Problem Statement
Over the past few decades dentistry has taken a more upstream preventative approach. As a result of this change, more older adults are able to retain their natural teeth longer. Due to this preventative shift, and older adult’s inability to access care the oral health needs are often unmet for those in the community and in supportive living.
Problem Characteristics
By the year 2036, older adults (65 years or older) are expected to represent one quarter of the Canadian population (Badewy et al. 2020). Older adults often lose dental insurance benefits when they retire, resulting in oral care becoming a financial burden. Adequate oral health is an integral component of nutritional status, communication, and overall wellbeing. Poor oral health can be associated with several systemic diseases (Bailey et al 2005; Tavares et al 2014). Problems associated with poor oral health addressed in primary healthcare, due to being a ‘free’ service, results in a burden financially and logistically to the system (Badewy et al 2020).
The fundamental preventative shift to preventative oral care has led to more older adults retaining their natural dentition, and having overall better oral health for longer in life. In 1970, 23.6% of adults were edentulous, and only 6.4% in 2010 (Health Canada 2010). The number of teeth retained into older adulthood can be seen as a marker of a healthy lifestyle, as well as general health. Oral health is a vital component of general health, allowing individuals to effectively eat, speak, perform daily activities, and relate to others. Swallowing dysfunction, pain while eating can cause an individual to resort to consuming a soft diet. This can result in a decline in the intake of nutrients, dietary fibers, vegetables, and meats, which can impact weight loss and frailty (Badewy et al. 2020; Lamster, 2016; Bailey et al, 2005).
In Canada, most primary health services are publicly funded. However, only 6% of total dental expenditures are publicly funded, none of which is allocated specifically to older adults. For all ages dental insurance is the primary indicator of access to oral health care (Estrada et al. 2018). Specifically, within older adults, 53.2% do not have dental insurance. Older adults are often on a fixed income which can create a financial barrier to receive vital oral care (Health Canada 2010).
While there is still limited research, evidence suggested there is relation between poor oral health and systemic health conditions. There is a bidirectional relationship between periodontal disease and diabetes (Tavares et al 2014; Montini et al. 2014). Periodontal disease may double the likelihood of having coronary artery disease, as well as is a predictor of aspiration pneumonia within hospitalized individuals (Tavares et al 2014; Badewy et al. 2020). Regardless of association, many chronic diseases require medications that have adverse effects on oral health (Montini et al. 2014; Lamster, 2016).
Increased access to oral care for older adults can reduce general healthcare use and cost (Badewy et al 2020). Difficulties eating, the effects of malnourishment, and oral pain have been associated with increased hospitalization, as well as healthcare costs in older adults. Preventative and timely dental care could avoid these repercussions (Bailey et al. 2005).
Decision Maker
Oral healthcare is continuously changing to a more preventative approach. This shift from optional oral care, to becoming an integral component of overall health needs to be accepted by all stakeholders. The creation of policies must promote oral health for all. Provincial bodies would be responsible for the creation and monitoring of an oral healthcare program for older adults, as they typically allocate healthcare spending.
References
Bailey, R., Gueldner, S., Ledikwe, J., Smiciklas-Wright, H. (2005). The Oral Health of Older Adults: An Interdisciplinary Mandate. Journal of Gerontological Nursing. Doi:10.3928/0098-9134-20050701-05.
Badewy, R., Singh, H., Quinonez, C., & Singhal, S. (2020). Impact of Poor Oral Health on Community-Dwelling Seniors. A Scoping Review. Health Services Insight. DOI:10.1177/1178632921989734
Estrada, I., Kunzel, C., Schrimshaw, E., Greenblatt, A., Metcalf, S., Northridge, M. (2018). “Seniors Only Want Respect” Designing an Oral Health Program for Older Adults. Speciality Care Dentistry Association. 38(1). Doi:10.1111/scd.12265
Health Canada. (2010). Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey: 2007-2009. https://www.caphd.ca/sites/default/files/CHMS-E-tech.pdf
Lamster, I. (2016). Geriatric Periodontology: How the Need to Care for the Aging Population can Influence the Future of the Dental Profession. Periodontology 2000. 72(1). Doi:10.1111/prd.12157
Montini, T., Tseng, T., Patel, H., & Shelley, D. (2014). Barriers to Dental Services for Older Adults. American Journal of Health Behaviour. 38(5). Doi:10.5993/AJHB.38.5.15
Tavares, M., Lindefjeld Calabi, K., San Martin, L. (2014). Systematic Diseases and Oral Health. Dental Clinics of North America. 58(4). Doi:10.1016/j.cden.2014.07.005
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