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Strive-The Student View Dental Health Care for the Elderly: Primary Concerns Regarding Oral Health
“I thought getting old meant eventually getting false teeth. I never knew there was a way to prevent this from happening; I just thought it was all part of life.” This disturbing sentiment has been expressed by people of all ages and cultures from all types of backgrounds. But the truth is that every year, more people are keeping their natural teeth well into their 80s and 90s. This may raise some concerns regarding access to oral care and its affordability for the elderly population. This paper will consider the meaning of quality of life and its relationship to oral care among the elderly; present statistics on elder oral care; and discuss specific concerns, problems and reasons for ability or inability to obtain proper oral care. “Quality of life is an individual’s perception of their position in life in the context of culture and the value systems in which they live and in relation to their goals, expectations, standards and concerns.”[1] Health-related quality of life has five different facets: 1) opportunity; 2) perception of health; 3) ability to study; 4) physical limitations and diseases and 5) the duration of life. This concept is the meeting place for how long and how well people live.[2] According to Williams, as cited by Darby and Walsh, the Oral Health-Related Quality of Life Model “postulates that the continuum of health and disease is influenced by environmental, sociocultural and economic influences that are either modifiable or nonmodifiable risk factors.”[3] This model, while specific to oral health, is in line with the health-related quality of life model in that people’s beliefs, and how they respond to the situations that affect their lives, influence their overall perception of quality of life. There is now a growing interest in the quality of life in dentistry.[4] Health, as defined by the World Health Organization (WHO), is a “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”[2] Total health ranges from wellness to illness, and even includes disability.[2] According to De Visschere and others, the need to conceptualize the relationship between oral health and the quality of life has not yet been fully developed in dentistry.[2] Vargas and coauthors found that at least 23 percent of the elderly population does believe that oral health is directly connected to the quality of life, primarily because of its impact on eating.[4] The oral cavity contributes to health-related quality of life at a basic biological level as it relates to the ability to chew and swallow. It encompasses survival of the individual in terms of ability to eat, as well as the absence of cancer, symptoms of disease, discomfort or pain. But also, at the social and psychological levels, it contributes to self-expression, communication, facial aesthetics and self-esteem.[2] It contributes to self-esteem because it is one thing that determines whether or not people like to smile or feel comfortable with their appearance. The more comfortable people are with their appearance, the easier it is for them express themselves verbally or through facial expressions. A person’s level of satisfaction with his or her oral health status relates to self-satisfaction. For example, a study showed that elderly people missing their front teeth were less confident and less pleased with their looks than those who were missing posterior teeth.[2] When oral health is overlooked, the overall status of health and the quality of life are compromised.[2] Another issue related to oral health-related quality of life is that over 100 physical or mental diseases are related to pharmaceutical regimens that produce symptoms in the oral cavity or appear to affect the ability to perform tasks associated with oral self-care.[2] For example, xerostomia and gingival hyperplasia are two types of manifestations that could be drug induced and would go untreated if dental care is not addressed in this population. Despite the fact that oral health is a huge part of being healthy (in general), and that it directly correlates with the quality of life in many ways, statistics show that the elderly population uses dental services at a much lower rate than any other age group. Even when low-cost dental services are offered to older people, a great number of those eligible still do not seek dental care.[1-6] The fact that so many eligible older people do not seek proper dental care is unfortunate, considering statistics have shown that the prevalence of root caries increases significantly with age, as do periodontal problems, tooth loss, oral cancers and other soft tissue lesions.[5] This survey also reported that 38 percent of the elderly population over the age of 65 admitted to not having sought dental care in over five years, and among edentulous elderly, the rate of nonuse is even higher.[5] Yet, older people are more likely than any other age group to use physician services. Only four percent of the elderly subjects surveyed reported not having sought a physician’s help in over five years.[5] These statistics raise some interesting questions, including what factors keep these people in need of dental care from seeking it. When it comes to dental care, the most frequently mentioned barrier is cost. Elderly people whose incomes were near the median were seven to eight times more likely to seek dental services than those with lower incomes.5 These findings suggest that if fees for dental care were reduced, utilization might increase. However, a number of studies have shown that when these services have been offered at lower costs, utilization increased only slightly.5 Even in the case of dental insurance, which has seen utilization increase by as much as 50 percent to 100 percent, the elderly still have the lowest rate of utilization compared with any other age group.[5] Many studies show that though older people are aware of special programs through which they might receive dental care, they seem to be unable to relate the programs to their own needs. For example, Kiyak found that only seven percent of edentulous elderly patients felt the need to seek professional dental care.[5] Despite the high numbers of senior citizens who did not seek dental care, at least 70 percent of the elderly subjects studied were proven to be in need of dental treatment. Of that 70 percent, only 25 percent to 40 percent perceived the need for care, and only 20 percent to 30 percent actually sought the professional care they needed.[5] One study reported that elderly patients ranked painful teeth or gingiva 25th, and irritated tongue and mouth 36th out of 200 health symptoms.[6] According to Visschere, a subgroup of the elderly population who does not seek care includes the elderly patients who simply cannot care for themselves and are institutionalized. In some cases, their poor oral hygiene may result from the institution staff lacking adequate knowledge of oral health care.[2] Another major concern among the institutionalized patients was difficulty eating, whether due to missing teeth, ill-fitting dentures, caries or periodontal disease.[5] Despite the strong emphasis society places on them, a pleasing appearance, a high quality of life, and the positive effects of good oral hygiene might not be obtainable for some members of the elderly population. Not having the money to pay for professional services is often a huge contributing factor as to why oral care is out of reach for some. In addition, physical limitations such as those caused by disease could put an obstacle between the elderly patient and the proper care. It is to be hoped that increasing our knowledge base through further research related to the oral health-total health connection will bring our society closer to a solution for this problem. References
Danielle Rouse is a third-year dental hygiene student at Southern Illinois University, Carbondale, Ill.
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