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Making decisions to aid compliance among older adults

May 1, 2020
With the rapidly growing senior population comes greater needs and challenges that all industries must consider.

The senior population has never been as large as it is now; it has been rapidly growing over the past few decades. With this size come greater needs and challenges that all industries must consider. In the 1790s, older adults comprised less than 2% of the American population.1 As of 2014, they made up 14% of the American population and 15.6% of tbe Canadian population.1,2 

In our office we typically see more patients of this age group than young adults and children. As a result, issues arise that challenge our clinical, therapeutic, and behavioral skills. In a time when pensions are thinning, housing is skyrocketing, and inflation is manic, the senior population may not be equipped for the radical economic changes that have occurred since they were young. This means we may need to be more thoughtful about what we recommend to patients. For instance, we may recommend high-tech multifunctional water flossers or electric toothbrushes that require pricey brush heads to young adults, but we may not be able to expect the same investment from older patients. 

This is not to say that older patients are unwilling to care for their oral health, but their priorities and financial spending may be elsewhere. It’s our job to find a solution that works for them to ensure their oral health is stable and positive. A health and disease framework, in addition to a holistic approach, should be used to better serve this population to incorporate understanding of their behaviors and their mentality toward oral health recommendations. 

Whether or not your patients enter the office with family members or caretakers, the conversation of self-care effectiveness and oral health status should be held with everyone as long as patients consent.3 Dementia, dysphagia, and dexterity may severely impact someone’s ability to function normally, whether eating a meal, seeking transportation by themselves, or brushing their teeth. It’s common for geriatric patients not to floss or comply with other self-care habits due to difficulty, time, or circumstances, which may lower their quality of life and exacerbate their personal conditions. 

Family insight

When we speak with families, we often gain much more information than we would have gotten from the patients. Patients may seem strong and independent for their age but might really have little control over some basic actions. They may act and speak confidently but may actually require significant caretaking. Their loved ones often speak the truth about how an elder patient is doing and provide the insight needed to help you improve their oral health. 

Communicating your observations is necessary for caretakers and health-care professionals to take the right actions and provide the tools to improve these circumstances. Whether we recommend a battery toothbrush, a smaller toothbrush head, or a toothpaste that targets periodontal pathogens, clear instructions and provision of samples and demonstrations can help improve patient compliance.

Assigned decision aides

For the benefit of patients, a family friend or third-party health-care professional may be involved as a designated decision aide (DA) to mediate discussions and provide a less biased view. DAs may help reduce conflict between parties by providing an external perspective and objective education while maintaining reasonable empathy for all involved.4-6 They may also have an indirect effect on the patient because external and new interactions may stimulate the patient to improve compliance. Although DAs may work with some people, individuality must be accounted for prior to introducing an aide to a patient’s interprofessional care team. 


Well-maintained routines may ease the expectations patients carry with dental visits, reduce anxiety, and increase compliance with oral health-care recommendations. Older adults’ routines may be adjusted according to each patient’s needs, such as an appointment time at the peak of medication effectiveness.7 Consistency also helps the dental professional care for the patient, as a more thorough understanding of the patient’s compliance, situation, and needs may yield effective strategies that work over time. Trial and error may provide the family or caretaker with a professional perspective of techniques that may be effective at home. 

More research and specific guidelines are required to further benefit older adult patients, while respecting individual needs and cognitive abilities. Our social responsibility is to reduce the stress and negative effects nonadaptive oral health care can have on patient progress. Proactive treatment is more effective than reactive treatment in the scheme of health care and life. Making decisions to aid compliance with older adults is necessary for dental hygienists’ treatment plans and actions to make a difference in patients’ lives and our society.


1. Gawande A. Being Mortal. Toronto, CA: Anchor Canada; 2017.

2. Action for Seniors report. Government of Canada. Fall 2014. Accessed November 14, 2019. https://www.canada.ca/en/employment-social-development/programs/seniors-action-report.html

3. Lee JJY, Barlas J, Thompson CL, Dong YH. Caregivers’ experience of decision-making regarding diagnostic assessment following cognitive screening of older adults. J Aging Res. 2018;2018:8352816.

4. Peate M, Meiser B, Cheah BC, et al. Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer. Br J Cancer. 2012;106(6):1053-1061. doi: 10.1038/bjc.2012.61.

5. Bailey RA, Pfeifer M, Shillington AC, et al. Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict. BMC Health Serv Res. 2016;16(1):10. doi:10.1186/s12913-016-1262-4.

6. Gagne ME, Legare F, Moisan J, Boulet LP. Impact of adding a decision aid to patient education in adults with asthma: A randomized clinical trial. PLoS One. 2017;12(1):e0170055. doi:10.1371/journal.pone.0170055.

7. Verloo H, Chiolero A, Kiszio B, Kampel T, Santschi V. Nurse interventions to improve medication adherence among discharged older adults: a systematic review. Age Ageing. 2017;46(5):747-754. doi:10.1093/ageing/afx076.

Jackie Tong, BDSc, RDH, graduated from the University of British Columbia. Raised in Vancouver, she is passionate about expanding the privileges of access, education, and information to rural areas. To further discuss opportunities for community projects and outreach, contact her at [email protected]