Integrated Oral Healthcare Model for Dependent Older Adults: An Experience-Based Co-Design Approach.

Abstract

Objective: To co-develop a stakeholder-informed oral healthcare model for dependent older adults that can be integrated into Thailand's existing Community-Based Long-Term Care (CBLTC) system using an Experience-Based Co-Design (EBCD) approach.

Materials and methods: A Participatory Action Research (PAR) approach was employed using Experience-Based Co-Design (EBCD). The process involved five iterative steps: baseline assessment, in-depth interviews, stakeholder-specific focus group discussions, a joint co-design session, and validation of the model. Participants included dependent older adults, formal and informal caregivers, family care teams, local authorities, and private-sector actors (N = 22). Data were collected through qualitative methods and analysed using inductive content analysis to derive the model components and assess stakeholder consensus.

Results: The findings revealed a critical gap in oral healthcare within the current CBLTC framework, despite existing coordination across medical and social care. Participants identified barriers such as a lack of trained personnel, inadequate referral systems, and insufficient caregiver capacity. Through a structured co-design process, a community-specific oral healthcare model was developed. The model defines stakeholder roles, referral pathways, and action plans for implementation.

Conclusion: The co-designed model offers a practical, equity-driven solution to a long-standing gap in Thailand's long-term care landscape. By embedding oral healthcare into the existing CBLTC infrastructure, the model elevates oral health as a critical component of holistic ageing care. Although further implementation and evaluation are required, this framework sets a precedent for inclusive, community-informed innovation that may inspire broader policy adoption and system-wide integration.