Boomers and the Greatest Generation

The older population (65+) numbered 40.4 million in 2010, an increase of 5.4 million or 15.3% since 2000.(1) The number of Americans aged 45-64, who will reach 65 over the next two decades, increased by 31% during 2000-2010. Over one in every eight, or 13.1%, of the population is an older American. Persons reaching age 65 have an average life expectancy of an additional 18.8 years (20.0 years for females and 17.3 years for males).(1)

The “Greatest Generation” are those born between 1901 and 1945, and “Baby Boomers” between 1946 and 1965.(2) This article will discuss how to work with older adults in the dental office.

It has been postulated that the boomer generation will be the first fully dentate generation in history.(3) As the first of 76 million boomers turned 65 on Jan. 1, 2011, this generation will be concerned about how to retain these teeth into their 90s.(3) As with all individuals, oral health is essential to general health and well-being among older adults. Poor oral health has been associated with chronic health conditions such as diabetes, respiratory illness and cardiovascular disease, and as individual age, are at a high risk of developing these chronic conditions.(4)

One report attempted to provide a global overview of oral health conditions in older people, use of oral health services, and self-care practices.(5) As well, it explored the types of oral health services available to older people, and attempted to identify some major barriers to and opportunities for the establishment of oral health services and health promotion programs. The researchers recommended that countries establish oral health programs to meet the needs of the elderly. Relevant and measurable goals should be established to assist in providing appropriate interventions to improve their oral health.(5) As risk factors for chronic systemic diseases are common to most oral diseases, the common risk factors approach will be instrumental in the organization and surveillance of oral health promotion and oral disease intervention programs. The integration of oral health into national general health programs may be effective to improve the oral health status and quality of life of this population group. One study looked at the influence of community factors on dental care utilization among older adults.(6) The results showed that individual factors such as being female, married, not poor, having a higher educational level, and private dental insurance were associated with higher probabilities of having used dental care. Also, dentist-to-population ratio has independent effects on older adults’ dental care utilization. By understanding the factors influencing dental care utilization among older adults, oral health care professionals will be better situated to meet the dental needs of this population.

As we age, the chances of us being hospitalized increases. One study looked at the incidence of non-ventilator hospital-acquired pneumonia (NV-HAP) and the effects of oral hygiene on it.(7) NV-HAP is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of the study was to identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and to determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. The study found a considerable extent of unreported NV-HAP. After they initiated the oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The cost savings resulting from avoided NV-HAP was $1.72 million. The authors recommended that nursing should blaze a trail in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV-HAP.(7)

However, whether in the public or private sector, in order to assist older individuals in accessing oral health care, we must be able to communicate with them. Communication between health care providers and older adults is sometimes difficult because the aging process and conditions that are prevalent in older adults present a variety of challenges.(8)

Things like sensory decline, age-related sight impairment, and hearing loss can make it more difficult for older adults to comprehend the nonverbal conversational cues that we often communicate visually. Health literacy often poses a communication barrier for older adults, their ability to obtain process and understand basic health information and services needed to make appropriate health decisions s sometimes diminished. Strategies to improve communication with older patients include: longer appointment times; attentive listening; using simple language; repeating key messages and instructions; minimizing the number of people, distractions and noise in the operatory when providing care for a patient with dementia; and communication at eye level with a smile.(8)

References 1. http://www.aoa.gov/Aging_Statistics/Profile/2011/docs/2011profile.pdf. 2. http://www.wmfc.org/uploads/GenerationalDifferencesChart.pdf. 3. Oro RJ and Oro DA. BOOMERS AND REHABS. JADA 2014; 145(2):125. 4. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005; 33(2):81-92. 5. Petersen PE, Kandelman D, Arpin S and Ogawa H. Global oral health of older people – Call for public health action. Community Dental Health (2010) 27, (Supplement 2) 257–268. 6. Lee W, Kim SJ, Albert JM, and Nelson S. Community factors predicting dental care utilization among older adults. JADA; 145(2):150-158, 2014. 7. Quinn B, Baker DL, Cohen S, Stewart JL, Lima CA, and Parise C. Basic Nursing Care to Prevent Non-ventilator Hospital-Acquired Pneumonia. Journal of Nursing Scholarship, Volume 46, Issue 1, pages 11–19, January 2014. 8. Stein PS, Aalboe JA Savage MW, and Scott AM. Strategies for communicating with older dental patients. JADA 2014; 145(2):159-164.