valuesof each facility.
41
Even in the
UnitedStates,where federal regulations
dictate that long-termcare facilities
provideoral careand supplies, docu-
mentationof a standardizedprotocol
isuncommon, andnursingassistants
provideoral care inconsistently.
44
Discrepancieshavebeenevenmore
apparent in similar facilities inCanada,
despite legislation in some jurisdictions
mandatingaccess toandassistance
withoral care for the residents.
45
Nurses,
as front-linepersonnel in the facilities,
are typicallygiven the responsibility for
oral care,withdental hygienistsplaying
a supplementary rolewhennecessary.
46
Unfortunately, nurses receive littleprac-
tical educationonoral care, andwhat
little information theyhave is impeded
bybusy schedules,morepressing
priorities,
47
and in some situationsby
a fear of dislodgingoral bacteria that
cancauseaspirationpneumonia.
46
Therefore, healthcareprovidersoften
strugglewithunclear procedural
guidelines, divisionof responsibilities
andethical conflicts indeliveringoral
care to frail elderlypatients, especially
whenpatients exhibit uncooperativeor
aggressivebehaviour.
40,41
PhysicalBarriers
In2010, Canadahadabout 19000den-
tists, 21000hygienists, 2200denturists
and300dental therapists
48
for apopu-
lationwith4.8millionpeopleaged
65years andolder,
49
which translates
loosely to1oral careprovider for every
100older residentsof thecountry.
However, dental professionals tend to
preferurban settings, andonly10%of
thempractise in rural areas,
50
where
one-thirdof seniorCanadians
live.
51
Hence, there isanobvious inequity
inaccess todental carebetweenurban
and rural areas.
Inaddition, 1 in4Canadian senior
citizens reported restrictions in their
activitiesof daily living, 15% required
homecare services, and7% lived ina
residential care facility.
52
Consequently,
manyelderlypeople,whether living
at homeor ina long-termcare facility,
havephysical challenges thatmay
affect their ability tovisit adental
officeandwouldprefer tohaveavisit
fromadental professional in their own
environment.
37,53-55
However, dental pro-
fessionals aregenerallyuncomfortable
offering servicesoutside theclinical
setting.
56
Furthermore,many residential
care facilities lack space for adental
unit, andnot all privatedental clinics
canaccommodateawheelchair or the
demandsof providingoral care topa-
tientswithdementia, severedyskinesia
or incontinence.
36
SocialResponsibilityand
Distributive Justice
Webelieve that reducing inequity in
oral care isa formof social responsibility,
theobligation toact for thebenefit
of societyasawhole.Healthcare isa
commongood, and theprinciplesof
commongoodanddistributive justice
posit that society shouldpromoteand
