Oral Health Experiences of Maori with Dementia and Whanau Perspectives - Oranga Waha Mo Nga Iwi Katoa

Abstract

IntroductionGood oral health enables full interaction with the social and material world; to have good kai, to speak clearly, to hongl, kiss, smile and laugh, without discomfort or embarrassment. It is also to be free from active disease in the mouth that affects overall health and wellbeing (Robson et al., 2011, p.9). Dementia is associated with poor oral health status (Chalmers, Carter, & Spencer, 2003; Philip, Rogers, Kruger, & Tennant, 2012; Rejnefelt, Andersson, & Renvert, 2006). The term dementia encompasses symptoms such as progressive memory loss, disorientation and problems with cognitive functioning caused by illnesses such as Alzheimer's disease, vascular dementia and Lewy body dementia (Prince, Albanese, Guerchet, & Prina, 2014). The purpose of this study was to explore the oral health experiences of Maori with dementia and their whanau. In 2008 there was estimated to be at least 1483 Maori with dementia in New Zealand, 3.6% of a total population of 40,746 New Zealanders with dementia (Access Economics, 2008). These numbers are predicted to increase to 4,338 or 5.8% of the total population with dementia in 2026. There appears to be no research published focusing on Maori with dementia and oral health.This research was carried out as a partnership between Te Ropu Rangahau Hauora a Eru Pomare and Alzheimers New Zealand with an overall goal of raising awareness of oral health issues for Maori with dementia. It was part of a larger study funded by the Health Research Council of New Zealand and the Ministry of Health. The study was tasked with the identification of oral health research priorities for three specific groups: low income Maori adults; older Maori adults; and Maori with special needs, disabilities, or who are medically compromised. The full study is reported in Robson et al. (2011). This paper reports in detail the findings from the project on oral health experiences and needs of Maori with dementia and their whanau.BackgroundResearch in a range of settings identified people with dementia as having poorer oral health status than those without dementia. In residential care people with dementia have a higher incidence of caries, reduced saliva flow and poorer oral hygiene (Rejnefelt, Andersson, & Renvert, 2006; Philip et al., 2012; Willumsen, Karlsen, Naess, & Bjprntvedt, 2012). An American study of 21 nursing home residents found significant underdetection and under-treatment of pain and dental problems in people with dementia (Cohen-Mansfield & Lipson, 2002). In community settings an Australian study found dentate people with dementia, as compared to a similar group without dementia, had significantly more oral diseases, decreased denture use over one year, increased denture related ulcers, increased plaque and increased caries (Chalmers, Carter, & Spencer, 2003). The need for assistance with teeth cleaning increased from the baseline 24% to 58.2% at one year. People with dementia were significantly less likely to see the dentist.Specific oral health issues centre on the gradual loss of ability to carry out oral self-care, communicate symptoms such as pain, and to consent to and tolerate dental treatments (Ettinger, 2000). Medications for managing behaviour, depression and other conditions contribute to hyposalivation or xerostomia which increases plaque accumulation and dental caries growth (Friedlander, Norman, Mahler, Norman, & Yagiela, 2006; Lam, Kiyak, Gossett, & McCormick, 2009). Sugar based medication may also increase the potential for tooth decay (Dougall & Fiske, 2008).Contemporary approaches to caring for people with dementia provide guidance on enabling oral health care with the focus on respectful relationships with the person and whanau. The term person-centred care is used to highlight the need to acknowledge and respect personhood and relationships (Frenkel 2004; Kitwood 1997), and the family/whanau-centred care concept highlights the role of whanau in supporting people with dementia (New Zealand Council of Christian Social Services, 2009). …