When it comes to public health programs, we often think of the ones that target school-aged children. However, the unmet dental needs of older adults in the United States are something we cannot ignore. This vulnerable population desperately needs our help and attention. In this article, I’ll present their needs and how we can address them. During this six-part series, I’ve covered many topics related to public health: integration, the importance of school-based programs, public health agencies such as federally qualified health centers, and the impact of strong community connections. Here, we will touch on many of those areas and how they relate to the aging population, particularly those residing in long-term care facilities (LTCFs).
Before we get into the specific needs of our aging population, let’s outline the different places an older adult may reside. All the places listed below, aside from home care, are considered LTCFs.
Home care: Also termed “aging in place,” this describes when an individual continues to live in their own home and may have a home health nurse who assists with any medical needs.
Assisted living: Residences that offer 24-hour supervision and personal care assistance as well as meals, social activities, and other amenities. This type of care may be provided in a skilled nursing facility or an assisted living facility.
Skilled care: A high level of care, this category describes a living situation that includes medical services such as physical therapy, catheter care, and a medical professional to administer medications via IV. This typically takes place in a skilled nursing facility, but can be provided in assisted living communities or even adult day-care settings.
Memory care: Another high level of care, memory care offers 24-hour supervision and the same services as skilled care, but also has a lower staff-to-resident ratio. In addition, staff is specifically trained to handle the cognitive, behavioral, emotional, and physical needs associated with dementia. Security is often increased in these facilities, and external access may be restricted. This level of care is for patients with Alzheimer’s disease, Huntington’s disease, Parkinson’s disease, or any other form of dementia.1
It is estimated that about 70% of people who reach age 65 will eventually need some form of long-term care, while about 35% will require nursing home care.2 By the year 2030, almost 70 million people will be 65 or older and 8.4 million will be 85 or older.3 These projections indicate a large population of aging adults with varying needs, including oral health needs. As people live longer and retain more of their natural teeth, we can anticipate an increase in dental needs. Many older adults, particularly those in nursing home settings, have complicated medical histories, including comorbidities that are impacted by poor oral health. This creates the opportunity for integrated efforts and puts dental providers in the position to play a critical role in the overall health of nursing home residents.
The impact of poor oral health for LTC residents is vast and is associated with poor physical, nutritional, social, and psychological health.4 Poor oral health can cause the following, among many other things:
- Mouth pain/fungal infections
- Difficulty chewing or swallowing
- Weight loss/failure to thrive
- Pneumonia
- Necessity for a liquid diet
- Diabetes, heart attack, stroke, and COPD (all associated with poor dental health, though a causal relationship has not been established)
The list of health concerns associated with poor oral health is long. There are many reasons an adult living in an LTCF may suffer from poor oral health; some of those include poor dexterity and a true inability to perform their own oral care, memory issues preventing daily oral care, and lack of time for nursing staff to be able to perform all they are tasked to do for the residents. Whatever the reason may be, the reality is that dental care is too often an unmet need for this vulnerable population. It is not uncommon to go into a skilled nursing facility and find patients with tooth pain, rampant decay, mouth sores, dry/cracked lips, candidiasis, poor-fitting dentures, and/or missing dentures. Many residents have not seen a dentist in years, and when they do, it’s only for a limited exam, not for preventive care.
It’s estimated that the ambulatory elderly patient takes up to five medications on a daily basis, and the average nursing home patient takes up to seven.5 Most dental providers who work in nursing home settings know that most patients take more than seven daily medications, and one of the main side effects is xerostomia. Many residents rely on nutritional shakes with high sugar content, and most have poor daily oral care. We certainly have our work cut out for us, and dental professionals are desperately needed in these facilities. Many LTCFs have difficulty finding providers to see their residents, and then there is the issue of transportation. We’ve discussed mobile and portable dentistry services in this public health series—this population greatly benefits from these services.
Your ability to serve the aging population and those in LTC facilities will be dependent on state rules and regulations regarding dental hygiene services. However, if this is an area of interest for you, there are certainly opportunities to get involved and serve these residents even if you cannot directly provide care.
There are hygienists out there doing some amazing work in the nursing home space. Sonya Dunbar, the Geriatric Toothfairy, is a hygienist on a mission to improve the oral health of all seniors. Angie Stone is another hygienist who has done extensive work with the nursing home population. Yet another hygienist who has created a different way to serve this population is Pam Cushenan through her Soft Smiles LLC program. There are many more hygienists who are getting creative and finding ways to provide care or education to those in LTC facilities.
If you haven’t noticed, the overarching theme of this series is being innovative and thinking outside the box, as well as making connections that will aid in the success of your program. We’ve said throughout the series that regardless of the topic, in public health there is no “one size fits all.” There is no right or wrong way to create a public health program, and the same applies to the aging population. Be creative, connect with your colleagues, and bravely take that first step. It may be complicated to get going, but the rewards are great. The aging population truly needs us!
Editor’s note: This is part five of a six-part series that highlights public health and advocacy for the dental hygienist. It first appeared in the September 2021 print edition of RDH magazine. Other articles in the series can be found in previous issues of RDH magazine or at rdhmag.com.
Related articles:
Part 1: Public health and advocacy for the dental hygienist
Part 2: Fluoride and sealants: How these preventive tools are helping our pediatric patients
Part 3: Mobile, portable, and teledentistry’s critical role in public health hygiene
Part 4: The FQHC’s impact on our communities
References
- Different types of eldercare and care homes. Paying for Senior Care. August 21, 2019. https://www.payingforseniorcare.com/types
- Long term care insurance. Elder Needs Law PLLC. https://www.elderneedslaw.com/articles/long-term-care-insurance
- Neufeld J. How many older adults will wind up in skilled nursing homes? Elder Needs Law PLLC. January 14, 2017. https://www.elderneedslaw.com/blog/how-many-older-adults-will-wind-up-in-skilled-nursing-homes
- Gaddy A. Project FLOS: Facilitating long-term care oral health services. Alexandria Health Department. March 2019. https://vahealthcatalyst.org/wp-content/uploads/2019/12/FLOS-Report.pdf
- How many pills do your elderly patients take each day? HCP Live. October 4, 2010. https://www.hcplive.com/view/how-many-pills-do-your-elderly-patients-take-each-day
Brooke Crouch, RDH, is a remote supervision dental hygienist with more than a decade of clinical experience in private practice, a state agency, and a federally qualified health center (FQHC). Crouch is an adjunct instructor and mobile dentistry consultant. She is vice president of the American Mobile & Teledentistry Alliance and she serves on several clinical advisory, oral health action, and community-based boards and committees throughout Virginia. Contact her at [email protected] or on her various social media at @brookecrouchrdh.
