Dental Care for Older Adults with Multiple Health Conditions

The Aging-Related Statistics suggest that by the year 2030, the number of U.S. adults 65 years or older will reach 72 million, representing nearly 20% of the total U.S. population, almost doubling in number as compared to the year 2000 [1]. Older adults are, therefore, a growing patient demographic for dental practices. Although around 5% of adults older than 65 years are edentulous, increased numbers of older adults are retaining their natural teeth compared with previous cohorts. [2] Recent surveys from National Health and Nutrition Examination Survey (NHANES) indicated that approximately 18% of adults aged 65 years or older with retained natural teeth have untreated caries [3] while 68% of these patients have periodontitis [4].

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These findings suggest that the overall clinical and oral health context of aging patients is important in order for dentists to provide the optimum dental care for older adults.

Potential Comorbidities and Physiology of Aging

The health status of adults older than age 65 years can be quite variable, ranging from functional independence to frail or cognitively impaired [5].  Most older persons have at least one chronic condition and many have multiple conditions including but not limited to hypertension (71%), arthritis (49%), heart disease (31%), any cancer (25%), and diabetes (21%) [6]. Moreover, The U.S. Surgeon General Report has stated that older Americans suffer from a “silent epidemic” of serious, consequential dental health problems [8]. When you consider that many of these patients also have cognitive and physical issues that complicate treatment, it’s easy to see the need for dental professionals who specialize in treating geriatric patients.
Considering all the challenges that were mentioned it’s important that older people have access to specialized care from dentists that have gone through extensive training and experience working with older patients with complex medical conditions. Some other reasons are:

Polypharmacy

Elder patients are more likely to take several over-the-counter and prescription medications that can make them more vulnerable to drug interactions, medication errors and drug reactions. Dental professionals who specialize in geriatric dentistry understand this and take special precautions to protect the safety and well-being of older patients. Moreover, hyposalivary functions affects 30% of patients older than 65 years and up to 40% of patients older than 80 years; this is primarily an adverse effect of medication(s), although it can also result from comorbid conditions such as diabetes, Alzheimer’s disease, or Parkinson’s disease. Xerostomia, while common among older patients, is more likely to occur in those with an intake of more than 4 daily prescription medications.

Sensory, physical and cognitive impairments

According to the American Dental Association, it’s not uncommon for geriatric patients to need communication demonstrating compassion and understanding to deal with their complicated dental treatment issues. When dealing with elder patients suffering from dementia or physical impairments, it’s not always possible to complete an exam or treatment. Experienced dental professionals understand that even the greatest patience and best preparation isn’t always enough. In turn, they are prepared to stop a treatment if necessary and pick things up at a later point in the day or week, as long as the delay won’t compromise the patient’s health.

Medical consultation

Using a robust referral system is important when treating older adults. As it was mentioned earlier, older adults may develop multiple comorbidities. Not all dentists may understand the complexity of the medical conditions and all the necessary treatment modifications to treat older adults safely. Therefore, it’s important to develop a robust referral system to involve primary physicians and geriatricians in providing dental treatment. Moreover, taking advantage of social workers could be very helpful when attempting to connect older adult patients to community resources.

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References:

  1. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: Key indicators of well-being. https://agingstats.gov/docs/PastReports/2012/OA2012.pdf. Accessed August 21, 2023.
  2. Public health and aging: retention of natural teeth among older adults–United States, 2002. MMWR Morb Mortal Wkly Rep 2003;52(50):1226-9
  3. National Institute of Dental and Craniofacial Research. Dental caries (tooth decay) in seniors (age 65 and over). National Institutes of Health. http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesSeniors65older.htm. Accessed August 21, 2023
  4. Eke PI, Dye BA, Wei L, et al. Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012. J Periodontol 2015;86(5):611-22.
  5. Thompson LA, Chen H. Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update. Clin Geriatr Med 2023;39(2):225-34.
  6. Administration on Aging (AOA). A Profile of Older Americans (2014): Health and health care. U.S. Department of Health and Human Services Administration for Community Living. https://www.acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2014-Profile.pdf. Accessed August 21, 2023.
  7. World Health Organization. Ageing and health (Fact Sheet No. 404).  August 2022. https://www.who.int/en/news-room/fact-sheets/detail/ageing-and-health. Accessed August 21, 2023.
  8. 2020 Surgeon General’s Report: Oral Health in America: Advances and Challenges
  9. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/aging-and-dental-health
https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/aging-and-dental-health

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