A total of 496 questionnaires were mailed out. Out of these, 11 questionnaires were returned because the dentists were no longer at the addresses leaving 485 valid questionnaires. A total of 386 questionnaires were returned. Out of these, 4 dentists declined to participate in the study. Two more questionnaires were excluded because they were filled in by a dental nurse and a dentist not working in the Dorset and Somerset area. In all, 380 valid questionnaires were returned out of the 485 questionnaires constituting a response rate of 78.4%.
Of the 485 valid questionnaires, 23 were mailed to Community Dental Officers (CDO) and 462 were sent to General Dental Practitioners (GDP). In terms of response, 20 CDOs responded (87%) while 360 GDPs responded (77.9%).
Characteristics of participants
The ages of the participants ranged from 24 to 65 years with the mean age being 43.7 years. Most of the participants were males (n = 262, 69%) while the rest were female (n = 116, 31%). Work experience among the participants ranged from 1 to 42 years with 19.9 years being the mean work experience.
Most participants were in group practice (n = 294, 78%) while 60 (16%) were in single-handed practice and 23 (6%) were in other kinds of practices including Community Dental Services (CDS). It should be noted that some dentists worked in multiple roles. Most participants were also in general practice (n = 340, 90%). Details are shown in Table 1.
Table 1: Characteristics of participants
Variable
|
Number (%)
|
Mean Age (years)
|
43.7
|
Sex
Male
Female
|
262 (69%)
116 (31%)
|
Mean Work experience (years)
|
19.9
|
Type of Practice
General Practice
Specialty Practice
Community Dental Service + PDS
Dental Access Center
Others
|
340 (90%)
14 (4%)
25 (7%)
6 (2%)
6 (2%)
|
Type of patients treated
Nursing/Residential home
Yes
No
Housebound patients
Yes
No
|
296 (78%)
83 (22%)
211 (56%)
168 (44%)
|
Treatment location
Nursing/Residential home
In surgery only
At home
Both
Housebound patients
In surgery only
At home
Both
|
119 (40%)
19 (6%)
158 (54%)
21 (10%)
29 (14%)
163 (77%)
|
Knowledge of elder abuse and neglect
Most participants had heard of elder abuse (n = 321, 84.7%) and elder neglect (n = 296, 78.1%). However, only a few had encountered specific incidents of elder abuse (n = 32, 8.4%) and neglect (n = 45, 11.9%). Similarly, few participants had treated an abused (n = 11, 2.9%) or neglected (n = 26, 6.9%) elderly patient. Again, few participants reported never hearing of elder abuse (n = 15, 4%) or elder neglect (n = 12, 3.2%). A higher proportion of participants reported having known or treated cases of neglect (n = 60, 18.8%) as compared to cases of abuse (n = 43, 11.3%). Most participants (n = 319, 85%) had not encountered cases of elder abuse or neglect in the last 5 years.
Dentists younger than 44 years (n = 36, 21%) encountered more cases of elder abuse as compared to those older than 44 years (n = 23, 11%) and this difference was statistically significant (chi-square = 6.34, p < 0.001).
There was no statistically significant difference in the likelihood of encountering a case of elder abuse between dentists working as CDOs and dentists working in other types of practices (chi-square = 3.18, p = 0.087).
Females were more likely (22% [n = 26]) to report having seen cases of suspected abuse and neglect in the elderly as compared to their male (13% [n = 34]) counterparts and this difference was statistically significant (chi-square = 5.88; p < 0.05).
Work experience did not make any statistical difference with regards dentists encountering elder abuse and neglect (chi-square = 2.76, p = 0.105). Dentists who treated patients in residential and nursing homes were more likely to encounter elder abuse cases than those who did not (chi-square = 14, p < 0.001).
Time frame within which most recent incident occurred
Of those dentists who had encountered cases of elder abuse or neglect, 26 (44%) reported that the incident had occurred within the last 12 months while 33 (56%) reported that the incident occurred more than a year ago. Within this latter group, the most recent incident had occurred within a 1–5-year time frame for 25 (76%) of the respondents. In summary, 51 out of 59 (86.4%) of cases had occurred within the last 5 years.
Persons alerting dentist to possibility of abuse/neglect
Most participants (n = 38, 64%) reported that the incident of abuse or neglect was brought to their attention through personal observation. No respondent was alerted by the police or a voluntary organisation. Table 2 summarises these results.
Characteristics of abused/neglected elders
The cases of elder abuse encountered by participants were 59. The age of the victims ranged from 65 to 94 years with a mean of 77.6 years. There were more females than males (n = 37, 61% vs n = 24, 39%). Most of the victims were living in residential or nursing homes at the time of the incident (n = 33, 55%). Of the cases encountered, 28 (47%) of them were suspected to be inflicted by a member of the nursing staff or residential home. Details are shown in Table 2.
Type of Injury sustained
The injuries sustained by victims of elder abuse/neglect encountered by participants ranged from bruises, to fractures. There were also cases of malnutrition. Most of the participants (n = 26, 43%) reported no apparent injuries in the cases they encountered. Some victims of elder abuse and/or neglect may have sustained more than one type of injury. Details are shown in Table 2.
Neglect observed or reported by patient
There were 86 reported cases of neglect with the commonest type being neglect of personal hygiene (n = 40,47%). Details are shown in Table 2.
Actions taken by dentist
Most participants (n = 24, 39%) spoke to relatives about the possibility of elder abuse. However, 23% (n = 14) took no action. Details are summarised in Table 2.
Comparing knowledge of elder abuse/neglect between PCTs
Bournemouth (n = 56, 15%) had the highest number of dentists while North Dorset had the least (n = 23, 6%).
There were more cases of elder neglect (n = 86) as compared to elder abuse (n = 59). Cases of neglect were more likely to be first detected by the dentist while abuse cases were more likely to be first reported by someone other than the dentist and this difference was statistically significant (chi-square = 8.42, p < 0.001).
Elders were more likely to be abused when living alone or with family and the abuse was more likely to be carried out by family members (n = 7, 87.5%) than when they had other living situations (n = 1, 12.5%) (chi-square = 13.83, p < 0.05). However, they were more likely to be neglected when living in nursing and residential homes (n = 33, 65%) as compared to living alone or with family (n = 18, 35%) (chi-square = 5.73, p < 0.05).
There was no statistically significant difference in knowledge of elder abuse/neglect between dentists in the Dorset and Somerset areas (chi-square = 4.9, p = 0.18).
Table 2: Participants’ knowledge of elder abuse/neglect
Variable
|
Number (%)
|
Elder abuse/neglect first noticed by
Dentist
Patient
Patient’s relative
Patient’s friend/neighbour
Nursing/Residential home staff
Hospital staff
|
38 (64%)
5 (9%)
6 (10%)
1 (2%)
4 (7%)
5 (8%)
|
Elder abuse first noticed by
Dentist
Others
|
1 (12.5%)
7 (87.5)
|
Elder neglect first noticed by
Dentist
Others
|
37 (72.5%)
14 (27.5%)
|
Living situation at time of incident
Nursing home
Alone
With spouse
Residential home
With child
Other
|
23 (38%)
13 (22%)
11 (18%)
10 (17%)
2 (3%)
1 (2%)
|
Suspected abuser
Nursing/Residential home staff
Unidentified
Spouse
Friend/Neighbour
Child/Sibling
Other
|
28 (46%)
14 (23%)
9 (15%)
4 (7%)
4 (7%)
1 (2%)
|
Type of elder abuse
No apparent injury
Other injuries
Malnutrition
Bruises including facial bruising
Abrasions
Broken dental prosthesis
Wounds/ Cuts/ Punctures
Fractured/Avulsed teeth
Burns/ Scalds
Bone/Skull fractures
Dislocations/ Sprains
|
26 (43%)
16 (26%)
14 (23%)
16 (26%)
6 (10%)
4 (7%)
2 (3.3%)
2 (3.3%)
2 (3.3%)
0 (0%)
0 (0%)
|
Type of elder neglect
Neglect of personal hygiene
Inadequate dental care
Inadequate food
Inadequate medical care
Inadequate housing
|
40 (66%)
24 (39%)
11 (18%)
8 (13%)
3 (5%)
|
Action taken by dentist
Spoke to relatives
No action
Other
Emergency dental treatment
Referred to social services
Referred to general practitioner
Referred to hospital
Referred to legal services/police
|
24 (39%)
14 (23%)
12 (20%)
12 (20%)
6 (10%)
9 (15%)
4 (7%)
0 (0%)
|