The 2014 U.S. Census estimated 63.7 million adults 65 years and older will be living in the United States by 2050. Elderly adults are now more likely to keep their teeth, live independently and demand better care. However, they are also more likely to have xerostomia, physical or cognitive impairments and other comorbidities. Oral hygiene and other daily activities can become challenging for older adults as individuals with impairments have increased dependence. This poses challenges to families, caretakers and medical and dental professionals. A recent study showed senior citizens’ dependence limits oral hygiene maintenance and access to dental care. It also increases their need for dental services.
Plaque on denture and tooth surfaces retains oral and respiratory pathogens which can cause tooth abscess, recurrent respiratory tract infections and pneumonia, according to a 2011 study . A review by Sjögren et al. found improving oral hygiene prevents ten percent of pneumonia-related deaths in elderly nursing home residents. Therefore, dental care in the elderly is key to preventing mortality and morbidity related to the respiratory tract, oral and vascular infections. In addition, poor oral hygiene increases the risk of dental decay and periodontal disease. Having unhealthy dentition decreases masticatory function leading to nutritional deficiencies. Malnutrition increases the risk of systemic diseases and can lead to poor overall health.
Caregivers and medical professionals often consider oral health as vital but not a critical component of patient care. Oral hygiene is less prioritized in elderly care plans compared to other competing life-threatening comorbidities. Part of the problem may be lapses in oral health knowledge among caregivers, as found in a 2017 review. Caregiver oral hygiene education was identified as vital to improving dental health among elderly patients. Minihan and colleagues also confirmed caregivers play a significant role in oral health care for older adults. However, a 2016 Cochrane review found inconclusive evidence on caregiver roles in elderly oral health.
Providing dental hygiene education to caregivers may be beneficial in advancing oral health for the elderly. When providing dental care to older adults, assessment of their functional status is crucial. A determination of physical and cognitive abilities must be established. This analysis is necessary to decide if patients can perform oral hygiene without assistance. Also, it is important to assess the knowledge, attitude and behaviors of caregivers towards oral hygiene. For patients needing assistance, provide oral hygiene instructions to both patients and caregivers. Consider forming partnerships with geriatric care communities to increase access to dental services in these communities. The University of Alabama at Birmingham School of Dentistry operates a dental clinic in the Fair Haven Retirement Community in Birmingham, Alabama. This is the only retirement community in Alabama with an associated dental clinic. Formed under the leadership of Dr. Lilian Mitchell, this partnership increases access to dental services in this elder community. It also improves the Oral Health Related Quality of Life (OHRQL) among elder adults in this community.
Accessing dental care and performing good oral hygiene can be a challenge for older adults. Unfortunately, competing priorities and insufficient resources can hinder the caregivers and nursing care staff from assisting residents in performing theses tasks. Providing oral hygiene education to caregivers and improving access to dental care among the elderly is key as these services can reduce the burden of diseases while improving the OHRQL.
~ Chijioke Ulasi, MPH, Alabama ’19, 2017-18 contributing editor