Getting the message out: Older adults need oral care

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.

Adults aged 65+ who have lost six or more teeth due to tooth decay or gum disease
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.

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6 thoughts on “Getting the message out: Older adults need oral care”

  1. Anonymous says:

    Of course WV has the worst teeth out of 53 places. I don’t like being in a state with that kind of reputation. :[

  2. yes says:

    turn lemons into lemonade. Why not become a dentist in WV then ??! Help alot of people and make alot of $$ !!!!! Just a thought

  3. Anne Mills says:

    Prevention is important, but oral care is often neglected at the bedside and during homecare. Check this resource for FREE instructional materials. They were developed by the Ohio Dental Assoc. and can be used for clinical education of nurses and caregivers. The “Smiles for Seniors” is a great resource!
    http://www.oda.org/gendeninfo/Smiles.cfm
    Nurses who work with dental providers may also wish to check out OSAP at http://www.osap.org/.

  4. RN says:

    Even if a person is diligent in their oral care, they will still develop problems if they don’t see a dentist at least q. 6 mos. for thorough cleanings. Most people can’t afford dental insurance, and out-of-pocket is out of the question. Maybe worse than that is the number of nursing home residents who depend on lazy staff for their oral care, and it seldom gets done. Not enough time isn’t a reason when staff emplyees still have time for breaks and cell-phone calls…

  5. Anonymous says:

    I agree that healthcare staff should make it a point to offer oral care to those who can’t do for themselves, but to insinuate that healthcare workers should not take breaks is totally ridiculous!

  6. Anonymous says:

    Many patients in the hospital do not receive oral care as part of their daily care. Many patients over 65 are diabetics and present an added risk for infection. When patients state that they have not received oral care since admission to the hospital,we have a problem! I continue to advocate, teach and offer oral care tools to my patients and hope that my actions are an example,to my colleagues.

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