In the early 2000s, you may have come across headlines reading “United States: An Aging Nation” or “2030 Projected Year Elderly Surpass Birth Rate.” The US Census Bureau acts as the primary data collector for such statistics, organizing countless infographics, studies, and surveys to keep abreast of demographic changes.
It is now 2020, and we still march onwards towards that inevitable future. As of 2019, the United Nations Department of Economic and Social Affairs clocked the world's elderly population at 703 million, with the United States contributing 73 million to that number.1 Dwindling birth rates2 and increased life expectancy means we can expect to see a burden of care fall on a shrinking generation of health-care providers.3 Information like this is critical as it is used to determine where money is needed for public health services for years to come.
Knowing what is coming, health-care providers across all sectors have been experimenting with various telehealth models to address issues plaguing the elderly population, such decreased mobility, inaccessibility to health-care services, and poor health literacy. In the dental field, all manner of dental professionals, from hygienists to assistants to dentists and beyond, will need to adapt routines to address the number of elderly patients whose oral health care falls through the cracks of a broken system.
Yet, when it comes to oral health care, seeking treatment remains at the bottom of the totem pole of priorities for seniors.3 Unfortunately, the sentiment that oral health is unimportant to the elderly is reflected in the way dental providers see senior patients as a less desirable customer. A 2016 study conducted by the American Dental Association highlights that some of the top reasons that seniors, while suffering from easily treatable conditions such as dry mouth or the aesthetic of their smile, have not visited the dentist in more than 12 months is because of cost, perceiving no need for a visit since they have none of their original teeth, fear of the dentist, and trouble finding an accessible dentist with convenient appointment times. Each of these barriers is easily addressed when dental providers embrace holistic patient care via teledentistry.
Teledentistry allows the provider, whether dentist or hygienist, to harness telecommunications to provide accessible and cost-effective care, and there is no sector where this is more useful than with elderly patients. There are many challenges that dental providers may face when it comes to attracting, retaining, and treating elderly patients, including Medicare reimbursement, addressing the oral-health consequences of age-related decline and polypharmacy, retaining regular recall appointments, and how to effectively communicate product recommendations and instructions.
The largest elderly cohort in the US, commonly known as baby boomers, are the generation born between 1946 and 1964. By the year 2030, the youngest of the baby boomer generation will be over 65 and the oldest well into their 80s. They are the most affluent generation in America to date which also makes them the primary consumers in many sectors such as travel, wellness, and realty. However, there is often an aversion to treating the elderly patient as more dental practices focus solely on attracting younger clientele or patients not on Medicare.
A study performed in Australia by Tiffany Patterson Norrie and colleagues used interview-style surveys to assess the impressions nursing home physicians and management staff had about how important oral health care is to their elderly patients. The results showed that while nursing home physicians and management saw oral health care as critical to an elderly patient's health, there was an overwhelming negative perception of dental care providers.4
Teledentistry is an adjunct to the hard work being done at brick-and-mortar dental offices to treat elderly patients that saves providers time and resources. Before an elderly patient even sets foot in the practice, dental professionals can use video calls and interactive online oral health education platforms to provide consultation, health history screening, product recommendation and instructions to patients of record remotely, effectively removing physical accessibility and convenient appointment time barriers. In-office practical steps to keeping oral health care accessible to the elderly are to keep educational resources in formats such as large print, multiple languages, or even as videos to help aging patients and any potential caregivers the opportunity to understand treatments and products that are essential to their oral health. Patient education provided in a language or format that is accessible to an elderly patient is particularly crucial during the phase of the appointment when you are giving a recommendation for a product.
Do not be afraid of visiting a product website to see what the manufacturer has already created to demonstrate how a product works. For example, GlaxoSmithKline, the makers of PoliGrip and PoliDent for dentures and partials, has several videos and free printable materials to help denture patients understand the care of their removable appliances as well as the lifestyle impact dentures can have. Communicating proper product usage to an elderly patient or caregiver can ensure that your professional recommendation turns into a successful oral health outcome.
Another way we can address the challenges of working with elderly patients in conjunction with teledentistry is to leverage our relationships with other health-care providers. A 2016 survey performed by the American Dental Association in partnership with the Health Policy Institute showed that only 42% of patients over the age of 65 visit the dentist once per year.3 By leveraging their position in the health-care spectrum pharmacists, primary-care physicians, nursing facilities, and other senior-centric professionals can reinforce messaging about preventative oral care and contribute to better oral health outcomes. Not only will cultivating those relationships grow your patient pool, it will also mitigate oral-systemic linked issues such as malnutrition, xerostomia, diabetes, cognitive decline, and more.
We are oral health-care specialists, but we are not alone in treating complex patients such as the elderly. When we have reached the end of our professional scope, reach out. In the spirit of holistic preventative dentistry, adapting our practices and recommendations to elderly clients using technology will not only ensure their long-term oral-systemic health but also create lifetime customers who are more apt to keep their appointments as well as refer friends and family. In this way we have teledentistry gives us the power to put the “care” in elder care.
- America Counts. 2020 Census will help policymakers prepare for the incoming wave of aging boomers. US Census Bureau. December 10, 2019. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html#:~:text=Baby%20boomers%20have%20changed%20the,estimated%20at%20about%2073%20million
- Fry R. Millennials overtake baby boomers as America’s largest generation. Pew Research Center. April 28, 2020. https://www.pewresearch.org/fact-tank/2020/04/28/millennials-overtake-baby-boomers-as-americas-largest-generation/
- American Dental Association Health Policy Institute. Oral health and well-being among Medicaid adults by type of Medicaid benefits. American Dental Association. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIgraphic_0518_1.pdf?la=en
- Patterson Norrie T, Villarosa AR, Kong AC, et ak. Oral health in residential aged care: Perceptions of nurses and management staff. Nurs Open. 2019;7(2):536-546. doi: 10.1002/nop2.418
Dalia Lai, BS, RDH, is a licensed dental hygienist with 5-plus years of experience as an oral health-care provider and educator with GlaxoSmithKline. She serves on the public relations and marketing counsel for the California Dental Hygienists’ Association and is founder of Fresh Takes, a continuing education company. For more information, email her at [email protected] or visit freshtakesed.com.