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Modern Hygienist | September 2008 Patients | Aging
For many elderly Americans, access to dental care is a luxury they’re forced to do without.
Lack of access to oral healthcare is a looming problem for people all over the world. Many Americans find it hard to imagine a country like the United States having access issues, but the numbers of those untreated and underserved are increasing each year. In the year 2015, population projections for the United States are expected to hit 312 million, and 14.7% of that population will be 65 years or older. The population is also becoming more diverse in terms of ethnicity, race, financial resources and living conditions. The attempt to provide oral healthcare to this group of seniors is just one of the many difficulties that we as health care providers will be faced with in the years to come.1 insurance woes In 2000, approximately 350,000 older Americans had no health insurance, and despite a high rate of chronic medical conditions, they were unable to receive home healthcare or outpatient services due to lack of insurance and out-of-pocket costs for services.2 Considerable attention has been paid to the need for comprehensive healthcare for uninsured children and younger adults, but little information has been published about the percentage of elderly without health insurance.2 Even though the number of older adults without insurance is small, their healthcare needs are substantial.2
Bear in mind that in most states, Medicare does not cover routine dental services. In states where Medicare does cover an annual “cleaning,” the reimbursement is very low, and most dentists do not want to get involved in treating patients with Medicare.3 The person without private insurance or the personal resources to have dental care most likely will go without oral healthcare.1 Problematizing personal care Oral infection now is recognized as a risk factor for a number of systemic diseases such as diabetes, respiratory disorders, cardiovascular and cerebrovascular diseases. The elderly often take multiple medications that can reduce saliva flow, reduce the efficiency of chewing, and lead to dental problems that affect the supporting teeth and their structure.1 The mouth is the gateway to the digestive system, and when chewing becomes difficult, nutritional problems are sure to follow.4 Many older adults are able to live independently, while others live in long-term care facilities.4 In either setting, nearly 45% of people over the age of 85 require assistance in daily activities such as bathing, dressing, feeding, toileting and oral healthcare.1 ,5 Because more elderly patients have preserved their natural teeth, there is an increase in oral disease due to the increased debilities that come with age.5 Dental equipment is a major expense for a long-term care facility and few dental treatment rooms are available in nursing homes. Most exams can be done in wheelchairs or Geri chairs when the basic tools necessary for evaluation and screening are available, and many nursing care facilities have sterilization equipment and suction machines that can be used by dental hygienists. Those who have an interest in treating the elderly patient should take continuing education courses on the care and treatment of geriatric patients, and take into consideration that some residents may be difficult to treat.3 |
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