Elder oral health care

by JoAnn R. Gurenlian, RDH, PhD
[email protected]

My parents are getting older. They are both 78 years of age. My siblings and I, of course, have been aware that they are aging. Recently, though, we started talking about making arrangements for their advancing age. My father is frail and caring for him has been taking a toll on my mom. We got together as a family and began to ask those important questions about planning for assisting living.

I hate to admit this, but I was the one with the reservations about placing either or both of my parents in a long-term care facility. Intellectually, I am aware that the facilities can be lovely, with much attention paid to progressing a loved one to increased levels of care as needed. My reservation stems from the lack of oral health care provided to these individuals. The very idea that my parents would not receive daily oral care if they were unable to do so themselves, has me thinking about moving them to my home and managing their care myself.

I doubt very much that loving families who are considering long-term care for their elderly parents ever give a thought to the oral care concern that we in the profession might share. They are all too happy to find a place that appears to be clean, has an attentive staff, does not have that unpleasant odiferous quality, and is financially manageable.

Having given health lectures to staff and residents and witnessing my grandmother live in a nursing home during the last two years of her life, I have seen firsthand the many interesting sights, smells, sounds, and procedures. I have seen residents who prided themselves on their appearance now with extensive tooth loss being reduced to eating a soft diet, and others having extensive periodontal conditions and caries causing pain and limiting their ability to function. Some individuals are not cognitively aware enough to remember to brush daily, while others simply need assistance in the process. The spectrum varies greatly for each individual. Nevertheless, even the caregivers in these facilities offer little in the way of supporting oral health care.

My recent investigation into this issue of elder oral health care revealed that these individuals have serious threats to their oral health. According to the Centers for Disease Control and Prevention, and the U.S. Department of Health and Human Services, older Americans are more prone to tooth decay. Approximately 23% between the ages of 65 and 74 have severe periodontal disease. Adults aged 75 or older represent the adult age group with the lowest percentage that have visited a dentist within the past year.

In a report regarding oral health in important target groups, the World Health Organization (WHO) indicated that the elderly have oral health challenges related to a changing dentition status, caries, periodontal pocketing and loss of attachment, edentulousness, denture related conditions, oral cancer, xerostomia, and craniofacial pain and discomfort. These factors can lead to inadequate diet, malnutrition, inadequate oral hygiene due to poor dexterity or limited mobility, compromised chewing and functioning abilities, lowered self-esteem, and social isolation.

Oral Health America published a report titled, "A State of Decay: The Oral Health of Older Americans." OHA noted that oral health care for the elderly is a luxury that many cannot afford. The report said older Americans do not receive routine dental care under Medicare. Further, less than 20% of Americans who are 75 years and older have any form of private dental insurance. This, coupled with the facts that there is a shortage of skilled geriatric oral care professionals and reimbursement for dental care is insufficient to attract dentists to want to treat Medicaid patients, contributed to the evaluation of a "D" for elder oral health care.

What can we do to improve elder oral health care? In their article on "Improving the oral health of older people: the approach of the WHO Global Oral Health Programme," Petersen and Yamamoto advocate for both clinical and community interventions. They refer to new goals for 2020 established jointly by the WHO, Federation Dentaire International and the International Association for Dental Research. To promote continuous improvement of the oral health of the elderly, these organizations recommend each country or community group formulate measurable goals for dental caries, periodontal disease, and tooth loss.

In addition, Petersen and Yamamoto advocate for establishing formal oral health care programs in long-term care facilities and nursing homes. These facilities should be staffed with oral health professionals who can provide oral examinations, prophylaxis, restorative, and periodontal treatment. Education to staff for assisting the patients with providing daily toothbrushing, fluoride rinses, and use of chlorhexidine acetate/xylitol gums were recommended.

Other ideas include increased training in geriatric oral health care be part of the curricula of dental and dental hygiene schools, and that research on oral health promotion and disease prevention for older people be conducted.

My intent here is not to play the blame game. Rather, I think it is time for oral health professionals to plan a course of action to improve the oral health status of the elderly. The model of long-term care needs to include an oral health framework in which regular dental and dental hygiene care is offered, daily oral health care regimens are maintained, and health policy supports the funding for these ventures.

Maybe I am being a bit selfish, but sooner or later we are all going to get to the age wherein our children will be looking at residential long-term care facilities for us. Shouldn't we create the structure that ensures that our oral health is preserved?

My intent here is not to play the blame game. Rather, I think it is time for oral health professionals to plan a course of action to improve the oral health status of the elderly.

JoAnn R. Gurenlian, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a graduate program faculty at Idaho State University, adjunct faculty at Burlington County College and Montgomery County College, and president-elect of the International Federation of Dental Hygienists.