PubL Itlth, Lond. (1975) 89, 57-63
A Survey of Housebound Persons in Cardiff with Special Reference to Dental Care J. F. Bates B.D.S., M.Sc., D.D.S,
A. Harrison B.D.S., F.D.S., R.C.S.
The We/sh Nadona/ Schoo/ of Med/c/ne, Department of Restorat/ve Dent/strg, The Denta/ Schoo/, Heath Park, Card~if, CF4 4XY
The dental treatment for the population of the United Kingdom is divided between the General Dental Service and the Public Dental Service both now being united under the control of the Area Health Authorities as part of the National Health Service. The former provides, in certain circumstances, arrangements whereby a local practitioner can carry out domiciliary treatment, but in the community where the ratio of dentists in this Service to the population varies between 1-3000 and 1-7000 there are many instances where patients confined to their homes cannot possibly obtain treatment. With the passing of the Chronic Sick and Disabled Persons Act, 1970, and reorganization of the Health and Local Authority services, a survey to establish the numbers of housebound people in the community was felt to be worthwhile. The 1970 Act requires local authorities to ascertain within their area the number of disabled people but large numbers of the population fail to take advantage of these services and, of these, the housebound may well form a considerable number. A preliminary pilot survey was undertaken in one area of Cardiff where it was anticipated that the percentage of housebound people would be higher because of the age of the houses and the type of community. 870 houses were visited and 690 replies were obtained. The difference was due to no-one answering the door, which seemed to indicate that no-one was in the house or, in a small number of cases, unable to answer the door. From the 690 replies, 65 people were defined as housebound and 46 with some further degree of disability or handicapped. The average age of the housebound was over 70 years of age, and the information obtained from this pilot survey enabled a more detailed survey to be planned on the assumption that these figures would be the maximum which were likely to be obtained. Method With the help of Professor A. Cochrane and the Medical Research Council Epidemiological Unit, 10 000 houses were selected by a computer from Kelly's Street Directory on a random basis. The print-out from the computer stipulated the page, the column, and the line so that it was possible to establish the addresses of the houses which were then written on to the questionnaire sheets (see Appendix). The questions were arranged in such a way that the last questions enabled some check to be made on the early questions which enabled the individuals concerned to be graded with regard to their incapacity. Whilst it is difficult to define exactly when a person is housebound, it is necessary to lay down certain criteria, and in this survey a housebound person was detined as being
58
J. F. Bates and A. Harrison
unable to leave the house or garden without some mechanical assistance such as a stretcher or a wheelchair. The questionnaire sheets were then sorted into local areas which were marked on small maps for the interviewer. Some small districts included in the Directory were outside the city limits and excluded, thus reducing the number of houses surveyed. Ten female interviewers were given an explanation of the objectives of the survey and some instruction in completing the questionnaire. A short field trial was also carried out, and the forms were collected each day and the interviewers questioned as to difficulties which were then resolved. Where no reply could be obtained from an occupied house the interviewer called at the adjacent house to ascertain whether any housebound people resided there. Where possible, the f o r m was completed in this way, but if this was unsatisfactory, and following a second visit to the house, the forms were collected separately into the " n o reply" return. When all the forms had been returned they were separated and the results are shown in Table 1. TABLE1. Housebound Survey t972 Housebound Disabled Doubtful
320 95 84
Not housebound or disabled Refused to answer questionnaire No reply Vacant, demolished, flats, shops and offices Deceased, moved Not known--unable to trace address
7232 32 944 232 120 73 9132
It was felt that the number of " n o reply" questionnaires was rather high, and in order to establish that there was, in fact, no-one housebound within the house, a postal questionnaire of 1 in 4 of these was sent out with a pre-paid reply envelope. F r o m these, 124 replies were received with 7 indicating that there were housebound people present. I f these people were housebound it is difficult to see how they were not available when the interviewer called, although m a n y old people may not answer the door through fear or were bed-ridden and without someone in attendance.
Dental Survey In December 1972, from the 320 housebound subjects obtained by interview, every second patient was sent a letter indicating the time at which two senior undergraduates would call to make a dental examination. I f this was inconvenient, a pre-paid envelope was provided for a further appointment at a specified time. Previous experience (Gerrish, Yardley, Stafford & Bates, 1972; Mark6n & Hedegfird, 1970) had established that for this type of survey, final year dental students could complete an examination as accurately as more experienced qualified staff and, therefore, the two undergraduates visited the homes and completed a dental examination using a form to record the details.
Results The age distribution of the 320 housebound people is shown in Figure 1. It was intended to examine 1 in 2 of the housebound persons, and of the 170 letters sent out requesting
Housebound persons in Cardiff
59
60
5O
4O
q 30 Z
20
I0 ~
o
I0
20
30 40
50 Age
60 70
80 90
I00
Figure 1. Age distribution of 320 housebound people.
permission to carry out an examination, 31 refused to co-operate. Occupants of a further 50 houses, when visited, refused a dental examination, mainly because they claimed they already had artificial teeth. The remaining 80 persons are, therefore, the subject of this report and their age distribution is shown in Figure 2. Of these, 74 had last seen a dentist at a dental surgery, and 68 had dentures fitted at that time. Only 2 people had had dental treatment carried out at h o m e and none had seen a dentist in the last three years. It would seem, therefore, that m o s t of the people were not housebound when last seen by a dentist. 20 18 16 14 12 x:l
=E IO
Z
8 6 4 2 0
] 50 60 70
80 90
N I00
Age
Figure 2. Age distribution of 80 subjects used in the survey. II, Males; ~ , females.
60
J. F. Bates and A. Harrison
Dental State Of the 80 people examined, only 10 possessed some of their own teeth, and of these 6 had periodontal involvement, some had roots remaining and dental decay present. All the six patients needed oral hygiene instruction and dental treatment. Three patients had no teeth or dentures, and of the 69 who were wearing complete dentures, 54 were satisfied with them although 28 requested some form of treatment. An examination of the dentures showed that 35 of the dentures were poor, 18 fair, and 16 satisfactory. None of the patients were in pain although, on examination, 39 required some form of non-urgent treatment. All the patients wore their dentures during the day-time and for eating, and 14 wore them at night as well. Fourteen patients complained that they were unable to eat all types of food without difficulty. General Conditions Seventeen of the patients were wearing hearing aids and three said they needed them but did not possess them. Six of the patients were bedridden, three were in wheelchairs. The illnesses suffered which caused the confinement are shown in Table 2 and are similar to those reported by the General Household Survey and by Harris (1971).
TABLE2. Illnesses suffered Arthritis Strokes and heart condition Leg injuries Emphysema Old age Others e.g. Polio Parkinsonism Mentally handicapped Urinary Diabetic
35 20 7 4 6
8
Discussion The number of patients confined to their homes in the United Kingdom is not readily obtainable. Previous surveys by Sheldon (1950) and the more recent national survey of Handicapped and Impaired in Great Britain (Harris, 1971) does not deal with local communities in detail. The General Household Survey also does not deal with housebound persons although 21% report that chronic or acute illnesses limited their activity. This was, however, mainly due to chronic illness. The need for a classification of people who are housebound in contrast to handicapped has been recognized in the elderly (McKendrick & Peach, 1968), and in the national survey (Harris, 1971) the ability to leave the house and visit the dental surgery is not included in the classification of disablement, but most of the housebound people fall in categories 1-6. The total of the handicapped in the population, according to Harris, is 1 128 000 in categories 1-6 (Tables 9 and 10), and the distribution of these is 68 % of categories 1-3 who are housebound: 28.5 % in categories 4 and 5; and 15 % in category 6 (Table 17). In total the Handicapped and Impaired Survey showed 8 % of persons over 16 as having some disability which limited activity. There is also a greater proportion of females in the disabled group except in industrial areas of the north of England and in Wales where accidents in the mines and industries
Housebound persons in Cardiff
61
increase the number of male disabled persons (Table 12). The high proportion of females occurs because the majority of disabled are elderly and the average life expectancy is higher for females. The General Household Survey also shows a higher incidence of limiting long-standing male illness in Wales (204-3/thousand)--an overall incidence higher than other areas. From this information, therefore (Harris--Table 12) it is estimated that out of a total number of 58,000 handicapped people in Wales, approximately 20,000 would be housebound, representing approximately 0.7 ~ of the total population. This, however, would be an average covering areas of rural population and densely populated mining areas. Two surveys, one by the Cardiganshire County Council, indicate that 660 people were housebound out of a total population survey of 51,590 (1.2 ~), whilst in a mining area such as Merthyr Tydffl County Borough, 1820 housebound people were present in a population of 54,800 (3.3 ~). Whilst the results may vary with the definition of housebound, it would seem logical that a higher percentage would be found in a mining area. In the case of the elderly, many of these either live alone (Harris--Table 15) compared with the handicapped young person, which makes it much more difficult for those in the impaired categories 5-8, who are partially housebound, to be taken to the dentist and they become, in effect, housebound. The Government Statistical Service (1972) indicates that the average number of persons in a house is three, and with 7264 houses surveyed, this represents 21 792 people out of a total population in Cardiff of 285 000. This indicates that 1.5 ~ of the population is housebound, with a total of 4275 people in Cardiff being confined to their houses. This is twice the number which would be estimated from the national survey but agrees with the reports of the Cardiganshire County Council and Merthyr Tydfil County Borough surveys. The dental status of these housebound subjects is similar to those people living in Council homes (Gerrish et al., 1972) and other elderly groups (Sheard, 1971). According to the 1961 Census, 87 000 persons live in residential accommodation provided by the local councils. The dental state of the housebound is also similar to those in geriatric hospitals in South Glamorgan (Payne, Evans, Stafford & Bates, 1973). A problem exists in providing dental treatment for all these people due to the shortage of dentists and the lack of a suitable organization to supply their needs. At this time of life, oral cancer is not unknown and some screening of patients to ensure freedom from pathology should be the priority of any service established to cater for these patients, and also to treat those situations which cause pain and soreness. Active treatment should also be provided where absolutely necessary, but in treating the elderly, care must be taken not to re-make dentures which have been worn for a considerable time since the patients have become adapted to them and are unlikely to be satisfied with new dentures. The lack of adaptation in the elderly makes it essential to keep what teeth they do possess as complete dentures may never be worn if the teeth are extracted. Conclusions
The dental state of the patients who are housebound does not appear to be markedly different from that of any other elderly community and it is, therefore, necessary to provide a service which fulfils a similar need to elderly patients in council homes and other institutions. The aim of the service should be one of prevention and improvement in oral health. Dental treatment by general practitioner or consultant should be available on request from a dental hygienist who would make routine examinations of patients in this group and all other elderly groups in institutions Controlled either by the Area Health Authorities or Local Authorities (Stafford, 1973).
62
J. F. Bates and A. Harrison
Ideally, the service should be centralized with m o b i l e d e n t a l facilities f o r the t r e a t m e n t o f p a t i e n t s either in their o w n h o m e s , council h o m e s or in those h o s p i t a l s where no d e n t a l facilities exist.
Acknowledgements We would like to thank Professor Cochrane and his staff at the Medical Research Council Epidemiological Unit for their help and advice, and all the dental students who helped in this project. Financial help was received for this project from the Department of Health and Social Security.
References Gerrish, J. S., Yardley, A., Stafford, G. D. & Bates, J. F. (1972). Dental Practitioner 22, 433. Government Statistical Service (1972). Social Trends, No. 3. Harris, A.,I. et aI. (1971). Handicapped and Impaired in Great Britain, Part 1. Office of Population Censuses and Surveys--Social Survey Division. London: H.M.S.O. Mark6n, K. E. & Hedegfird, B. (1970). Swedish Dental Journal 63, 949. H.M.S.O. (196t). Age and Mental Condition and General Tables Census. H.M.S.O. (1973). The General Household Survey. McKendrick, W. & Peach, F. P. (1968). Prevention rather than cure; a survey of the social conditions of a group of aged persons. The Medical Officer, 120, 247-251. Payne, P. E. C., Evans, D. J., Stafford, G. D. & Bates, J. F. (1973). Age and Ageing 2, 39. Sheard, A. V. (1971). Survey of the elderly in Scunthorpe. Public Health 85, 208-218. Sheldon, J. H. (1968). The Social Medicine of Old Age. London: Oxford University Press. Stafford, G. D. (1972). Public Health 87, 9-16. Director of Social Services. Report on Survey of the Old and Handicapped in Merthyr Tydfil County Borough. Director of Social Services, Cardiganshire County Council, (1970). Report on Survey of the Old and Handicapped.
Appendix Survey of Housebound Subjects--Card~ff" Name of householder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of house . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . District . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surveyor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (1) Is there anyone who usually lives in this house who has difficulty getting out ? NOTE: "Out" means outside the house and garden. IF YES: Name of housebound person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of dentist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO
DOUBTFUL
YES
Housebound persons in Cardiff H o w many times has he/she been out in the past week
63
....................
If T W I C E O R LESS
in the past m o n t h . . . . . . . . . . . . . . . . . . . .
If T W I C E O R LESS
in the past year
i
Could he/she CouM he/she Could he/she CouM he/she
go out attend attend attend
....................
for essential shopping ? his/her doctor's surgery ? a hospital clinic without an ambulance ? a dentist ?
NO NO NO NO
DOUBTFUL DOUBTFUL DOUBTFUL DOUBTFUL
YES YES YES YES
N O T E : " C o u l d " implies the use o f available help from relatives, including a car.
Could this person W I T H O U T aid
1. 2. 3. 4. 5. 6.
Walk outdoors ? Walk indoors? Negotiate stairs ? Wash and bath ? Dress ? Cut toenails ?
NO NO NO NO NO NO
(2) Is there any person living here who although not housebound, suffers from any permanent and substantial handicap or disability ? NO
YES YES YES YES YES YES DOUBTFUL
(3) If this is so: (a) What is nature of handicap ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) What is n a m e of this person ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (c) What is age of this person ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (4) H o w many persons live in this house?
OAP Other Adults Children 0-4 5-18 Total
....................
YES
A Survey of Housebound Persons in Cardiff with Special Reference to Dental Care J. F. Bates B.D.S., M.Sc., D.D.S,
A. Harrison B.D.S., F.D.S., R.C.S.
The We/sh Nadona/ Schoo/ of Med/c/ne, Department of Restorat/ve Dent/strg, The Denta/ Schoo/, Heath Park, Card~if, CF4 4XY
The dental treatment for the population of the United Kingdom is divided between the General Dental Service and the Public Dental Service both now being united under the control of the Area Health Authorities as part of the National Health Service. The former provides, in certain circumstances, arrangements whereby a local practitioner can carry out domiciliary treatment, but in the community where the ratio of dentists in this Service to the population varies between 1-3000 and 1-7000 there are many instances where patients confined to their homes cannot possibly obtain treatment. With the passing of the Chronic Sick and Disabled Persons Act, 1970, and reorganization of the Health and Local Authority services, a survey to establish the numbers of housebound people in the community was felt to be worthwhile. The 1970 Act requires local authorities to ascertain within their area the number of disabled people but large numbers of the population fail to take advantage of these services and, of these, the housebound may well form a considerable number. A preliminary pilot survey was undertaken in one area of Cardiff where it was anticipated that the percentage of housebound people would be higher because of the age of the houses and the type of community. 870 houses were visited and 690 replies were obtained. The difference was due to no-one answering the door, which seemed to indicate that no-one was in the house or, in a small number of cases, unable to answer the door. From the 690 replies, 65 people were defined as housebound and 46 with some further degree of disability or handicapped. The average age of the housebound was over 70 years of age, and the information obtained from this pilot survey enabled a more detailed survey to be planned on the assumption that these figures would be the maximum which were likely to be obtained. Method With the help of Professor A. Cochrane and the Medical Research Council Epidemiological Unit, 10 000 houses were selected by a computer from Kelly's Street Directory on a random basis. The print-out from the computer stipulated the page, the column, and the line so that it was possible to establish the addresses of the houses which were then written on to the questionnaire sheets (see Appendix). The questions were arranged in such a way that the last questions enabled some check to be made on the early questions which enabled the individuals concerned to be graded with regard to their incapacity. Whilst it is difficult to define exactly when a person is housebound, it is necessary to lay down certain criteria, and in this survey a housebound person was detined as being
58
J. F. Bates and A. Harrison
unable to leave the house or garden without some mechanical assistance such as a stretcher or a wheelchair. The questionnaire sheets were then sorted into local areas which were marked on small maps for the interviewer. Some small districts included in the Directory were outside the city limits and excluded, thus reducing the number of houses surveyed. Ten female interviewers were given an explanation of the objectives of the survey and some instruction in completing the questionnaire. A short field trial was also carried out, and the forms were collected each day and the interviewers questioned as to difficulties which were then resolved. Where no reply could be obtained from an occupied house the interviewer called at the adjacent house to ascertain whether any housebound people resided there. Where possible, the f o r m was completed in this way, but if this was unsatisfactory, and following a second visit to the house, the forms were collected separately into the " n o reply" return. When all the forms had been returned they were separated and the results are shown in Table 1. TABLE1. Housebound Survey t972 Housebound Disabled Doubtful
320 95 84
Not housebound or disabled Refused to answer questionnaire No reply Vacant, demolished, flats, shops and offices Deceased, moved Not known--unable to trace address
7232 32 944 232 120 73 9132
It was felt that the number of " n o reply" questionnaires was rather high, and in order to establish that there was, in fact, no-one housebound within the house, a postal questionnaire of 1 in 4 of these was sent out with a pre-paid reply envelope. F r o m these, 124 replies were received with 7 indicating that there were housebound people present. I f these people were housebound it is difficult to see how they were not available when the interviewer called, although m a n y old people may not answer the door through fear or were bed-ridden and without someone in attendance.
Dental Survey In December 1972, from the 320 housebound subjects obtained by interview, every second patient was sent a letter indicating the time at which two senior undergraduates would call to make a dental examination. I f this was inconvenient, a pre-paid envelope was provided for a further appointment at a specified time. Previous experience (Gerrish, Yardley, Stafford & Bates, 1972; Mark6n & Hedegfird, 1970) had established that for this type of survey, final year dental students could complete an examination as accurately as more experienced qualified staff and, therefore, the two undergraduates visited the homes and completed a dental examination using a form to record the details.
Results The age distribution of the 320 housebound people is shown in Figure 1. It was intended to examine 1 in 2 of the housebound persons, and of the 170 letters sent out requesting
Housebound persons in Cardiff
59
60
5O
4O
q 30 Z
20
I0 ~
o
I0
20
30 40
50 Age
60 70
80 90
I00
Figure 1. Age distribution of 320 housebound people.
permission to carry out an examination, 31 refused to co-operate. Occupants of a further 50 houses, when visited, refused a dental examination, mainly because they claimed they already had artificial teeth. The remaining 80 persons are, therefore, the subject of this report and their age distribution is shown in Figure 2. Of these, 74 had last seen a dentist at a dental surgery, and 68 had dentures fitted at that time. Only 2 people had had dental treatment carried out at h o m e and none had seen a dentist in the last three years. It would seem, therefore, that m o s t of the people were not housebound when last seen by a dentist. 20 18 16 14 12 x:l
=E IO
Z
8 6 4 2 0
] 50 60 70
80 90
N I00
Age
Figure 2. Age distribution of 80 subjects used in the survey. II, Males; ~ , females.
60
J. F. Bates and A. Harrison
Dental State Of the 80 people examined, only 10 possessed some of their own teeth, and of these 6 had periodontal involvement, some had roots remaining and dental decay present. All the six patients needed oral hygiene instruction and dental treatment. Three patients had no teeth or dentures, and of the 69 who were wearing complete dentures, 54 were satisfied with them although 28 requested some form of treatment. An examination of the dentures showed that 35 of the dentures were poor, 18 fair, and 16 satisfactory. None of the patients were in pain although, on examination, 39 required some form of non-urgent treatment. All the patients wore their dentures during the day-time and for eating, and 14 wore them at night as well. Fourteen patients complained that they were unable to eat all types of food without difficulty. General Conditions Seventeen of the patients were wearing hearing aids and three said they needed them but did not possess them. Six of the patients were bedridden, three were in wheelchairs. The illnesses suffered which caused the confinement are shown in Table 2 and are similar to those reported by the General Household Survey and by Harris (1971).
TABLE2. Illnesses suffered Arthritis Strokes and heart condition Leg injuries Emphysema Old age Others e.g. Polio Parkinsonism Mentally handicapped Urinary Diabetic
35 20 7 4 6
8
Discussion The number of patients confined to their homes in the United Kingdom is not readily obtainable. Previous surveys by Sheldon (1950) and the more recent national survey of Handicapped and Impaired in Great Britain (Harris, 1971) does not deal with local communities in detail. The General Household Survey also does not deal with housebound persons although 21% report that chronic or acute illnesses limited their activity. This was, however, mainly due to chronic illness. The need for a classification of people who are housebound in contrast to handicapped has been recognized in the elderly (McKendrick & Peach, 1968), and in the national survey (Harris, 1971) the ability to leave the house and visit the dental surgery is not included in the classification of disablement, but most of the housebound people fall in categories 1-6. The total of the handicapped in the population, according to Harris, is 1 128 000 in categories 1-6 (Tables 9 and 10), and the distribution of these is 68 % of categories 1-3 who are housebound: 28.5 % in categories 4 and 5; and 15 % in category 6 (Table 17). In total the Handicapped and Impaired Survey showed 8 % of persons over 16 as having some disability which limited activity. There is also a greater proportion of females in the disabled group except in industrial areas of the north of England and in Wales where accidents in the mines and industries
Housebound persons in Cardiff
61
increase the number of male disabled persons (Table 12). The high proportion of females occurs because the majority of disabled are elderly and the average life expectancy is higher for females. The General Household Survey also shows a higher incidence of limiting long-standing male illness in Wales (204-3/thousand)--an overall incidence higher than other areas. From this information, therefore (Harris--Table 12) it is estimated that out of a total number of 58,000 handicapped people in Wales, approximately 20,000 would be housebound, representing approximately 0.7 ~ of the total population. This, however, would be an average covering areas of rural population and densely populated mining areas. Two surveys, one by the Cardiganshire County Council, indicate that 660 people were housebound out of a total population survey of 51,590 (1.2 ~), whilst in a mining area such as Merthyr Tydffl County Borough, 1820 housebound people were present in a population of 54,800 (3.3 ~). Whilst the results may vary with the definition of housebound, it would seem logical that a higher percentage would be found in a mining area. In the case of the elderly, many of these either live alone (Harris--Table 15) compared with the handicapped young person, which makes it much more difficult for those in the impaired categories 5-8, who are partially housebound, to be taken to the dentist and they become, in effect, housebound. The Government Statistical Service (1972) indicates that the average number of persons in a house is three, and with 7264 houses surveyed, this represents 21 792 people out of a total population in Cardiff of 285 000. This indicates that 1.5 ~ of the population is housebound, with a total of 4275 people in Cardiff being confined to their houses. This is twice the number which would be estimated from the national survey but agrees with the reports of the Cardiganshire County Council and Merthyr Tydfil County Borough surveys. The dental status of these housebound subjects is similar to those people living in Council homes (Gerrish et al., 1972) and other elderly groups (Sheard, 1971). According to the 1961 Census, 87 000 persons live in residential accommodation provided by the local councils. The dental state of the housebound is also similar to those in geriatric hospitals in South Glamorgan (Payne, Evans, Stafford & Bates, 1973). A problem exists in providing dental treatment for all these people due to the shortage of dentists and the lack of a suitable organization to supply their needs. At this time of life, oral cancer is not unknown and some screening of patients to ensure freedom from pathology should be the priority of any service established to cater for these patients, and also to treat those situations which cause pain and soreness. Active treatment should also be provided where absolutely necessary, but in treating the elderly, care must be taken not to re-make dentures which have been worn for a considerable time since the patients have become adapted to them and are unlikely to be satisfied with new dentures. The lack of adaptation in the elderly makes it essential to keep what teeth they do possess as complete dentures may never be worn if the teeth are extracted. Conclusions
The dental state of the patients who are housebound does not appear to be markedly different from that of any other elderly community and it is, therefore, necessary to provide a service which fulfils a similar need to elderly patients in council homes and other institutions. The aim of the service should be one of prevention and improvement in oral health. Dental treatment by general practitioner or consultant should be available on request from a dental hygienist who would make routine examinations of patients in this group and all other elderly groups in institutions Controlled either by the Area Health Authorities or Local Authorities (Stafford, 1973).
62
J. F. Bates and A. Harrison
Ideally, the service should be centralized with m o b i l e d e n t a l facilities f o r the t r e a t m e n t o f p a t i e n t s either in their o w n h o m e s , council h o m e s or in those h o s p i t a l s where no d e n t a l facilities exist.
Acknowledgements We would like to thank Professor Cochrane and his staff at the Medical Research Council Epidemiological Unit for their help and advice, and all the dental students who helped in this project. Financial help was received for this project from the Department of Health and Social Security.
References Gerrish, J. S., Yardley, A., Stafford, G. D. & Bates, J. F. (1972). Dental Practitioner 22, 433. Government Statistical Service (1972). Social Trends, No. 3. Harris, A.,I. et aI. (1971). Handicapped and Impaired in Great Britain, Part 1. Office of Population Censuses and Surveys--Social Survey Division. London: H.M.S.O. Mark6n, K. E. & Hedegfird, B. (1970). Swedish Dental Journal 63, 949. H.M.S.O. (196t). Age and Mental Condition and General Tables Census. H.M.S.O. (1973). The General Household Survey. McKendrick, W. & Peach, F. P. (1968). Prevention rather than cure; a survey of the social conditions of a group of aged persons. The Medical Officer, 120, 247-251. Payne, P. E. C., Evans, D. J., Stafford, G. D. & Bates, J. F. (1973). Age and Ageing 2, 39. Sheard, A. V. (1971). Survey of the elderly in Scunthorpe. Public Health 85, 208-218. Sheldon, J. H. (1968). The Social Medicine of Old Age. London: Oxford University Press. Stafford, G. D. (1972). Public Health 87, 9-16. Director of Social Services. Report on Survey of the Old and Handicapped in Merthyr Tydfil County Borough. Director of Social Services, Cardiganshire County Council, (1970). Report on Survey of the Old and Handicapped.
Appendix Survey of Housebound Subjects--Card~ff" Name of householder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of house . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . District . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surveyor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (1) Is there anyone who usually lives in this house who has difficulty getting out ? NOTE: "Out" means outside the house and garden. IF YES: Name of housebound person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of dentist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO
DOUBTFUL
YES
Housebound persons in Cardiff H o w many times has he/she been out in the past week
63
....................
If T W I C E O R LESS
in the past m o n t h . . . . . . . . . . . . . . . . . . . .
If T W I C E O R LESS
in the past year
i
Could he/she CouM he/she Could he/she CouM he/she
go out attend attend attend
....................
for essential shopping ? his/her doctor's surgery ? a hospital clinic without an ambulance ? a dentist ?
NO NO NO NO
DOUBTFUL DOUBTFUL DOUBTFUL DOUBTFUL
YES YES YES YES
N O T E : " C o u l d " implies the use o f available help from relatives, including a car.
Could this person W I T H O U T aid
1. 2. 3. 4. 5. 6.
Walk outdoors ? Walk indoors? Negotiate stairs ? Wash and bath ? Dress ? Cut toenails ?
NO NO NO NO NO NO
(2) Is there any person living here who although not housebound, suffers from any permanent and substantial handicap or disability ? NO
YES YES YES YES YES YES DOUBTFUL
(3) If this is so: (a) What is nature of handicap ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) What is n a m e of this person ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (c) What is age of this person ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (4) H o w many persons live in this house?
OAP Other Adults Children 0-4 5-18 Total
....................
YES
