Solving an age-old problem

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Kosta Cotsonis of HammondCare.
Kosta Cotsonis of HammondCare.

Many residents in aged care facilities face oral health problems. Find out how HammondCare is responding to the issue and what you can do to help. By Charmaine Teoh.

With many studies linking poor oral health with conditions such as cardiovascular disease, diabetes, and respiratory disorders, there is an urgent need for aged care facilities to look after their residents’ teeth and gums.

Unfortunately many facilities lack the knowledge and resources to provide dental education, treatment and management programs. Carers also have limited oral health knowledge and competencies that make it difficult for them to monitor and treat common oral health conditions. No matter how old we are, we should be staying on top of our oral hygiene.

Compounding these issues is the fact most residents come from a time when oral health was not considered important. They may not have seen a dentist for several years or hold outdated ideas such as wearing their dentures overnight instead of taking them out.

Most residents would typically only see a dentist if they are mobile and have relatives who can take them. Those who don’t have families or have behavioural issues would rarely have the opportunity to visit a dental practice. It can also be difficult to access specialist oral health services. Referrals can take a long time to process, by which time a resident’s condition may have deteriorated or they may even have passed away.

“The harsh reality is that many aged care residents are at risk of developing health issues due to their poor oral health,” says Kosta Cotsonis, oral health officer for HammondCare, an independent Christian charity specialising in aged care, dementia, palliative care and rehabilitation. “That’s why it’s so important we target oral health now and put preventative measures in place, so we can limit the need for urgent referrals and improve the quality of life for people.”

To address oral health issues among aged care residents, the Australian Government launched the Better Oral Health in Residential Care training program in 2009. The program aimed to increase awareness of oral hygiene issues and was rolled out to 4885 staff members in 2809 aged care homes, multi-purpose services and Indigenous flexible care services.

The training included standard protective oral hygiene, such as proper brushing, preventing gum disease and reducing tooth decay and ulcers; brushing techniques for residents with challenging behaviours, and dental care for people at the palliative stage. In addition, registered nurses and trainers were provided with the skills and tools to undertake oral health assessments, oral health care planning and dental referrals.

One issue with the program was that nurses and carers had no-one to turn to if they wanted to refer residents, or check that they were providing the right treatment. While steps are being taken to address this issue, there needs to be an oral health ‘champion’ at aged care facilities whom staff can approach if they have questions.

At HammondCare, that person is Cotsonis. Initially employed to coordinate the facility’s dental student placement program, HammondCare quickly discovered that Cotsonis—a qualified oral health therapist—could provide
immediate, informed advice on oral health issues.

As HammondCare’s Oral Health Officer, Cotsonis has three areas of responsibility: educating staff about oral hygiene practices; detecting and preventing oral health issues among residents; and providing advice on clinical treatment and management.

According to Cotsonis, education is a priority. “Nurses often say to me that they never received any specific instructions on oral health care during their training,” he says. “We teach staff about common oral health conditions and how to perform oral health assessments. They also learn how to instil good dental health habits in residents, as well as strategies to manage difficult behaviours.”

Cotsonis is also developing an oral health education package tailored to residents receiving rehabilitation, palliative, dementia, hospital, and home and community care. The learning and development team at each HammondCare facility will deliver the information to nurses and carers. There are also plans to hold monthly workshops to reinforce key messages.

One of Cotsonis’ first tasks was to review HammondCare’s oral health policies and procedures and update them to include Better Oral Health in Residential Care guidelines. He also worked with management to introduce new oral health screening protocols.

For example, when a resident is admitted to HammondCare, they undergo a basic oral care screening. “Staff look inside the resident’s mouth and note down any concerns they might have,” explains Cotsonis. “The training we provide shows them what to look for and how to complete the screening form. This allows staff to better communicate their queries to myself or our local dental professionals.”

Residents living at the facility and in their own home are put on a care plan to help them manage their existing oral health issues and prevent others from developing. Their oral health is assessed every six to 12 months, and they are taught good oral health behaviours.

“Eventually we will get to a stage where we can provide dental treatment for our residents, but for now we’re focusing on managing the disease and looking for ways to prevent it in the first place,” says Cotsonis.

Dentists can play an important role in helping residents with their oral health. As only a handful of them can make the trip to a dental surgery, it’s no surprise most aged care facilities would jump at the chance to receive an on-site visit from a dentist. In New South Wales, dentists can register with the Oral Health Fee for Service Scheme to receive compensation for assessing, treating and providing oral health services to residents.

While it is ideal to have an on-site dental clinic, Cotsonis says oral health assessments and oral health care planning can be achieved without one.

“Poor hand dexterity and self-efficacy with oral care is very common among residents in the aged care sector,” he says. “This is why observing and evaluating the residents’ oral hygiene routine alone can truly make a huge difference. Providing oral hygiene instructions will help empower residents and staff to make positive oral health choices.

“Oral health among the aged is a complex issue and must be tackled as early as possible,” Cotsonis says. “Studies suggest that people already have oral health conditions well before they are admitted into residential care. Dentists should advocate good oral health practices with their patients, no matter what age they are. If they enter an aged care facility later on, they will have established oral health habits and their teeth and gums will be as healthy as they can be,” says Cotsonis.

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