TITLE: Barriers to accessing dental care amongst the elderly in retirement villages in Johannesburg. INTRODUCTION & BACKGROUND The aging population in South Africa has increased from 3.2 million in 2001 to 3.7 million in 2007 (Africa, 2009). Oral health problems in aging include edentulism, denture related conditions such as denture stomatitis, coronal and root surface caries, periodontal disease, xerostomia, and oral cancer (WHO, 2010). These conditions have been shown to impact negatively on the oral health related quality of life and general health of the elderly (Locker, 1988; Kandelman et al, 2008). However despite the oral disease experiences and availability of free oral health services in the public sector, oral health service utilisation amongst the elderly in South Africa continues to be low (Van Wyk, 1994, DoH, 2010). In addition there is no current available data on their oral health status, their oral health needs and barriers experienced in terms of accessing oral health services. AIMS The aim of the study was to determine barriers to dental care access by an elderly population residing in government subsidised retirement villages in the Johannesburg Metropolitan region, during the period of January to December 2011. OBJECTIVES To describe the oral health status of the residents in order to estimate their normative oral health needs. To describe perceived oral health needs of the residents from the retirement villages. To determine the proportion of elderly residents from retirement villages who have accessed dental care in the past 12 months. To identify and describe barriers to oral health services. To determine factors associated with oral health service utilisation. MATERIALS & METHODS The study was a cross-sectional study with an analytic component. Participants were recruited from 10 retirement villages located across region B to region G in Johannesburg. Permission to access the site and participants was granted by each individual site manager. Three hundred and eight individuals gave consent and agreed to participate in the study. Data was collected from questionnaires and a clinical oral examination assessing the DMFT and CPITN scores according to WHO criteria was conducted. RESULTS The sample (n=308) had a mean age of 72 years old. The mean DMFT of 17 and mean CPITN of 1.6 indicated that there was a need for dental care amongst the participants. Perceived oral health need related significantly to normative need and utilisation (p<0.01). Less than a third (28%) of the study population had accessed dental care in the past 12 months. Structural, financial and personal factors were found to have contributed to the barriers experienced by the elderly in Johannesburg. Participants with a high perceived need were found to more likely (OR: 2.37 CI: 1.00-5.83: P=0.05) to utilise services than those who were over the age of 80 and those living with partners. CONCLUSION Though oral health access was freely available in the public sector, the study found that there were unmet dental treatment needs amongst participants. Most participants perceived they needed dental care yet only less than a third accessed dental services in the past 12 months due to the structural, financial and personal barriers experienced. RECOMMENDATIONS The elderly need to be made aware of their exemption from user fees in the public sector. The inclusion of denture provision services via outreach programmes may assist in reducing the denture waiting list at public dental clinics. KEYWORDS: Dental access, utilisation, barriers.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC. / Dentistry, Faculty of / Graduate

Thesis (MSD) -- Boston University, Henry M. Goldman School of Dental Medicine, 2010 (Department of Health Policy and Health Services Research). / Includes bibliographic references: leaves 73-75. / Objectives: To describe the oral health of Rhode Island Seniors and to evaluate gender differences in oral health. Methods: This is a cross-sectional study of individuals who underwent oral screening at the HeathLink Wellness Health Fair, RI, in June, 2008. Data was collected using a self-administered questionnaire on self-reported general and oral health, and a dental examination for those who attended the HealthLink Wellness Progran’s health fair. Data was coded and entered into Epi-Info version 3.4.1, then analyzed using SAS version 9.1. The clinical oral health outcome variables studied were: number of teeth, edentulousness, root tips, untreated caries, dentures, and DMFT. The self-perceived oral health outcome variables were: difficulty relaxing, avoided going out or feeling nervous or self-conscious, felt pain or distress due to teeth, gums or denture, and overall poor self-perceived oral health. The main predictor variable was gender. Other predictor variables included age, self-reported chronic diseases (diabetes, hypertension, heart disease, and dry mouth), smoking history and current smoking status, self-perceived oral health, number of teeth, dentures, and DMFT. Descriptive statistics, bivariate analyses, and multivariate logistic and linear regression analyses were performed. Results: The study sample consisted of 166 subjects with a mean age of 72.3[plus or minus]7.8 years (range=42-89 years). Descriptive analyses of the study sample’s oral health showed that the subjects had overall good oral health, with 47% having good oral hygiene, 19% had untreated caries, 8% had root tips, 46% had at least one denture (upper or lower, complete or partial), and 12% were completely edentulous. On average, study subjects retained at least half of their natural dentition (mean=16.8[plus or minus]0.8 teeth). The mean DMFT score was 18.5[plus or minus]0.5 teeth. The mean number of teeth with untreated caries was 0.4[plus or minus]0.1 teeth. Multiple logistic regression models and linear regression models were performed after controlling for potential confounders and statistically significant associations were found between the main predictor, gender; and the outcome variables, self-perceived oral health, and clinical oral health. Females were 3.3 times more likely to feel difficulty relaxing due to their teeth, gums or denture (95% CI=1.5-7.6, p=0.002), were 10 times more likely to avoid going out or felt nervous or self-conscious due to their teeth, gums or denture (95%CI=2.1- 48.2, p=0.004), were 5.9 times more likely to have felt pain or distress due to their teeth, gums or denture (95% CI=1.8-19.8, p=0.005), and were 3.2 times more likely to avoid eating some foods due to their teeth gums or denture (95% CI=1.0-10.1, p=0.03). When a new variable was constructed, that reflected an overall score for self-perceived oral health, a multiple linear regression model showed that females had overall poorer self-perceived oral health (p=[less than]0.0001) than males. When clinical oral health outcome variables and gender was analyzed, females were less likely to have decayed teeth (p=0.005), had lower DMFT (p=0.02), and had a greater number of teeth (p=0.03) than males. Conclusion: In this study sample, there is an association between clinical oral health and self-perceived oral health and gender compared to the national data. Also, despite the fact that males had poorer clinical oral health than females, females reported poorer self-perceived oral health than males.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0039 ; please contact computer services.

Thesis (doctoral)--Universiteit te Nijmegen, 1989.

Thesis (doctoral)--Universiteit te Nijmegen, 1989.

O perfil epidemiológico da população idosa brasileira evidencia um quadro de extensas perdas dentárias e problemas de saúde bucal. A fim de reverter este quadro, observa-se o desenvolvimento de diversas políticas públicas de saúde cujo objetivo está em garantir atenção integral à saúde da população idosa, com ênfase no envelhecimento saudável e ativo. Porém, no que diz respeito aos Serviços de Saúde Bucal, poucos estudos têm sido desenvolvidos na ambição de conhecer a satisfação deste grupo etário com tais serviços. O objetivo deste estudo foi investigar a associação entre a resiliência e a satisfação com os Serviços Odontológicos, levando em consideração variáveis exógenas, determinantes primários, comportamentos e condições de saúde. Investigou-se a hipótese de que a resiliência está associada à satisfação com os Serviços Odontológicos acessados pelos idosos. O lócus da pesquisa foi a gerência distrital Lomba-Partenon, em Porto Alegre – RS, onde 771 idosos foram identificados em seus domicílios por meio de amostragem por conglomerado. Os indivíduos responderam a um questionário sócio-demográfico e de comportamentos em saúde, à Escala de Resiliência e a questões relativas ao Serviço Odontológico acessado e à satisfação com o mesmo; além disso, foi realizado um breve exame bucal para contagem do número de dentes e identificação do uso de prótese dentária. Baseado em uma abordagem hierárquica realizada através de Regressão Logística Multivariada, as odds ratios estimadas das variáveis que ficaram significativamente associadas com o desfecho em estudo, satisfação com o Serviço Odontológico, após a análise totalmente ajustada, foram: 1) obtenção de consulta odontológica classificada como regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtenção de consulta odontológica classificada como ruim: OR= 2,17, 95% IC (1,05 a 4,50) e 3) alto potencial de resiliência: OR= 0,60, 95% IC (0,37 a 0,97). Portanto, os resultados confirmam a hipótese de associação entre elevado potencial de resiliência e satisfação com os Serviços Odontológicos acessados por idosos. / The epidemiological profile of the elderly population shows a picture of extensive tooth loss and oral health problems. In order to reverse this situation, there is the development of various public health policies whose aim is to ensure comprehensive health care of the elderly population, with an emphasis on healthy aging and active. However, with regard to Dental Health Services, few studies have been developed to meet the satisfaction of this age group with such services. The objective of this study was to investigate the association between satisfaction with the resilience and Dental Services, taking into account exogenous variables, the primary determinants, behaviors and health conditions. It was investigated the hypothesis that resilience is associated with satisfaction with dental services accessed by older people. The locus of this research was the district management Lomba-Partenon, in Porto Alegre – RS, where 771 seniors were identified in their homes through cluster sampling. The subjects answered a questionnaire for socio-demographic and health behaviors, Resilience Scale and questions regarding the dental care accessed and satisfaction with it. In addition, there was a brief oral examination to count the number of teeth and identify the use of dental prosthesis. Based on a hierarchical approach performed by multivariate logistic regression, the estimated odds ratios of variables that were significantly associated with the outcome under study, satisfaction with dental care services, fully adjusted after analysis, where: 1) obtaining a dental visit classified as regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtaining a dental visit classified as bad: OR= 2,17, 95% IC (1,05 a 4,50) and 3) high potential for resilience: OR= 0,60, 95% I C (0,37 a 0,97). Therefore, the results confirm the hypothesis of an association between high potential for resilience and satisfaction with dental services accessed by older people.

O perfil epidemiológico da população idosa brasileira evidencia um quadro de extensas perdas dentárias e problemas de saúde bucal. A fim de reverter este quadro, observa-se o desenvolvimento de diversas políticas públicas de saúde cujo objetivo está em garantir atenção integral à saúde da população idosa, com ênfase no envelhecimento saudável e ativo. Porém, no que diz respeito aos Serviços de Saúde Bucal, poucos estudos têm sido desenvolvidos na ambição de conhecer a satisfação deste grupo etário com tais serviços. O objetivo deste estudo foi investigar a associação entre a resiliência e a satisfação com os Serviços Odontológicos, levando em consideração variáveis exógenas, determinantes primários, comportamentos e condições de saúde. Investigou-se a hipótese de que a resiliência está associada à satisfação com os Serviços Odontológicos acessados pelos idosos. O lócus da pesquisa foi a gerência distrital Lomba-Partenon, em Porto Alegre – RS, onde 771 idosos foram identificados em seus domicílios por meio de amostragem por conglomerado. Os indivíduos responderam a um questionário sócio-demográfico e de comportamentos em saúde, à Escala de Resiliência e a questões relativas ao Serviço Odontológico acessado e à satisfação com o mesmo; além disso, foi realizado um breve exame bucal para contagem do número de dentes e identificação do uso de prótese dentária. Baseado em uma abordagem hierárquica realizada através de Regressão Logística Multivariada, as odds ratios estimadas das variáveis que ficaram significativamente associadas com o desfecho em estudo, satisfação com o Serviço Odontológico, após a análise totalmente ajustada, foram: 1) obtenção de consulta odontológica classificada como regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtenção de consulta odontológica classificada como ruim: OR= 2,17, 95% IC (1,05 a 4,50) e 3) alto potencial de resiliência: OR= 0,60, 95% IC (0,37 a 0,97). Portanto, os resultados confirmam a hipótese de associação entre elevado potencial de resiliência e satisfação com os Serviços Odontológicos acessados por idosos. / The epidemiological profile of the elderly population shows a picture of extensive tooth loss and oral health problems. In order to reverse this situation, there is the development of various public health policies whose aim is to ensure comprehensive health care of the elderly population, with an emphasis on healthy aging and active. However, with regard to Dental Health Services, few studies have been developed to meet the satisfaction of this age group with such services. The objective of this study was to investigate the association between satisfaction with the resilience and Dental Services, taking into account exogenous variables, the primary determinants, behaviors and health conditions. It was investigated the hypothesis that resilience is associated with satisfaction with dental services accessed by older people. The locus of this research was the district management Lomba-Partenon, in Porto Alegre – RS, where 771 seniors were identified in their homes through cluster sampling. The subjects answered a questionnaire for socio-demographic and health behaviors, Resilience Scale and questions regarding the dental care accessed and satisfaction with it. In addition, there was a brief oral examination to count the number of teeth and identify the use of dental prosthesis. Based on a hierarchical approach performed by multivariate logistic regression, the estimated odds ratios of variables that were significantly associated with the outcome under study, satisfaction with dental care services, fully adjusted after analysis, where: 1) obtaining a dental visit classified as regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtaining a dental visit classified as bad: OR= 2,17, 95% IC (1,05 a 4,50) and 3) high potential for resilience: OR= 0,60, 95% I C (0,37 a 0,97). Therefore, the results confirm the hypothesis of an association between high potential for resilience and satisfaction with dental services accessed by older people.