Background: Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior\r\nof older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use\r\nand oral self-care behavior of frail older people.\r\nMethods: We conducted a qualitative study through 51 open interviews with elders of varying frailty in the\r\nEast-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and\r\nmeaning of the themes to the point of consensus among the researchers.\r\nResults: Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail\r\nelders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene\r\nroutines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and\r\nC) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated\r\nwith the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1)\r\nlack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general\r\ncontext of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than\r\noral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing\r\nsocial supports.\r\nConclusion: The level and type of frailty influences people�s perspectives on oral health and related behaviors. Frail\r\nelders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist\r\ncan relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development,\r\ndiscontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple\r\nmeasures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and\r\nsupport, are discussed.
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