The Legislative Impact on Dentistry for Aging Populations
Dentistry for aging populations will not benefit from healthcare reform, except that the intensity and length of this debate is drawing attention to the populations that will and will not benefit from change, explains Beth Truett, president and CEO of Oral Health America (OHA). Some of the issues that dentistry will need to address going forward include the inclusion of oral healthcare in Medicare; the recognition of geriatric dentistry as a specialty; inclusion of geriatric dentistry in workforce training; integration of dental and medical care; and payment codes to improve reimbursement, she elaborates.
“Oral Health America plans to sharpen its focus on the dental health of older Americans because we are face-to-face with a growing problem,” Truett says. “Seniors and retirees constitute an increasing percentage of the American population, yet almost no national public health or public policy interventions have been developed to change the healthcare system in ways that would meet the oral health needs and problems of older adults.”
This is problematic for a number of reasons, Truett continues. First, consider population growth among this group. Today there are more than 35 million individuals who are 65 years or older, a number that is expected to grow to 70 million by 2050.
Second, regarding the insurance status of older adults, 100 million Americans lack dental insurance, which represents approximately twice the number of individuals who are medically uninsured. However, Truett says that approximately 70% of older Americans are not covered by private dental insurance, and most individuals on Medicare do not have sufficient resources to pay for their own dental expenses.
Third, within this group, minority, low income, and uninsured individuals suffer disproportionately from poor oral health, Truett adds. Yet, according to the Agency for Healthcare Research and Quality’s survey (AHRQ), ethnic minorities and those designated as “poor” or “low income” are significantly less likely than Caucasians or individuals with middle or high incomes to have visited a dentist between 1996 and 2004.
“Among low income elders, AHRQ’s survey found that 57% of older adults reported no dental visits, and those from poor, low, or middle income families, as well as those with less formal education, were less likely to have private dental coverage than elderly individuals from families with higher income and more education,” adds Truett. “In addition, cutting across all economic strata, many seniors may be homebound or have limited access outside the home or live in long-term care facilities.”
According to Frank A. Catalanotto, DMD, geriatric dentistry issues are going to suddenly increase, particularly as the baby-boomer population enters retirement age and is living longer. Because this generation is keeping its teeth longer, there is potential for significantly increased demand. “What’s going to happen, however, is that a lot of that population, which may have had dental insurance when they were younger and employed, is not going to have dental insurance anymore,” Catalanotto explains. “That’s why the issue of an adult Medicare benefit is something that many people are talking about, but it’s not going to happen this year. “
For aging and elderly populations, the issues of access and resources are exacerbated by the incidence and severity of disease, says Truett. First, periodontal disease and dental caries result in problems such as missing teeth, with 26% of older Americans suffering from complete tooth loss, she says. Secondly, improperly fitting dentures and oral infections can significantly impact the overall health of the elderly, Truett elaborates.
“Not only do these problems negatively affect the quality of life of seniors— including their ability to eat and communicate—and compromise medication compliance, but research also links oral disease with serious systemic diseases that most commonly affect the elderly, such as diabetes, stroke, cardiovascular disease, and respiratory illness,” Truett cautions. “Finally, oral and pharyngeal cancers, which result in 7,500 deaths annually, are primarily diagnosed in the elderly, with the median age of diagnosis at 64.”
“OHA believes that there is tremendous opportunity to leverage the interest in geriatric oral healthcare that is evident today among researchers, educators, business, and industry, and non-profit direct service and advocacy organizations. Systemic change is needed in the form of oral healthcare reform. However, change ‘on the ground’ is equally important,” emphasizes Truett. “Medical and dental practitioners must focus on improving patient care and health outcomes for the elderly by increasing knowledge and collaboration among the disciplines.”
Truett notes that OHA recently sponsored a symposium in collaboration with the New York Academy of Sciences and Columbia University to unveil current research affecting senior populations and further the conversations between healthcare professionals. Materials from the symposium, including e-Briefings prepared by professional science writers, will be available to practitioners and the public, and links will be offered to related resources, including Web sites, books, and other scientific literature, she says.