The ongoing Royal Commission into Aged Care Quality and Safety has highlighted several shocking deficiencies in the care of older Australians including the lack of oral care, writes Dr Kathleen Matthews.
Among the measures in urgent need of addressing is the significant lack of oral care provisions for older Australians being cared for at home or living in residential aged care facilities.
So why is it a problem? In a nutshell, good oral health is an essential part of general health, whatever your age.
Poor oral health can contribute to potentially life-threatening cardiovascular and respiratory diseases, Type 2 Diabetes and pneumonia among older people.
In addition, while Medicare currently looks after the general health of our older adults, the mouth gets left behind. There is no Medicare-funded dental service for older Australians, leading to gaps in access and exacerbating risks to health.
While other allied health services such as podiatry and occupational therapy are provided via Medicare to older Australians, there are no such provisions for oral health. And with the number of Australians aged 85 years projected to double by 2042 to more than one million, the problem will only increase.
Residential aged care facility staff and carers in the community do a terrific job looking after older Australians, but they are not trained oral health professionals. They need education to enable them to provide those vital daily oral hygiene provisions for residents when needed.
With anecdotal evidence abounding of residents in aged care homes being left with untreated debilitating oral conditions, mouldy toothbrushes and other unacceptable conditions, it is clear something must be done urgently.
In its submission to the royal commission, the Australian Dental Association NSW has made several recommendations which it believes will go a long way to addressing the current situation.
Chief among them is the need for a Medicare-funded oral health assessment by a registered dental practitioner for residents aged 75 and over, to facilitate regular oral health visits.
Every resident entering a residential aged care facility must have an oral health assessment by a registered dental practitioner to inform their oral hygiene measures, while all older adults should have an appropriate oral health care plan and referral pathway identified for them, whether they are community-dwelling or living in an aged care facility.
In addition, a registered dental practitioner should be made available during admissions to in-patient geriatric hospital wards to provide an oral health assessment and educate family members and carers, help make oral care plans and provide tips and information on preserving oral health.
There are currently several programs running in NSW providing oral health services to older Australians, varying from public to private. Modelling has shown these programs, such as the Senior Smiles Program currently running in Newcastle and the Central Coast, would provide cost-effective and social benefits if implemented further.
Access to appropriate oral health care services is a not a privilege but a basic human right, but this is currently not the case for a large proportion of the older Australian adult proportion.
With the economic impact of poor oral health on older Australians estimated to be in the hundreds of millions of dollars, this is an unnecessary drain on our health resources that must be addressed.
It is time to urgently stop the rot and ensure that oral health is made a priority for our elderly. ADA NSW’s recommendations will, if implemented, help achieve that aim.
Read ADA NSW’s submission to the royal commission here and its recommendations here.
Dr Kathleen Matthews is a dentist based in the NSW Riverina and vice-president of ADA NSW, the peak body representing the dentistry profession in NSW and the ACT.
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A vital issue.
Dental are would need to be funded by Medicare of through aged care funding. Aged Pensioners simply could not afford the care. Dentists need training in supporting people with dementia. Dental care would either need to be hospital admission or a home visit if the person is in residential care. In rural areas dentists will not visit the home.
My mother went into aged care 5 years ago at the age of 85. She had all her own teeth and had been meticulous in her life with oral care. She always flossed as well. Now, at 90 years of age, mum has one front tooth left. She went into care for care and assistance. With crippled hands she was no longer able to clean her own teeth. Often forgotten in aged care. Very sad to see her with one tooth left. Ps she does not want dentures.
Studies have indicated that oral care could be improved in the residential facilities through:
supervised oral care and education to improve the staff’s knowledge, provision of poster of guidelines on the process of oral care and toothbrush and toothpaste must be available to the residents. However these interventions may have limited outcomes in residents with reduced muscle strength.
Some studies have found that adequate oral hygiene improves the residents’ quality of life through improved oral health and reduced cost to the health care system due to reduced dental-related hospital admission of elderly.