Is the Oral Health of Aged Care Residents Falling Through the Cracks?
Mary is an 85-year-old woman suffering from dementia, living in residential aged care. Mary used to be very happy but in recent months has become sad, crying a lot and disengaging from her usual activities. Her carers believe that her sadness is a result of her continuing decline, but a chance look in her mouth finds something that had nothing to do with her dementia.
Mary’s oral health had been neglected since the onset of dementia and, as a consequence, she had developed untreated tooth decay and poor gum health. Sadly, Mary’s problem is not an isolated one, with many older people living in care having undiagnosed oral health problems. These can have dire consequences on quality of life, including pain and suffering, an inability to eat or speak and possible general health implications. Luckily for Mary, after several visits with a team of oral health professionals, Mary was back to her happy self.
This story captures the fate of many older people living in residential care and not just those with dementia. Poor oral health due to declining cognitive function, ageing, poorer dexterity and/or chronic conditions means that many people enter aged care facilities with existing oral health problems. As our older Australian population is growing, so too is the number of older people who have more teeth than previous generations. This is setting up a growing problem for people working in Aged Care.
About one third of people delay or avoid going to the dentist because of the cost, which means that many older people (both living in the community and in care) have substantial oral health problems. With increasing age, there is increased risk of gum disease and root surface tooth decay. The subsequent poor oral health can affect the ability to chew and swallow, thus affecting overall nutrition, which can be a particular issue for older people in care settings. Poor oral health can also disrupt speech and sleep, and can affect self-esteem, psychological and social wellbeing, and impact general quality of life.
A growing body of research indicates that poor oral health is associated with many other diseases. For example, poor oral health is associated with heart and lung infections, stroke, and aspiration pneumonia. These all add to the costly health burden in Aged Care, however they can easily be avoided.
There are some very simple strategies for reducing the under-detected problem of poor oral health among Aged Care residents. Oral Health Screening is easy for general health professionals to learn, including residential care workers and nurses. This simple check can identify where oral health problems exist and, when carried out when a person first enters residential care, allows an oral health plan to be integrated into the resident’s overall care plan. Screening may also identify the need for referral for treatment, or identify the need for better attention to oral hygiene.
There are several tools available online to train residential care workers in techniques for getting people to look after their own mouths or for learning how to brush or apply oral health products. There are also aids available to assist with brushing. Advice about medications and dry mouth from oral health professionals and pharmacists may also be included in care plans. Public and private oral health professionals are able to assist with treatment options for people living in residential care.
Simple organisational changes in residential care settings across Australia have demonstrated that incorporating oral health into care planning makes a vast difference to the lives of older people living in care.
So, if you know an older person who is in an Aged Care facility, ask a few simple questions about their Oral Health Plan, advocate for the importance of maintaining good oral health, and make a difference for older people like Mary who are suffering from undiagnosed oral health issues. Turn on the smiles of all older people living in residential care.
As featured on Aged Care Insite – www.agedcareinsite.com.au – September 2017