Barriers to Crucial Dental Care for Older Americans

By Aldrich, Nancy | Aging Today, January/February 2006 | Go to article overview

Barriers to Crucial Dental Care for Older Americans


Aldrich, Nancy, Aging Today


The second of two articles.

The U.S. Preventive Services Task Force recommends regular dental visits for all people 65 and older, yet only 43% of older Americans reported a dental visit in 1996, according to the Agency for Healthcare Research and Quality (Medical Expenditure Panel Survey, 1996). As they enter their retirement years, most elders lose employer-based dental insurance, and at the same time are dealing with a reduction in income, explained Richard J. Manski of the University of Maryland and Baltimore College of Dental Surgery. That means that most older people pay their dental expenses out of pocket and, for many, these costs come at a time of reduced income. Unfortunately for retirees, Medicare does not cover routine dental care and Medicaid provides only limited coverage in certain states.

Other reasons why older adults do not regularly use dental services include lack of perceived need for care: mobility limitations and transportation difficulties; fear of dental visits; limited availability of dental services in certain rural and urban areas; and diminished physical, cognitive and functional status associated with multiple complex medical conditions and disabilities. Among other issues affecting certain populations arc low literacy, which can keep an older adult from understanding information and services. These barriers to dental care will be compounded as the 77 million boomers reach retirement age.

LONG-TERM CARE

Barriers to good oral health care are especially prominent in long-term care facilities due to a lack of insurance coverage, limited patient mobility, the inconvenience of making trips to the dentist, and the lack of funding and expertise in facilities to provide complete dental care. Although about 80% of nursing homes report that they make dental services available, only 19% of all nursing home residents receive dental services, according to the National Nursing Home Survey. Clinical studies show an absence of oral hygiene and the existence of widespread oral health problems among nursing home residents.

Tooth decay rates are very high among the nursing home population, especially for those who depend on others to do their oral hygiene care, said Judith A. Jones, who heads the general dentistry department at Boston University School of Dental Medicine. Yet, she explained, most oral health problems for people living in nursing homes "could be prevented by good daily oral hygiene and regular preventive care. But it is just not available."

Teresa Dolan, dean of the University of Florida College of Dentistry, observed that few dentists are trained specifically in the oral health care of the geriatric population. The U.S. Health Resources and Services Administration supports only a few university dental training programs that have a geriatric component, she said. "The funding for those programs has decreased dramatically," Dolan noted. "While most dental school curriculums include some geriatric content, there is not much clinical experience in nursing home settings for the more compromised patients." Also, only a small proportion of dentists are from underserved racial and ethnic groups, which may be a disincentive for diverse populations to seek dental care. …

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