LIVING ARRANGEMENT AS A BARRIER TO ORAL HEALTHCARE AMONG OLDER POPULATION: A SCOPING REVIEW

This scoping review aims to systematically map and synthesise existing evidence on how living arrangements influence access to oral healthcare among community-dwelling older adults aged 60 years and above. Population ageing is accelerating globally, particularly in low- and middle-income countries, leading to increased prevalence of chronic conditions and oral diseases such as dental caries, periodontal disease, edentulism, and xerostomia. Although oral health is integral to overall well-being, access to dental services among older adults remains uneven and is shaped by multiple social determinants. Living arrangement is defined as household composition and cohabitation context (e.g., living alone, with spouse, with children, or in multigenerational households). It has been identified as a key social determinant influencing social support, financial capacity, health behaviours, and healthcare utilisation. Existing studies suggest that older adults living alone or without family support may experience poorer oral health outcomes and reduced dental service utilisation. However, current evidence is fragmented, with substantial variation in study design, definitions of living arrangements, outcome measures, and contextual factors. Consequently, there is limited consolidated understanding of how specific living arrangements operate as barriers to oral healthcare. Using the Joanna Briggs Institute methodological framework and PRISMA-ScR reporting guidelines, this review will apply a Population–Concept–Context (PCC) approach to identify relevant quantitative, qualitative, and mixed-methods studies published in English over the past ten years. Searches will be conducted in PubMed, Scopus, and Web of Science, supplemented by reference list screening. Eligible studies will involve community-dwelling older adults and explicitly examine living arrangements in relation to barriers to oral healthcare, including physical, social, financial, logistical, or organisational factors. Two independent reviewers will conduct screening and data extraction, with disagreements resolved through consensus or third-reviewer adjudication. The primary objectives are to: 1. categorise types of living arrangements reported among older adults; and 2. synthesise how factors within these arrangements—such as social support, caregiving availability, financial resources, and logistical constraint that may affect access to dental care. Data will be analysed descriptively and thematically to map patterns, relationships, and gaps across different residential contexts and geographical settings. Findings will be presented in tables and narrative summaries. Expected outcomes include a comprehensive evidence map of living arrangements as barriers to oral healthcare, identification of key mechanisms linking household context to dental access and recognition of research gaps requiring further investigation. The review is intended to inform policymakers, public health planners, and oral health professionals by providing an empirical foundation for designing targeted interventions among older adults