Adopting a Comprehensive Approach to Ensure Effective Delivery of Oral Healthcare Services among Elderly

ABSTRACT

Oral health is closely linked to overall wellbeing among the elderly as poor oral hygiene can result in conditions like tooth loss, periodontal diseases, and xerostomia. The purpose of the current article is to justify the need for maintaining oral health among the elderly, identify the barriers that can prevent maintenance of oral health, and propose potential interventions to overcome these identified barriers. To ensure that elderly people have an adequate intake of essential nutrients, they must have healthy teeth and gums, which enable them to chew foods efficiently. Elderly people with good oral health tend to have clear speech and effective communication, which improves their self-confidence and eliminates the possibility of being socially isolated. Despite the presence of multiple benefits of good oral health, there are multiple constraints that can limit the maintenance of optimal oral health among the elderly. Acknowledging the significance of maintaining oral health and the presence of different barriers that can interfere with the maintenance of optimal oral health among the elderly, there is an indispensable need to implement specific interventions to improve the existing scenario. In conclusion, oral health is an integral component of the overall health and wellbeing of elderly people. The need of the hour is to implement a comprehensive package of interventions to ensure easy access to quality-assured oral healthcare services for the benefit of the elderly people.

INTRODUCTION

Elderly people experience multiple physiological changes that affect various body systems, which influences overall health, requiring a holistic approach to healthcare.[1] Oral health is closely linked to overall wellbeing among the elderly as poor oral hygiene can result in conditions like tooth loss (which impacts chewing, nutrition, and speech), periodontal diseases, and xerostomia (which can lead to difficulty in speaking and eating and more risk of cavities).[1,2] Moreover, poor oral health has also been linked with a heightened risk of cardiovascular diseases, respiratory infections, and diabetes.[3] The presence of these factors calls for the need to prioritize oral health among elderly people as timely interventions not only can improve the overall wellbeing but even reduce the magnitude of preventable diseases and augment their quality of life.[1,2,3] The purpose of the current article is to justify the need for maintaining oral health among the elderly, identify the barriers that can prevent maintenance of oral health, and propose potential interventions to overcome these identified barriers.

MAINTAINING ORAL HEALTH AMONG THE ELDERLY: THE NEED

To ensure that elderly people have an adequate intake of essential nutrients, they must have healthy teeth and gums, which enable them to chew foods efficiently.[4] In the absence of oral health, including tooth loss and pain, elderly people find it difficult to chew different food items, which in turn results in consuming only some specific types of food items, and this forces people to become malnourished and even experience weight loss and weakness.[4] In continuation, people with good oral health tend to chew better, reducing gastrointestinal discomfort and aiding in improved absorption of nutrients.[4] Elderly people with good oral health tend to have minimal invasive dental treatments or limited financial expenditures on oral care-related procedures.[5] Further, elderly people with good oral hygiene have limited bacterial accumulation in the mouth, decreasing the potential risk of inhaling harmful bacteria into the lungs.[3]

Elderly people with good oral health tend to have clear speech and effective communication, which improves their self-confidence and eliminates the possibility of being socially isolated.[1] In fact, elderly people with good oral health are more likely to engage in social interactions without being embarrassed due to missing teeth, bad breath, or speech difficulties.[1,2] Moreover, they tend to have an attractive smile and better self-esteem, which plays a crucial role in reducing anxiety and depression which are quite prevalent among elderly people.[6] The findings of a study performed among 500 elderly patients in Poland reported that the severity of depression among the study population showed a significant rise with a higher number of missing tooth, decayed tooth, and oral dryness.[6]

Even among people who are wearing dentures, proper oral care can reduce the risk of soreness, infections, and difficulties in chewing and speaking.[7] Based on the findings of a study, where records of a British Regional Health Study were included and followed-up for 9 years, it was estimated that tooth loss was linked with all-cause mortality.[3] In the same study, the records obtained from Health, Aging, and Body Composition were documented and followed-up of 15 years, and it was concluded that tooth loss, dry mouth, and having ≥3 oral problems were linked with all-cause mortality.[3] Thus, by preventing infection, improving systemic health, and augmenting social and psychological wellbeing, oral health plays a crucial role in a longer and healthier life for elderly people.[3,4,5,6,7]

IDENTIFIED BARRIERS

Despite the presence of multiple benefits of good oral health, there are multiple constraints that can limit the maintenance of optimal oral health among the elderly.[8,9,10,11,12,13,14,15] Most elderly people who are on fixed incomes/pensions cannot afford dental care due to high costs and limited insurance coverage, and this concern is further aggravated by the fact that most health insurance schemes exclude dental services.[8] There is a potential concern that many elderly people or their caregivers are not aware of the importance of maintaining oral health or the connection between oral health and systemic diseases, and this remarkably contributes toward poor oral care.[9] The next challenge is that many dentists might not be exposed to handling the specific needs of elderly patients during their training period, which reduces their ability to deliver efficient care.[10] In addition, the shortage of geriatric-specialized dental care providers can also limit the delivery of optimal oral care to elderly people.[10]

Elderly people often suffer from arthritis or weakness and might struggle to travel to dental clinics due to limited transportation options, especially in rural and underserved regions.[11] At the same time, some elderly people suffer from either dementia or cognitive decline, which can result in the neglect of oral hygiene due to memory loss, decreased ability to adhere to given instructions, or even becoming resistant to dental care.[12] In addition, some coexisting conditions (like arthritis, stroke, and Parkinson’s disease) can impair the ability of elderly people to brush and floss effectively.[13] There is another possibility that some elderly people might have had negative past experiences with dental care, due to which they are either afraid or anxious or are even reluctant to seek dental care.[14] Finally, the presence of linguistic barriers or cultural beliefs can also discourage elderly people from different backgrounds to timely access of dental care services.[15]

PUBLIC HEALTH INTERVENTIONS

Acknowledging the significance of maintaining oral health and the presence of different barriers that can interfere with the maintenance of optimal oral health among the elderly, there is an indispensable need to implement specific interventions to improve the existing scenario.[10,11,16,17,18,19,20,21,22,23] At the policymakers’ level, oral health should be regarded as a public health priority and accordingly, policies should be implemented to improve access to care for elderly people.[16] This policy-level change must be supported by integrating oral healthcare into primary geriatric care, and this can be accomplished by encouraging primary care physicians and nursing professionals to assess oral health and refer elderly patients to dental care services as one of the integral components of routine healthcare.[17] In addition, regular oral health checkups must be carried out in nursing homes and other long-term care facilities to facilitate the process of early detection and treatment of oral conditions.[18]

As lack of awareness about the importance of oral health is a key barrier, intensive efforts must be taken to increase the awareness of oral hygiene, denture care, and early detection of oral diseases.[9] This can be done by organizing educational campaigns, community workshops, and specific training programs for caregivers.[9] To improve the competence levels of healthcare providers in meeting the unique needs of elderly people, they must be trained in specialized geriatric oral healthcare services.[10] Moreover, efforts must be made to establish mobile dental clinics, outreach programs, and dental services in domiciliary settings to improve access for elderly people who either have mobility issues or are living in remote and underserved areas.[11,19] In continuation, steps must be taken to augment accessibility to dental services (like the establishment of elderly-friendly dental clinics, transportation facilities, and extended work timings of healthcare professionals) to accommodate elderly patients.[5,11]

In addition, it is vital to establish tele-dentistry services to promote virtual consultations, including advice for healthy oral practices and follow-up care.[20] There is a need to encourage the use of fluoride among elderly people as it can strengthen tooth enamel and prevent the development of cavities.[21] To sustain all the above interventions and to eliminate financial barriers, there is an indispensable need to increase funding and expand insurance coverage to include comprehensive dental care for elderly people.[8] In addition, access to low-cost or subsidized dentures must be encouraged, as it will also support their nutrition and clarity of speech.[22] There is an immense need to carry out research activities to generate evidence for policymakers to draft elderly friendly oral healthcare services.[10,11,18] Finally, to improve oral health and offer comprehensive care to elderly people, there is a definite need to encourage a collaboration between different stakeholders (viz. dentists, physicians, dietitians, and outreach workers).[16,23,24]

CONCLUSION

In conclusion, oral health is an integral component of the overall health and wellbeing of elderly people. The need of the hour is to implement a comprehensive package of interventions to ensure easy access to quality-assured oral healthcare services for the benefit of the elderly people.

CONFLICTS OF INTEREST

There are no conflicts of interest.

AUTHORS CONTRIBUTIONS

SRS: Conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work. PSB: Literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work. BFP: Literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work. VHM: Literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

ETHICAL POLICY AND INSTITUTIONAL REVIEW BOARD STATEMENT

Not applicable.

PATIENT DECLARATION OF CONSENT

Not applicable.

DATA AVAILABILITY STATEMENT

The data are contained in the article.

Funding Statement

Nil.