1. Introduction
The United Nations (UN) defined a post-aged society or a super-aged society as that when the proportion of the population aged 65 and above accounts for more than 20% of the total population [
1]. The elderly population is expected to be larger than the population of children under five years within a decade, and to double by 2040 to eventually reach as many as two billion individuals by 2050, by which time it will represent more than 20% of the world’s population [
2]. The population belonging to WHO’s South-East Asia region is also ageing rapidly; for instance, the proportion of people aged 60 or above was 9.8% in 2017 and is expected to increase to 13.7% by 2030 and to 20.3% by 2050 [
3]. Between 2019 and 2050, 9 out of the 10 countries with the largest percentage-point increase in the share of older persons in the world will be in East and South-East Asia. The largest increase is foreseen in the Republic of Korea (23%), followed by Singapore (20.9%) and Taiwan Province of China (19.9%) [
1]. In the case of South Korea, among the elderly, the very old (above 80 years) are also the fastest-growing population, which is creating new challenges. A combination of increased life expectancy and reduced fertility is increasing the absolute number of old persons, even as it is boosting their relative share of the population. South Korea has already become an aged society, as the proportion of its population aged 65 and older exceeded 14% in 2018, and is projected to reach 20.3% by 2025, at which time it is expected to enter a super-aged society worldwide [
4]. However, unlike countries that have long prepared for an elderly society, including Japan (with a 27.3% elderly population) and Switzerland (with a 23.4% elderly population), Korea has earned an elderly society status at an unprecedented rate [
5,
6]. Thus, the related social and economic problems that it is experiencing are very serious. This trend is not unique to Korea, however; the increase in the aged population in every corner of the world has led to social and health problems that include various forms of violence perpetrated against older adults.
The human rights of older persons is a topic that has been neglected for a long time. In at least some countries, it is a dimension that is being increasingly considered, but often haphazardly. The human rights of the elderly were first mentioned in 1948 in the UN’s Declaration of the Rights of the Elderly. The declaration focused on 10 social rights of the elderly: the right to receive assistance, to work, to food, to clothing, to shelter, to care for their physical and mental health, to leisure, to safety, to security, and to respect [
7]. Additionally, in 1991, the UN enacted the United Nations Principles for Older Persons and presented 18 specific principles that governments should consider in each of the five areas of independence, participation, care, self-fulfillment, and dignity [
8]. Internationally, however, the debate on the predicament of senior citizens in terms of rights is only beginning. For example, it was only in 2009 that the Human Rights Council Advisory Committee recommended a study on the “need to protect the human rights of the older person in the context of a human rights framework” [
9]. Rim and Yun [
10] emphasized the importance of the elderly’s perception of human rights violations against them and, notably, their caregivers’ perceptions of such violations. Rim and Yun further pointed out that the perception of human rights violations against the elderly is lacking and that human rights violations against the elderly have diverse and complex causes such as individual, family, and social situations. In Korea in 2016, there were 6,811 reports of elder abuse, the most serious form of human rights violation, of which 40.1% was psychological abuse, 31.3% was physical abuse, 11.4% was neglect by others, 7.7% was negligence of self, 7.2% was financial abuse, 1.3% was sexual abuse, and 1.0% was abandonment [
11]. These figures suggest that there is an urgent need for institutional arrangements at the national and social levels to guarantee the protection of the human rights of the elderly. The research of Kim et al. [
12] found that lack of awareness of human rights and abuse of the elderly are highly related. In another work, Kim et al. [
13] found that the higher the awareness of human rights is, the lower the abuse is. As such, awareness of the human rights of the elderly is a very important part of the life of a healthy elderly person.
The oldest elderly people are often described as a frail and multimorbid group [
14]. For the individual, frailty increases vulnerability due to diminished strength, endurance, and physiological function [
15]. Frail individuals have a higher risk of developing poor oral health due to limitations in their ability to perform self-care and difficulties in visiting dental health care clinics [
16]. In the elderly, mastication discomfort and dysphagia due to tooth loss lead to nutritional deficiency, which is related to mental health and quality of life as well as physical activity [
17].
Good oral health is important for older people’s well-being and quality of life, and is essential for healthy ageing [
18]. However, there is insufficient knowledge about how older people view their oral health and oral care [
19]. Koistinen et al. found that 85% of the older people from 36 Swedish STC units were satisfied with their oral health, even though clinical assessments by registered dental hygienists showed that 77% of these individuals had oral problems such as coating and food debris [
20]. As such, the elderly lack accurate awareness of their oral health. Therefore, dental hygienists should understand the characteristics of the elderly and try to take care of their oral care. In Europe, the oral health of the elderly has improved, increasing the number of elderly people who maintain natural teeth for life [
21]. In Sweden, approximately 60% of people aged 80–89 years have 20 or more teeth [
22]. In line with this, Korean dental hygienists should also focus on oral care by identifying the characteristics of the rapidly increasing number of the elderly.
In order to become a suitable dental hygienist in this aging era, it is necessary to understand the characteristics of the elderly through various experiences with them and to know the importance of human rights of the elderly. Based on these experiences, dental hygienists should also strive to promote oral health that can improve the human rights and quality of life of the elderly. Therefore, the purpose of this study is to confirm the effect of dental hygienists’ experiences related to the elderly on the perception of human rights violations of the elderly.
4. Discussion
Oral conditions in the elderly cause them to have a weak ability to chew food. This can lead to dysphagia, which reduces the quantity and quality of meals, and ultimately leads to poor overall health through nutritional deficiencies and weight loss [
27,
28]. In fact, in a research panel survey of 6935 aging people, it was found that in the case of the 65-year-old and older group, when their Geriatric Oral Health Assessment Index (GOHAI) [
29] increased by 1 unit, their health satisfaction and quality of life significantly improved [
30]. As such, oral and systemic health are closely related [
31]. However, with increasing age, declining health, and dependence on care, older people are more likely to develop poor oral health [
16]. Moreover, the number of older people in need of care is expected to increase as the population continues to age [
32]. Therefore, as the role of oral health care for the elderly is more emphasized, it is important for dental hygienists to properly perceive the elderly [
33]. Unlike nurses, dental hygienists rarely have access to knowledge about the elderly through university education courses in Korea. Meanwhile, as health insurance is applied to the elderly over 65 with implants and dentures, the number of elderly patients visiting the dentist is increasing [
34]. In line with this trend, dental hygienists should raise awareness of the human rights of the elderly for better oral care of the elderly and increase their understanding of the elderly by undertaking more experiences with the elderly. Therefore, the purpose of this study is to make oral care more efficient by analyzing the effect of dental hygienists’ various experiences with the elderly on the perception of human rights violations of the elderly and understanding the characteristics of the elderly.
As a result of this study, among the three experiences related to the elderly, the highest perception of human rights violations among the elderly was associated with receiving education on the elderly. The next experience was interest in the problems of the elderly, followed by volunteering for the elderly. Therefore, in order to improve understanding of human rights violations for the elderly, it will be important to precede education on the characteristics of the elderly. These results were similar to those of Sim and Kim [
35]. In addition, Lee et al. [
36] reported that those who had received oral health guidance education for the elderly had better attitudes toward the elderly, as well as better psychological characteristics, family relationship characteristics, and judgmental thinking skills compared to those without such experience.
Violation of the human rights of the elderly means that the elderly do not take care of themselves or their caregivers neglect their duty to care for them, e.g., by inflicting physical, psychological, sexual, financial, or neglectful harm on the elderly [
6]. The biggest difference between those dental hygienists who had received education on the elderly and those who had not received such education was in their perception of financial human rights violations. Therefore, dental hygienists will know that they have the right to protect the assets of the elderly through education related to the elderly. Additionally, the biggest difference between those dental hygienists who had experience in taking an interest in issues related to the elderly and those who had not had such experience was in their perception of psychological human rights violations. The biggest difference between those dental hygienists who had experienced volunteer work related to the elderly and those who had not had such experience was in their perception of “neglect” human rights violations. These results are consistent with the results of Kang and Im [
24], in which the elderly volunteer experience had a high average score in the perception of psychological human rights violations. Such psychological and neglect-oriented human rights violations are difficult to recognize as abuse and to assess for damages, so dental hygienists should pay attention to elderly-related volunteer activities and problems related to the elderly. In the results of this study, all three experiences related to the elderly were highly related to the perception of violations of financial human rights violations against the elderly. In addition, the dental hygienists who had experienced education related to the elderly showed a high perception of psychological human rights violations against the elderly, and those who had experienced volunteer activities related to the elderly showed a high perception of neglect-oriented human rights violations against the elderly. These results are similar to the results of a study in the UK, where neglect (1.1%) was reported as the most common type of abuse, followed by financial (0.7%) and psychological abusee (0.4%) [
37]. To properly recognize financial, psychological, and neglect-oriented abuses, which account for a high proportion of human rights violations against the elderly, dental hygienists should make efforts to have the three mentioned categories of experiences related to the elderly.
In Korea, oral health services are provided as long-term care insurance for the elderly, but there is no system for oral hygiene services paid at home. In fact, there are only five dental hygienists in the country who provide visiting nursing oral hygiene services [
38]. Therefore, due to the increasing number of the elderly, an experts’ course on oral care for the elderly is required for dental hygienists working in dental clinics. Therefore, additional research on the elderly oral care expert course including experience related to the elderly is needed. Furthermore, if a curriculum related to geriatric dentistry is opened and ran in the university curriculum, it will be possible for dental hygienists to better understand the human rights of the elderly and the oral health status of the elderly when they are still students. The limitation of this study is that since the experiences related to the elderly were confirmed only through questionnaires for dental hygienists, care should be taken in generalizing them. An experimental study on the perception of human rights violations against the elderly by applying the experiences of dental hygienists related to the elderly is necessary in the future. In addition, further studies are needed to identify various factors that affect the elderly-related experiences of dental hygienists and their perception of human rights violations against the elderly. It is expected that the results of this study can be used as basic data for the development of programs that will provide dental hygienists elderly-related experiences as a means of enhancing their perception of human rights violations against the elderly.