A gaping hole: Oral health care for dependent older people
Bibliographic record
Abstract
Following decades of improved oral health care, many people in New Zealand now reach older age with their own teeth. However, dependent New Zealanders (those who require regular care support through home-based care or aged residential care facilities) have poor oral health, suggesting that they are not receiving adequate oral health care. This affects their overall health and quality of life in ways that may be painful, debilitating or fatal. These problems are exacerbated by shortfalls in oral health services, which are frequently unaffordable and/or inaccessible.\n\nThis thesis explores the feasibility and acceptability of publicly-funded oral health care provision for dependent older people in New Zealand among key informants from the oral health and aged care sectors. The New Zealand oral health and aged care systems are compared and contrasted with those from Canada, Australia, the United Kingdom and Ireland. These comparable countries face similar issues in cost and access barriers for dependent older people, and have various approaches that could be applied in the New Zealand setting. The research was framed by Guay’s (2005) three-point model of addressing demand, expanded by Smith (2010) to include awareness. Semi-structured interviews were conducted with eight key informants, comprising experts in dentistry, aged care, health policy and older people’s advocacy.\n\nThis research confirmed that dependent older New Zealanders’ oral health is in a state of crisis. Oral health policy has not been sufficiently developed or implemented to guide oral health care for older people. Preventive oral health care is insufficient for purpose, while cost and access barriers frequently prohibit clinical treatment. The oral health and aged care workforces both require improved conditions, regulation, training and interdisciplinary alliances to meet dependent older people’s oral health needs. While the workforce is interested in making these changes, centralised public funding is necessary for their implementation, and to reduce cost barriers for patients. Accessibility can be helped through a combination of in-house, mobile and domiciliary care provision, and more widespread training in special care dentistry. Any oral health care programme must foreground the human rights of older people, disabled people, and other socioeconomic minorities such as Māori and Pasifika people.\n\nThis thesis concludes that publicly-funded oral health care for dependent older people is not only acceptable but urgently necessary, and highly feasible if effective political strategies are developed for its implementation. It therefore recommends a call to action by oral health and aged care professionals, older people’s advocates, disability rights organisations, and others concerned about dependent older people’s health and wellbeing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.008 | 0.007 |
| Scholarly communication | 0.006 | 0.011 |
| Open science | 0.002 | 0.011 |
| Research integrity | 0.007 | 0.008 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".