Educational Preparedness to Provide Care for Older Adults in Alternative Practice Settings: Perceptions of dental hygiene practitioners.

Purpose: Research indicates that geriatric education continues to be inadequate across the health professions and graduates are unprepared to care for the increasing numbers of older adults. The purpose of this study was to explore dental hygiene practitioners' perspectives regarding whether their dental hygiene education prepared them to treat older adults in community and institutional settings.Methods: A qualitative phenomenological study design was utilized to conduct in-depth interviews with a purposive sample of dental hygienists currently providing care for older adult patients in alternative practice settings.Results: Fifteen dental hygienists from across the U.S. working with older patients in alternative settings, met the inclusion criteria (n=15). Common themes related to dental hygiene practice emerged from the qualitative data included: adapting patient care to alternative settings; emotional toll on the practitioner; physical challenges; outcome goals for treatment; need for hands-on clinical experience in alternative settings as dental hygiene students; and working as part of an interprofessional team.Conclusion: Participants generally agreed that they were not prepared to care for dependent older adults in alternative settings as part of their dental hygiene education. Clinical experiences working with older adults in alternative settings, as part of the dental hygiene clinical curriculum, are needed to prepare graduates to care for this growing population.

Access to Preventive Oral Health Services for Homebound Populations: A pilot program.

Purpose: Certified Public Health Dental Hygienists (CPHDH) perform traditional dental hygiene scope of practice duties, along with caries stabilization (interim therapeutic restorations) through collaborative agreements with a dentist, in the state of New Hampshire. The purpose of this pilot study was to assess the oral health status, dental needs, including referral and utilization, and satisfaction of care received by homebound individuals in their place of residence when provided by a CPHDH.Methods: A purposive sample of homebound individuals participated in a mixed methods study that included quantitative data from an intake survey, a retrospective chart review, and qualitative in-depth interviews.Results: Study participants (n=15) had an average of 22.4 natural teeth; 44% of participants had not seen a dentist for two or more years. Forty-three percent of participants required a referral to a dentist due to dental needs beyond the scope of the CPHDH. Themes from the interviews included: difficulty in accessing a traditional dental care delivery model despite a high value placed on oral health and a high need for dental care. In general, participants expressed satisfaction with care received by the CPHDH.Conclusion: Participants reported a positive experience and satisfaction with care received from a CPHDH suggesting that this is a viable approach to provide preventive oral health services and caries stabilization to populations with complex access to care challenges.

Oral Health Status of Independent Older Adults in Texas: An observational study comparing urban and rural areas.

Purpose: The purpose of this study was to assess the oral health needs of community-dwelling older adults participating in congregate meal centers and to determine whether differences exist in the oral health needs of older adult populations residing in urban versus rural communities in the state of Texas.Methods: Study participants were recruited at 6 congregate meal centers located in identified rural and urban communities in the greater metropolitan area of Austin, Texas. (N=78) Participants completed a validated, modified questionnaire containing 20 items on the following topics: self-reported oral health, tooth loss, dental insurance, frequency of dental visits, time since last dental visit, access to dental care, dry mouth, and oral cancer screening. Each participant received an oral health screening based on the Association of State and Territorial Dental Directors Basic Screening Survey for Older Adults. The examiners received hands-on training prior to the study to ensure the validity of their findings and to test for inter-examiner reliability.The chi-square test of independence was performed to analyze the participants' responses on the Basic Screening Survey to identify any relationships between the variables.Results: There were no significant differences in oral health conditions of older adults residing in urban versus rural communities. Over 50% of the participants (64.9% urban; 56.1% rural) reported incomes below $15,000 and lacked dental insurance to cover all or a portion of their oral health care needs. Eighty-seven percent of the participants reported tooth loss due to dental caries, 35% required periodontal care, and 37% reported occasional and 43% reported frequent oral pain over the last 12 months.Conclusions: Oral health promotion and disease prevention is an emergent need for older adult populations residing in urban and rural communities of the state of Texas. Analysis revealed that the majority of the older adult populations in both settings to have financial and socioeconomic barriers to access preventative and restorative dental care services.