Multidimensional assessments of the outreach dental care service for elders using residential or day-care services in Hong Kong

Abstract

OBJECTIVES: Aim of this research was to assess the impacts of the government subsidized outreach dental care program (ODCP) for elders using residential or day-care services in Hong Kong from the perspectives of the service recipients – the elders and caregivers in long-term care (LTC) facilities and that of the service providers – administrative staff of the non-governmental organizations (NGOs) and dentists working in the outreach dental teams. MATERIAL AND METHODS: The first part of the research was a longitudinal prospective study conducted among elderly LTC services users receiving the ODCP dental service. The transition score of the Oral Health Impacts on Daily Living questionnaire was adopted to investigate the perceived change in oral health-related quality of life (OHRQoL) among the elders. Pre- and post-service change in oral health status of the elders was explored by clinical examinations. Change in perceived oral health status and problems and the elders’ satisfaction with the ODCP were explored using plain questions or modified questionnaires. The second and third parts of the research were qualitative studies adopting interpretive phenomenological approach. Opinions of the caregivers of the LTC facilities who were responsible for the coordination with the ODCP dental teams, administrative staff of the NGOs and outreach dentists were explored through telephone interviews. RESULTS: A total of 413 elders participated in the prospective cohort study at baseline, and 377 and 359 of them were followed at two months and one year after receiving the ODCP service, respectively. The number of decayed teeth and functional tooth units, and the prevalence of denture cleanliness problem among the elders decreased while more dental plaque deposition and a higher prevalence of early periodontal disease were detected at the one-year follow-up. A higher proportion of the elders perceived their oral health status as healthy and a lower proportion of elders had perceived oral health problems one year after the service. The majority of the elderly participants perceived no change in OHRQoL post-service. Most elders were generally satisfied with the dental service received and hoped that more of their dental problems could be covered and solved in the ODCP. In the qualitative studies, 22 caregivers in the LTC facilities, 8 administrative staff of NGOs and 7 dentists were interviewed. They thought the awareness of the importance of oral health among the elders, family members and caregivers was improved. Most of the oral health problems faced by the elders were detected and solved by the dental treatments provided onsite or in the NGO dental clinics in the ODCP. Improvements on the coordination between the caregivers in LTC facilities and the outreach dental teams, and supportive administrative strategies and policies were suggested by the interviewees. CONCLUSIONS: The dental service provided in the ODCP kept the elders away from deterioration in OHRQoL and solved some of their oral problems. The ODCP also had positive impacts on the elders, their family members and the caregivers regarding the promotion of the importance of oral health. The ODCP is beneficial to the elders using LTC services in Hong Kong.

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