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Reported dental attendance and perceived barriers to care in frail and functionally dependent older adults


Objectives: This study was designed to investigate the reported dental attendance and the perceived barriers to dental care for frail and functionally dependent older adults.

Design: A single centre study of a housebound group of more than 60 years of age and their personal carers.

Setting: The study was carried out from a general dental practice in Ware, Hertfordshire, a market town 20 miles north of London.

Subjects and methods: A group of 263 housebound adults more than 60 years old were identified. The subjects were living in 5 residential homes, 3 sheltered housing complexes and in private accommodation. The subjects and 115 of their personal carers were interviewed.

Results: 93% only attended a dentist when they had problems. The presence of natural teeth, residential status and age were all statistically significant independent explanatory variables for the time since the previous reported dental visit. Lack of perceived need was found to be a barrier to care for 86% of subjects. Cost and lack of suitable transport were also commonly identified. However, the true cost implication to a patient was poorly appreciated especially by those 34% of subjects who cited cost as a barrier. 52% of the whole group, rising with age to 75% of those more than 90 years old, expressed a preference for treatment to be carried out in their own homes. 93% of carers had found difficulty in arranging dental care for their clients but the difficulties were not always the same as the subjects' perceived barriers. Among the carers, younger, regular dental attendees who were paid to care were more likely to see benefit in obtaining dental care for their clients.

Conclusion: The mechanisms by which these barriers to care may be lowered should be investigated in order to meet the unmet need identified by this study


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Lester, V., Ashley, F. & Gibbons, D. Reported dental attendance and perceived barriers to care in frail and functionally dependent older adults. Br Dent J 184, 285–289 (1998).

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