Population projections by the Australian Bureau of Statistics indicate a rapid increase in the proportion of the population aged 65 years and older from 14% in 2012 to 22% in 2061 and 25% in 2101. Older people in residential aged care facilities (RACFs) have limited access to appropriate oral health systems, preventative dental care and other dental services. Research indicates that many older people are in urgent need of oral health care when they enter aged care facilities. An increasing dependency on care, coupled with inadequate oral care after entering facilities, can also lead to further deterioration in this group’s oral health. There are also a number of barriers to the provision of adequate oral care in Australian residential aged care facilities including insufficient resources, ambivalent attitudes from health professionals and carers to providing oral care, lack of oral health knowledge and inadequate training of carers, including non-dental health professionals. Cultural issues and different lived experiences of carers can play an important role in knowledge of and comfort with dental services.
There is a need for greater collaboration across dental health services, dental professionals, dental associations, pharmaceutical agencies and dental technician industries to enhance the promotion of better oral health in RACFs. Studies support a shift from a service delivery oriented model of oral care to a more collaborative, team-based, inter-professional approach. Also, there is an increasing trend to engage both dentists and other dental professionals in providing oral health services in residential aged care environments. Dental hygienists already provide dental care to aged care residents in Japan, Sweden and the United States. An Australian study investigating the dental examination and referral capability of dental hygienists found that there ‘was excellent agreement between the dentist and the dental hygienist regarding the decision to refer residents to a dentist for treatment.
Currently dental care for older adults in various types of residential aged care in Australia is often conducted on an ad hoc basis with little structure to such services. Many aged care residents do not receive adequate oral hygiene or any dental services. In the current system, when delivering dental care to residents in aged care facilities, dentists work most often in isolation from other health care teams, often without adequate or any links to the primary health care team of the resident.
Ageing Australians with high dental treatment needs have been recognised as a concern in terms of poor access to services that would improve quality of life. The limited number of geriatric-specialised dental services in Australia adds to poor oral health outcomes for older persons. The oral health status of older adults can decline with failing health, systemic diseases and medical treatment for comorbidities, with a profound effect on nutritional status and quality of life.
Most previous studies into oral health in RACFs have approached the issue from the perspective of adapting current dental services and adding more care responsibilities for residential aged care staff. This project recognised that the incorporation of the dental professional into the primary health care team was a major factor required to achieve the adequate oral health care of residents in aged care facilities and investigated the perceptions of the stakeholders involved (dental professionals, non-dental health professionals and carers) of the barriers and enablers they faced and that dental professionals face in providing oral care to residents in aged care facilities.