|Year : 2020 | Volume
| Issue : 2 | Page : 134-138
Attitudes and perceived barriers in geriatric dental care among undergraduate dental students in capital region of Andhra Pradesh
Talluri Devaki1, Krishna Priya Mallikapuram2, Bommireddy Vikram Simha1, Viswa Chaitanya Chandu1, Nijampatnam P M Pavani1, Ravoori Srinivas1
1 Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Public Health Dentistry, Swamy Devi Dyal Dental College, Panchakula, Haryana, India
|Date of Submission||31-Oct-2018|
|Date of Decision||10-Feb-2020|
|Date of Acceptance||24-May-2020|
|Date of Web Publication||24-Jun-2020|
Dr. Talluri Devaki
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur - 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: This is the era of the elderly. In India, there is an exponential increase in the aging population. Increase in longevity means that the community will have to bear a greater burden of disease. The general health and well-being of older adults are related to their oral health. Aim: The to study the perceived barriers and attitudes of undergraduate dental students towards geriatric dental care. Materials and Methods: Four hundred and eighty senior dental students participated in the present cross-sectional questionnaire study. The first sought background information including gender, age, prior treating in geriatric dental care, and prior experience in treating the elderly in their education. The responses were categorized in a Likert scale. Data were analyzed using SPSS version 20. P < 0.05 was considered as statistically significant. Fisher exact test was used to know the attitude to work with elderly and the barriers in elderly dental care. Gender-wise comparison of mean attitude score toward the elderly was done. Results: The perceived barriers of dental students' showed significant association with respect to financial ability of the elderly (P = 0.017), follow-up of elderly patients (P = 0.04), elderly patient compliance (P = 0.05), and inadequate communication skills in treating elderly patients (P = 0.05). Females (2.500 ± 0.48) showed positive attitude when compared to male (1.166 ± 0.19) study subjects. The total attitudes mean score was 1.87 ± 0.34. Conclusions: Even though dental students were willing for elderly dental care, student's inadequate knowledge of geriatric care, poor communication skills, and lack of confidence in management of elderly patients are the identified barriers.
Keywords: Ageing, attitudes, barriers, dental students
|How to cite this article:|
Devaki T, Mallikapuram KP, Simha BV, Chandu VC, Pavani NP, Srinivas R. Attitudes and perceived barriers in geriatric dental care among undergraduate dental students in capital region of Andhra Pradesh. J Indian Assoc Public Health Dent 2020;18:134-8
|How to cite this URL:|
Devaki T, Mallikapuram KP, Simha BV, Chandu VC, Pavani NP, Srinivas R. Attitudes and perceived barriers in geriatric dental care among undergraduate dental students in capital region of Andhra Pradesh. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2022 Aug 20];18:134-8. Available from: https://www.jiaphd.org/text.asp?2020/18/2/134/287632
| Introduction|| |
Geriatric dental education can be defined as that portion of the predoctorol dental curriculum that deals with special knowledge, attitude, and technical skills required in provision of oral health care to older adults., According to the population census 2011, there are nearly 104 million elderly persons (aged 60 years and above) in India. Of them, 53 million were female and 51 million were male. A report released by the United Nations population fund and help age India suggests that the number of elderly persons is expected to grow to 173 million by 2026. Both the share and size of the elderly population is increasing over time. From 5.6% in 1961, the population has increased to 8.6% in 2011. For males, it was marginally lower at 8.2%, while for females, it was 9.0. Aging is a natural process. Old age should be regarded as a normal, inevitable biological phenomenon. During the latter half of the 20th century, the age composition of the population changed dramatically, with more people living to older ages and the older population getting older. This demographic change will have a major impact on the delivery of general and oral-health care, as well as on the providers of these services. Although some older adults have physical and/or psychological conditions that require special attention in the dental office setting, one should not assume that all older people share common conditions., To evaluate a specific patient, the dentist must understand the cultural, psychological, educational, socioeconomic, dietary, and chronologically specific experiences that may have influenced his or her life. Oral health and status are affected by similar factors, and they are the accumulation of a person's life experiences with dental care, as well as with caries, periodontal diseases, and iatrogenic diseases.,, Increased knowledge of aging has previously been found to have only a modest effect on improving attitudes toward older people. To develop competence in managing geriatric patients, dental students must undergo educational experiences that result in development of special clinical skills and a caring attitude toward the elderly. Training in geriatric dentistry would enable the dentists to understand and empathize with the psychological behavior of the elderly, especially those suffering from some chronic medical illness. Negative attitudes toward the elderly are not unique to dental professionals. The apparent acceptance of edentulous state as the ultimate result of aging rather than as a pathological process has resulted in the lack of seriousness associated with the treatment of dental problems of the aged. Many studies have shown the attitudes of health professionals, in general, to be negative toward the elderly.,,, Such studies have not been conducted in India to measure the attitudes of dental students toward the elderly. The present study was conducted with the aim to know the association of perceived barriers in elderly care and to assess the attitude of undergraduate dental students toward the geriatric population.
| Materials and Methods|| |
A cross-sectional questionnaire study was carried out among the students from clinical years of two teaching dental institutions in the Capital Regional Development Authority of the state of Andhra Pradesh. Ethical clearance (reference no 132/IEC/SIBAR/2017) was obtained from the Institutional Ethical Committee of the teaching dental institution. The study sample consisted of 480 undergraduate dental students who deal with geriatric patients in their clinical postings. The sample size was estimated using the formula n = Zα2Zβ2pq/d2. Here, Zα was taken under 95% confidence level, Zβ was taken under 80% power of the test, and the given permissible error as 6% was allowed. All the students who were available in the period of March 2017 to February 2018 were included in this study. Among those, 199 were final-year students and 281 were interns. A structured, hand–delivered, and self-administered questionnaire was used for data collection. The validity of the questionnaire was checked by test–retest method and the Cronbach's alpha value was 0.8. The contents of the questionnaire were according to the geriatric dentistry guidelines and their objectives of dental education.,,,, Information obtained from the students included personal data such as age, gender, training regarding geriatric care, and their perceived barriers in the provision of dental care for geriatric patients. Responses regarding perceived barriers were recorded using 5-point Likert scale ranging from 1 = not important, 2 = very important, 3 = no idea, 4 = important and to 5 = very important. The attitudes of students toward the elderly were measured using the geriatric attitudes scale. The responses were recorded using a Likert scale with five categories ranging from strongly disagree = 1 to strongly agree = 5. A response of “strongly disagree or disagree” indicates a negative response and “strongly agree or agree” is indicative of positive response. A response of “not sure” was considered to be reflective of uncertainty or indecision. Informed consent was obtained from all the participants before the questionnaire was administered. Statistical analysis was done using SPSS Version 20 software (IBM SPSS statistics for Windows version 20, Armonk, NY, USA) and descriptive statistics and Chi-square test were done for analyzing the data. Owing to the limited number of responses in few categories of independent variables, categories were merged to facilitate the ease and relevance of the statistical analysis. In those, Fisher's exact test was used for the analysis. P < 0.05 was considered as significant.
| Results|| |
Of 480 undergraduate dental students, 64 (13.3%) were male and 416 (86.7%) were female. The mean age of the study subjects was 21.58 ± 1.143. The minimum age was 19 years and maximum 25 years. Among those, 199 were final years and 291 were interns. Sixty percentage reported not receiving any training in the provision of dental care for geriatric subjects. About 78.3% of dental students were showed a willingness to work for elderly patients [Table 1]. Most of the students (72.9%) positively answered the statements: “Looking after old people is a social duty,” “listening to past experiences of old people is interesting and I pay more attention and I behave more understandingly to my old patients than my young ones.” A total of 68.8% disagreed with the statement that old people do not add much to society [Figure 1]. Regarding barriers to provide elderly care, approximately half of the dental students believed that the financial ability of the elderly patient to pay for services, lack of appropriate facilities in dental offices, and insufficient knowledge of geriatric dental care are common barriers. More than half of the students opined that follow-up of the elderly patients is difficult and is an important barrier for the provision of dental care [Figure 2]. Attitudes of the dental students showed significant results with respect to financial ability of the elderly (P = 0.017), follow-up of elderly patients (P = 0.04), elderly patient compliance (P = 0.05), and inadequate communication skills in treating elderly patients [P = 0.05 and [Table 2]. The mean attitudes based on gender, females (2.500 ± 0.48) showed a positive attitude when compared to male (1.166 ± 0.19) study subjects. The total attitude mean score was 1.87 ± 0.34 [Table 3].
|Table 1: Distribution of the study subjects according to gender and their responses|
Click here to view
|Figure 1: Percentage of dental students' agreement with statements given about elderly people|
Click here to view
|Figure 2: Undergraduate dental students' responses to important barriers for the provision of dental care to elderly patient for each of eight items (ranged from very important to not at all)|
Click here to view
|Table 2: Attitude of dental students to work with the elderly and the barriers in elderly dental care|
Click here to view
|Table 3: Gender wise comparison of the study subjects' attitude toward the elderly|
Click here to view
| Discussion|| |
This study was designed to explore undergraduate dental students' knowledge of geriatric dental care and their attitudes toward the elderly. The rapid growth of the elderly population emphasizes the need for geriatric dental care knowledge in dental professionals. Dental providers' beliefs, attitudes, and comfort level with treating older patients are major factors in encouraging or discouraging dental care utilization by the elderly. Some studies addressed dentists' and dental students' opinions about treatment of the elderly in long-term care facilities, but few studies have focused on dental students' barriers for providing dental care for elderly patients.,,,, The first- and second-year students were not taken because they were not in touch with patients. In this study, most of the undergraduate dental students' showed positive attitudes toward the elderly which was similar to the study done by Gupta et al. In the present study, the female students had comparatively more positive attitudes to the male students which was statistically significant P = 0.000, which was coinciding with the statement given by Gupta et al. According to their study, male participants had a less positive attitude when compared to the female participants. Old people do not add much to society with this almost 71.2% female participants' and 53.1% of male participants' disagreement with this statement, which shows that they had much more positive attitude toward the elderly which was statistically significant P = 0.001. Inadequate communication skills with elderly patients with this barrier, 65.6% of males and 35.1% females were considering as very important barrier which was statistically significant P = 0.001. Majority of males (65.6%) and females (80.6%) said that they had inadequate knowledge of geriatric dental care. The study participants' inadequate knowledge of geriatric dental care, poor communication skills, and lack of confidence in management of elderly patients are the important barriers to dental provision to the elderly care. Regarding attitudes, females are more positive than males, and it seems that female dental students' were more caring and empathetic toward the elderly in the provision of dental care. Limitations of the study observed were the study sample should include a large number of subjects, then the results were more generalizable.
| Conclusion|| |
The study results conclude that the positive attitudes of undergraduates toward geriatric patients, even though they willing to give geriatric dental care, the lack of knowledge in giving care was one of the observed barriers for the elderly care. The key findings like 376 dental students were willing to work with elderly patients, only 22 students were not willing to work with elderly, and 82 students said that there was no difference between younger and older patients care that shows a positive attitude of the participants in the dental college toward the elderly care. The female undergraduate students were more empathetic when compared to male undergraduate students. There is a need to improve the knowledge and skills in the management of the elderly so that positive attitudes can be utilized properly to improve the quality of life of the elderly population in India. The level of knowledge and attitudes found in the present study can be improved by conducting regular educational programs.
The dental colleges must take responsibility for training students to meet growing elderly dental care needs. The first and foremost suggestion is that the addition of geriatric dental education to the undergraduate dental curriculum. A separate subject in the training of dental students must be introduced to provide quality dental care to the elderly population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
MacEntee MI, Pruksapong M, Wyatt CC. Insights from students following an educational rotation through dental geriatrics. J Dent Educ 2005;69:1368-76.
Thomas AM, Ship II. Current status of geriatric education in American dental schools. J Dent Educ 1981;45:589-91.
Harris NO. Primary Preventive Dentistry. 6th
ed. New York: Prentice Hill; 1999.
Park K. Preventive and Social Medicine. 21st
ed. Jabalpur: Bhanot Publishers; 2011.
Eklund, SA, Changing treatment, patterns. JADA 1999;130:1707-12.
Evans CA, Kleinman DV. The surgeon general's report on American's oral Health: Opportunities for the dental profession. JADA 2000;13:1721-8.
Ettinger RL, Mullingan R. The future of dental care for the elderly population. J Calif Dent Assoc 1999;27:687-92.
Holtzman J, Beck JD, Ettinger RL. Cognitive knowledge and attitudes toward the aged of dental and medical students. Educ Gerontol 1981;6:195-207.
Kiyak HA, Milgrom P, Ratener P, Conrad D. Dentists' attitudes toward and knowledge of the elderly. J Dent Educ 1982;46:266-73.
Gupta S, Venkatraman S, Kamarthi N, Goel S, Goel S, Keswani T. Assessment of the attitudes of undergraduate dental students toward the geriatric population. Trop J Med Res 2014;17:104-8. [Full text]
Bishop JL. A study of dental hygienists' attitudes towards working with elderly patients. Dent Hyg (Chic) 1979;53:125-7.
Borreani E, Wright D, Scambler S, Gallagher JE. Minimising barriers to dental care in older people. BMC Oral Health 2008;8:7.
Kaz ME, Schuchmann L. Oral health care attitudes of nursing assistant in long term care facilities. Spec Care Dent 1988;8:228-31.
Firtell DN, Stade EH. The declining complete denture patient pool in dental schools. J Prosthet Dent 1984;51:122-5.
Lee O, Kim BC, Han S. The portrayal of older people in television advertisements: A cross-cultural content analysis of the United States and South Korea. Int J Aging Hum Dev 2006;63:279-97.
Adegbembo AO, Leake JL, Main PA, Lawrence HP, Chipman ML. The influence of dental insurance on institutionalized older adults in ranking their oral health status. Spec Care Dentist 2005;25:275-85.
Kiyak HA, Reichmuth M. Barriers to and enablers of older adults' use of dental services. J Dent Educ 2005;69:975-86.
Chowdhry N. Factors that Influence Dentists Decisions to Treat Patients in Long-Term Care. MSc. Thesis; 2010.
Pakshir HR. Dental education and dentistry system in Iran. Med Princ Pract 2003;12 Suppl 1:56-60.
Lamster IB, Northridge ME, Takamura JC. Improving Oral Health for the Elderly: An Interdisciplinary Approach. Netherlands: Springer Verlag; 2008.
Hatami B, Ahmady AE, Khoshnevisan MH, Lando HA. Senior dental student's attitudes toward older adults and knowledge of geriatric dental care in the Islamic Republic of Iran. East Mediterr Health J 2014;19 Suppl 3:S172-7.
Chalmers JM, Hodge C, Fuss JM, Spencer AJ, Carter KD, Mathew R. Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes. Aust Dent J 2001;46:277-83.
Nitschke I, IIgner A, Muller F. Barriers to provision of dental care in long-term care facilities: The conformation with ageing and death. Gerodontology 2005;22:123-29.
Chowdhry N, Aleksejūnienė J, Wyatt C, Bryant R. Dentists' perceptions of providing care in long-term care facilities. J Can Dent Assoc 2011;77:b21.
Fabiano JA, Waldrop DP, Nochajski TH, Davis EL, Goldberg LJ. Understanding dental students' knowledge and perceptions of older people: Toward a new model of geriatric dental education. J Dent Educ 2005;69:419-33.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]