Oral Health in Older Adults in Wolverhampton

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1 Oral Health in Older Adults in Wolverhampton Dr Majel McGranahan Public Health Registrar Our mission: Working as one to serve our city

2 Why does oral health matter? Talking Eating Socialising without embarrassment Retaining independence Aging population Looked after older people: more susceptible to poor oral health

3 Oral health in older adults in the UK 11 million people aged above 65 years in the UK 1 More likely to have severe untreated caries More likely to have gum disease Less likely to rate oral health as good Older adults living in care homes Less likely to keep their teeth More likely to have untreated caries 1 West Midlands Dental Epidemiology Programme: Survey of Care Homes 2011

4 Oral health in older care home residents in the West Midlands 2 : Twice as likely to have dental caries compared to non-care home residents aged One in three (30.8%) care home residents brush their teeth twice per day One in four (25.8%) need help brushing their teeth 98.2% of care homes include oral health in their care plans 2 West Midlands Dental Epidemiology Programme: Survey of Care Homes 2011

5 Older adults and oral health Dry mouth Complex dental needs Inflamed gums Tooth loss Malnutrition Dental caries Older adults oral health problems Communication difficulties Oral cancer Lack of dexterity so poor or infrequent brushing

6 Socio-economic status and oral health Oral health worsens with decreasing socio-economic status Wolverhampton: third most deprived area in the West Midlands 41.9% of care homes in Wolverhampton are in the most deprived quintile (compared to a 23.9% West Midlands average)

7 Difficulties for care homes Staff Awareness Training: high staff turnover Residents Education Co-operation

8 What support is available to care homes? Digital advice pack with links to resources sent to care homes in November 2017 Training videos for staff Online e-learning for staff Oral Health Risk Assessment Tool NICE Guidelines for Older Adults in Care Homes 2016

9 Oral health in older adults: Domiciliary Care Adults receiving domiciliary care: Less likely to brush their teeth twice per day than adults in the general population (43% vs. 75%). More likely to complain of pain or a problem in their mouths (14% vs. 9%). Domiciliary care providers in Wolverhampton: Support (if required) with brushing teeth or dentures and aid with oral hygiene as appropriate No requirement to undertake an oral health risk assessment

10 Oral Health in Adults with Learning Difficulties Wolverhampton 59.2 per 1000 people have moderate learning difficulties (double England average) 5.34 per 1000 people having severe learning difficulties. Adults with Learning Difficulties Worse oral health compared to the general population Priority often given to other, perhaps more life-threatening ailments

11 Oral Health in Adults with Learning Difficulties Make healthy choices Depending on an individual s cognitive, mental and physical abilities, a person may be less likely to Those receiving enteral feeding may be more at risk of certain oral complications because they do not produce enough saliva Practice good oral health hygiene Attend and cooperate with dental professionals

12 Wolverhampton Special Care Dental Service Sees people with Severe learning difficulties Severe mental health problems Severe autistic spectrum disorders Physical disabilities Additional needs Most will not fulfil the criteria for access Important to support people to access mainstream services

13 Urgent Care - Wolverhampton 24-hour emergency dental service No domiciliary out of hours service Those who are unable to access a dental clinic have to attend A+E if they experience a dental emergency out of hours

14 Who is responsible for oral health in older adults? Local Authorities Statutory requirement: commission or provide oral health promotion programmes Oral health surveys NHS England Commissions Dental Services, including some oral health promotion

15 Recommendations Ensure care homes are aware of resources and support Ensure low sugar foods in care homes are available in care homes Encourage GPs to prescribe sugar-free liquid medications if applicable Undertake an oral health survey of older adults in care homes decennially Liaise with social care to introduce regular oral health assessments and education for staff and residents as part of contracts for care homes and domiciliary care

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