Respecting our elders

April 1, 1996
As the hip Baby Boomers join the ranks of older adults, be ready for some changes in what your senior patients expect

As the hip Baby Boomers join the ranks of older adults, be ready for some changes in what your senior patients expect

Colleen Reiter, RDH

How many patients between the ages 55 to 80 do you treat each day? Three or four? Maybe the office in which you work treats a dozen a day. Do you know what they expect of you? Do you know what they are experiencing? Can you make them feel more at ease during appointments?

Americans have grown up and are growing older. Until now, the majority of people in the United States were relatively young. Not any more - the reverse is becoming true. For example, people age 75 or older are now in the fastest growing portion of our population.

Hot on the heels of this group are the Baby Boomers, ages 31-49. They will begin turning 50 this year. How many from this group do you care for each day? Chances are good that the patients sitting in your chair most of the day are either older adults or Baby Boomers nearing older adulthood.

We know that issues important to Baby Boomers, all throughout their lives, have become the main issues politically, socially, and economically. Aging youthfully is one of those issues. Hundreds of books have already been written regarding the changes in lifestyles and attitudes toward aging that Americans will witness as the Baby Boomers grow older.

Experts divide older adults into three major age categories:

- ages 50 to 64 = middle-age

- ages 65 to 79 = late-age

- ages 80-plus = old-age

The focus here is to increase your awareness of the changes late-age and old-age adults have already experienced and what lies ahead for them. As a result, you`ll be better able to accommodate them from a customer service and patient relations aspect.

The best years of our lives

Let`s consider some general facts about older adults (65-plus) whom you might treat today. According to Lifetrends, written by Gerber, Wolff, Klores, and Brown, these adults are powerful because they represent "20 percent of U.S. households and possess 40 percent of the nation`s wealth." The people in this age group also are expected to live longer than any previous generation. These are impressive changes when compared to the past.

Charles Russell, PhD, wrote in his book, Good News About Aging, that late life is the time when adults "have the most confidence, self-esteem, and happiness." In fact, a recent poll of older adults indicated that the majority felt that the best years of their lives began after age 40. Other studies have shown that when individuals turn 50 they tend to feel 10 or 20 years younger than their actual age. This is probably due to more active and healthier lifestyles.

Additionally, in Old Age is not for Sissies, Art Linkletter states that age is an attitude. Think about it. Haven`t you seen spirited older adults acting livelier than younger adults? If you`ve been around many older adults, you know that they are young at heart. Since a number of adults over 65 share Linkletter`s philosophy, they are likely to tell you that "you`re as old as you feel."

By the way, this group of adults are also better educated than any previous generation, have higher expectations of those serving and caring for them, know what they want, and are very opinionated. They are much more sophisticated than the older adults who sat in dental chairs during the last decade.

Let`s shift to some of the major changes that older adults might be experiencing - besides wrinkles. For example, Cheryl Russell, author of "The Baby Boom Turns 50" in the December 1995 issue of American Demographics, notes that arthritis rates nearly quadruple after age 45. Other diseases prevalent in adults over 65 are heart problems, strokes, cancer, diabetes, circulation problems, and hypertension.

Since they do not drink six to eight glasses of water and the aging kidneys function less efficiently, they also suffer from dehydration. Clinically, a dry mouth might be an indication that the patient is dehydrated. You might show your concern by asking if they drink the amount of water that their physician recommends. In addition, watch for the other dental problems that accompany a dry mouth.

A major complaint among older adults is chronic constipation. Obviously, it is one problem that they will not disclose. Since our objective is the best care for the whole patient and not just their teeth, some clues that might be noticed include a high plaque index, missing teeth, or ability to chew or swallow. Any of these problems may prompt them to switch from a high-fiber (healthier) diet to a soft diet. This could be especially true if the person lives alone. Since dehydration further complicates constipation, your concern might best be shown by encouraging them to drink the suggested amount of water and then find out about their dietary habits before making suggestions.

The key with older adults is to spend time talking with them and letting them know that you care.

Altered senses change their view

Changes in the senses are a part of growing old too. A critical sense that has been so heavily relied upon begins to fail - the eyes. How frightening that must be! With eye changes occurring, older adults might have trouble seeing in dim lights or in glare. It may also be more difficult for them to shift their focus from near to far or light to dark. Other complex eye problems like cataracts or macular degeneration further impede their vision.

You can better accommodate them by making sure the office has direct light. When showing them something in the mouth, allow time for their eye focus to shift. Verify that they can see the part of the tooth to which you are pointing before you continue talking about it.

Another critical sense that often declines is hearing. Most hearing problems are irreversible and leave the patient unable to distinguish between similar sounds and/or unable to hear high pitches. Find out if a patient has a "good" ear. Speak slowly, clearly, and in short, concise sentences, removing your mask if necessary. Stay close when talking, and keep background noise to a minimum. Showing you care enough to do these things (rather than just ignoring them or standing in the room shouting) means a great deal.

Other sensory changes also occur in taste, smell, and touch. Older adults often lose their ability to taste salts and sugars. So they add more until it suits their taste. Too much salt or sugar in the diet can cause problems such as increased plaque or caries. The patient might even describe symptoms of hypertension. It`s always a good preventive measure to routinely check blood pressure on older adults. In offices where it`s done routinely, the patients look forward to it as much as they look forward to getting a new toothbrush during their visit.

Besides taste buds changing, the sense of smell often declines, causing food to taste bland. Think about the way the smell of food affects how you expect it to taste. Sometimes the smell and taste senses are also further affected by medications the patients are taking.

Along with changes in taste and smell is a change in touch. A decrease in feeling might mean that they become less aware of temperatures. In which case, you might notice tissue burns from foods and beverages that were hotter than they realized. You might also see increased gingival margin plaque because they have trouble feeling where the toothbrush is reaching. Spend time discussing what you see regarding their oral health - that`s what they want and expect of you.

Stimulating talk stirs the mind

Let`s examine how the mind changes. Typically, older adults might need more time to process complex information. Much depends on their intellect and their desire to remember. A mind that`s intellectually stimulated will continue to perform well. A number of older adults are returning to college and completing graduate degrees.

Unfortunately, one major fear about the mind`s health prevails. That is the fear of getting Alzheimer`s disease. It may only strike 5 percent of older adults, but it is still incurable.

Despite numerous physical changes that might occur, social changes can be the most devastating. The loss of friends, a spouse, or decreased mobility due to illnesses can lead to isolation. Since Americans spend the majority of their lives at work, the lack of social interactions after retirement can also lead to isolation. However, individuals whom retire now often start their own businesses and stay active up through their nineties.

Encourage older adults to join local groups that are active. One such group in Atlanta is called Life Enrichment Services. It was founded by Anne Eaton, who completed one career and then, at the age of 69, returned to college. She earned a master`s in sociology with a specialty in gerontology. She now provides a wide range of training programs and services to older adults and trains individuals to start similar programs.

Going the extra mile with your care is important. For people who have become isolated, their medical and dental appointments are often their only chance to interact with others, and the loneliness is apparent. Reception areas can become great meeting places for them. So if they haven`t already introduced themselves (as many usually do), maybe the receptionist will inadvertently be a matchmaker.

Do more than just hold the door open

To determine other ways you might help older adult patients, pretend that you are their age with arthritis and impaired vision and begin your venture from the office parking lot. Is there safe and easy access? Puts everything in a different perspective, doesn`t it?

In the reception area, there`s a problem when older adults struggle to get up off of soft sofa cushions. The firmer the cushion, the better. Until such cushions can be replaced, try placing a board under the cushions to make them firmer. Straight-backed chairs with arms are ideal.

Beware of furniture, blocked pathways, or curled edges on area rugs that might cause accidents for patients who have difficulty maneuvering. Also, remember to shade windows to prevent glare from sun or snow. Other visual aids for patients might include the use of red or yellow colors to indicate changes in floor levels.

Keeping in mind that these patients are educated, opinionated, and experienced in good service because of their lifestyles, the extra attention that you give to detail is appreciated. For example, why not design all written communications for older adults with enlarged print? It might reduce the added calls for explanations of what they`re unable to see.

Just call me Mister...

Some of their expectations include quality care, respect, privacy, comfort, gentleness, compassion, and professionalism from you. Art Linkletter has a list of Golden Rights for Senior Americans in his book, Old Age is not for Sissies. Sharing one of these, he states that "irrespective of individual status or achievement, senior Americans have the right to expect to be held in esteem and treated with consideration and dignity because of age alone."

When addressing older adults, it is best to be formal and say, "Mr.," "Mrs.," or "Ms." before their last names to show your respect (if you`re not already in a habit of doing this). As you seat a patient in your operatory, you might consider raising the chair close to the patient`s lower thigh level so a slight bend of the leg is all that`s necessary. While consulting in practices, we have seen patients struggling to sit or get out of dental chairs. If the automatic return button takes the chair too low to the floor, your older patient could have trouble exiting the chair. Just a little common sense and courtesy will alleviate most potential problems before they develop.

As you review the older adult`s medical history and update it, keep in mind some of the following:

- They often use many OTC medications in addition to prescription drugs.

- They often do not tell each doctor what other doctors prescribe.

- They often have difficulty understanding directions for medications.

- They often fail to consider the possible interaction between food, alcohol, poor eating habits, and their medications.

You can help by answering questions and discussing information they might need. That again is going the extra mile to provide care.

Before beginning any procedures, check on patient comfort. While dental chairs are not cozy recliners, they are comfortable for most patients. However, since they don`t always fit all body types, keep extra pillows or towels to roll and slip under that patient`s neck, upper, or lower back. Also, keep a blanket handy in case the office temperature is too cool for your older patient.

During procedures using water sprays, such as the ultrasonic scaler or prophy-jet, you might need to reposition older patients more upright. Many of them have breathing difficulties. The water falling against the back of their throats complicates breathing, and they might panic. Although a supine position is ideal, let`s face it: There periodically will be exceptions. It`s easier to anticipate their needs and prevent a situation that might trigger a medical emergency. Your kind, reassuring smile and mannerisms, along with a healthy dose of patience on your part will be forever remembered by your older patients.

How many patients over age 65 will be sitting in your dental chair this week? What can you do differently to care for them? Comprehending their needs, whether physical, psychological, social, or dental, will boost your confidence and make you a better provider. Additionally, your show of interest and compassion in accommodating them will increase their confidence in you as a practitioner.

After all, they expect quality care and excellent service, and, when you provide it, they become loyal patients who refer friends and neighbors. Now that`s good patient relations!

Colleen Reiter, CDA, RDH, MS, is a national speaker, author, business consultant, and former dental school faculty member. She is president and CEO of Business $uccess, Inc. in Atlanta Ga. Colleen holds bachelor`s and master`s degrees from the University of North Carolina at Chapel Hill in advanced clinical dental hygiene, adult education, and business and program management.