Barriers and facilitators to accessing oral healthcare for older people in the uk: a scoping review

ABSTRACT INTRODUCTION Access to dental services is a growing problem for older people in the UK. The aim of this scoping review is to identify the barriers and facilitators influencing older

people's ability to access oral healthcare in the UK based on the existing literature. METHODS The scoping review followed the framework proposed by Levac and colleagues (2010).

Peer-reviewed literature was retrieved in April 2023 from Web of Science, Medline, PsycInfo and CINAHL for the period 1973-2023. After screening, data were extracted to identify barriers and

facilitators mapped to individual, organisational and policy-level factors. The themes generated were used to identify gaps in the literature and policy recommendations. RESULTS Overall, 27

studies fulfilled the inclusion criteria. Most studies published were from England; there was a large representation of opinion pieces. The main barriers and facilitators related to cost of

services, perceptions of dentistry, availability of services and both the dental and social care workforce. CONCLUSION Multiple barriers exist surrounding access to dental care for older

people. Various facilitators exist but not all are successful. More research needs to be carried out on older people's access to dental services in the community, particularly for the

‘oldest old' and minority groups. KEY POINTS * This study maps the existing evidence surrounding access to oral healthcare for older adults in the UK. * The study highlights that many

barriers and facilitators to accessing oral healthcare exist but there are gaps in the literature regarding representation of marginalised groups within this population, such as older people

living in the devolved nations, the ‘oldest old' (85+) age group, and minority ethnic groups living outside of London. * Whilst many barriers and facilitators have not changed in the

last 50 years, commissioners and policymakers need to consider how the structure of dental services needs to actively support older people's access-related needs. SIMILAR CONTENT BEING

VIEWED BY OTHERS ACCESS TO DENTAL CARE IN INDIVIDUALS WITH DISABILITY: A SYSTEMATIC REVIEW Article 15 January 2024 POTENTIAL EDUCATIONAL AND WORKFORCE STRATEGIES TO MEET THE ORAL HEALTH

CHALLENGES OF AN INCREASINGLY OLDER POPULATION: A QUALITATIVE STUDY Article Open access 10 March 2022 BARRIERS TO AND FACILITATORS FOR ATTENDING DENTAL CARE APPOINTMENTS AMONG ADULTS IN LOW-

AND MIDDLE-INCOME COUNTRIES: A SCOPING REVIEW Article 12 May 2025 INTRODUCTION Within the UK, a significant proportion of people are aged 65 or older.1,2 This is leading to a larger

population subgroup who require access to dental services but who may suffer difficulties doing so due to the ageing process. The extent and prevalence of oral diseases is greater in older

people. This is a result of multiple factors, such as greater difficulty with self-care practices, dry mouth from polypharmacy and the development of comorbid conditions which influence oral

health, such as diabetes.3,4 In addition, as more older people are retaining their teeth into old age, those with heavily restored dentitions require increased maintenance than other

population groups and previous generations.5,6 This typically leads to older people facing a greater level of impact of poor oral health on their quality of life, contributing to oral and

general frailty and malnutrition.4,7,8,9,10 Access to dental services is an important factor in being able to support older people's oral health. Dental teams may assist with ongoing

prevention, symptomatic relief of odontogenic pain, xerostomia and pathological mobility, earlier detection and screening of oral cancer, and provision of dentures.11,12,13 There is limited

guidance on oral healthcare for older people in the UK. Guidance that does exist typically focuses on those in care homes, which includes the National Institute for Health and Care

Excellence (NICE) guidelines and the Care Quality Commission (CQC) guidance.14,15 However, the care home population only constitutes 3.2% of older people in England and Wales.16 To

effectively design healthcare policy and inform commissioning decisions, a clear evidence base needs to be established to highlight comprehensively what is important in accessing oral

healthcare. Many studies have assessed access to oral healthcare for specific groups, such as vulnerable adults, people with mental health issues, those with protected characteristics and

those in care homes.17,18,19,20 Scoping reviews have only been undertaken on one aspect of access to oral healthcare. Examples includes the provision of rural geriatric care, teledentistry,

and geriatric dental education, and older people's views on accessing oral healthcare.21,22,23,24 To date, however, no studies have been carried out to summarise the barriers and

facilitators for all older people. The aim of this study is to identify the barriers and facilitators influencing older people's ability to access oral healthcare in the UK. MATERIALS

AND METHODS The objectives of this study were: * Review current literature related to accessing oral healthcare for older people in the UK since 1973 and identify the evidence available *

Identify barriers and facilitators for access and organise them into categories: individual, organisational and policy levels * Identify areas for further research, commissioning and policy

recommendations for older people in the UK. A scoping review was considered necessary to map the evidence surrounding access to dental services for all older people. The scoping review

followed the enhanced framework from Levac and colleagues which used the stages described by Arksey and O'Malley.25,26 A protocol was drafted and followed to ensure adherence to the

Joanna Briggs Institute (JBI) guidelines.27 Inclusion criteria were as follows: * Studies in English language only * Any peer-reviewed research or opinion piece evaluating older

people's access to oral healthcare, particularly evaluating access to dental services * Any appropriate study found post hoc where additional search terms were discovered * Studies

based in the UK and/or any devolved nation * Studies carried out between 1973-2023. Exclusion criteria were: * Studies not carried out in English * Studies evaluating only populations under

age 60 or where the population is not specified as ‘older people', unless the study involves those caring for, or providing healthcare for, older people * Case reports, case series,

letters and conference abstracts and proceedings * Studies which evaluated oral healthcare or mouth care without describing access to dental services, and studies which did not discuss

access to oral healthcare for older people * Scoping review protocols * Systematic reviews. Age 60 years was chosen as the age cut-off as some older studies used this to reflect historical

retirement ages for women and shorter life expectancies in the UK.28 As the review sought to advise policymakers within the UK, non-UK sources were excluded. Search terms: (dental OR oral)

AND (healthcare OR service*) AND (‘older people*' OR elderly OR senior OR geriatric) AND (challenge OR facilitators OR ‘barrier* and facilitator*' OR hindrance OR access* OR avail*

OR enabl* OR motivators). A librarian was consulted for clarification with Boolean operators relevant to each database search. Databases searched were Web of Science (including Medline),

PsycINFO and CINAHL. Abstracts and papers were retrieved. The number of studies selected is shown in Fig. 1. Some papers were unobtainable. The study was constrained by time so it could be

used to contribute to commissioning decisions about dental services and national survey design. Consequently, there was no hand-searching of reference lists or grey literature. The final

search was carried out on 25 April 2023. Study titles and abstracts were screened for inclusion into the study. Full-text articles were viewed where the study was thought to address access

to oral healthcare for older adults but where this was not explicitly discussed in the abstract. Two reviewers then carried out full-text screening of a sample of articles. Figure 1 shows

the PRISMA-ScR flowchart of study selection (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Scoping Review). The results were exported to the reference management

software Endnote Online and duplicates removed. The JBI extraction template was used.27 This instrument was piloted by one reviewer. A second reviewer provided feedback and the data

extraction form was finalised. Data extraction was carried out by a single reviewer in June 2023, following training from a second reviewer. Data extraction included the following

information: title; lead author; year of publication; country; population; setting; age of participants; study type; study aims; key results; facilitators and barriers according to

individual/organisational/policy-level; research gaps; and additional notes. Due to the nature of the scoping review, whilst some study limitations were identified, studies were not assessed

for quality.29 Results of the barriers and facilitators were categorised into individual, organisational and policy-level factors which are summarised in Table 1 and Table 2. A qualitative

thematic analysis was conducted to identify themes which could link barriers or facilitators together into sub-categories: these were agreed by both reviewers. Using individual, policy-level

and organisational factors can identify clear areas where policy and commissioning at both national and community levels can occur, whilst highlighting ways that local factors may also be

addressed. Organisational and policy-level factors were compared between studies and used to create specific policy recommendations, in line with other scoping reviews on access to dental

care.17,18,19 RESULTS The initial search of peer-reviewed articles yielded 1,272 papers; the overall number of included studies was 27. The PRISMA flowchart shows the number of included

studies (Fig. 1). Most studies were qualitative (n = 10; 37%). Five studies did not specify the age of participants apart from describing them as ‘older adults'. Three studies included

adults over the age of 60; for one of these, women were included over age 60 and men were included over age 65, reflecting the sex differences in the legal pensionable age at the time the

study was undertaken. Other age ranges given were unspecified (five studies), over 75 (one study), over 63 (one study), and mostly over 85 (one study). The years included in the study ranged

from 1984-2021. Of the studies included, eight were opinion pieces, three were mixed-methods studies, ten were qualitative studies and two were quantitative. There was one audit, one

service evaluation and one strategy review. Of the English studies, a mixture of regions were represented: London (3), North West (3), North East (3), South East (2) and South West (1).

There were two studies from Scotland, one from Wales and none from Northern Ireland. Of the 18 primary studies included, the mean sample size was 636 (range 21-10,600). These samples

included a combination of older adults, care home staff, dental workforce and other stakeholders in dentistry. Two studies specifically included an ethnically diverse sample and four studies

assessed minority ethnic groups exclusively. Barriers and facilitators are summarised in Tables 1 and 2. INDIVIDUAL BARRIERS The main barriers related to cost, dental anxiety, mobility

issues, generational attitudes and beliefs about dentistry and dental services. Overall, 17 (63%) papers mentioned cost as a barrier to

care.30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46 Cost was a barrier to care either directly or indirectly, including the fear of cost.34,36,37,41,44 Cost was more of a barrier for

those living in the community; those in residential homes relied on the family to pay, which was sometimes a barrier.31,46 DENTAL ANXIETY Dental anxiety and past negative experiences of

dentistry were barriers to care.38,45,47 Negative experiences included past painful, frightening or unsuccessful treatments, or disliking the dental surgery or dentist's

character.34,41,42,47 LONELINESS Six papers discussed living alone, isolation, or lack of social support as being a barrier to care.34,35,43,44,48,49 This was more for adults aged over 85,

men, those living alone and those without an escort.34,35,36,41,51 Living in a care home with dementia became a barrier due to the lack of ability to communicate oral health needs.44

MOBILITY In total, 11 papers identified mobility as a barrier to attendance, which was from having difficulty leaving the house, being disabled, frail, or unable to use

stairs.30,31,32,34,35,36,38,41,45,48,51 Issues existed with not being able to get to the practice due to distance, parking, public transport or other health conditions.33,33,35,37,39,41,48

For those with dementia, the resultant confusion or disorientation from journeying to appointments resulted in care-resistant behaviour.38,39 GENERATIONAL ATTITUDES Five studies identified

generational attitudes as a barrier which did not change over life.30,33,36,37,44 These included the fear of bothering the dentist, fatalistic attitudes towards oral health in ageing and a

preference to manage problems at home.35,37 In total, 13 reports identified lack of perceived need for dental visits as a barrier to accessing care, which related to older people being born

when being edentulous was more common, particularly before the NHS.30,31,32,33,34,35,36,37,40,41,42,43 Some people believed that dentists were profit-driven and were influenced by social

networks, negative media representation of dentistry and lack of knowledge of available services.33,41,47 Some older people considered seeing doctors rather than dentists for mouth

problems.31,32,38 INDIVIDUAL FACILITATORS The main individual facilitators were related to dental beliefs. These included being motivated to attend and seek care, having positive experiences

of dentistry and a belief that visits are beneficial and a moral duty.30,32,34,38,41,42 ORGANISATIONAL BARRIERS RACISM AND CULTURAL FACTORS Older people from minority ethnic groups

experienced additional challenges to accessing care. These included experiences of racism and hostility from services, lack of knowledge of local services, and not having dentists nearby who

could speak the same language.33,37,47 Specific cultural beliefs reinforced the lack of perceived need for dentists, such as that tooth loss was not serious, that treatments could be

inappropriate and the fear of being perceived negatively for help-seeking behaviours.37 DENTAL WORKFORCE The number of dentists carrying out NHS care, community dental services, NHS dental

practices and services providing domiciliary care was both varying and inadequate.39,46,52,53 Not all dental practices offered domiciliary appointments, even upon request.41,46 For general

dentists, this was due to lack of remuneration, equipment difficulties, anxieties around medical emergencies and personal safety, and not being able to provide quality care in a non-dental

setting.30,38,49 REFERRAL PATHWAYS AND ORGANISATIONAL STRUCTURES The referral pathways for both domiciliary and community dental services were often complex and included long waiting

times.46,52 For in-practice appointments, barriers included a lack of accessible parking, no ground floor surgeries, no wheelchair access and small surgeries which could not accommodate

mobility aids.41,49,53 Some dental services did not have any relationship with local care homes, nor did they contact older people for recall visits, yet older people could not book

appointments in advance.31,41,43,46,51 ORGANISATIONAL BARRIERS AND FACILITATORS The main facilitators surrounding the organisation of dental services related to increasing the availability

of domiciliary, outreach and/or teledentistry appointments,34,38,46 ensuring waiting times were reduced,41 and becoming more wheelchair-friendly.38 DENTAL PRACTICE ENVIRONMENT Dentists'

attitudes could create an unfriendly surgery environment which became a barrier to accessing care; a positive, friendly, listener-oriented attitude was considered a facilitator.41,54 One

older study identified dentists as not understanding their role in maintaining oral health as part of healthy ageing; a more recent study highlighted aspects of non-verbal communication,

such as being rushed.41,51 HEALTH AND SOCIAL CARE WORKFORCE Workforce issues related to the need to upskill both dentists and the social care workforce around oral health and care for older

people, as well as raising awareness and planning services to promote oral health in other sectors and to become more culturally competent, were proposed

facilitators.31,35,39,43,44,45,52,53,54,55 Studies highlighted that both formal and informal carers lacked knowledge and held unhelpful attitudes for older people in seeking care.31,35 These

were more severe if carers were older, dentally anxious, unpaid, or not regular dental attenders themselves.31 Carers were often busy and had little time to attend dental issues or

appointments; where they did, they did not have the required information on medications and exemption charges that the dentist needed to provide care.36,43,43,49,54,56 Care staff sometimes

acted as gatekeepers for making appointments when oral health needs of residents was considered unimportant or not a priority, or from a belief that the older person would be unamenable to

receiving treatment.31,35,44,46,48,56 They also made inappropriate referrals to doctors for oral issues.46,54 The key organisational facilitators related often to raising the importance of

oral health in care homes to improve referrals, including more training for caring staff and implementing oral health assessments.31,35,39,53,54,56,57 POLICY-LEVEL BARRIERS AND FACILITATORS

Policy-level barriers identified were the lack of free dental services for older people,40,41,46 lack of automatic exemption charges,41 lack of adequate remuneration for domiciliary

services,44,52 changes to the NHS contract system resulting in privatisation of practices,46,48,57 lack of needs-based workforce planning and service commissioning, especially for

domiciliary care,36,38,39 and lack of training of health and social care workers in mouth care.38,53 Policy-level facilitators typically existed as proposed solutions. These included:

commissioning services according to need, including care home services,30,31,39,40,41,47,49,53 creating guidelines relevant to older people,38,39,47,54 and improving referral

pathways.,39,41,46,49,52 including blending in-surgery with domiciliary appointments,38 and improving referral pathways. They also included upskilling the dental workforce and improving

training to manage generational values and communication needs.33,39,41 Seven studies identified the need for collaboration between all aspects of health and social care.38,40,41,46,53,54,57

Ensuring media representations of dentistry were more balanced was also highlighted.41Policy recommendations synthesised from the primary results are shown in Box 1 and Box 2. BOX 1 POLICY

RECOMMENDATIONS * Remove dental charges for older people or increase the scope of eligible exemptions * Eliminate penalties for exemption charges for older people * Commission a greater

number of dental services for older people * Commission oral health educators and other dental care professionals to provide oral healthcare for older adults * Reform the NHS dental contract

to incentivise dentists to provide care for older people and an increased number of domiciliary services * Introduce flexible commissioning to include access sessions for older people *

Establish gerodontology as a dental specialty * Implement oral healthcare into the curriculum for the social care workforce * Standardise gerodontology as part of the undergraduate dental

curriculum in the General Dental Council's Standards for education67 * Develop straightforward referral pathways for those in health and social care to refer to dental services *

Enforce existing of NICE requirements for oral healthcare to be carried out in care homes by the CQC14,15 * Consider patient and public involvement in designing of new dental services for

older people * Expand the range of community dental services available in health centres * Provide funding to older people or dental practices to claim expenses for costs associated with

attending appointments * Provide grants to encourage dental practice relocation to more accessible premises and/or to adapt practices to become more accessible * Provide free equality,

diversity and inclusion training for dental teams * Commission more outreach services to deprived communities * Commission care pathways which can combine domiciliary assessments with

in-surgery care. BOX 2 RESEARCH GAPS * Studies on barriers and facilitators to accessing oral healthcare for people living in the community * Studies on older people in the 85+ year age

group * Studies assessing access to oral healthcare for family members, informal carers and health and social care professionals * Studies assessing particular barriers and facilitators to

accessing oral healthcare in particular communities such as minority ethnic groups outside of London and women * Studies in the devolved nations, particularly Northern Ireland * Studies

exploring the role of the media on access to care for older people * Studies exploring the role of culturally competent dental services in access to care for minority groups * Studies

exploring attitudes of dentists towards ageing and older people * Studies exploring the impact of the current NHS access crisis on older people * Studies exploring the role of dental tourism

in the UK and private cosmetic dentistry on availability of services * Studies exploring the potential for skill mix to be a facilitator for improving access to dental care. DISCUSSION The

aim of this study was to identify and map existing research surrounding access to oral healthcare for older adults to provide policymakers and commissioners with an evidence-base to improve

access and surveys for this population subgroup. Whilst not all barriers and facilitators may apply to all older people, the results of the study nevertheless highlighted age-specific

factors. Many of the barriers and facilitators overlapped with those experienced by other vulnerable groups, as shown in other studies.18,19,20,21,58,59 This was the first study to limit the

search to dental care in the UK whilst extending the time period to encompass the last 50 years. A key finding was that, over a 50-year period, many of the barriers and facilitators to

accessing dental care had not in fact changed. For example, education and workforce issues surrounding training for geriatric dentistry were the same as studies mentioned 20 years

previously.48 Almost half of the studies reported the lack of perceived need to see a dentist as a barrier to care. Whilst this may be interpreted as a call to educate older people as to the

importance of visiting a dentist, it signifies that there is a discrepancy between older people's health needs and priorities and what the dental profession considers to be important

for their health. This highlights the need for dental services to be co-produced by older people with the aim to meet older people's felt needs, rather than only considering normative

need.54,59 In the last 50 years, the health and social care landscape has become increasingly dominated by neoliberal marketisation.60 Dental practices in the UK operate as small businesses,

which ultimately must be profit-driven to succeed.61 Potential policy-level facilitators for care included the Disability Discrimination Act, which was later replaced by the Equality

Act.38,62 However, later studies describe lack of wheelchair access as a continued barrier to attending dental practices physically despite these policies existing.41,46,53 Borreani _et

al_.41,42proposed that the 2006 dental contract would reduce some barriers associated with cost of care. In reality, this led to confusion over the cost of treatment, increasing ‘fear of

cost', whilst direct costs persisted as a barrier to attending dental care.41,46 Policymakers must consider how to commission and support dental services to accommodate older people so

that practices are not financially disincentivised from seeing this population. A limitation of the study was due to changes in terminology. One study was retrieved post hoc from the primary

reviewer's own research knowledge, despite the original terms being supported by a librarian. Another limitation was that hand-searching and grey literature was not included despite an

exploratory search revealing that guidelines do exist surrounding oral healthcare for older adults.1,15,16,63,64,65,66 This is an area which could be explored in the future; yet, notably,

much of the existing guidance focuses on those in care homes or with dementia. This scoping review highlighted multiple gaps in the literature (Box 2). There were not many studies available

to assess barriers and facilitators to accessing dental care for people living in the community, particularly for those in the 85+ age group. Few of the studies in this review distinguished

between the varying levels of frailty and privilege amongst older people. Studies who did define ‘older people' typically followed national census categories or historic retirement

ages, despite the breadth of ages this could encompass.2,66 Furthermore, there was a lack of studies in the last 25 years on minority ethnic groups living outside of London, women and older

people living in the devolved nations, especially Northern Ireland. Future studies could identify populations underrepresented in research and stratify cohorts according to age and/or

dependency. To further explore barriers experienced by community-dwelling older adults as opposed to care home populations, research could include family members, informal carers and other

health and social care professionals. Multiple studies identified the beliefs and attitudes held by older people towards dentistry, particularly the factors which distinguished an older

person from having positive rather than negative perceptions of dentists and oral health. Aspects which were identified but not explored in depth included negative media attention around

dentistry, lack of dental health education of older people, culturally hostile healthcare services and dentists' varying attitudes towards older people. Research into these fields could

provide insights into the development of more inclusive services. CONCLUSION In conclusion, many barriers and facilitators exist relating to older people's access to dental services.

Future research is required to explore specific barriers and facilitators within the diverse subgroup of older people beyond those in care homes. Without addressing older people's needs

now, the problem of access is likely to worsen as the ageing population grows. DATA AVAILABILITY The data are available from the authors upon request. REFERENCES * UK Government. What is

known about the oral health of older people in England and Wales. 2015. Available at

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/489756/What_is_known_about_the_oral_health_of_older_people.pdf (accessed November 2022). *

Office for National Statistics. Population and household estimates, England and Wales: Census 2021. 2022. Available at

https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/populationandhouseholdestimatesenglandandwales/census2021 (accessed November 2024). *

Alpert P T. Oral Health: The Oral-Systemic Health Connection. _Home Health Care Manag Pract_ 2016; 29: 56-59. * Ramsay S E, Whincup P H, Watt R G _et al_. Burden of poor oral health in

older age: findings from a population-based study of older British men. _BMJ Open_ 2015; 5: e009476. * NHS England. Adult Dental Health Survey 2009 - England Key Findings. 2011. Available at

https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series (accessed July 2024). *

Steele J. _NHS Dental Services in England - An Independent Review_. 2009. * Age UK. State of the nation: older people and malnutrition in the UK today. 2017. Available at

https://www.ageuk.org.uk/globalassets/age-uk/documents/programmes/malnutrition-taskforce/mtf_state_of_the_nation.pdf (accessed August 2023). * Tanaka T, Takahashi K, Hirano H _et al_. Oral

Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly. _J Gerontol A Biol Sci Med Sci_ 2018; 73: 1661-1667. * Minakuchi S. Philosophy of Oral

Hypofunction. _Gerodontology_ 2022; 39: 1-2. * Zenthöfer A, Rammelsberg P, Cabrera T, Schröder J, Hassel A J. Determinants of oral health-related quality of life of the institutionalized

elderly. _Psychogeriatrics_ 2014; 14: 247-254. * Thomson W, Ma S. An ageing population poses dental challenges. _Singapore Dent J_ 2014; 35: 3-8. * UK Government. Oral cancer in England: a

report on incidence, survival and mortality rates of oral cancer in England, 2012 to 2016. 2020. Available at

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/891699/Oral_cancer_report_170420.pdf (accessed August 2023). * Matear D, Barbaro J. Caregiver

puterspectives in oral healthcare in an institutionalised elderly population without access to dental services: a pilot study. _J Royal Soc Prom Health_ 2006; 126: 28-32. * Care Quality

Commission. Smiling matters: oral health in care homes. 2019. Available at https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes (accessed March 2023).

* National Institute for Clinical Excellence. Improving oral health for adults in care homes. 2018. Available at

https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/improving-oral-health-for-adults-in-care-homes (accessed March 2023). * Office for National Statistics. Changes in the

Older Resident Care Home Population between 2001 and 2011. 2014. Available at

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/changesintheolderresidentcarehomepopulationbetween2001and2011/2014-08-01 (accessed March 2023). *

Slack-Smith L, Hearn L, Scrine C, Durey A. Barriers and enablers for oral health care for people affected by mental health disorders. _Aust Dent J_ 2017; 62: 6-13. * El-Yousfi S, Jones K,

White S, Marshman Z. A rapid review of barriers to oral healthcare for vulnerable people. _Br Dent J_ 2019; 227: 143-151. * El-Yousfi S, Jones K, White S, Marshman Z. A rapid review of

barriers to oral healthcare for people with protected characteristics. _Br Dent J_ 2020; 228: 853-858. * Göstemeyer G, Baker S R, Schwendicke F. Barriers and facilitators for provision of

oral health care in dependent older people: a systematic review. _Clin Oral Invest_ 2019; 23: 979-993. * Legge A R, Latour J M, Nasser M. Older Patients' Views of Oral Health Care and

Factors which Facilitate or Obstruct Regular Access to Dental Care-Services: A Qualitative Systematic Review. _Community Dent Health_ 2021; 38: 165-171. * Nilsson A, Young L, Glass B, Lee A.

Gerodontology in the dental school curriculum: A scoping review. _Gerodontology_ 2021; 38: 325-337. * Ben-Omran M O, Livinski A A, Kopycka-Kedzierawski D T _et al_. The use of teledentistry

in facilitating oral health for older adults. _J Am Dent Assoc_ 2021; 152: 998-1011. * Chandel T, Alulaiyan M, Farraj M _et al_. Training and educational programs that support geriatric

dental care in rural settings: A scoping review. _J Dent Educ_ 2022; 86: 792-803. * Arksey H, O'Malley L. Scoping studies: towards a methodological framework. _Int J Soc Res Methodol_

2005; 8: 19-32. * Levac D, Colquhoun H, O'Brien K K. Scoping studies: advancing the methodology. _Implement Sci_ 2010; 5: 69. * Joanna Briggs Institute. Appendix 11.1: JBI template

source of evidence details, characteristics and results extraction instrument - JBI Manual for Evidence Synthesis. 2022. Available at

https://jbi-global-wiki.refined.site/space/MANUAL/4687579 (accessed November 2022). * Moneyfarm. UK Retirement Age: Learn all you need to know about female and male retirement age in UK.

2024. Available at https://blog.moneyfarm.com/en/pensions/retirement-age-in-the-uk-when-can-you-retire-and-get-your-state-pension/ (accessed July 2023). * Grant M J, Booth A. A typology of

reviews: an analysis of 14 review types and associated methodologies. _Health Inf Libr J_ 2009; 26: 91-108. * Steele L. Provision of dental care for elderly handicapped people. A community

dental officer's view. _J R Soc Health_ 1984; 104: 208-209. * Hoad-Reddick G, Grant A A, Griffiths C S. Knowledge of dental services provided: investigations in an elderly population.

_Community Dent Oral Epidemiol_ 1987; 15: 137-140. * Tobias B, Smith J. Barriers to dental care, and associated oral status and treatment needs, in an elderly population living in sheltered

accommodation in West Essex. _Br Dent J_ 1987; 163: 293-295. * Diu S, Gelbier S. Oral health screening of elderly people attending a Community Care Centre. _Community Dent Oral Epidemiol_

1989; 17: 212-215. * Mattin D, Smith J. The oral health status, dental needs and factors affecting utilisation of dental services in Asians aged 55 years and over, resident in Southampton.

_Br Dent J_ 1991; 170: 369-372. * Merelie D L, Heyman B. Dental needs of the elderly in residential care in Newcastle-upon-Tyne and the role of formal carers. _Community Dent Oral Epidemiol_

1992; 20: 106-111. * Lester V, Ashley F P, Gibbons D E. Reported dental attendance and perceived barriers to care in frail and functionally dependent older adults. _Br Dent J_ 1998; 184:

285-289. * Kwan S Y, Holmes M A. An exploration of oral health beliefs and attitudes of Chinese in West Yorkshire: a qualitative investigation. _Health Educ Res_ 1999; 14: 453-460. * Fiske

J. The delivery of oral care services to elderly people living in a noninstitutionalized setting. _J Public Health Dent_ 2000; 60: 321-325. * Bell M, Davis D, Easterby-Smith V, Ellis J.

National Working Group for Older People. Meeting the challenges of oral health for older people: a strategy review. Chapter 4: Dental services access and provision. _Gerodontology_ 2005; 22:

16-22. * Lane E A, Gallagher J E. Role of the Single Assessment Process in the Care of Older People. How Will Primary Dental Care Practitioners be Involved? _Prim Dent Care_ 2006; 13:

130-134. * Borreani E, Wright D, Scambler S, Gallagher J E. Minimising barriers to dental care in older people. _BMC Oral Health_ 2008; 8: 7. * Borreani E, Jones K, Scambler S, Gallagher J

E. Informing the debate on oral health care for older people: a qualitative study of older people's views on oral health and oral health care. _Gerodontology_ 2010; 27: 11-18. * Austin

R S, Olley R C, Ray-Chaudhuri A, Gallagher J E. Oral Disease Prevention for Older People. _Prim Dent Care_ 2011; 18: 101-106. * Sullivan J. Challenges to oral healthcare for older people in

domiciliary settings in the next 20 years: a general dental practitioner's perspective. _Prim Dent Care_ 2012; 19: 123-127. * Beacher N, Sweeney M P. The Francis report - implications

for oral care of the elderly. _Dent Update_ 2015; 42: 318-323. * Patel R, Mian M, Robertson C, Pitts N B, Gallagher J E. Crisis in care homes: the dentists don't come. _BDJ Open_ 2021;

7: 20. * Boneham M A, Williams K E, Copeland J R M _et al_. Elderly people from ethnic minorities in Liverpool: mental illness, unmet need and barriers to service use. _Health Soc Care

Community_ 2007; 5: 173-180. * Walls A W, Steele J G. Geriatric oral health issues in the United Kingdom. _Int Dent J_ 2001; 51: 183-187. * Ahmad B, Landes D, Moffatt S. Dental Public Health

In Action: Barriers to oral healthcare provision for older people in residential and nursing care homes: A mixed method evaluation and strategy development in County Durham, North East

England. _Community Dent Health_ 2018; 35: 136-139. * Aminu A Q. Adult Dental Health Survey 2009: association between oral health outcomes and living arrangements of older adults in the UK.

_Br Dent J_ 2019; 227: 115-120. * Hamilton F A, Sarll D W, Grant A A, Worthington H V. Dental care for elderly people by general dental practitioners. _Br Dent J_ 1990; 168: 108-112. *

Longhurst R H. Availability of domiciliary dental care for the elderly. _Prim Dent Care_ 2002; 9: 147-150. * Doshi M, Lee L, Keddie M. Effective mouth care for older people living in nursing

homes. _Nurs Older People_ 2021; 33: 18-23. * Howells E P, Davies R, Jones V, Morgan M Z. Gwên am Byth: a programme introduced to improve the oral health of older people living in care

homes in Wales - from anecdote, through policy into action. _Br Dent J_ 2020; 229: 793-799. * Curtis S A, Scambler S, Manthorpe J, Samsi K, Rooney Y M, Gallagher J E. Everyday experiences of

people living with dementia and their carers relating to oral health and dental care. _Dementia_ 2021; 20: 1925-1939. * Sweeney M P, Williams C, Kennedy C, Macpherson L M D, Turner S, Bagg

J. Oral health care and status of elderly care home residents in Glasgow. _Community Dent Health_ 2007; 24: 37-42. * White V, Edwards M, Sweeney M, Macpherson L. Provision of oral healthcare

and support in care homes in Scotland. _J Disabil Oral Health_ 2009; 10: 99-106. * Prosser G M, Louca C, Radford D R. Potential educational and workforce strategies to meet the oral health

challenges of an increasingly older population: a qualitative study. _BDJ Open_ 2022; 8: 6. * Bradshaw J. Taxonomy of social need. _In_ McLachlan G (ed) _Problems and Progress in Medical

Care_. 7th ed. pp 71-82. Oxford: Oxford University Press, 1972. * Dutta S J, Knafo S, Lovering I A. Neoliberal failures and the managerial takeover of governance. _Rev Int Stud_ 202; 48:

484-502. * Toon M, Collin V, Whitehead P, Reynolds L. An analysis of stress and burnout in UK general dental practitioners: subdimensions and causes. _Br Dent J_ 2019; DOI:

10.1038/sj.bdj.2019.46. * Government Equalities Office. Equality Act 2010: What do I need to know? Disability quick start guide. 2010. Available at

https://assets.publishing.service.gov.uk/media/5a79c79940f0b66d161ae174/disability.pdf (accessed March 2023). * UK Government. Commissioning better oral health for vulnerable older people.

2018. Available at https://www.gov.uk/government/publications/commissioning-better-oral-health-for-vulnerable-older-people (accessed March 2023). * National Institute for Health and Care

Excellence. Oral health for adults in care homes. 2016. Available at https://www.nice.org.uk/guidance/ng48 (accessed July 2024). * UK Government. Oral health toolkit for adults in care

homes. 2020. Available at https://www.gov.uk/government/publications/adult-oral-health-in-care-homes-toolkit/oral-health-toolkit-for-adults-in-care-homes (accessed July 2023). *

Parliamentary and Health Service Ombudsman. Women's State Pension age: our findings on the Department for Work and Pensions' communication of changes. Available at

https://www.ombudsman.org.uk/publications/womens-state-pension-age-our-findings-department-work-and-pensions-communication/background-relating-changes-state-pension-age-women (accessed

September 2023). * General Dental Council. Standards For Education. 2015. Available at

https://www.gdc-uk.org/docs/default-source/quality-assurance/standards-for-education-%28revised-2015%29.pdf (accessed July 2024). Download references AUTHOR INFORMATION AUTHORS AND

AFFILIATIONS * University of Sheffield, Sheffield, UK Anna Beaven & Zoe Marshman Authors * Anna Beaven View author publications You can also search for this author inPubMed Google

Scholar * Zoe Marshman View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS Anna Beaven: conception and design of study, data analysis,

interpretation of data, drafting article, agreement for accountability. Zoe Marshman: conception and design of study, critically revising the work, final approval for publication, agreement

for accountability CORRESPONDING AUTHOR Correspondence to Anna Beaven. ETHICS DECLARATIONS The authors declare no conflicts of interest. No ethical approval was needed for this study as it

is a literature review and no human subjects were directly involved. RIGHTS AND PERMISSIONS OPEN ACCESS. This article is licensed under a Creative Commons Attribution 4.0 International

License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source,

provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative

Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not

permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

http://creativecommons.org/licenses/by/4.0.© THE AUTHOR(S) 2024. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Beaven, A., Marshman, Z. Barriers and facilitators to accessing

oral healthcare for older people in the UK: a scoping review. _Br Dent J_ (2024). https://doi.org/10.1038/s41415-024-7740-x Download citation * Received: 30 November 2023 * Revised: 26

February 2024 * Accepted: 02 March 2024 * Published: 16 August 2024 * DOI: https://doi.org/10.1038/s41415-024-7740-x SHARE THIS ARTICLE Anyone you share the following link with will be able

to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing

initiative