Treating Senior Patients: Quality of Life Concerns

Why should a practice care about senior citizens’ quality of life? Why make improvements and modifications to a practice based on the senior population’s needs and desires? Regular dental treatments for the elderly have the potential to improve the lives of an entire generation. Dental professionals should prepare for an increasing need for services with the boomer generation’s impending retirement. While it increases dentists’ client base, regular dental treatment for seniors can improve their outlook, attitude, and oral health.
Although many seniors continue to lead normal, active lives, a combination of factors including poor oral health and mental health, medications, and physical limitations can deteriorate their quality of life. By striving to understand the challenges seniors face in all aspects of life, dentists may begin to personalize treatments while growing their practices and improving patients’ quality of life through comprehensive dental care.

ENCOURAGING  SENIOR VISITS

Proper dental care is an important part of maintaining a high quality of life for the elderly; however, due to physical limitations, these patients often require special considerations for treatment. Dental professionals should pay particular attention to obstacles their senior patients face and understand their special needs. By implementing action plans in support of senior patients, a practice can increase its patient base and improve the quality of life for seniors everywhere.
As a near senior citizen myself (Dr. Groba), I’m learning that all sorts of things are more difficult to perform, and more pain is usually involved in the process. Having undergone full-mouth reconstruction recently, I can certainly tell you that a tremendous amount of stress can be associated with such an undertaking! But to get back to the subject, senior programs may need to be designed to support elderly women specifically, as oral health issues are more significantly reported among women, who usually live longer than men.1 Of people ages 50 to 64, women are also 2% more likely to be uninsured than men, possibly diminishing the health and financial services they receive.2
A practice should observe the senior patients who visit to determine if they are primarily women. If this is the case, consider offering additional resources developed specifically for women’s health needs, making oral hygiene easier for female patients with carpal tunnel syndrome or rheumatoid arthritis. Women are 3 times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men.3 In addition, half of the elderly population in the United States is affected by arthritis, and women account for 60% of cases.4 For example, dental professionals may suggest that arthritic seniors attach their toothbrush to a tennis ball for dexterity. While this might sound peculiar, these types of creative solutions can often help practitioners serve patients best.
For a long, healthy, comfortable life, both men and women require regular preventive care and treatment to help limit complications and compromise of their systemic health. Practices may begin treating more seniors by asking middle-aged or younger patients to bring a parent or grandparent with them on their next visit. As seniors are often on a fixed budget, it may be best to develop payment plans or discount services for designated, regular oral healthcare. We like Capital One Healthcare Financing (Dental Fee Plan) and have had good luck with them. Additionally, the cost of living is constantly rising, forcing seniors to cut back financially where they can, which sometimes leads to neglected oral health and decreased quality of life. The challenges seniors face in areas of insurance, billing, and disability services present more barriers to proper healthcare. An analysis of survey data from the Federal Reserve Board examining money management skills of older consumers found that persons age 65 and older were less likely to have experience with financial products and basic money management skills, which may lead providers to design billing procedures around the needs of elderly patients.5
Seniors are often unable to fill out lengthy paperwork or sit on the phone to discuss billing. Practices should begin to design a simple financing and referral service especially for seniors, because seniors will shortly become big spenders. In the coming years, this consumer group will continue to multiply. In the US, the number of adults older than 65 years of age is expected nearly to double over the next 25 years.6 As baby boomers age, it pays to make small sacrifices to access an ignored market and improve their quality of life at the same time.

INTERNAL BARRIERS TO ORAL HEALTHCARE

While dental professionals may do their part to encourage seniors’ visits to the office, patients themselves may be hesitant to accept care. Seniors may have difficulty accepting their decreased mobility or capability, forming a self-imposed debilitation. Dental professionals must keep psychological considerations in mind when treating senior patients. For example, the likelihood of senile dementia does increase with age, affecting 20% to 30% of the older population by age 85.7,8 In addition, seniors may experience depression, frustration, or stress related to the death of a loved one, retirement, or physical impairment, all of which deteriorate quality of life and deserve careful consideration. Most dental professionals utilize patience and understanding when treating an individual who may be undergoing a transitional period. In addition to providing empathetic care, it is a good idea to evaluate the patient’s mental health before treatment. The patient’s psychosocial status can be assessed during the history-taking component of initial and recall dental visits, or by asking family members for assistance in identifying psychosocial factors that can influence oral healthcare.9
Good oral healthcare is an important contributor to perceived health. One study found that oral health is an important contributor to the well-being of older adults, and results supported the contemporary thinking that poor perceived oral heath leads to diminished quality of life for seniors.10 High proportions of those studied perceived their quality of life lowered by oral health-related dysfunction, pain, or disability. With the death of a loved one or with family a distance away, seniors may feel frustrated, careless, or disconnected. Give senior patients extra appointment time, which may enable staff to listen and gain valuable health information without the rush of a normal appointment.

TREATMENT CONSIDERATIONS

Table. Gentle Ways to Inquire About Patients’ Cleaning Habits.

Do you find it physically difficult to reach certain parts of your mouth?
Do you suffer from pain that makes it hard to brush or floss?
Do physical limitations prevent you from brushing twice a day?
What do you do with your denture at night?
What are your favorite oral products?
What products would you like to see available and what would they accomplish?

As noted, many seniors face plenty of obstacles before even reaching their dental appointment. That said, it is important to have a clear understanding of each patient’s unique story and dental history, regardless of age. However, when dealing with an elderly patient, it is sometimes the case that the patient does not have a strong relationship with a dental professional or cannot track dental records down due to extended periods with little or no professional dental care. In this case, dental professionals must do a thorough, detailed examination of the oral cavity. Questioning a senior patient or family member about the patient’s oral health habits may also help develop dental background or history. Doing so will ensure a comprehensive treatment that is more likely to improve the patient’s quality of life (Table).
Seniors’ quality of life may be diminished by something as minor as difficulty getting into the dental office. Often when seniors seek dental care, they encounter accessibility obstacles such as lack of railings, escalators, elevators, and automatic doors. More easily injured and tired, seniors may be inhibited by a heavy door or exhausted by a flight of stairs. Keep seniors’ limited capabilities in mind around the office. Make clear signs directing clients to the elevator and prop a heavy door open during the day if possible.
While dental professionals may make treatment possible for seniors, seniors may not fully understand the need for or appreciate professional oral care. Even when care is briefly explained, some senior patients may have a difficult time understanding the increased need for a dental professional’s attention. According to the National Institute of Dental and Craniofacial Research, many conditions that plague the body manifest in the mouth, such as diabetes, heart disease, oral lesions, xerostomia, and Sjögren’s Syndrome, an autoimmune disorder that primarily affects women.11 In fact, seniors are more in need of dental care as they age.

CARING FOR EDENTULOUS PATIENTS

Some seniors believe that having lost all their teeth eliminates the need for a dental professional’s services, which couldn’t be further from the truth. Older patients who wear dentures need regular dental appointments to ensure proper denture fit over time, screen for diseases and sores, access instructions for practicing good oral hygiene at home, receive product recommendations, keep abreast of technological advancements, and other denture care issues. For instance, 2 implants with appropriate attachments, placed under a lower denture, can greatly enhance the patient’s quality of life. Additionally, medications, infections, weight loss, or obesity can affect health, and the surface and shape of the oral cavity, and many senior patients may not even be aware of the availability of products suitable to help care for their mouths.
Dental professionals may suggest a denture cleanser like Polident fresh cleanse (GlaxoSmithKline) or ProTech (Denture Care) to help remove plaque and eliminate germs.  Denture care and overall oral health for seniors will become increasingly important as the population ages and vulnerability to disease, illness, and side effects of medication present increased challenges to seniors’ oral healthcare. The following guidelines can be followed by practices providing senior-inclusive oral healthcare:

  • Make sure the patient has a complete understanding of the proper oral care they should be practicing at home.
  • Instruct edentulous patients to be particularly careful when cleaning their dentures, as dentures are a porous material shown in studies to harbor bacteria, which can be reduced via overnight soaking.
  • Supply samples of denture cleanser and large-print treatment instructions for elderly patients to bring home.
  • Work with elderly patients to schedule regular dental exams, organize extra reminders, send large-print postcards, and leave clear, understandable messages on voicemail.

Arm patients with the tools to make good health decisions. Print out a worksheet calendar with regular care appointments and dates when they should order more dental products. Include approximate costs to help seniors manage a budget.

MEET THE NEED

Use the tools and suggestions offered here to better your practice and increase your patient base. As the population ages, dental professionals need to be more aware of the existence, circumstances, and quality of life of senior patients. As the baby boomer generation retires and uncovers an increased need for oral healthcare, a practice’s success may depend on it. An underutilized consumer group for dental services, elderly patients display an obvious need for dental care, leading to improved quality of life. As seniors face numerous physical and psychological challenges outside of the office, dental professionals should make it as easy as possible for older patients to take the first steps toward responsible oral care.


References

 

1. Minino AM, Heron MP, Smith BL. Deaths: preliminary data for 2004. Natl Vital Stat Rep. 2006;54:1-49.
2. AARP. Beyond 50.02: A Report to the Nation on Trends in Health Security. Washington, DC: AARP; May 2002:45.
3. National Institute of Neurological Disorders and Stroke. Carpal Tunnel Syndrome Fact Sheet. NINDS Web site. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Published November 2002. Updated December 11, 2007. Accessed January 29, 2008.
4. New York State Dept of Health. What is arthritis? In: New York State Arthritis Action Plan. Albany, NY: New York State Dept of Health; 2002.
5. AARP. Beyond 50.04: A Report to the Nation on Consumers in the Marketplace. Washington, DC: AARP; 2004.
6. National Institute on Aging. Aging America poses unprecedented challenge. Bethesda, MD: NIA; 1996.
7. Ebersole P, Hess P. Toward Healthy Aging: Human Needs and Nursing Response. 5th ed. St Louis, MO: Mosby; 1998.
8. Ship JA, Mohammed AR, eds. Clinician’s Guide to Oral Health in Geriatric Patients. Baltimore, MD: American Academy of Oral Medicine; 1999.
9. Gluch JI. Customizing oral hygiene care for older adults. Contemporary Oral Hygiene. April 2003.
10. Locker D, Clarke M, Payne B. Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res. 2000;79:970-975.
11. The oral-systemic health connection – oral opportunistic infections: links to systemic diseases. National Institute of Dental and Craniofacial Research Web site. http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralSystemicHealthConnection
/OralSystemic.htm
. Accessed January 30, 2008.


Dr. Groba graduated from the University of Texas Dental Branch in 1974 with honors in prosthodontics and periodontics. He has been a practicing dentist for 30 years in Friendswood, Tex, a small community of approximately 14,000 next to the NASA Space Center. He has lectured internationally on all aspects of smile makeovers from bleaching to full cosmetic veneers. Dr. Groba is a member of the Houston District Dental Society, the ADA, the AGD, and the Academy of Cosmetic Dentistry, and has lectured at the University of Texas Dental School in Houston. He has been published in Excellence in Dentistry, Dental Economics, Dentistry Today, and Dentistry OnLine. He and his wife Marie are internationally known for their invention of patient tracking systems and practice management services. He can be reached at (281) 482-1275 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Dr. Nia completed his undergraduate training at Georgia State University with a bachelor’s degree in business administration in management, with a concentration in chemistry. He received his DMD from the University of Pennsylvania School of Dental Medicine, and while there earned a MSEd in higher education from the Graduate School of Education. He holds active membership with the AGD, American Academy of Cosmetic Dentistry, International Congress of Oral Implantologists, and the American Academy of Implant Dentistry. He can be reached at (281) 482-1275 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .