By Accountable Care Journal-
(Originally published 16 October 2018)
Pratik Patel BDS, Principal Dentist, Educational Supervisor with Health Education England and Co-Chair of Brent and Harrow Local Dental Committee, looks at Improving oral health for older people in care homes in Brent and Harrow.
It is my experience that despite the talk of holistic approaches to care, dentistry and oral health are often overlooked. A key group who can, as a result, suffer from neglect to their oral health are older adults, particularly older adults in care. In January 2018, Healthwatch identified access to NHS dentistry, particularly for older adults, as one of its six priorities for the NHS for the year, suggesting that the tide may finally be turning.
The true measure of any society can be found in how it treats its most vulnerable members. Older adults in care are one of the most vulnerable groups in our society. Most recent initiatives in oral health have been aimed at addressing the appalling and avoidable decay rates in children, but this focus has meant that vulnerable older people have almost been forgotten about. This is a state of affairs that Brent and Harrow LDC is determined to address for our local community. We are working closely with Brent Council, the Community Dental Services (CDS) and local care and nursing home providers to ensure that older people get the care they need to maintain good oral health, preserve their dignity and enjoy a life free from avoidable pain and discomfort.
More of our patients are keeping their teeth and having increasingly complex restorative procedures carried out, such as bridge work and implants, meaning the ageing population may find maintaining their oral hygiene more difficult. Age related and associated conditions, such as arthritis, Parkinson’s and dementia may also affect a person’s ability to self-manage their oral health. With the number of people living into old age increasing, a clear system and set of processes have to be established to ensure that access to oral health care is available.
Poor access to oral hygiene and care can lead to the development of avoidable conditions (such as aspiration pneumonia and malnutrition), not to mention lead to a significant reduction in the quality of life for an individual. The ability to eat, drink and socialise is part of the World Health Organisation’s definition of good dentition. The importance of oral health in social interaction cannot be overlooked. Lacking confidence to socialise will increase loneliness and isolation, which is associated with premature death, stroke and developing Alzheimer’s.
Those with Alzheimer’s or other dementias may find it difficult to communicate the fact they have oral pain or ill-fitting dentures. As a result they can be left in unnecessary pain and discomfort which can in turn lead to a range of negative behaviours. For this particularly vulnerable group, early interventions, prevention and oral health maintenance are especially important.
We know that care homes and carers face a huge number of conflicting and competing priorities in their fight to maintain the health and wellbeing of their charges. It is the aim of Brent and Harrow LDC to work with these groups to help alleviate the pressure and strain that poor oral health can cause.
Work has now begun with Brent Council, who introduced us to the Enhanced Health in Care Homes (EHCH) Steering Group Forum. There was representation from 15 local care home providers, CQC, Brent Council, Brent and Harrow CCG and St Luke’s Hospice. We raised awareness of the issues and tried to deal with current barriers homes are facing in enabling access to care. We have been invited to attend future EHCH meetings where we will continue to support providers and signpost them the relevant resources to help with the change.
Working with Public Health England and Health Education England on the group: Working towards dementia friendly dental practices in London, selected training resources have already been developed, which we will help distribute to local practitioners. We are also looking to help arrange a full day of training on dementia friendly dentistry for practitioners.
By increasing awareness of the problem and helping to provide relevant training we can start to change the existing culture surrounding this issue. With dentists working with local authorities, care providers and other clinical colleagues, we are confident that for this cohort of patients we can make holistic and patient centred care a reality in a shareable and sustainable model.