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After many years of advocacy, momentum is growing to improve the dental care for older Australians. By Cameron Cooper
For more than a decade, Dr Janet Wallace has backed the cause for better oral health outcomes for older Australians. So when the Royal Commission into Aged Care Quality and Safety recently recommended that at least one oral health practitioner be assigned to every aged care provider in Australia, she was overwhelmed.
“I was near to tears when I read it,” says Dr Wallace, an Associate Professor in Oral Heath at the University of Sydney. “We know this will make a difference for our frail and elderly.”
Dr Wallace is the architect of the Senior Smiles program, which provides preventive oral health care in residential aged care facilities. She is among a cohort of dental professionals across Australia who have raised the alarm over the detrimental impact that poor dental care for older adults is having on their overall wellbeing and quality of life. This can lead to other health issues such as malnourishment, falls and aspiration pneumonia. “It has huge knock-on effects,” Dr Wallace says.
The Australian Government has pledged $452 million to help address chronic problems in the nation’s aged care sector following the royal commission’s report.
While it is not yet clear how much of this money will be spent on dental services, the commissioners made a number of recommendations that could enhance the delivery of oral healthcare for the elderly.
In addition to the call for oral health practitioners in aged care centres, it endorsed a Seniors Dental Benefits Scheme to start no later than January 2023 that would fund dental services for those in care, or for eligible older Australians living in the community. More education and training to improve the aged care workforce was also suggested.
Australian Dental Association New South Wales president Dr Kathleen Matthews says the key now is for such proposals to be well-designed, properly implemented and extensively promoted. “This needs to involve all stakeholders—patients, health practitioners, families and aged care providers,” she says. “If the model is not well-designed, it runs the risk of not being fit for purpose.”
Dr Matthews notes that one in five Australians aged 65 and over have not seen a dental practitioner for two years, despite 60 per cent of over-65s suffering moderate or severe gum disease. Yet research shows that if the elderly clean their teeth properly and access preventive care, the incidence of deadly side effects such as aspiration pneumonia drops significantly. “So there’s science around this, but for me it’s also about dignity for the elderly.”
Although he welcomes the royal commission’s report, St Vincent’s Hospital Dental Department’s head dentist Dr Peter Foltyn is adamant that a crucial issue has not been addressed in the findings—that is, a lack of understanding of the mouth by Australian medical GPs who are the gatekeepers of oral health, not dentists.
“When somebody is in later life it’s mainly the medical GP who is contacted about health issues and the mouth is rarely considered by them as being relevant,” he says.
This can lead to scenarios such as GPs making a presumptive diagnosis of urinary tract infection in patients with poor cognition when actually there is a dental abscess present, or dementia patients facing an increased risk of falls from episodes of delirium caused by a failure to identify infected teeth. “This means we need to better educate our medical profession about oral health—and quickly,” Dr Foltyn says.
Calling for greater funding of mobile dental services as part of the solution for the provision of dental care in aged care facilities, Dr Foltyn also notes that the royal commission has not addressed two worthy suggestions: oral health assessment as part of the aged care assessment team (ACAT) program, and mandatory dental check-ups for over-75s receiving a residential aged care or home package.
Dr Angie Nilsson, clinical director of Townsville Oral Health Service at Queensland Health, has long lamented that patients’ oral health often slips when they move into aged care centres. “Who was looking after their dental care? No-one,” she says.
Dr Nilsson hopes the Seniors Dental Benefits Scheme will especially assist the frail and care-dependent who cannot physically attend a regular dental surgery. As efforts ramp up to fix a struggling system, she points to barriers such as the rapid turnover of staff at aged care centres and the low oral health literacy of staff who may neglect their own oral care. “If you’ve got carers who can’t look after their own teeth, how do we expect them to look after someone who may be combative with dementia?” she asks.
Dr Nilsson favours dedicated dental surgeries at care centres and supports the use of qualified “champions” within care environments who can liaise with centre managers, patients and dentists and coordinate care. “Without such a person, even just getting consent for the patient to have treatment can be difficult.”
As the dental sector weighs up oral healthcare options for the aged, Senior Smiles acts as a blueprint.
Economic analysis of the program estimates that for every $1 spent on preventive oral health care in residential aged care, it provides $2.40 in benefits to the healthcare system and an additional $3.18 in social benefits.
Dr Wallace says the presence of a qualified dental professional working within the Senior Smiles model in residential aged care facilities serves to educate staff about residents’ dental needs and quickly facilitates access to appropriate dental treatment.
Senior Smiles aside, other models also provide a way forward for improving access to dental treatment and educating aged care staff, including Resi-DENTAL in the Hunter New England local health district in NSW, and Reach-OHT, an initiative of the Inner West Oral Health Outreach Program in Sydney.
Australia can also learn from overseas, according to Dr Foltyn, who notes that in Sweden aged care workers receive decent wages and enjoy respect from the community. The result is that staff stay in the system for many years and develop real knowledge and the capacity to liaise with doctors, dentists and patients about oral healthcare. “In Australia, we pay our aged care staff very poorly and a lot of them are overworked,” Dr Foltyn says.
Dr Nilsson says the fight for better oral care for the elderly is a “long journey”, but she is encouraged that the issue is now being seriously acknowledged at government levels courtesy of the royal commission. “That’s an important start.”
At ADA NSW, Dr Matthews says dentists stand ready to keep advocating for what is an important professional and community issue.
“We need to keep shining the light on the oral health of the elderly.”