Dental care services for

old age patients in

Wales – Proposing
change to practice
Prepared By:
Outline
 Aim of the Research.
 Target Audience and Strategy.
 Literature Review and Research.
 NHS Role in Dental Health Care.
 Major Oral Problems for Old
Age People and Need For
Change.
 Lewin Change Model.
 Leadership Framework.
 Level of Decision Making.
 Minimizing Challenges
 Conclusion and
Recommendations.
 References.
Aim of the Research
According to statistics, there are an increasing number of old age people in
Wales who are deprived of the basic health care treatments. Health it one of
the fundamental area of concerns for old age people and providing them with
the appropriate treatment is necessary to encourage a healthy life and for the
betterment of the society. This research highlights the dental health care
condition of old age people in Wales and the feasibility of oral services to
older patients. The study highlights the current condition of dental health
care services for old age people and propose effective change and practices
to overcome the hurdles and challenges in the way.

Target Audience and Strategy

The target audience for the study are patients over the age of 65 and the oral health care
specialist who are given the recommendations for the practice of desired change. The author
has used the data and literature for the last 15 years that is relevant to the topic and carried
out research targeting the dental health care facilities, plans and government initiatives and
programs in the area.
Literature Review and
Research
Oral health is a part of daily fitness and is
essential for healthy mouth regardless of the age
of patient.
In this regard, several studies have been
conducted to review the dental care services
across Wales and the steps taken by government
of Wales for the betterment of this health sector.
 The government has designed many programs
related to dental care including staff training a
care homes, mouth care policies etc. but still
73% of total care plans did not cover any
dental health program ( British Dental
Association, 2021).
 Approximately 23000 people older age lives in
care homes and have poor dental health
conditions.
 Literature Review and
Research
 It is claimed by Howells and Davies that the
care staff for care homes are not trained to
provide any dental healthcare services to older
patients (Howells & Davies 2020).
 Figure 1 shows the difference in the number of
trained oral staff to the total staff operating in
care homes.
 Inn 2014, a report known as “A Place to Call
Home” highlight the poor condition of dental
health care services for older people and
encouraged the importance of changed practice
in the field (Monaghan, 2010).
 Karki et al. (2015) performed an analysis and
identify that 73% of older people living in care
homes have tooth decay issues.
Figure 1: Total number of care staff and oral health
champions; Source (Howells & Davies, 2020)
 NHS Role in Dental Health Care

 NHS stands for National Health Service (England) and it aims to provide
useful strategies to help people preserve their health and fitness. It promotes
health lifestyle for people to fight against illness and remain healthy.
 NHS and the government of Wales have established many programs in order
to preserve and support the dental health of people across the country.
 Some of these programs includes the mouth care policies, training of care
home staff, risk assessments etc. (NHS, 2022).
 However, analysis related to these programs stated that the government of
Wales have poor policies for dental health of older people (Richards, 2020).
 The care homes for older patients lack the basic necessities of dental health
and the staff is also untrained for any dental services.
Major Oral Problems for Old Age People
 The dental services are limited to the hospitals and clinics and it requires a 5-
7 hrs. waiting time for people to consult the dentist.
 It is not feasible for older people to wait this long for the treatment and ends
up coming back home without getting treated.
 The senior citizen mostly do not brush their tooth twice and consult to
dentist only when the experience unbearable pain or tooth problem.
 The staff for care homes is not provided with any dental care training to deal
with the oral problems of old age people.

Need for Change

The existing dental healthcare sector is inefficient in providing services to the old age group of
people. It is said that the dental sector should incorporate change in their practice to help the older
people. The study suggest that its much more beneficial for older people to be dealt at home from
the dentist in order to avoid extensive travelling and waiting (McDermott, 2012).
Lewin Change Model
The discussed study highlight the Lewin Change
Model to incorporate change in the dental care
service system. this model includes three steps to
practice change as follows;
 Unfreezing: Unfreezing is the initial step as
many people will resist the change at start.
Thus, this step includes the awareness among
people to acknowledge the change (Webster,
2014).
 Changing: The next step involves changing
and to learn new practices and redirect the
goals and processes.
 Refreezing: Finally the new change and ideas
are refrozen to avoid any conflict and to make
sure people do not revert. (Kozioł-Nadolna, Figure 2: Lewin’s Change Model; Source:
2020). (Webster, 2014).
 Leadership Framework
The leadership Framework implemented I this study
is the Dunham and Pierce Leadership framework
that has four characteristics.
1. Leader: one who is responsible to bring change,
in this study the leader includes the government
of Wales.
2. Follower: The one who is directed to follow the
change. In the study, the dental health specialist
fall in this category.
3. Context: It refers to the circumstances in which
leader manage his team and for this study, the
work and health environment lies in this
category.
4. Outcome: The final results. In our research, it
includes the satisfaction and improvement in the Figure 3: Dunham & Pierce Leadership Process;
dental health of older people. Source: (Avolio & Walumbwa, 2009).
 Level of Decision Making

The decision making process lies in the four

levels namely as state/national level decision,
system decision, organizational decision and
individual decision. Our highlighted case
study lies in the category of system level
decision as the suggested change to visit the
older people at home to provide the dental
treatment lies in the category of system
decision. This category refers to formal
allocation of resources as well as serve the
need to re-organize the dental service sector
for older people.
Figure 4: Level of decision making;
Source: (Eisenhardt, 2000)
Large image Minimizing the Challenge
According to the study and the current
pandemic situation of the entire world, it is
beneficial for the health professionals as well
as the older age patients to be treated at homes.
The dental sector and oral specialist should
adopt the change and re structure their services
in a certain way to provide the necessary and
effective dental treatment to the older patients.
Furthermore, specific dental training should be
provided to treat the minor problems and
regular dental consultation at home and also
train the care home staffs so as to provide the
old age people their required dental treatments
easily.
Conclusion
Health is the basic necessity of life and good oral,
mental and physical health and proper medical facilities
are the right of every citizen. This study highlights the
dental problems of old age people in Wales, the role of
Welsh Government in the dental health sector and the
needed change in the dental care service sector to
provide the general oral treatment to the older patients
without any long waiting and hurdles. Poor
performance and negligence towards the old age people
generally above 65 years of age is noticed through
different research and many care homes lacks the
dental facilities for old people. Thus, the study propose
the needed change in the dental service system and
includes the Lewin’s Change Model and Dunham And
Pierce Leadership Framework to put forward the
proposed change model.
Recommendations
The Following recommendations are
suggested after evaluating the condition and
role of dental care sector for the treatment of
old age patients;
 Proper training of dental services before
dealing with oral issues.
 Planned strategies for older people to
meet the dental services and get treated
easily.
 Preventative advice regarding
maintenance of good dental health should
be easily available for old age people and
their families.
 Hospitals should promote home based
dental treatment of older patients.
 References

• British Dental Association, 2021. Oral healthcare for older people. [Online]
Available at: https://bda.org/about-the-bda/campaigns/oralhealth/Pages/oral-
healthcareolder.aspx
[Accessed 25 January 2022].
• Howells, E. P. & Davies, R., 2020. Gwên am Byth: a programme introduced to improve the
oral health of older people living in care homes in Wales - from anecdote, through policy
into action. British Dental Journal, 229(10), pp. 793-799.
• Karki, A., Monaghan, N. & Morgan, M., 2015. Oral health status of older people living in
care homes in Wales. British Dental Journal, 210(11), pp. 331-334.
• McDermott, R., 2012. Characteristics and Acute Care Use Patterns of Patients in a Senior
Living Community Medical Practice. Journal of the American Medical Directors, 13(1),
pp. 260-263.
• Eisenhardt, K. M., 2000. Strategic Decision Making. JSTOR, pp. 17-37.
 References

• Monaghan, N., 2010. Oral health policy and access to dentistry in care homes.. J Disab Oral
Health, 11(1), pp. 61-68.
• NHS, 2022. Improving Oral Health for Older People Living in Care Homes in Wales. [Online]
Available at: http://www.wales.nhs.uk/improvingoralhealthforolderpeoplelivingincarehomesinwales
[Accessed 25 January 2022].
• Richards, W., 2020. General dental practice and improved oral health: is there a win-win for both
the professional establishment and government?. British dental journal official journal of the British
Dental Association, 228(8), pp. 581-585.
• Kozioł-Nadolna, K., 2020. The Role of a Leader in Stimulating Innovation in an Organization.
Administrative Science, 10(59).
• Webster, M., 2014. Successful Change Management — Kotter’s 8‐Step Change Model.
Leadership Thoughts, 2(1), pp. 23-35.
• Avolio, B. & Walumbwa, F., 2009. Leadership: Current Theories, Research, and Future Directions.
Annual Review of Psychology, pp. 421-449.
Thank You