Health status, care dependency and oral care utilization among older adults: a register-based study

Abstract

Background and objectives: The aim of the study was to examine oral care utilisation among older Danes and to describe the extent to which oral care use is associated with the co-existence of challenges relating to general health and care dependency.

Materials and methods: The study used registry data covering the entire population of older adults (≥65 years) in seven municipalities in Denmark (N = 178 787 individuals). Oral care services utilisation was computed from administrative data on oral care contacts up to and including 2019, including both private oral care and a municipal oral care programme (MOCP). Various registry data sources were used to compute risk factors to describe oral care utilisation across indicators of general health and care dependency.

Results: Indicators for poorer health were associated with larger proportions of individuals enrolled in the MOCPs and larger proportions of non-users of any type of oral care. Higher degrees of care dependency were associated with larger proportions of individuals enrolled in MOCPs and individuals with no use of any oral care services, with the exception of nursing home residents, who comprised a lower proportion of non-users than individuals receiving at-home care. Municipal oral care mainly enrolled older adults who were nursing home residents (60% of nursing home residents were enrolled).

Conclusion: Our findings support existing evidence on the link between oral care utilisation and general health and frailty. While the municipal care programmes assisted in covering oral care for those with the highest level of care dependency, future preventive strategies for ensuring care continuity for older adults that are increasing in frailty may want to focus on the earlier stages of frailty and of general health deterioration.

Keywords: care dependency; frailty; general health; older people; oral healthcare use; polypharmacy.

FIGURE 1

Oral care utilisation 2017–2019 compared across groups characterised by various types of health‐related challenges, stratified by age group. Light grey: Routine user (POCC). Black: Occasional user (POCC). Dark grey: MOCP. Beige: Non‐user. Note: N = 178 787 aged ≥65 years by end of 2019. All of the age‐stratified cross‐tabular distributions of oral care utilisation on risk factors are statistically significantly different (p < .001 for chi‐square tests). CCI, Charlson Comorbidity Index. Polypharmacy= >6 drug types/6 months for at least three 6‐month periods during 2017–2019. Anxiety/depression and dementia indicators are based on hospital diagnoses and dispensed medicines (see Section 2: Methods).

FIGURE 2

Oral care contacts in regular care prior to municipal oral care enrolment in 2019–2020. Number of years since last oral healthcare services use in POCC. Note: N = 2894 persons (≥65) enrolled in the MOCP in the seven municipalities in 2019–2020.