Oral health in old age : perception among elderly persons and medical professionals

The general aim of this thesis was to investigate perceptions of oral health among elderly persons and among medical professionals working at primary health care centres. The study samples consisted of elderly persons and medical professionals in the County of Stockholm.

The thesis combines a quantitative and a qualitative perspective. The quantitative method was based on a questionnaire and clinical examination with defined variables carried out by a dental hygienist. Two different data collection methods were compared in Paper I. The qualitative methods comprised two types of in-depth interview. One interview study was phenomenological-hermeneutic inspired by Giorgi (Paper II) and the other was based on grounded theory inspired by Strauss & Corbin (Papers III & IV).

The results show that there are differences between the way the individuals who participated in the studies perceive their oral health and function and the way it is evaluated by professionals in clinical examinations (Paper I). Furthermore, the individuals' perceived oral health as a whole comprised of several aspects: functional, social and psychological. All the aspects were connected to well-being and quality of life (Paper II).

The studies of the medical professionals (Paper III) revealed that the general practitioners were unaware of the oral health of their elderly patients. They perceived cultural differences between medicine and dentistry. The district nurses (Paper IV) reported several obstacles that prevented them from taking responsibility for the whole nursing care around an individual. They perceived oral health and oral problems as belonging exclusively to dentistry.

The findings of all these studies emphasise the complexity of oral health and oral care when it comes to both the communication between the dental professionals and the patients and the cooperation between the medical and dental professionals. The research also points to the importance of finding ways to support and promote oral health among elderly individuals. As their general health deteriorates, their ability for self-care is reduced and they become less independent. Identifying this breaking point at which intervention becomes necessary is one of the major challenges to ensure good oral health in ageing.

In conclusion, improved understanding and co-operation between general practitioners and dental teams, as well as between district nurses and dental hygienists, is necessary to improve oral health and oral care which is important to enhance the well-being of the elderly.

List of scientific papers

I. Andersson K, Gustafsson A, Buhlin K (2004). Self-perceived oral function in elderly residents in a suburban area of Stockholm, Sweden. Oral Health Prev Dent. 2(3): 195-201.
https://pubmed.ncbi.nlm.nih.gov/15641622

II. Andersson K, Nordenram G (2004). Attitudes to and perceptions of oral health and oral care among community-dwelling elderly residents of Stockholm, Sweden: an interview study. Int J Dent Hyg. 2(1): 8-18.
https://doi.org/10.1111/j.1601-5037.2004.00059.x

III. Andersson K, Furhoff A-K, Nordenram G, Wardh I (2006). "Oral health is not my department" - Perceptions of elderly patients' oral health by general practitioners in primary health care centres. A qualitative interview study. Scandinavian journal of caring sciences. [Accepted]
https://doi.org/10.1111/j.1471-6712.2007.00446.x

IV. Andersson K, Nordenram G, Wardh I (2006). "Oral health has low priority" - Perceptions of elderly patients' oral health by district nurses in primary health care centres. A qualitative interview study. [Submitted]
https://doi.org/10.1080/00016350701278898