Academic journal article Bulletin of the World Health Organization

Prevalence of Caries and Edentulousness among 65-74-Year-Olds in Europe

Academic journal article Bulletin of the World Health Organization

Prevalence of Caries and Edentulousness among 65-74-Year-Olds in Europe

Article excerpt


Almost all industrialized countries are witnessing a demographic evolution characterized by the aging of their population. A theory of demographic transition has been proposed to account for this, whereby every population, at a certain stage of its history, passes from a situation where there is a balance between high fertility and high mortality to one where there is a balance between low fertility and low mortality (1). This demographic transition is related to a decrease in infant mortality, increase in lire expectancy, and falling fertility (2).

Europe is currently experiencing such a transition, although differences in the rhythm of changes can be observed between western European countries, with developed market economies, and eastern European countries, with economies in transition. In 1990, over-65-year-olds represented 15.0% of the 120 million inhabitants of 52 European countries, by 2005 they will represent 16.5%, and by 2025, 22.4%. Demographic projections indicate an inversion in the former pyramidal distribution of population by age groups. By 2020, over-65-year-olds will be more numerous than children aged less than 15 years. In the course of the next 25 years, the elderly cohort is predicted to increase by 82%, whereas the total number of persons of working age, i.e. those aged 20-64 years, will increase by only 46% and newborns by only 3% (3).

The economic, social, and health consequences of this aging process are so important that health authorities are paying particular attention to the elderly population. However, globally, there have been not only demographic changes but also political and economic transitions associated with social and cultural evolution. These changes further emphasize the need to renew health policies at all levels.

The increase in life expectancy associated with changes in the organization of the workplace -- retirement age being lowered in some countries and increased in others and also less job security -- have introduced a new definition of "the elderly". Classification based on chronological age of individuals is no longer sufficient since there is also a need to take into consideration the degree of dependence, quality of life, and level of sociability (4, 5). The majority of active or retired people remain within the scope of the economic system, while dependent older people have a higher probability of being institutionalized (6).

The planning of oral health services is directly dependent on qualitative health information. In Europe, the oral care system is oriented mainly towards ambulatory care. Oral health care provided at home is rare and care provided in institutions seems to be slightly more structured. In any case, the countries of the European Union have no common strategy for providing oral health care for functionally dependent elderly people.

Since 1979 the WHO Oral Health Programme (ORH) has promoted and undertaken activities in favour of developing oral health policy for senior citizens. The main actions have included the following:

-- the establishment in 1982 of oral health goals for elderly cohorts (aged 65-74 years) within the framework of Health for All by the year 2000 (7);

-- in 1985, support for the creation of the International Gerodontology Association;

-- participation in joint WHO/Federation Dentaire Internationale working groups on oral health of the elderly; and

-- a recommendation in 1987 to evaluate the oral health status and treatment needs of the WHO index age group (65-74 years) (8).

In industrialized countries gerodontology is an evolving discipline as evidenced, for example, by the establishment of specific courses covering it in French dental schools, beginning in the academic year 1998; and the availability of Master's courses in gerodontology in the United Kingdom.

The consequences for dentists related to the provision of services for older people are very important. …

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