My great-grandmother “GG” was scrappy, maybe because she was a product of the roaring ’20s. She would come for a week visit and stay for three to six months. We didn’t have a guest bedroom, so we would just rearrange the furniture in the dining room and add a bed so we could keep her longer.
She knew all my friends by name, she told the best dirty jokes, and she kept me up way too late on school nights playing card games. Those were simpler times: sleeping on pullout sofas, sneaking snacks with grandparents, and watching MASH in their laps. Many of you recall similar wholesome and comfortable memories.
My love for GG carried over into dental school and after graduation. I soon found myself working in a nursing home one day a week and pursuing a fellowship in geriatric dentistry. As I transitioned into private practice, we prioritized free days in the practice for local seniors.
I have always been drawn to older adults. Maybe it was the stories they told about simpler times, the perspective they shared about success versus significance, or maybe it was the feisty spirit that prevailed as the body chose not to cooperate.
Dentists and Senior Care
We can and must do our part as dentists to make life better for older adults in this country. There is currently no Medicare dental benefit, and the adult dental benefit does not cover the cost of care needed for seniors who qualify for Medicaid. Without the means to address oral health issues, older adults will continue to experience consequences to their overall health, quality of life, and financial stability.
Ten years from now, one in every five US residents will be retirement age.
“The aging of baby boomers means that within just a couple decades, older people are projected to outnumber children for the first time in US history,” said Jonathan Vespa, a demographer with the US Census Bureau.
Between 2010 and 2015, Colorado’s more than 29% growth in its 65 and older population was the third fastest in the United States, compared to its ranking fourth place in overall growth at 8.5%. That will place greater cost pressure on the younger generation to fund older adult care.
As we all know, public health successes such as community water fluoridation and other prevention and treatment efforts have led to an increased number of retained natural teeth. This means more older adults are susceptible to caries and periodontal disease during a time in life when they are also facing significant physical, mental, and social challenges.
In Colorado, adults 75 and older are the least likely age group to have dental insurance (50.9%). The good news is that this group had the largest increase in coverage from 2017 to 2019 of all age groups—14.7%. Older adults are also visiting dental professionals at higher rates, with more than 70% of adults ages 55 and older visiting a dental professional in the last year.
Ninety percent of Colorado seniors have at least one chronic condition, such as diabetes, cardiovascular disease, or stroke, of which many are linked to periodontal disease. For seniors with weakened immune systems, oral infections can act as a source for ongoing infection. The Centers for Disease Control and Prevention report that 70% of seniors have periodontal disease, and it’s highest among ethnic minorities, including 63% of Hispanics and 59% of blacks. In Colorado, half of Hispanic or black older adults report they’ve lost six or more teeth.
When you couple chronic conditions, periodontal disease, and racial disparities with increasing obesity rates and wide economic differences, it’s clear that providers must rise to the challenge of addressing the greatest barriers to care that older adults face.
The Quadruple Aim
If we address health inequity through the approach of the Quadruple Aim, we may reach this demographic better by integrating and promoting oral health services and care coordination with primary care, safety net, and community-based settings.
To transition healthcare from the current “value through volume” system to a system that aligns provider incentives directly to patient outcomes, “value through outcomes,” we must start thinking differently. As clinicians we must remain committed to:
- Improving the patient experience: We can help seniors by opening our practices to them and reducing barriers to transportation services for those who experience access and cost of care issues.
- Improving health outcomes: We must understand the mouth-body connection and learn to collaborate better with our physician colleagues so we best coordinate care for the wants and needs of our patients.
- Improve the cost of care: Cost is the number one barrier for patients who want and/or need oral healthcare. We should be proponents of helping patients optimize their dental benefits and for government support programs, like the Medicare dental benefit that should cover prevention and restorative treatment, to ensure that oral health is part of comprehensive care.
- Prioritizing provider and team health: We must increase awareness and support systems to keep teams healthy and happy so they may best serve the needs of older adults. Sometimes the pace of treating seniors is different and less productive, and it can become routine. We must implement systems that keep providers and teams engaged, inspired, and aware of the risks of burnout.
These are tough times, but we are in a position of great influence and responsibility. Since March of 2020, we have seen this population, already facing many disparities, be exposed to greater risk of morbidity and mortality due to COVID-19.
Let’s not lose sight of the opportunity we have to help those who helped us most. It’s not only the right thing to do. It’s because this group needs us now more than ever. Someday, if we are lucky, dentists and dental teams will play a critical role in our overall health, and we too will get to play cards with and sneak treats to our great-grandkids.
Dr. Guyton serves as the chief dental officer for Delta Dental of Colorado and Delta Dental of Virginia. He provides thought leadership in oral health and wellness with a focus on medical-dental integration, value-based plan design and reimbursement, product development, and provider relations. Previously, he was vice president of clinician development at Pacific Dental Services, dean of the PDS University-Institute of Dentistry, director of corporate professional services at Dentsply International, COO at Jameson Management, and a private practice owner. He is also a practicing dentist and an associate professor at the University of Colorado School of Dental Medicine. For more information, listen to his interview about older adult healthcare on No Copay Radio.