Barriers to accessing dental care amongst the elderly in retirement villages in Johannesburg

Molete, Mpho Primrose
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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.