Despite its link to overall health, older adults often do not get the proper oral health care they need.
“Affordable, accessible preventive care, including oral health care, is essential to people living longer, more productive lives,” said Anne Cardinale, RN, GCNS-BC, director of New York state’s Ulster County Office for the Aging and New York State Nurses Association (NYSNA) member. “But few Americans over age 75 have private dental insurance, and Medicare does not pay for routine dental care.
“It’s hard enough to get seniors to come in for health care that’s paid for, let alone dental care, which can be quite costly,” she continued. “Most seniors are on fixed incomes. So they’ll choose spending their money on food and prescribed medications over going to the dentist.”
Cardinale is the chair of a NYSNA Gerontological Practice-Focused Group, which crafted a resolution on improving older adults’ access to oral health care that was brought before last year’s ANA House of Delegates (HOD). The HOD is comprised of 630 nurses from around the country who help shape ANA’s broad policy on practice, health care, and workplace issues.
As part of the resolution, which the HOD subsequently approved overwhelmingly, Cardinale and her workgroup noted that 20 percent of the U.S. population will be 65 or older by the 2030, and that almost no public health or public policy interventions are aimed at improving oral health among the growing elderly population.
The resolution also pointed to the 2000 document, “Oral Health in America: A Report of the Surgeon General,” which identified a “silent epidemic” of dental and oral diseases that affects some population groups, including older adults.
That report and subsequent research has shown a clear correlation between poor oral health and a number of diseases, such as pneumonia, sepsis, and heart disease, Cardinale said.
The HOD resolution specifically calls for ANA to support legislation to assure the basic oral health care needs of older adults, as well as help raise awareness of the importance of oral health and preventive care for older adults. Over the past few months, ANA has been instrumental in promoting health system reform legislation with a strong emphasis on preventive care. Varying reform measures being debated by federal lawmakers include some oral health care components – although they are largely aimed at the pediatric population or considered an “add on” to basic health care.
One nurse who spoke in favor of the HOD measure and who sees the ongoing need for comprehensive health care is geriatric nurse practitioner Eileen Toughill, PhD, RN, APN, recently retired chief nursing officer for the Visiting Nurses Association of Central Jersey (VNACJ), current nurse educator at Monmouth University, and a New Jersey State Nurses Association member.
“Oral health has been overlooked for a long time, partially because, like many preventive measures, it requires a lot of self-care,” Toughill said. “Many people don’t think about it until it’s too late, and they begin to lose their teeth.” She noted a 2000 Centers for Disease Control and Prevention (CDC) report, which said that 26 percent of adults between age 65 and 74 lost all their natural teeth.
Further, not all providers assess older adults for oral health issues, and generally appointments at free or low-costs dental clinics are few and fill up fast, she said.
Poor oral health–combined with normal physiological changes as people age–really can impact older adults’ overall health and self-esteem, Toughill explained. For example, people who have missing or unhealthy teeth may not be able to chew properly, and their decreased saliva production interferes with the digestive process of carbohydrates in the mouth.
“Older adults should be eating nutritious foods, like fresh vegetables and fruits, but instead may rely on canned, soft food if they are edentulous,” Toughill said. Canned foods are high in sodium, and this high sodium intake is particularly ill-advised in many older adults who may have cardiac and other chronic health conditions.
Toughill again pointed to the CDC report which addressed another major health concern: oral cancer. Specifically it noted that mouth and throat cancers are the sixth most common cancer in men in the United States, and fourth most common in African-American men.
“Yet because older adults see so many specialists, their oral health may be overlooked because many health care providers may not be checking the mouth thoroughly,” she said.
In addition to nurses lobbying for legislation aimed at improving oral health care, Toughill and Cardinale recommend that nurses engage in other actions, such as the following:
- Promoting mouth care as a vital component of routine care to older adults in acute, long term and home care settings.
- Ensuring that a thorough oral health exam is part of the physical assessment of all adults in primary care settings.
- Working with their employers to increase partnerships with dentists, dental schools, and community-based agencies to offer free or low-cost dental and oral cancer screenings.
- Lobbying for funding and helping implement a range of outreach programs, such as a dental van that can go to outlying areas where seniors may live.
- Educating colleagues and the community about the importance of preventive dental and oral health care for people of all ages, but particularly older adults.
Finally, Cardinale said, “Nurses have always advocated for preventive care. We need to make sure everyone views oral health as an essential part of overall health – as essential as food.”
Oral health rates vary state to state
The severity of the oral health problem in the United States varies from state to state, with higher instances of poor oral health in the southern states and Appalachia, where residents have less access to oral health care. Still, even in the best ranked state, Utah, almost one third of the adult population over 65 has lost six or more of their natural teeth.
|Rank||State||%||1||Utah||32.6||2||California||36.3||3||Arizona||36.7||4||Minnesota||38.3||5||Connecticut||38.3||6||Washington||39.1||7||Texas||39.4||8||Colorado||41.2||9||Massachusetts||41.6||10||Montana||42.6||11||New Mexico||43||12||Michigan||43||13||Oregon||43||14||Rhode Island||43.2||15||Virginia||43.4||16||Maryland||43.5||17||Nebraska||43.7||18||DC||43.8||19||New Jersey||44.1||20||Florida||44.2||21||Idaho||44.4||22||Virgin Islands||45.1||23||New Hampshire||45.8||24||United States||45.9||25||Wisconsin||46||26||Kansas||46.4||27||New York||46.8||28||Wyoming||46.9||29||Nevada||47.1||30||Ohio||47.3||31||Vermont||47.8||32||Delaware||47.8||33||Iowa||48.4||34||Illinois||49||35||North Dakota||49.3||36||Missouri||49.4||37||South Carolina||49.7||38||Maine||49.9||39||Alaska||50.9||40||Indiana||50.9||41||Georgia||52.5||42||Louisiana||52.7||43||Pennsylvania||52.7||44||Tennessee||53.6||45||Arkansas||53.8||46||South Dakota||54.2||47||North Carolina||55||48||Oklahoma||55.5||49||Alabama||56.3||50||Mississippi||58.2||51||Kentucky||58.9||52||Puerto Rico||62.9||53||West Virginia||69.6|
Susan Trossman is the senior reporter in ANA’s communications department.