Background
Methods
ZZP-score | Physical status | Disorders | Hours/week of care needed | |||||
---|---|---|---|---|---|---|---|---|
Social coping | Psychosocial functioning | Personal care | Mobility | Motor functioning | Medical care | Behavioural disorders | ||
1 | + | 0 | + | + | 0 | 0 | 0 | 3-5 |
2 | +++ | + | ++ | + | + | + | 0 | 5,5-7,5 |
3 | ++++ | ++ | ++++ | +++ | ++ | + | 0 | 9,5-11,5 |
4 | ++++ | +++ | ++ | + | + | + | + | 11-13,5 |
5 | +++++ | ++++ | ++++ | ++++ | ++ | + | + | 16,5-20 |
6 | ++++ | +++ | +++++ | +++++ | +++ | ++ | 0 | 16,5-20 |
Data collection and analysis
Participant characteristics | Number |
---|---|
Sex
| |
Female | 35 |
Male | 16 |
Age
| |
65-80 yr | 24 |
>80 yr | 27 |
ZZP-score*
| |
ZZP1 | 14 |
ZZP2-3 | 17 |
ZZP4-6 | 20 |
Dental status
| |
Natural teeth only | 15 |
Nat. teeth and partial dentures | 12 |
Nat. teeth and full upper dentures | 12 |
Full upper and lower dentures | 12 |
Institutionalized
| |
Yes | 28 |
No | 23 |
Reflexivity of the researchers
Qualitative rigor
Results
Theme A: Adhering to routines in order to sustain a sense of self worth
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A1 |
A while ago, I was in hospital for a week where they gave me a special bowl to brush my teeth in. I find that awful, very awful. But there’s no way around it when you can’t stand up. […] I still think I should not skip brushing. […] I wish to feel clean. (woman, 70, severely frail, severe Parkinson).
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A2 |
I just wanted to feel normal again. When you do your daily routines, combing your hair, brushing your teeth, just like you always do, it feels as if you’re not that ill. (man, 75, talking about his recent stay at the intensive care unit after acute renal failure).
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A3 |
I wish to be cared for, I don’t won’t to lie here as a pile of old dirt, that goes for the mouth, for everything. (woman, 86, severely frail).
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A4 |
If a nurse talks to me and brushes my teeth and then she says, well that’s nice and fresh like this, by saying so she lets me know that I still count as a human being. (woman, 80, slightly frail).
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A5 |
You owe it to yourself to maintain a healthy mouth […] I live healthily, I hardly ever take sweets and I brush my teeth every night. (woman, 94, moderately frail).
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A6 |
I like to care for my teeth [….] I like to be able to care for my teeth. It is so important that you don’t neglect your personal care […] they have told me that I have always looked so well after my body and my teeth […] that makes me proud. (woman, 70, severely frail, severe Parkinson).
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A7 |
In that case [if she would not brush and her teeth would be visibly unclean] I’m quite sure that people would think ‘can’t that person brush her own teeth anymore’? (woman, 78, moderately frail).
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A8 |
I thought, all those nurses, they get quite close to you. […] I would really dislike it if they would see me as mister rotting. […] as someone who is too slack to prevent the decay that after all he can do something about. (man, 75, severely frail, talking about his recent stay in hospital).
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Theme B: Lack of motivation: the benefits of dental visits or daily tooth cleaning are not worth the effort
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Subtheme: lack of belief in results
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B1 |
It’s not that I don’t want to go, but whom should I see? From what I have come across, it is only misery. (man, 93, full dentures, severely frail).
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B2 |
When I take my dentures out, it feels freed. But I have to wear them, so… You think what could be done about it, I understand, but if I would have believed that a dentist could help me, I would have gone there a long time ago. But I know that it wouldn’t help. (woman,86, full dentures, slightly frail).
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B3 |
I’ve got this feeling that my lower jaw is shrinking a lot. There’s hardly anything left there. But that’s a family thing, my mum had that too. (woman, 85, full dentures, moderately frail).
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B4 |
They [dentures] have not been sitting well from the beginning. But I’ve always thought that it was because of this fungal infection, I had in my gullet. [..] That that infection has moved up to my mouth. […] Cause my mum had the same, her mouth was always sore. […] And her gums were sore too. And then she was rubbing like this. […] I have determined for myself that it really is that fungal infection. […]. And I won’t go to the dentist, because that is no use, they cannot fix it. (woman,86, full dentures, slightly frail).
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B5 |
I don’t go anymore. He [a dentist] can’t do anything for me, can he? […] Last time I went was 10 years ago, and ever since I have not had any complaints, so why should I go? (woman, 85, dentate, moderately frail).
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B6 |
Well I have tried to clean them [dentures] with a brush, but they weren’t that dirty, and they didn’t get that clean either […] well, no moss grows on them [dentures], what else should you care about? (man, 93, full dentures, severely frail).
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Subtheme: Reduced importance of oral health and oral care
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B7 |
I simply cannot brush my teeth properly anymore. […] But I don’t mind having to take dentures. […] My health is more important than my teeth now. (man, 80, severe Parkinson, severely frail).
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B8 |
When you can’t do anything anymore, then you don’t wish to do anything anymore, then you can’t be bothered about anything. (woman, 85, severely frail).
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B9 |
My teeth don’t interest me. Because I am depressed. […] I only rinse them [dentures] when something gets underneath, and that’s it. […] I don’t know if a dentist could help me, I don’t care. (woman, 73, moderately frail).
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B10 |
I can’t get them 100% clean, not even with an electric toothbrush […] It is too hard to reach them […] I’ve tried, but it didn’t work, and now it doesn’t bother me anymore. […] I don’t mind losing my teeth. (man, 80, severely frail).
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B11 |
I wouldn’t [see a dentist], not unless I would have serious toothache. Life won’t last that long anymore when you’re so old as I am. […] My teeth will keep, I think. (woman, 85, severely frail).
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B12 |
I’m only bothered with having a fresh feel in my mouth now […] when you’ve kept your teeth this long like me, they will survive. (woman, 84, moderately frail).
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B13 |
I would not go to the dentist [in order to replace bad teeth]. […]. If I cannot bite anymore I will eat porridge. (woman, 93, severely frail).
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Subtheme: Conscious choice to preserve energy for other goals
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B14 |
I don’t see a dentist anymore. I don’t feel like it. I rather preserve my energy for other things. […] But if I would have pain, I would go again. I wouldn’t go on with a painful mouth. (woman, 77, severe arthritis, severely frail).
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B15 |
When I can achieve, with only a small effort, that my mouth remains fresh and a bit healthy, then I don’t mind doing it, but if it takes a big effort, then not, which is why I don’t see a dentist anymore. (woman, 93, severely frail).
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B16 |
And in the past I would clean my dentures after a meal, but, and that is laziness, I openly admit it, I don’t do that anymore. […] After all it takes an effort, and I have to divide my energy sensibly. I could go walk back and forth to the bathroom, but I rather be knitting something, or do something else. (woman, 86, severely frail).
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B17 |
I don’t wish to look for another dentist, because that requires a lot of you. When you get older and weaker […] you can’t work up the effort. I could do it when I was younger, but now, look I don’t cycle anymore. I am just slower […]. It really is not important enough. […] And now I need to look after my husband [ a Parkinson patient], and I have to save all my time and effort for that. (woman, 80, slightly frail).
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Theme C: Structural barriers: I’d like to, but I can’t
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Subtheme: Disorientation: I don’t know how it works here
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C1 |
Since I live here, I don't always get the right care. Because I don't know how it works when I need care here, if I should go back to see my old dentist or if they [staff] arrange someone. I wouldn't know. (woman, 86, recently institutionalized, slightly frail).
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C2 |
I wouldn't mind seeing a dentist, but I don't know anyone here. I don't know who would be good. […] Everything is so distressing here. (woman, 79, moderately frail).
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C3 |
I would have to look up where to go to. I am not at home anymore. And I don't have all the addresses anymore. So to find all that out, that is an enormous....But I should do it. I should look up where my own dentist is. And then i should go. It has been too long ago since I went there. (woman, 93, severely frail).
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C4 |
I have to brush regularly. And, you should write this down, that does not happen here. They forget to help remind me. You have to do it yourself […] and then I lie on my bed and I think, oh my God, I did not brush my teeth. And I cannot walk by myself, I need someone to bring me to the bathroom […] They don’t help me enough. I am forgetful now, and they don’t remind me.[…] I have looked after my teeth my whole life, and now they let it get in a mess. (woman, 93, severely frail).
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C5 |
It is a bit difficult with my hands […] and to reach the wash basin. […] [interviewer: why haven’t you asked the nurses to help you?]. I didn’t think about it, didn’t know I could do that. (man, 65, spastic, wheel chaired, severely frail).
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Subtheme: Inconveniencing social support: getting (the right) help is hard.
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C6 |
I do want to have it fixed. […] but I cannot burden my daughter to take me to the dentist as well. She has had enough on her plate. [interviewer: and have you considered asking your other children?] Well I have asked it enough. I cannot go on insisting. “Mum, stop nagging,” they say to me. (woman, 83, severely frail).
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C7 |
I would only go now if I would have pain. And then I would ask my daughter to bring me to the dentist. […] I would only go if she can make it, because she’s busy herself. (woman, 97, severely frail).
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C8 |
I still live independently and I have to bother people with my requests so often, and I have to ask so many people to do something for me, and I don’t like that. (woman 80, slightly frail).
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C9 |
The whole inside hurts because of my lower dentures. And I thought, I should go the dentist, but well, I don’t have a husband no longer, and that means I would have to go there myself. […] So I haven’t gone yet. (woman, 87, slightly frail).
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C10 |
I think that a nurse does not like to brush my teeth. A nurse is not really paid to do it, has not been trained to do it […] that makes it hard to accept help, the thought that people do not like to help you brush, it makes you feel so dependent. (woman, 80, slightly frail).
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