J. Dent. 1992;
20:
167-l
167
70
Provision of domiciliary dental care for the older person by general dental practitioners in Scotland R. Bedi, H. Devlin*,
J. F. McCord*
University of Birmingham, Department of Restorative
and J. W. Schoolbreadt
Dental Hospital of Manchester, Department of Child Dental Health, *University Dentistry, Manchester and tscottish Dental Practice Board, Edinburgh
ABSTRACT The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided. via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P < 0.001). In Scotland, approximately 1 per cent of70-79-year-old patients and 2 per cent ofpatients over 80 years received domiciliary dental care over a I-year period. For those elderly people who received such care, the mean percentage doubled for every S-year increase in patient age. KEY WORDS:
Dental practice, Gerodontology
J. Dent. 1992; 20: October 199 1)
167-I
70
(Received
17 June
1991;
reviewed
18 September
Correspondence should be addressed to: Dr J. F. McCord, Department Dental Hospital of Manchester, Higher Cambridge Street, Manchester
INTRODUCTION of this paper is to describe the domiciliary treatment provided for the older person (over 70 years of age) by general dental practitioners in Scotland, under the National Health Service (NHS), from 1 October 1987 to 30 September 1988. Elderly persons are considered the least likely of any age group to utilize dental services, and impaired mobility may discourage individuals who both need and desire dental care (Gordon, 1972; Kiyak, 1989). It has been established that there are wide variations, depending on the age of the elderly person, in both the amount and type of dental care provided (Bedi et al.. 1992); those over 85 years of age received less overall dental care than might be expected from the overall population distribution. This may be due, in part, to the fact that this older age group is less mobile as a result of disability and ill health. In order that dental care of older patients could be ascertained, it was decided that an analysis of courses of dental
The
aim
@ 1992 Butterworth-Heinemann 0300-5712/92/030167-04
Ltd.
1991;
accepted
of Restorative Dentistry, Ml 5 6FH. UK.
24
University
treatment registered with the Scottish Dental Practice Board (SDPB) was necessary. To date, there have been few published analyses of domiciliary care for the elderly in Scotland, other than the summary of data from the SDPB. General Dental Service Regulations (I 990) regarding domicilialy visits: Patients with medically associated problems of mobility are entitled to domiciliary dental care but if these patients are not registered with a practice then no dentist is legally obliged to provide such a service. If a patient is under current treatment when his/her condition makes a domiciliary visit necessary, or if the dental practitioner has contracted to provide continuing care over two years, ‘a dentist shall visit and treat a patient whose condition so requires at the place at which the patient normally resides or is temporarily resident provided that such place is not more than five miles from his practice premises’. For such
168
J. Dent 1992; 20: No. 3
Tab/e 1. Number of courses of treatment practitioners in Scotland, 1987-88
Age of patient
No. of courses of treatment provided
(yrl 70-74 75-79 80-84 85+ Total
(%) 69970 (48.5) 45 928 (31.8) 22227 (15.4) 6168 144293
for older patients by general dental
No. of courses of treatment provided under domiciliary care
96 of courses of treatment provided under domiciliary care
810
1.2
1097
2.4
1239
5.6
(4.3)
797
12.9
(100)
3943
2.7
Tab/e II. Number of treatment items for older persons by age of dentist
No. of registered dentists
No. of dentists providing care for patients > 70 years
No. of dentists providing domiciliary care for patients > 70 years
< 30 30-39 40-54 55 +
1003 772 598 281
617 553 467 215
314 297 282 119
Total
2654
1852
1012
Age of dentist iyrl
a visit no charge is levied on the patient. The dentist is entitled to an additional fee for these visits. Ifthe patient is at a location which is more than five miles from the dentist’s surgery, then a general dental practitioner has no legal obligation to provide domiciliary treatment. The fees payable for domiciliary visits under NHS arrangements are assessed according to the total distance travelled, i.e. the mileage necessitated solely for the purpose of the visit to the patient (circuit). If more than one patient is visited during a circuit, the fee should be claimed on the estimate for the last patient visited.
METHODS
AND MATERIALS
Information on the domiciliary dental care by general dental practitioners (GDPs) in Scotland was obtained from the SDPB, as part of an overall study to determine the provision of dental care for the elderly in Scotland. Details of this study have been reported previously (Bedi et al.. 1992). All treatment items provided under (NHS) domiciliary care for patients over 70 years of age, from October 1987 to September 1988, were determined.
Statistical
methods
To allow meaningful comparisons across the different age groups of older persons, the Scottish National Population Statistics (1988) were assessed to determine the proportion of individuals within each age group for the year 1988. Patients were grouped in one of four age categories: 70-74 years, 75-79 years, 80-84 years and > 85 years of age.
Similarly, for the purposes of description, dentists divided into four categories according to age: 1 2 3 4
< 30 years 30-39 years 40-54 years 55 years of
were
of age of age of age age and over
In this form, contingency tables were constructed to consider the type and frequency of domiciliary care provided, by the age of the dentist and the age of the patient receiving treatment. A domiciliary visit was considered according to the three categories of fee that could be claimed depending on the circuit travelled: up to 10 miles, lo-40 miles and > 40 miles. A chi-squared test of trend of populations was used to determine whether the age of dentist or patient affected the type of domiciliary care provided. The analysis of proportions in samples with intrinsic order was carried out as described by Fleiss (1981), to ensure a more powerful statistical test.
RESULTS The number of people in Scotland aged 75 years and over has increased from 1981 to 1988; in the 1988 population estimate for Scotland the figure was 505 465 (9.91 per cent of the total population). Over the same period, there has been a larger increase (33 per cent) in the number of those aged 80 years and over (167 276 or 3.28 per cent of the total population). If these national statistics are viewed in conjunction with the SDPB data, it can be estimated that
Bedi et a/.: Domiciliary
care of older patients
169
Table 111.Number of domiciliary visits made per age of patient and age of dentist Distance of circuit and number of circuits/claims < 10 miles 7O-40 miles > 40 miles 7 2 3 7 2 3 7 2 Age of patient (yr) 70-74 75-79 80-84 85 +
307 376 480 269
288 450 494 323
559 822 885 651
19 31 19 22
16 24 23 29
20 51 38 58
Ag; c&dentist (yr) 30-39 40-54 > 55
426 404 423 179
496 416 499 144
1010 817 775 315
34 24 27 6
25 35 27 5
50 51 44 22
Total
z 2 2
172 12 10
1223 1759 1953 1364
2 7
7 18
2050 1772
5 1
1803 674
;
Tab/e IV. Type of domiciliary care provided for older patients in Scotland No. of items by age of parienrs yr 75-79 yr 80-84 yr > 85 yr
70-74 Examination Oral surgery Extractions Minor oral surgery Arrest haemorrhage Restorative care Crowns Endodontics Amalgam restorations alone Glass ionomer restorations Scaling Replacement dentures Dentures started but not inserted Reline (either one or two dentures) Repairs (acrylic) Eases/adjustments Emergency care Dressing Dry socket Sensitive denture
644
927
1017
530
Total 3118
96 3 6
104 1 5
121 1 1
56 1 1
377 6 13
6 7
6 6
2 1
3 5
17 19
29
23
18
10
80
14
15
19
11
59
47 371
56 534
49 551
25 250
177 1706
25
32
26
24
107
48
74
92
62
276
46 3
63 7
91 7
53 8
253 25
7 1
6
10 4 4
-
less than 1 per cent of those aged 70-79 years of age and approximately 2 per cent of those aged 80 and over received domiciliary dental care, although the percentages from the SDPB relate to courses oftreatment and not a per capita basis. Table Z lists the number of domiciliary items of treatment provided, according to the age of the patient. For each of the patient age groups studied, there was a significant difference in the proportion of patients in each group receiving domiciliary care (P < 0.001. d.f. = 3). From Table I, it can be seen that the percentage of items provided under domiciliary care, within the NHS, approximately doubles for each 5-year increase in age of the elderly. Two-thirds of registered dentists in Scotland are under 40 years of age (Table II). Whereas 34 per cent of dentists aged < 40 years provided domiciliary care, a larger
:,
26 6 13
percentage (46 per cent) of dentists aged > 40 years provided domiciliary care (P < 0.001). For each of the dentist age groups studied, the proportion of dentists in each age group providing domiciliary treatment, for those patients over 70 years of age, was statistically significant (P < 0.001, d.f. = 3). The overall number of domiciliary visits provided for those aged 70-79 years (n = 2982) was similar to the number (II = 3317) of visits to patients aged 80 years and over and is listed in Table III. There was no significant difference in the distance travelled by dentists (< 10 miles, lo-40 miles and > 40 miles) when attending each of these age groups of patients (P > 0.05 d.f. = 2); Table ZZZ indicates that 93.7 per cent of domiciliary visits are in circuits less than 10 miles. The main items of treatment provided during domiciliary visits are set out in Table IV. Other than examinations,
170
J. Dent.
1992;
20:
No. 3
prosthodontic
items formed a large proportion (17 per with replacement dentures claimed on 1706 of occasions (12 per cent). Extractions accounted for 307 items (3 per cent). cent) of the treatment,
DISCUSSION The proportion of the elderly population of Scotland in need of domiciliary care is unknown, although it would appear that 65 per cent of a sample of institutionalized elderly people in North-west England are professionally perceived to require dental care (Hoad-Reddick et al.. 1987). Hunt (1978) claimed that, in an English population, 20 per cent of those over 8.5 years of age were housebound or bedfast. If similar figures are applicable to the Scottish population in 1991, many more individuals in this age group might require dental care via domiciliary visits. Patient-perceived need for dental care is considered to be a strong predicting factor as to whether dental services are sought by an individual (Osborne et al., 1979). Some surveys have indicated that not all elderly persons with dental problems seek dental care (Kail and Silver. 1984; Palmquist, 1989). Impaired mobility is a major discouragement to patients seeking treatment (Hamilton et al., 1990) and many less mobile elderly people are unaware that edentulous subjects require regular dental inspections (40 per cent in a sample by Diu and Gelbier, 1989). For the above reasons, there is a far greater need for domiciliary services for those aged 70 years of age and over, especially those aged over 85 years of age. Less than half of the latter age group are able to go out without assistance and, in consequence, may suffer the added indignity of social isolation (MacEntee et al.. 1987). Although, in some surveys, many dentists claim to provide domiciliary care (Hamiltonetal.. 1990). this study demonstrates that a higher percentage of older (i.e. > 40 years of age) dentists provide domiciliary care. This could be because older dentists have been settled in one practice for many years and assume domiciliary care of their patients as they become older. This concept is substantiated by studies in the USA which have indicated that dentists who graduated prior to 1980 were more likely to be consulting patients in nursing homes than those dentists who graduated after this date (Ettinger et al.. 1990), although it could also be argued that older dentists had more time to visit nursing
may also be that younger attending
elderly
patients
homes
than
dentists because
younger
dentists.
are inhibited of a negative
It
from attitude
towards findings
elderly patients (Sheiham et al., 1986). If the of this study are to be improved upon, further
education required,
in gerontology and domiciliary techniques are if not in the undergraduate curriculum, then in
postgraduate
education.
CONCLUSION It is concluded that the need for provision of domiciliary dental care to older patients will increase considerably in the next decade. Although national figures for domiciliary visits performed by community dental officers and by practitioners under private contract are not available, the former is likely to increase considerably, in parallel with the need to educate the public and carers. In addition, it is likely that retraining courses in restorative dentistry will be necessary for some of the aforementioned officers. If the older population are to maintain oral health and dignity then the provision of domiciliary care needs to be further evaluated, especially at the first anniversary of the contract system.
References Bedi R., Devlin H., McCord J. F. et al. (1992) Dental care provided for the older person by Scottish General Dental Practitioners. Health Bull. (in press). Diu S. and Gelbier S. (1989) Oral health screening of elderly people attending a community care centre. Community Dent. Oral Epidemiol. 17, 212-215. Ettinger R. L.. McLeran H. and Jakobsen J. (1990) Effect of a geriatric educational experience on graduate activities and attitudes. J. Dent. Educ. 54, 273-278. Fleiss L. (1981) Stafistical Methods for Rates and Proportions. 2nd edn. New York: Wiley-Interscience, pp. 138-146. Gordon R. H. (1972) Meeting needs of the aged. Am. J. Public Health 62, 385-388. Hamilton F.. Grant A. A. and Worthington H. J. (1990) Dental care for elderly people by general dental practitioners. Br. Dent. J. 168, 108-l 12. Hoad-Reddick G.. Grant A. A. and Griftiths C. S. (1987) Knowledge of dental services provided: investigations in an elderly population. Community Dent. Oral Epidemiol. 15, 137-140. Hunt A. (1978) The Elderly at Home. A Study of People Aged 65 Years and Over Living in the Community 1976. OPCS. London, HMSO.
in England
in
Kail P. and Silver M. M. (1984) Dental demands of elderly people living at home in Hertfordshire. Br. Dent. J. 157, 94-97.
Kiyak H. A. (1989) Reducing barriers to older persons’ use of dental services. Int Dent. J. 39, 95-102. MacEntee M. I., Weiss R.. Waxler-Morrison B. J. et al. (1987) Factors affecting oral health in long term care facilities. Community Dent. Oral Epidemiol. 15, 314-316. Osborne J., Maddick I., Gould A. et al. (1979) Dental demands of old people in Hampshire. Br. Dent. J. 146, 351-353. Palmquist S. (1989) Utilisation of dental services in an elderly population. Swed. Dent. J. 13, 61-68. Scottish National Population Statistics (1988) Population Estimates, Scotland. Registrar General for Scotland. London, HMSO. Sheiham A., Ettinger R. L. and Beck J. D. (1986) English dental students’ attitudes towards the aged. Gerodontics 2. 142-146.
20:
167-l
167
70
Provision of domiciliary dental care for the older person by general dental practitioners in Scotland R. Bedi, H. Devlin*,
J. F. McCord*
University of Birmingham, Department of Restorative
and J. W. Schoolbreadt
Dental Hospital of Manchester, Department of Child Dental Health, *University Dentistry, Manchester and tscottish Dental Practice Board, Edinburgh
ABSTRACT The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided. via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P < 0.001). In Scotland, approximately 1 per cent of70-79-year-old patients and 2 per cent ofpatients over 80 years received domiciliary dental care over a I-year period. For those elderly people who received such care, the mean percentage doubled for every S-year increase in patient age. KEY WORDS:
Dental practice, Gerodontology
J. Dent. 1992; 20: October 199 1)
167-I
70
(Received
17 June
1991;
reviewed
18 September
Correspondence should be addressed to: Dr J. F. McCord, Department Dental Hospital of Manchester, Higher Cambridge Street, Manchester
INTRODUCTION of this paper is to describe the domiciliary treatment provided for the older person (over 70 years of age) by general dental practitioners in Scotland, under the National Health Service (NHS), from 1 October 1987 to 30 September 1988. Elderly persons are considered the least likely of any age group to utilize dental services, and impaired mobility may discourage individuals who both need and desire dental care (Gordon, 1972; Kiyak, 1989). It has been established that there are wide variations, depending on the age of the elderly person, in both the amount and type of dental care provided (Bedi et al.. 1992); those over 85 years of age received less overall dental care than might be expected from the overall population distribution. This may be due, in part, to the fact that this older age group is less mobile as a result of disability and ill health. In order that dental care of older patients could be ascertained, it was decided that an analysis of courses of dental
The
aim
@ 1992 Butterworth-Heinemann 0300-5712/92/030167-04
Ltd.
1991;
accepted
of Restorative Dentistry, Ml 5 6FH. UK.
24
University
treatment registered with the Scottish Dental Practice Board (SDPB) was necessary. To date, there have been few published analyses of domiciliary care for the elderly in Scotland, other than the summary of data from the SDPB. General Dental Service Regulations (I 990) regarding domicilialy visits: Patients with medically associated problems of mobility are entitled to domiciliary dental care but if these patients are not registered with a practice then no dentist is legally obliged to provide such a service. If a patient is under current treatment when his/her condition makes a domiciliary visit necessary, or if the dental practitioner has contracted to provide continuing care over two years, ‘a dentist shall visit and treat a patient whose condition so requires at the place at which the patient normally resides or is temporarily resident provided that such place is not more than five miles from his practice premises’. For such
168
J. Dent 1992; 20: No. 3
Tab/e 1. Number of courses of treatment practitioners in Scotland, 1987-88
Age of patient
No. of courses of treatment provided
(yrl 70-74 75-79 80-84 85+ Total
(%) 69970 (48.5) 45 928 (31.8) 22227 (15.4) 6168 144293
for older patients by general dental
No. of courses of treatment provided under domiciliary care
96 of courses of treatment provided under domiciliary care
810
1.2
1097
2.4
1239
5.6
(4.3)
797
12.9
(100)
3943
2.7
Tab/e II. Number of treatment items for older persons by age of dentist
No. of registered dentists
No. of dentists providing care for patients > 70 years
No. of dentists providing domiciliary care for patients > 70 years
< 30 30-39 40-54 55 +
1003 772 598 281
617 553 467 215
314 297 282 119
Total
2654
1852
1012
Age of dentist iyrl
a visit no charge is levied on the patient. The dentist is entitled to an additional fee for these visits. Ifthe patient is at a location which is more than five miles from the dentist’s surgery, then a general dental practitioner has no legal obligation to provide domiciliary treatment. The fees payable for domiciliary visits under NHS arrangements are assessed according to the total distance travelled, i.e. the mileage necessitated solely for the purpose of the visit to the patient (circuit). If more than one patient is visited during a circuit, the fee should be claimed on the estimate for the last patient visited.
METHODS
AND MATERIALS
Information on the domiciliary dental care by general dental practitioners (GDPs) in Scotland was obtained from the SDPB, as part of an overall study to determine the provision of dental care for the elderly in Scotland. Details of this study have been reported previously (Bedi et al.. 1992). All treatment items provided under (NHS) domiciliary care for patients over 70 years of age, from October 1987 to September 1988, were determined.
Statistical
methods
To allow meaningful comparisons across the different age groups of older persons, the Scottish National Population Statistics (1988) were assessed to determine the proportion of individuals within each age group for the year 1988. Patients were grouped in one of four age categories: 70-74 years, 75-79 years, 80-84 years and > 85 years of age.
Similarly, for the purposes of description, dentists divided into four categories according to age: 1 2 3 4
< 30 years 30-39 years 40-54 years 55 years of
were
of age of age of age age and over
In this form, contingency tables were constructed to consider the type and frequency of domiciliary care provided, by the age of the dentist and the age of the patient receiving treatment. A domiciliary visit was considered according to the three categories of fee that could be claimed depending on the circuit travelled: up to 10 miles, lo-40 miles and > 40 miles. A chi-squared test of trend of populations was used to determine whether the age of dentist or patient affected the type of domiciliary care provided. The analysis of proportions in samples with intrinsic order was carried out as described by Fleiss (1981), to ensure a more powerful statistical test.
RESULTS The number of people in Scotland aged 75 years and over has increased from 1981 to 1988; in the 1988 population estimate for Scotland the figure was 505 465 (9.91 per cent of the total population). Over the same period, there has been a larger increase (33 per cent) in the number of those aged 80 years and over (167 276 or 3.28 per cent of the total population). If these national statistics are viewed in conjunction with the SDPB data, it can be estimated that
Bedi et a/.: Domiciliary
care of older patients
169
Table 111.Number of domiciliary visits made per age of patient and age of dentist Distance of circuit and number of circuits/claims < 10 miles 7O-40 miles > 40 miles 7 2 3 7 2 3 7 2 Age of patient (yr) 70-74 75-79 80-84 85 +
307 376 480 269
288 450 494 323
559 822 885 651
19 31 19 22
16 24 23 29
20 51 38 58
Ag; c&dentist (yr) 30-39 40-54 > 55
426 404 423 179
496 416 499 144
1010 817 775 315
34 24 27 6
25 35 27 5
50 51 44 22
Total
z 2 2
172 12 10
1223 1759 1953 1364
2 7
7 18
2050 1772
5 1
1803 674
;
Tab/e IV. Type of domiciliary care provided for older patients in Scotland No. of items by age of parienrs yr 75-79 yr 80-84 yr > 85 yr
70-74 Examination Oral surgery Extractions Minor oral surgery Arrest haemorrhage Restorative care Crowns Endodontics Amalgam restorations alone Glass ionomer restorations Scaling Replacement dentures Dentures started but not inserted Reline (either one or two dentures) Repairs (acrylic) Eases/adjustments Emergency care Dressing Dry socket Sensitive denture
644
927
1017
530
Total 3118
96 3 6
104 1 5
121 1 1
56 1 1
377 6 13
6 7
6 6
2 1
3 5
17 19
29
23
18
10
80
14
15
19
11
59
47 371
56 534
49 551
25 250
177 1706
25
32
26
24
107
48
74
92
62
276
46 3
63 7
91 7
53 8
253 25
7 1
6
10 4 4
-
less than 1 per cent of those aged 70-79 years of age and approximately 2 per cent of those aged 80 and over received domiciliary dental care, although the percentages from the SDPB relate to courses oftreatment and not a per capita basis. Table Z lists the number of domiciliary items of treatment provided, according to the age of the patient. For each of the patient age groups studied, there was a significant difference in the proportion of patients in each group receiving domiciliary care (P < 0.001. d.f. = 3). From Table I, it can be seen that the percentage of items provided under domiciliary care, within the NHS, approximately doubles for each 5-year increase in age of the elderly. Two-thirds of registered dentists in Scotland are under 40 years of age (Table II). Whereas 34 per cent of dentists aged < 40 years provided domiciliary care, a larger
:,
26 6 13
percentage (46 per cent) of dentists aged > 40 years provided domiciliary care (P < 0.001). For each of the dentist age groups studied, the proportion of dentists in each age group providing domiciliary treatment, for those patients over 70 years of age, was statistically significant (P < 0.001, d.f. = 3). The overall number of domiciliary visits provided for those aged 70-79 years (n = 2982) was similar to the number (II = 3317) of visits to patients aged 80 years and over and is listed in Table III. There was no significant difference in the distance travelled by dentists (< 10 miles, lo-40 miles and > 40 miles) when attending each of these age groups of patients (P > 0.05 d.f. = 2); Table ZZZ indicates that 93.7 per cent of domiciliary visits are in circuits less than 10 miles. The main items of treatment provided during domiciliary visits are set out in Table IV. Other than examinations,
170
J. Dent.
1992;
20:
No. 3
prosthodontic
items formed a large proportion (17 per with replacement dentures claimed on 1706 of occasions (12 per cent). Extractions accounted for 307 items (3 per cent). cent) of the treatment,
DISCUSSION The proportion of the elderly population of Scotland in need of domiciliary care is unknown, although it would appear that 65 per cent of a sample of institutionalized elderly people in North-west England are professionally perceived to require dental care (Hoad-Reddick et al.. 1987). Hunt (1978) claimed that, in an English population, 20 per cent of those over 8.5 years of age were housebound or bedfast. If similar figures are applicable to the Scottish population in 1991, many more individuals in this age group might require dental care via domiciliary visits. Patient-perceived need for dental care is considered to be a strong predicting factor as to whether dental services are sought by an individual (Osborne et al., 1979). Some surveys have indicated that not all elderly persons with dental problems seek dental care (Kail and Silver. 1984; Palmquist, 1989). Impaired mobility is a major discouragement to patients seeking treatment (Hamilton et al., 1990) and many less mobile elderly people are unaware that edentulous subjects require regular dental inspections (40 per cent in a sample by Diu and Gelbier, 1989). For the above reasons, there is a far greater need for domiciliary services for those aged 70 years of age and over, especially those aged over 85 years of age. Less than half of the latter age group are able to go out without assistance and, in consequence, may suffer the added indignity of social isolation (MacEntee et al.. 1987). Although, in some surveys, many dentists claim to provide domiciliary care (Hamiltonetal.. 1990). this study demonstrates that a higher percentage of older (i.e. > 40 years of age) dentists provide domiciliary care. This could be because older dentists have been settled in one practice for many years and assume domiciliary care of their patients as they become older. This concept is substantiated by studies in the USA which have indicated that dentists who graduated prior to 1980 were more likely to be consulting patients in nursing homes than those dentists who graduated after this date (Ettinger et al.. 1990), although it could also be argued that older dentists had more time to visit nursing
may also be that younger attending
elderly
patients
homes
than
dentists because
younger
dentists.
are inhibited of a negative
It
from attitude
towards findings
elderly patients (Sheiham et al., 1986). If the of this study are to be improved upon, further
education required,
in gerontology and domiciliary techniques are if not in the undergraduate curriculum, then in
postgraduate
education.
CONCLUSION It is concluded that the need for provision of domiciliary dental care to older patients will increase considerably in the next decade. Although national figures for domiciliary visits performed by community dental officers and by practitioners under private contract are not available, the former is likely to increase considerably, in parallel with the need to educate the public and carers. In addition, it is likely that retraining courses in restorative dentistry will be necessary for some of the aforementioned officers. If the older population are to maintain oral health and dignity then the provision of domiciliary care needs to be further evaluated, especially at the first anniversary of the contract system.
References Bedi R., Devlin H., McCord J. F. et al. (1992) Dental care provided for the older person by Scottish General Dental Practitioners. Health Bull. (in press). Diu S. and Gelbier S. (1989) Oral health screening of elderly people attending a community care centre. Community Dent. Oral Epidemiol. 17, 212-215. Ettinger R. L.. McLeran H. and Jakobsen J. (1990) Effect of a geriatric educational experience on graduate activities and attitudes. J. Dent. Educ. 54, 273-278. Fleiss L. (1981) Stafistical Methods for Rates and Proportions. 2nd edn. New York: Wiley-Interscience, pp. 138-146. Gordon R. H. (1972) Meeting needs of the aged. Am. J. Public Health 62, 385-388. Hamilton F.. Grant A. A. and Worthington H. J. (1990) Dental care for elderly people by general dental practitioners. Br. Dent. J. 168, 108-l 12. Hoad-Reddick G.. Grant A. A. and Griftiths C. S. (1987) Knowledge of dental services provided: investigations in an elderly population. Community Dent. Oral Epidemiol. 15, 137-140. Hunt A. (1978) The Elderly at Home. A Study of People Aged 65 Years and Over Living in the Community 1976. OPCS. London, HMSO.
in England
in
Kail P. and Silver M. M. (1984) Dental demands of elderly people living at home in Hertfordshire. Br. Dent. J. 157, 94-97.
Kiyak H. A. (1989) Reducing barriers to older persons’ use of dental services. Int Dent. J. 39, 95-102. MacEntee M. I., Weiss R.. Waxler-Morrison B. J. et al. (1987) Factors affecting oral health in long term care facilities. Community Dent. Oral Epidemiol. 15, 314-316. Osborne J., Maddick I., Gould A. et al. (1979) Dental demands of old people in Hampshire. Br. Dent. J. 146, 351-353. Palmquist S. (1989) Utilisation of dental services in an elderly population. Swed. Dent. J. 13, 61-68. Scottish National Population Statistics (1988) Population Estimates, Scotland. Registrar General for Scotland. London, HMSO. Sheiham A., Ettinger R. L. and Beck J. D. (1986) English dental students’ attitudes towards the aged. Gerodontics 2. 142-146.
