Background
There is abundant evidence of a discrepancy between perceived oral treatment need and dental service-use by older people, a discrepancy that has persisted for more than 35 years. Studies have indicated that, of a group of non-institutionalized elderly people with clinically assessed or normative oral treatment needs, about half perceived the need and about one quarter sought treatment. Recent studies among elderly residents in Dutch and Italian nursing homes showed even larger differences between normative and self-perceived needs. Apparently, large discrepancies exist between self-perceived and normative treatment need, and between self-perceived treatment need and service-use.
Frailty, as a "dynamic state affecting an individual who experiences losses in one or more domains of human functioning (physical, psychological, social)", is likely to contribute to these discrepancies by negatively affecting both dental service-use and oral hygiene-related behaviors. However, despite extensive research on barriers to dental service-use and oral hygiene-related behavior in which barriers have been associated with impaired mobility, impaired activities of daily living, low energy, depression, and lack of social support, it remains unclear how frailty in its many forms influences the oral care of older people. For example, it is not clear whether service-use and toothbrushing are disturbed more by impaired mobility, dexterity, or low morale, or, as some suggest, by a lack of time and energy caused by more pressing general health problems. Nor do we know what motivates frail people to apply oral care despite physical and cognitive impairments, or why there are discrepancies between perceived treatment need and service-use. This knowledge should help to make evidence-based decisions about the allocation of resources aimed at improving the oral health related quality of life of people who are affected by frailty.
This study aims to explain how frailty influences dental service-use and oral self-care by older people.