Good oral health is an intrinsic part of overall wellbeing for people of all ages, but is particularly important for Australia’s elderly population. Poor oral health can impact quality of life and contribute to life-threatening conditions such as malnutrition or pneumonia. This is distressing for families and further contributes to an unnecessary and avoidable drain on Australian health resources. Many older adults, particularly those in care homes, have increased vulnerability to oral diseases. Factors contributing to this include multiple medications, significant limitations in mobility, marked diet changes and limits in ability to perform personal hygiene measures.
In Australian residential aged care homes (RACFs) there is no priority to clean residents’ teeth or offer access to dental treatment. It’s commonplace for residents to go days and even weeks without having their teeth or dentures cleaned. Medicare rightly funds a person having professional foot care four times a year to aid mobility and reduce the risk of falls, but there is nothing for dental professional assessment or care. In some RACFs providing access to dental health care, dental practitioners line up behind podiatrists and hairdressers. Cutting toenails and hair styling has become a higher priority than oral health. The problem is also exacerbated by the current uncoordinated approach to providing daily dental care and regular access to professional oral treatment for both residents in RACFs and frail elderly residents on home care packages. Tooth brushing and denture cleaning should be mandated for inclusion in daily care plans for residents.
Many aged care staff and carers do a wonderful job looking after our ageing Australians. They cannot, however, be expected to know the signs of dental disease and infection. This lack of specialised knowledge, time demands and poor staffing ratios give carers huge barriers to providing the necessary oral health support for older Australians. Throw in the lack of timely assessments, lack of ongoing structured oral care education for RACF staff and lack of access to qualified dental professionals and the situation is worsened further.
So what’s the solution? As Australian Dental Association (ADA) NSW’s recent submission to the Royal Commission into Aged Care Safety and Quality highlighted, elderly Australians must be given patient-centred, timely oral health care that forms part of their overall integrated healthcare plan. Several other peak professional organisations, including the Australian Dental Prosthetists Association, the Dental Hygienists Association of Australia, NSW Dental and Oral Health Therapist Association and the NSW Council of Social Services collaborated with ADA NSW to develop the submission and outline solutions.
Older adults entering residential care must have an oral health assessment and care plan provided by a qualified dental practitioner. This will identify individual dental health problems immediately and support their ongoing oral health needs. People on all levels of home care packages must have access to a government supported oral health assessment and care planning by a registered dental practitioner either within their community or if needed within their home. Family members and carers must also have access to education and oral care plans.
Furthermore, RACFs with more than 50 residents must be strongly encouraged to employ a registered dental practitioner to provide training, oral health assessments and oral care plans. This would enable a professional coordinated approach to residents’ oral health, staff education and preventive dental services. Embedding an oral health advocate and expert within the facility to provide support and enhance access to specialised dental health services for people with complex illnesses and conditions such as dementia. Provision must also be made to ensure that access to culturally-appropriate oral health care services for older Indigenous adults are available. These objectives are essential in caring for our older Australians.
In NSW there are currently models of care and workforce capability that can be scaled up to achieve these goals within the near future. It is not a privilege but a basic human right that these vulnerable members of our society have access to the oral health care they require in order to provide the best possible quality of life. ADA NSW believes oral health must be made a priority for our elderly Australians.
Dr Kathleen Matthews is ADA NSW vice-president and is a practising dentist based in Wagga Wagga, NSW.Do you have an idea for a story?
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