Later life care: a recipe for reform
The impact of oral health on wellbeing
When we consider the health and care needs of our older relatives, it’s unlikely that oral health features prominently in many people’s thoughts. Supporting older people to manage their health needs effectively is an essential part of enabling them to live independently, and the focus for many families and clinicians is often, quite rightly, on issues such as dementia, cancer and falls. However, the impact that oral health has on a person’s wellbeing, and indeed their broader health, should not be underestimated.
Having an oral health problem such as a dental abscess, broken tooth, severe untreated tooth decay, or other conditions that require attention from a dentist, can have a major effect on someone’s quality of life. As well as causing considerable pain, eating, drinking and taking medication can become a real challenge. Such problems can also make people much more reluctant to speak or smile, meaning that socialising with family and friends becomes a lot more difficult. In addition, poor oral health has been linked to several wider health conditions including malnutrition (which is thought to affect around 1.3 million older people) and hospital-acquired aspiration pneumonia (this can be caused by inhaling certain types of bacteria known to be found in dental plaque),.
Another occurrence that can cause significant distress for some older patients is denture loss. Manufacturing a new set of dentures is a process that can take several weeks and multiple appointments with a dentist, meaning that someone may be left unable to eat or speak properly for an extended period. This is particularly traumatic for those who may be receiving end of life care and only have a limited amount of time to spend with their family. We therefore believe it is vital that all hospitals and care homes have processes in place to minimise the risk of denture loss. Denture care, and oral health care more widely, should also be fully embedded within end of life care pathways.
One way in which we can do care differently is to develop a wider view of the factors which influence older people’s health and independence, and ensure that the support and care we provide reflects this. Oral health is a ‘hidden’ health issue which is often overlooked as a priority in older people’s care, but is nonetheless an important determinant of their overall wellbeing.
'Mouth Care Matters'
In a recently published report on improving older people’s oral health, we have highlighted the importance of providing health and social care practitioners with appropriate training about oral health. There are already some excellent examples of good practice that it is planned to build on in this respect. Health Education England and Surrey and Sussex Healthcare NHS Trust have developed an initiative called “Mouth Care Matters”, which aims to improve the healthcare team’s awareness of oral health by providing training on mouth care to nursing staff, doctors and allied health professionals. Another strand of the programme covers care homes, and involves local dental foundation trainees providing oral health training to care home staff. Ultimately, we think that all those working in both acute and community care settings who have regular contact with older people should have a robust understanding of the importance of good oral health, and how to help those they care for maintain it.
Alongside this, it is crucial to ensure that older people are able to access treatment and support if an oral health problem is discovered. This can be problematic though, with evidence suggesting that care service managers often struggle to access emergency or domiciliary dental care for their clients when they need it. Improving access to dental services for older people is a complex issue, and potentially has cost implications for a number of stakeholders. We therefore believe that government, the health service, local authorities, care providers and the oral health profession itself need to come together to develop a joint strategy to address the challenges around this.
The role of stakeholders in promoting good oral health
Regulators, standards bodies and “consumer champion” organisations can also play a key role in promoting the importance of good oral health for older people. In June, the National Institute for Health and Care Excellence published a new Quality Standard on oral health in care homes. This provides a vital baseline for oral care standards in care homes – one that we think other types of care service should also aspire to – and is something that the Care Quality Commission and other devolved health and social care regulators should monitor during inspections. In addition, the Healthwatch network in England can help to drive improvements in oral care for older people, with an interesting model provided by work that Healthwatch Camden have undertaken with Independent Age to pilot a new set of quality indicators for care homes. This included assessing whether residents had access to a dentist during “enter and view” visits by Healthwatch volunteers, as well as other key health professionals such as physiotherapists and opticians.
Oral health may not be the first thing we think of when considering older people’s care needs, but it can have a significant impact on their wellbeing and independence. Reflecting the importance of good oral health – as well as other similar ‘hidden’ health issues – in the support we provide to older people is one notable way in which we can start to do care differently.
The views expressed in this blog are those of the blog’s author alone and do not necessarily represent those of Independent Age. Independent Age is not responsible for the accuracy of the information supplied in blogs by external contributors.