Part 2

The Irish Society for Disability and Oral Health
Annual Spring Lecture
We’re older but are we wiser?
!
!
!
Ageing and its implications for general
and special care dentistry in Ireland
Insights into oral healthcare
for older adults with ID
Lessons from IDS-TILDA
Caoimhin Mac Giolla Phadraig
Ussher Lecturer in Public Dental Health (Disability Studies)
Trinity College Dublin
Overview
•
Context and the IDS TILDA Study
•
Dentate status and denture use!
•
Dental attendance and service use!
•
Oral hygiene!
•
Conclusion
Population ageing
Population ageing and ID
Kelly C, Kelly F. Annual Report of the National Intellectual Disability Database Committee 2010. Dublin: Health Research Board, 2011 Contract No.: 29/01/2013.
Implications of ageing for those
with ID and their families
•
Life expectancy for adults with mild ID is
now similar to that of the general
population and people with moderate or
severe ID now routinely reach their late
60s and late 50s, respectively. Bittles, et al. 2002
•
Elderly parents are becoming less able
to care for their adult children with ID and
smaller family size means that there are
fewer siblings to support them. Heller,&et&al.&2008&
•
Older people with intellectual disabilities
in Ireland experience high rates of
comorbid common adult and older agerelated conditions McCarron et al. 2013
!
1. Bittles AH, Petterson BA, Sullivan SG, Hussain R, Glasson EJ, Montgomery PD. The influence of intellectual disability on life expectancy. The journals of gerontology Series A, Biological
sciences and medical sciences. 2002;57(7):M470-2.
2. Heller T, Factor A. Family support and intergenerational caregiving: report from the State of the Science in Aging with Developmental Disabilities Conference. Disability and health journal.
2008;1(3):131-5.
3. McCarron M, Swinburne J, Burke E, McGlinchey E, Carroll R, McCallion P. Patterns of multimorbidity in an older population of persons with an intellectual disability: Results from the intellectual
disability supplement to the Irish longitudinal study on aging (IDS-TILDA). Research in Developmental Disabilities. 2013;34(1):521-7.
The Intellectual Disability Supplement to
The Irish Longitudinal Study on Ageing
www.idstilda.tcd.ie
•
Longitudinal study
•
Wave 1 2009
•
Wave 2 2013
•
Wave 3 (planning
stage)
•
Mirror TILDA +
•
Adults over 40 years of
age with ID
•
A nationally
representative sample
•
Broad range of settings
and levels of ID
!
•
Pre-interview
Questionnaire
•
CAPI
•
Self administered where
possible
•
Health Fare
Dentate status
•
When do oPwID become
edentulous? !
•
What proportion are
edentulous?
•
What happens when oPwID
become edentulous?
•
What else would you like to
know?
Dentate status
•
When do oPwID become
edentulous? !
•
What proportion are
edentulous?
•
What happens when oPwID
become edentulous?
•
What else would you like to
know?
Only age was predictive of complete tooth loss
Dentate status
•
When do oPwID become
edentulous?
100%#
90%#
80%#
•
•
What proportion are
edentulous?!
What happens when oPwID
become edentulous?
70%#
60%#
50%#
Total#Edentulous#
40%#
Total#Dentate#
30%#
20%#
10%#
•
What else would you like to
know?
0%#
IDS#TILDA#
TILDA#
Edentulous Rate: 34% IDS TILDA compared to 15% TILDA
Dentate status
•
What proportion are
edentulous?
100%#
90%#
80%#
•
•
When do oPwID become
edentulous?
What happens when oPwID
become edentulous?!
70%#
60%#
50%#
#####I#have#no#teeth#or#
dentures#
40%#
#####I#have#full#dentures#
30%#
20%#
10%#
•
What else would you like to
know?
0%#
IDS#TILDA#
TILDA#
Edentulous with no Complete Denture: 61% IDS TILDA compared to 5% TILDA
Dentate status
•
•
What proportion are
edentulous?
I"have"full"dentures"
I"never"had"dentures"and"don't"
want"any"
When do oPwID become
edentulous?
•
What happens when
oPwID become
edentulous?!
•
What else would you like
to know?
I"never"had"dentures"and"would"
like"some"
I"had"dentures"but"don't"wear"
them""
Most people without CRDs did not want dentures
Most people who had dentures used them
Most who did not wear their dentures, did not like
their dentures
What did I learn?
•
There is massive inequity in Ireland
•
Older adults in Ireland have poorer
oral health outcomes if they have
intellectual disabilities
•
Oral follows intellectual disability
•
There is probably no justification for
a targeted service to meet this
unmet prosthodontic need
•
We need to maximise the likelihood
of rehabilitation
•
There is a need for life long
prevention
Dental attendance
•
How often do oPwID attend?
•
What barriers do oPwID face
in attending the dentists?
•
What type of adjunct do
oPwID use when they attend?
•
What else would you like to
know?
Dental attendance
Never%
>%2%years%ago%
1.2%years%ago%
<1%year%ago%
•
How often do oPwID attend?!
•
What barriers do oPwID face
in attending the dentists?
•
What type of adjunct do
oPwID use when they attend?
•
What else would you like to
know?
86.5% within the last two years
Age, type of residence, dentate status & oral
problems associated with frequency
Dental attendance
•
How often do oPwID attend?
•
What barriers do oPwID face
in attending the dentists? !
•
What type of adjunct do
oPwID use when they attend?
•
What else would you like to
know?
“I have no teeth and I have no problems with my mouth.“
Dental attendance
•
How often do oPwID attend?
•
What barriers do oPwID face
in attending the dentists?
•
What type of adjunct do
oPwID use when they
attend?!
•
What else would you like to
know?
Behaviour*Management*
Non$pharmacological.
Seda2on.
General.anaesthe2c.
What did I learn?
•
There is massive inequity in
Ireland: older adults in Ireland
have poorer attendance if they
don’t have intellectual disabilities
•
Poor attendance is not due to
barriers, it is due to choice
•
A lack of problems / teeth
contributes to people deciding
that they won’t attend
•
We rely mainly on nonpharmacological behaviour
management and oral sedation to
enable dental care
Oral Hygiene
•
How often do oPwID clean
their teeth?
•
Do oPwID report any difficulty
cleaning their teeth?
•
What level of difficulty do
oPwID report when cleaning
their teeth?
•
What else would you like to
know?
Oral Hygiene
•
•
How often do oPwID clean
their teeth?!
Do oPwID report any difficulty
cleaning their teeth?
Once%or%more%a%day%
2%to%6%/mes%per%week%
Once%per%week%
Less%than%once%per%week%
•
What level of difficulty do
oPwID report when cleaning
their teeth?
•
What else would you like to
know?
Never%
Tooth cleaning: 93% at least daily
Oral Hygiene
•
How often do oPwID clean
their teeth?
•
Do oPwID report difficulty
cleaning their teeth?!
No#Difficulty#
Some#difficulty#
Cannot#do#at#all#
•
•
What level of difficulty do
oPwID report when cleaning
their teeth?
What else would you like to
know?
Level of difficulty is very closely tied with
level of support needed, level of disability
and residential setting
Independent/Family.
Mild%
No#Difficulty#
No#Difficulty#
Some#or#a#lot#of#difficulty#
Some#or#a#lot#of#difficulty#
Cannot#do#at#all#
Cannot#do#at#all#
There is a vast range of difficulty across residential setting
and across severity of disability
Community)Group)Home)
Moderate(
No#Difficulty#
No#Difficulty#
Some#or#a#lot#of#difficulty#
Some#or#a#lot#of#difficulty#
Cannot#do#at#all#
Cannot#do#at#all#
There is a vast range of difficulty across residential setting
and across severity of disability
Residen'al*
Severe/Profound,
No#Difficulty#
No#Difficulty#
Some#or#a#lot#of#difficulty#
Some#or#a#lot#of#difficulty#
Cannot#do#at#all#
Cannot#do#at#all#
There is a vast range of difficulty across residential setting
and across severity of disability
What did I learn?
•
•
•
•
We need to highlight the fact
that people who may not receive
help may actually need help
We need to shift focus from
frequency of brushing to
technique, time spent and tools
used
We must modify promotion
interventions based on
residential setting
There is a need to standardise a
range of tools in the toolkit
Oral Hygiene Dependency Pyramid
Training focus differs according to level of dependency
Flossing aides
Standard Brushing Techniques
Motivation
Environment
OHCP planning
Brush after Brush
Hand on hand
Modified Toothbrushes
Carer administered brushing
Managing Bite reflex
Gag reflex
Clinical holding
Self-care
led
Carer and
Self
Carer
led
Conclusions
•
Policy response needed to promote the oral health
of most vulnerable older adults and meet their needs
•
Practice level there is a need to review the benefit to
our patients with disabilities by assessing them
annually if we don’t prevent or manage disease?
•
Research should assess the oral health needs of this
priority group and provide knowledge for policy
makers / commissioners to ensure that decisions are
evidence based
Professor June Nunn, TCD
Professor Mary McCarron, TCD
Professor Philip McCallion,
University of Albany
Eilish Burke, TCD
Eimear McGlinchey, TCD
Dr. Rua el Halaali, DDUH
IDS TILDA team
www.specialcaredentist.ie
www.projectsmileireland.com
www.idstilda.tcd.ie